Here are many of the authoritative materials used to develop the Cymbalta Hurts Worse (CHW) Gradual Taper Method. None of the authorities listed here are directly involved with this website. We list them only to identify the source materials we have used to develop the Gradual Taper method.
Key to formalizing of our method are the over 45,000 CHW members who, over more than a decade, have provided feedback and guidance on the methods documented in the group and on this site. They may comprise the largest group ever engaged in validating a tapering process.
STUDIES, PUBLICATIONS, PRESENTATIONS
Dr. Mark Horowitz, Clinical Research Fellow in Psychiatry
Mark A. Horowitz, MD, PhD is a psychiatrist and researcher in London, who has a PhD from the Institute of Psychiatry at King’s College London on the action of antidepressants. When he tried to come off these drugs himself he was given a short, sharp education in the pain of withdrawal and the lack of knowledge in the medical field about this topic. Since then he has tried to bring more awareness to the topic of safe deprescribing of psychotropic drugs through his academic work, including an article published in The Lancet Psychiatry journal on how to safely taper antidepressants and in JAMA Psychiatry on how to taper antipsychotics. He has also worked with the Royal College of Psychiatrists in the UK to publish their guidance on how to safely stop antidepressants. He has a deprescribing clinic in the NHS that helps patients from around the country come off psychiatric medications.
North East London NHS Foundation Trust (NELFT) video:
https://www.youtube.com/watch?v=DnoyAcwO_OA
excellent article: [ignore the many “click me’s”]
https://europeantimes.news/2024/05/users-of-antidepressants-may-suffer-due-to-doctors-not-knowing-new-research-and-guidelines/
book: The Maudsley Deprescribing Guidelines
The Maudsley® Deprescribing Guidelines is a comprehensive resource describing guidelines for safely reducing or stopping (deprescribing) antidepressants, benzodiazepines, gabapentinoids, and z-drugs for patients, including step-by-step guidance for all commonly used medications, covering common pitfalls, troubleshooting, supportive strategies, and more. Most formal guidance on psychiatric medication relates to starting or switching medications with minimal guidance on deprescribing medication. Most importantly, this book covers the critical subject of why and how to implement hyperbolic tapering in clinical practice.
Anders Sorenson, PhD, Danish clinical psychologist
Anders Sørensen, PhD is a Danish clinical psychologist with a PhD in psychiatric drug withdrawal. His private practice in Denmark specializes in helping people come off psychiatric drugs through gradual, hyperbolic tapering and psychotherapy, and on helping people avoid starting psychiatric drugs via psychotherapy. His practice always aims at making sense of emotional suffering and “symptoms” and at helping people regulate their difficult emotions, thoughts, and traumas via their own mind (as far as is possible), not via drugs. He has also undertaken research which assesses the state of guidance on psychiatric drug withdrawal.
He has also paid close attention to tapering methods with the aim of identifying approaches which might make withdrawal more tolerable for people. In addition to his research work, Anders utilizes psychotherapy in his private practice when helping people to come off the drugs.
PhD thesis: https://www.psykologanders.dk/wp-content/uploads/2022/10/PhD-thesis.pdf
website: https://www.madinamerica.com/2022/11/anders-sorensen-tackling-psychiatric-drug-withdrawal-research-practice/
video: https://www.youtube.com/watch?v=IOc8t1A7YSg
video: https://www.youtube.com/watch?v=or0MRaEdNBE
article: https://www.newsweek.com/how-kick-antidepressant-drugs-without-triggering-relapse-new-research-1745509
article: https://digitalcollection.zhaw.ch/bitstream/11475/26458/3/2022_Horowitz-etal_Estimating-risk-of-antidepressant-withdrawal.pdf
course: https://www.scientificfreedom.dk/2023/03/27/psychiatric-drug-withdrawal-first-course-in-denmark/
Dr. Peter Breggin
“In this book, Dr. Breggin systematically outlines how to safely withdraw a patient from psychiatric medication with rich case examples drawn with the detail and sensitivity to individual and situational differences that reveal not only his extensive clinical experience, but his clear, knowledgeable, and compassionate vision of a more humane form of treatment. In this volume, Dr. Peter Breggin has again demonstrated that he is a model of what psychiatry can and should be.” — Gerald Porter, Ph.D., Vice President for Academic Affairs, School of Professional Psychology, Forest Institute, Springfield, MO
“Peter Breggin has written a unique, brilliant, and comprehensive book that every mental health professional should read and “prescribe” to their patients and families! Dr. Breggin is a true pioneer in identifying the dangers of psychiatric drugs, being the first to warn us decades ago that treatment of the mentally ill would devolve to the shameful status it reveals today.” — Fred Ernst, Ph.D., Professor of Psychology, University of Texas – Pan American
Adele Farmer
Adele Farmer is the founder of SurvivingAntidepressants.org. She resides on the West Coast of the US and is retired from information architecture and user experience design for software. She went off 10mg paroxetine in 2004 and it took 11 years to recover from the withdrawal syndrome. She has studied psychiatric drug withdrawal syndrome since 2004 and founded the website SurvivingAntidepressants.org in March 2011.SurvivingAntidepressants.org was designed to collect case histories. It has more than 12,000 registrations and receives more than 300,000 page views per month. It has 6,000 naturalistic longitudinal case histories by patients. It provides more than 60 tapering topics (“Tips for tapering [drug]”) and explanations of titration methods (e.g. gradual 10% per month hyperbolic tapering method self-guided by patient). The site content is widely shared on Facebook and other websites. See website listing below.
