I have been working with my 16 year old over the past year to taper off. What has worked for us is a VERY slow process. We get the capsules and literally count them out and take her down a couple every week. We started at 150 mg about a year ago and we are now at 50 mg. It's slow and tedious but when we tried to make a significant decrease it didn't go well. We've just kind of resigned ourselves to "slow and steady wins the race." She does not have a psychiatrist. Her pediatrician prescribes and we keep her informed as to how it's going. The only side effect so far is a headache the day after we do a decrease. Hope this helps!