Box 3.

Which drug to taper first?.

It is essential to change only one drug at a time to avoid confounding withdrawal symptoms or adverse effects.152 • The drug displaying greatest toxicity via adverse effect usually is the tapering priority.143 • Follow with the most activating drug, usually an antidepressant or stimulant.130,151,153 • To shield sleep, so very often broken during psychotropic tapering,36,74 anxiolytics and drugs taken for sleep are tapered last. • If reduction of a drug causes adverse effects from another drug to emerge, tapering the first drug may be interrupted to reduce the second drug, e.g., reduction in escitalopram (which can be stimulating) has caused co-administered nightly mirtazapine to make the person too groggy in the morning, then mirtazapine may be reduced at least part way.