Protracted Withdrawal Syndrome (PAWS, P.A.W.S., PWS) articles
“Conclusion: PWS or PAWS from antidepressants can be severe and long-lasting, and its manifestations clinically heterogeneous. Long-term antidepressant exposure may cause multiple body system impairments. Although both somatic and affective symptoms are frequent, they are mostly unrelated in terms of occurrence. Proper recognition and detection of PWS thus requires a comprehensive assessment of medication history, duration of the withdrawal syndrome, and its various somatic, affective, sleep, and cognitive symptoms.”
- https://pdfs.semanticscholar.org/22b0/1b003a336f3d0beb7d303c1404eaf540fa8f.pdf
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7768871/pdf/10.1177_2045125320980573.pdf
- https://www.psychologytoday.com/us/blog/side-effects/202101/protracted-withdrawal-syndrome-after-antidepressant-use/amp
- https://www.sciencedirect.com/science/article/pii/S0165178125001453
- https://www.theguardian.com/australia-news/2024/dec/19/the-new-science-ending-the-terror-and-panic-of-coming-off-long-term-antidepressant-use
- https://www.psychiatryonline.org/doi/10.1176/appi.pn.2025.09.9.1
- https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00133-0/fulltext
- https://www.healthline.com/health/depression/antidepressant-withdrawal-symptoms-timeline
- https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/postacute-withdrawal-syndrome-paws-after-stopping-antidepressants-a-systematic-review-with-metanarrative-synthesis/8BE6D20F785E9DB6259F6757B5719C0E
- https://my.clevelandclinic.org/health/diseases/25218-antidepressant-discontinuation-syndrome
- https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressant-withdrawal/faq-20058133
- https://www.psychiatrist.com/jcp/understanding-and-managing-antidepressant-withdrawal-syndromes/
- https://www.npr.org/sections/shots-health-news/2025/07/09/nx-s1-5460018/antidepressant-ssri-side-effects-withdrawal-symptoms
- https://www.health.harvard.edu/blog/discontinuation-syndrome-and-antidepressants-2019040416361
- [PAYWALL] https://www.nytimes.com/2019/03/05/health/depression-withdrawal-drugs.html?rref=collection%2Ftimestopic%2FAntidepressants
Wikipedia
DISCONTINUATION SYNDROME: … In 2012 The Institute for Safe Medical Practices (ISMP) published a report: “Duloxetine and Serious Withdrawal Symptoms”. The report highlights early clinical studies which found “abrupt discontinuation showed that withdrawal effects occurred in 40-50% of patients, that 10% of those were severe and approximately half were not resolved when side effects monitoring had ended after one or two weeks”.
Withdrawal symptoms listed in 48 case reports (in the first quarter of 2012) included anger, crying, dizziness and suicidal ideation.
The report concluded there was insufficient information and a lack of clear warnings about the effects of discontinuing duloxetine and that in many cases withdrawal symptoms may be “severe, persistent, or both”, adding “the prescribing information for physicians and pharmacists does not provide realistic schedules for tapering or a clear picture of the likely incidence of these reactions”.
https://en.wikipedia.org/wiki/Duloxetine
Mad in America – Withdrawal Protocol Overview
“In short, the best tapering schedule is one that allows the person to withdraw while avoiding or minimizing withdrawal symptoms to a level where they can be tolerated and do not require major life adjustments. Since people have different tolerances, withdrawal is likely to need a person-centered, almost unique approach. Tapering speeds There is a wide disparity between tapering guidelines developed by professional organizations and the advice and practices that have originated within the “lived experience” community. The professional guidelines typically recommend much shorter tapers than recommended by those with lived experience, and protocols for lowering doses may vary greatly as well.”
https://www.madinamerica.com/withdrawal-protocols-antidepressants/
Eli Lilly Cymbalta documentation, highlighted
WEBSITES AND OTHER RESOURCES
Surviving Antidepressants Website
Adele Farmer created this valuable site. “We are a community of volunteers providing peer support for tapering all psychiatric drugs and their withdrawal syndromes. This site is organized in forums containing topics developed over many years of peer support. As this content is patient-authored, it should not be taken as medical advice, but information that you can discuss with your medical provider.”
https://www.survivingantidepressants.org/
The Withdrawal Project
The Withdrawal Project is an information resource designed to help people empower themselves to make more meaningfully informed choices — aligned with their personal desires and needs — regarding taking, reducing, and coming off psychiatric drugs. TWP’s website includes a free, comprehensive, self-directed Companion Guide to Psychiatric Drug Withdrawal aimed at helping people learn and make decisions about the most risk-minimizing ways to prepare for responsibly tapering off antidepressants, benzodiazepines, stimulants, antipsychotics, mood stabilizers, Z-drugs and other psychiatric drugs, along with coping techniques for dealing with common withdrawal symptoms.
International Institute for Psychiatric Drug Withdrawal
- Support research and practice-based knowledge that will facilitate safe reduction of and withdrawal from psychiatric drugs.
- Contribute to evidence-based practices for reduction of and withdrawal from psychiatric drugs, and facilitate their inclusion in general practice guidelines.
- Support the human right to informed choice with regard to psychiatric drugs.
- Promote practices that help families, friends, and practitioners support safe reduction of and withdrawal from psychiatric drugs, and take into account relational and social aspects essential to this process.
Mad in America
From their “Withdrawal – Antidepressants” section
- Learn about research on antidepressants and withdrawal effects.
- Read blogs and listen to podcasts related to withdrawal from antidepressants.
- Access other resources related to withdrawal from antidepressants.
DRUG INTERACTION CHECKERS
Medscape.com Drug Interaction Checker
https://reference.medscape.com/drug-interactionchecker
Drugs.com Drug Interaction Checker
https://www.drugs.com/drug_interactions.html
WebMD Drug Interaction Checker
https://www.webmd.com/interaction-checker
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