Concierge Psychiatry
of Main Line Where Your Story Matters
of Main Line Where Your Story Matters
Evidence-Based Care
Carefully supervised, gradual reduction of psychiatric medications, guided by current evidence, with close monitoring and support.
There are many valid reasons to consider reducing or stopping psychiatric medications—from sustained stability and readiness to try life without medication, to side effects, pregnancy planning, or preference for non-pharmacological approaches. Whatever your reason, we believe medication decisions should be made collaboratively, informed by evidence, and carried out as safely as possible. We support thoughtful, evidence-based deprescribing, and a lower stable dose can be just as valid a goal as stopping entirely.
Research shows that abrupt discontinuation can lead to withdrawal (discontinuation) symptoms, symptom recurrence, or other complications. NICE guidance (2022) and the Maudsley Deprescribing Guidelines (2024) recommend gradual tapering with progressively smaller reductions as the dose gets lower.
Withdrawal can be dangerous. Stopping some medications suddenly, especially benzodiazepines, sleep medications such as Z-drugs, and some anticonvulsants, or stopping alcohol after heavy use, can cause seizures, confusion or hallucinations and can be life-threatening. Never stop or reduce a medication on your own. Severe withdrawal may need hospital or other medically supervised care. If you have seizures, confusion, hallucinations or thoughts of suicide, call 911 or call or text 988.
Horowitz and Taylor (2019), writing in The Lancet Psychiatry, showed that serotonin-transporter occupancy rises steeply at low antidepressant doses. As a result, equal-sized dose cuts have increasingly large effects toward the end of a taper. This pharmacology supports hyperbolic tapering, where reductions get smaller as the dose gets lower, an approach now reflected in NICE guidance and the Maudsley Deprescribing Guidelines. Trials comparing tapering methods directly are still limited.
In May 2026, the U.S. Department of Health and Human Services announced an initiative on psychiatric prescribing that includes informed consent, shared decision-making and deprescribing, with formal federal guidance on tapering to follow. Whatever the policy climate, we approach every decision about continuing or reducing a medication individually, weighing your benefits and risks.
Physical dependence is an expected effect of long-term benzodiazepine use and is not the same as addiction. If you have ever had a withdrawal seizure or withdrawal delirium, please tell us, because some tapers need a more closely supervised setting.
Never stop or reduce psychiatric medications without medical supervision. Abrupt discontinuation can cause serious withdrawal symptoms, seizures (with some medications), or rapid symptom recurrence. Withdrawal from benzodiazepines or alcohol can be life-threatening. Our goal is to help you reach your goals as safely as possible.
Your dedicated psychiatrist knows your complete medication history and guides you through each step. Frequent check-ins and the kind of close monitoring that careful tapering requires, which is difficult to provide in brief, infrequent appointments.
Equal-sized dose cuts have a small effect on the brain at higher doses but an increasingly large effect toward the end of a taper. Hyperbolic tapering is designed around this pharmacology.
Reducing by the same amount at every step may feel manageable early on, but the final steps can produce a much larger change in the medication's effect on the brain.
Final steps can be the hardest
Hyperbolic tapering means making dose reductions progressively smaller as the dose gets lower, because the last part of the dose of many medications has the largest effect on the brain. In practice, this often means the final stages of a taper take the longest.
Designed to keep each step more even
The right steps, intervals and formulations differ by medication and by person, so your plan is built and adjusted with your psychiatrist. It is not a fixed schedule, and this page is not a guide to tapering on your own.
If you're considering reducing or stopping your medications, we're here to help you do it as safely as possible. Request a private consultation to discuss your goals with your dedicated psychiatrist.
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