Mental Health Blog

Managing SSRI Discontinuation in Children and Adolescents

• April 30, 2026
• The REACH Institute

The decision to wean a child or adolescent off selective serotonin reuptake inhibitors (SSRIs) often comes with feelings of both hope and trepidation—not just from the parent and child, but also from the primary care clinician.

A recent meta-analysis published in The Lancet Psychiatry found that 15% of patients experience withdrawal symptoms when stopping SSRI medication. While these symptoms are rarely discussed in pediatric literature, concerns regarding increased anxiety, depression, and physical malaise (such as gastrointestinal issues or flu-like symptoms) are common, as the discontinuation experience varies significantly between patients. 

To help PCPs minimize the risk of withdrawal symptoms and to ensure a successful taper, we spoke with REACH faculty member and psychiatrist Dr. Aradhana Bela Sood, MD, MSHA. She believes the key is for clinicians to act as a steady guide, “shepherding the child and parents through this process” rather than just managing the dose. Here is her roadmap for a gentle, successful transition.

The First Step: Assessing Readiness

Before considering SSRI discontinuation, it’s important for the PCP to establish whether the child is ready to stop the medication. Dr. Sood says that general clinical recommendations suggest a minimum of 6–9 months of stability on the medication before attempting a taper. “Stopping too early carries a high risk of relapse,” warns Dr. Sood. “It takes time for the brain to regulate serotonin on its own.”

If after 6-9 months of SSRI stability, the child and the parents want to discontinue the medication, then the child, parent, and PCP should be aligned on what Dr. Sood calls their “clarity of purpose.” Getting clear about why the child started the medication, why they want to discontinue, and why now is the right time to do so is the “essential first step.”

Beyond “clarity of purpose,” Dr. Sood emphasizes weighing the decision against the child’s current stressors and resilience level. If the medication was started to help the child cope with symptoms following an acute event, like a natural disaster, and the child has developed strong coping mechanisms through therapy, the prognosis for discontinuation is excellent. However, Dr. Sood warns that chronic “background” stressors, such as parental discord, the logistical strain of a divorce, or economic insecurities, require more caution. Even in these cases, tapering may be possible if the child is well-supported: “If these stresses remain, but the child is resilient and engaging effectively with therapy, then transitioning off the medication to therapy alone can be appropriate.”

Timing the Taper: An Important Consideration for Youth

Once there is a consensus that it’s time to taper off SSRIs, careful scheduling is essential. Dr. Sood advises against reducing medication during high-stress periods, such as exam season or the start of a new school year.

In fact, she typically waits until the end of the school year to revisit the conversation: “We can finish the year-end celebrations [such as graduations] and re-evaluate in late June. That way, if challenges arise, we have a buffer to adjust before school resumes.”

Consistent with Dr. Sood’s advice on timing, research indicates an autumnal surge in mental health interventions for youth. An open cohort study published in BMJ Mental Health found a distinct increase in SSRI prescriptions and diagnoses of depression and anxiety among adolescents from September to November. 

The Mechanics of “Shepherding”: Monitoring and Titration

When the time is right, the taper should be gradual. Dr. Sood says a general recommendation is a 25-30% decrease per week, but that PCPs must account for the medication’s half-life and monitor for any withdrawal symptoms, citing SwitchRx as a reliable tool for calculating titration or switching medications.

In the meantime, regular check-ins are important to monitor for common withdrawal symptoms like “general malaise,” flu-like symptoms, or physical reactions like dizziness. If these occur, it is important to slow down the titration. 

For these general check-ins, Dr. Sood recommends asking, “Do you feel different, uncomfortable, weird or strange?” Asking about specific symptoms can inadvertently increase their occurrence through suggestion. Additionally, Dr. Sood recommends asking how the child feels on a scale of 1-10, and using specific joy-seeking questions like “Are you looking forward to baseball season?” 

Therapy as “Hand-holding” During Titration

Medication discontinuation should rarely happen in isolation, according to Dr. Sood. She explains that therapy acts as the “hand-holding” component that remains when the medication is gone. “It’s really important that the child and family understand that therapy provides essential support during the discontinuation process,” she says.

Dr. Sood emphasizes that the child should ideally be in therapy before and during the weaning process to build a foundation of awareness of their body’s internal senses or signals (i.e., Interoceptive Awareness). Specific types of therapy can help the child become more resilient to acute and chronic stressors. 

• Cognitive Behavioral Therapy (CBT) is Dr. Sood’s preference to help the child identify and challenge biased thinking patterns.
• Somatic Techniques, such as deep breathing, are essential for quickly calming down and regulating the physical sensations of stress or anxiety.
• Trauma-Informed CBT is a critical consideration if the child’s history involves trauma.

While therapy in conjunction with medication and medication withdrawal is ideal, it’s important to acknowledge that it’s a privilege many families can’t afford. For many patients, the PCP becomes the person who can hold their hand through the process. 

This may feel daunting to some PCPs, but Dr. Sood assures that good outcomes are likely if they follow the tapering advice (not too fast, not too slow), individualize it to the child (taking stressors into consideration), and ask the right questions to check for withdrawal symptoms. “For any PCP who feels uncertain, every state has psychiatric access lines where you can call and speak to someone like me to help with navigation. You’re not alone in this.”

Resources:

• SwitchRx: A reliable site for calculating titration or switching medications.
• Guidelines for Adolescent Depression in Primary Care Toolkit

The American Academy of Child & Adolescent Psychiatry (AACAP) has medication guides, specifically created for parents, which can be a very helpful resource for families.