Antidepressant tapering by clinicians who understand

Outro is for people 18 years and older who are currently taking an antidepressant medication and thinking about decreasing or stopping the medication altogether.

As a virtual care service, Outro’s services are currently not available for people in certain situations or with certain conditions. These include (but are not limited to) people who:

• Have active and serious substance abuse issues
• Have been diagnosed with dementia
• Have been diagnosed with schizophrenia or schizoaffective disorder
• Have been hospitalized for bipolar disorder in the past 12 months
• Have attempted to end their life in the past 12 months
• Are actively suicidal or in crisis

Safe antidepressant deprescribing requires a comprehensive approach that is often difficult for an individual prescriber to provide, due to the time required. It also requires up-to-date knowledge on the latest techniques in tapering antidepressants that are not yet widely taught in North America. Think of Outro as a specialist in tapering.

At Outro, we walk with you every step of the way. Our specialized, high-touch care team takes time to get to know you and your goals, and provides an advanced, individualized approach to tapering off antidepressants informed by the latest guidance and clinical evidence. Through Outro’s app, your symptoms and progress are continuously monitored by your Provider, who can reach out to offer coping strategies or adapt your care plan accordingly. If you have questions or concerns that arise in between appointments, your Outro provider is available via 1-to-1 chat.

Many people have difficulties when they try to go off antidepressants. Our team of expertly trained clinicians will develop a tailored tapering program, informed by the latest scientific evidence and designed to minimize withdrawal effects - even for these people who have tried to stop before.

Hyperbolic tapering (sometimes called the Horowitz-Taylor method) is based on the fact that as antidepressant dose goes up, drug action on brain cells increases, but not in equal steps, higher dosages having less and less additional influence – a decreasing return on investment. The graph showing this is called a hyperbolic curve (goes up faster at low doses and flatter at higher doses).

Tapering based on this method gradually backs you out of the drug with reductions following this natural curve, with the size of dose reduction getting smaller as the dosage gets lower. As very low doses (e.g. 1 or 2mg) have much larger effects than people expect, many people need to taper down to very small doses before stopping so that the final ‘jump’ to zero is not too large a shock to the nervous system.

Compounded medications are often crucial in the tapering process, as commonly available dose sizes aren't small enough to reach the sizes necessary to follow a safe tapering plan. For example, the smallest usually available dose size for venlafaxine is 37.5mg (a drop from 37.5mg to 0mg can easily lead to debilitating withdrawal symptoms).

The costs of medications are not included in your Outro subscription. To help you in your taper, Outro works in partnership with leading compounding pharmacies to provide the most reliable and affordable medication formulations and sizes. Speak with your Outro provider to learn more!

We currently offer taper management for antidepressant medications (e.g., duloxetine, escitalopram, sertraline, venlafaxine). You can see the full list here.

We are making preparations to expand to other psychotropic medications like benzodiazepines and gabapentinoids, which also follow the hyperbolic tapering method. You can express an interest in tapering these medications in our sign-up form.