Discontinuation of Sertraline in Children

Introduction to Discontinuation

A thoughtful and safe plan for medication discontinuation is as important as a plan for starting medications, according to the American Academy of Child and Adolescent Psychiatry 1
The American Academy of Child and Adolescent Psychiatry recommends a gradual tapering approach rather than abrupt discontinuation to minimize withdrawal symptoms and prevent rebound worsening of the underlying condition 1

Reduce dose by approximately 25% every 1-2 weeks, as recommended by the American Academy of Child and Adolescent Psychiatry 1
The total discontinuation period should typically span 4-8 weeks depending on the duration of treatment, current dose, and individual sensitivity to withdrawal effects 1

Schedule follow-up visits at 1-2 week intervals during the tapering process, as suggested by the American Academy of Child and Adolescent Psychiatry 1
Monitor for both withdrawal symptoms and return of the original condition, and continue monitoring for several weeks after complete discontinuation, as symptoms may emerge weeks to months after the last dose 1
Ensure parental oversight of medication regimens throughout the discontinuation process, as recommended by the American Academy of Child and Adolescent Psychiatry 2

Avoid discontinuation during high-stress periods, such as the beginning of the school year or exams, as recommended by the American Academy of Child and Adolescent Psychiatry 1
Do not discontinue medication in inpatient settings with short lengths of stay, as this can result in unmonitored return of symptoms after discharge, according to the American Academy of Child and Adolescent Psychiatry 1
For children taking sertraline for multiple conditions, consider the severity of each condition when planning discontinuation, as suggested by the American Academy of Child and Adolescent Psychiatry 1

Review the child's history of psychiatric symptoms and response to medication before discontinuing, as recommended by the American Academy of Child and Adolescent Psychiatry 1
Develop a clear monitoring plan and discuss it with the family before beginning the taper, according to the American Academy of Child and Adolescent Psychiatry 1
Document the rationale for discontinuation, clearly communicate the tapering schedule to both the child and parents, and provide education about potential withdrawal symptoms and when to contact the provider 1
Be particularly cautious with children who had severe symptoms or suicidal ideation before treatment, as recommended by the American Academy of Child and Adolescent Psychiatry 1