Fluoxetine substitution for deprescribing antidepressants: a technical approach

Stopping treatment with serotonin reuptake inhibitors (SRIs) often leads to withdrawal symptoms, which can be mitigated by a slow, hyperbolic taper using subtherapeutic dosage strengths. Unfortunately, conventional drug formularies lack the necessary breadth of dosing options to gradually wean SRIs, and alternative methods (e.g., bead counting, homemade dilutions, compounding) are difficult to implement for many patients. It has been suggested that fluoxetine, a widely available antidepressant with an unusually long elimination half-life, can help patients successfully discontinue SRIs, but the technique is poorly characterized. We propose a standardized fluoxetine substitution protocol that facilitates the discontinuation of compatible SRIs while minimizing adverse events.