samanthaelizabeth: How do you manage to keep working while taper off

[samanthaelizabeth]

There is no way out for me.  The drug doesn't work anymore and I'm not willing to take the risk of changing it.  So I guess I just go through life feeling blah?

[ChessieCat]

Hi SE,

 

I'm discussing your situation with Alto.  I'm working today but will check back in tonight.

[samanthaelizabeth]

Thank you.

[degen12]

Sertraline is very stimulating at high doses. Has to do with it's DRI and sigma-1 receptor antagonism (disinhibits mesolimbic DA release). Serotonin is stimulating anyway but sertraline is particularly bad in this department as it's so far from the "clean" SSRI it was originally advertised as. I always found sertraline to cause behavioural disinhibition and destabilization at high doses.

 

How did you feel when you originally cut to 150 mg sertraline? There isn't much difference in serotonin transporter inhibition between 200 mg and 150 mg but there is a lot of other garbage that starts to become significant the higher you go with this drug. I would not be surprised if you got relief within days of a cut. I'm not saying that you should make a 50 mg cut to your sertraline, just that the effect on the serotonin transporter is not that different between those two doses. With that in mind a 5-10% doesn't seem as daunting.

 

I realize you are getting a lot of conflicting opinions here.

 

What you're experiencing sounds a lot like the "mild" serotonin syndrome I experienced so many times on SSRIs. Mirtazapine and sertraline interaction is theoretically the cause (literature is so full of "stable for years on serotonergic drug x, mirtazapine added and serotonin syndrome develops"), but it would take far, far too long to taper mirtazapine, as it becomes very slow and grueling below 15 mg. Listen, I'm not an expert, this is my amateur opinion and I have a record of giving bad opinion, and this is just based on my own experiences. I'm not qualified to give medical advice.

 

That being said, I'm very interesting to see what the brass here will recommend.

[samanthaelizabeth]

2 minutes ago, degen12 said:

I'm interesting to see what the brass here will recommend.

Ya me too!

[samanthaelizabeth]

"Dr. Stuart Shipko, a Californian psychiatrist who has published on SSRI withdrawal, no longer advises patients who have been on SSRIs for more than ten years to try to stop unless they are willing to risk disabling symptoms, including a state of agitation and inner restlessness which he calls ‘tardive akathisia’. He states that his ‘clinical observation is that long lasting symptoms occur even in patients who taper very slowly, not just those who stop quickly, and that there is no guarantee that these symptoms will go away no matter how long the patient waits."

 

See i'm not willing to risk this- I would just like to see if I could taper to a lower amount.  I don't see any true success stories on here, at least where someone didn't go back on an SSRI even after a long 4 year taper and at 20 months they are back on a drug.  Who here is truly happy after their long taper without a relapse?

 

I don't want to offend anyone, but I need evidence that years of tapering down to zero won't result in me having to go back on another drug.  I just want to live my life and be happy, i'm not interested at all in suffering.  I saw someone else post their "success" story that wasn't really a success because they went back on another SSRI 20 months out, even with a very (4 years) taper.

[degen12]

2 minutes ago, samanthaelizabeth said:

"Dr. Stuart Shipko, a Californian psychiatrist who has published on SSRI withdrawal, no longer advises patients who have been on SSRIs for more than ten years to try to stop unless they are willing to risk disabling symptoms, including a state of agitation and inner restlessness which he calls ‘tardive akathisia’. He states that his ‘clinical observation is that long lasting symptoms occur even in patients who taper very slowly, not just those who stop quickly, and that there is no guarantee that these symptoms will go away no matter how long the patient waits."

 

See i'm not willing to risk this- I would just like to see if I could taper to a lower amount.  I don't see any true success stories on here, at least where someone didn't go back on an SSRI even after a long 4 year taper and at 20 months they are back on a drug.  Who here is truly happy after there long taper without a relapse?

 

I don't want to offend anyone, but I need evidence that years of tapering down to zero won't result in me having to go back on another drug.  I just want to live my life and be happy, i'm not interested at all in suffering.  I saw someone else post their "success" story that wasn't really a success because they went back on another SSRI 20 months out, even with a very (4 years) taper.

 

You can set a more moderate goal like for example, I am going to taper my sertraline to 100 mg. Then when you reach 100 mg, in however many months/years. You can make the decision at that point whether to continue or not. It would still be a net positive.

[samanthaelizabeth]

Just now, degen12 said:

 

You can set a more moderate goal like for example, I am going to taper my sertraline to 100 mg. Then when you reach 100 mg, in however many months/years. You can make the decision at that point.

Yes, that is what I intend on doing...

[degen12]

3 minutes ago, samanthaelizabeth said:

Yes, that is what I intend on doing...

 

Then don't worry about what may or may not happen when you get to very low dosages. That's a problem for another day. I myself have considered that I may need a small dose of Cipralex indefinitely, but then I realize I'm fortune telling. I like to focus on the positives that reducing my overall medication load has.

[samanthaelizabeth]

3 minutes ago, degen12 said:

 

Then don't worry about what may or may not happen when you get to very low dosages. That's a problem for another day. I myself have considered that I may need a small dose of Cipralex indefinitely, but then I realize I'm fortune telling. I like to focus on the positives that reducing my overall medication load has.

What SSRI have you been on since 1999?  Why are you trying to taper? Are you functioning and happy?

[degen12]

6 minutes ago, samanthaelizabeth said:

What SSRI have you been on since 1999?  Why are you trying to taper? Are you functioning and happy?

 

I've taken all of them except Effexor and it's newer cousin Pristiq. Majority of the time was spent on Zoloft/sertraline. I am semi-functional, I have struggled with depression for years. This requires a long response and I'm glad to have found someone who wants to hear! However it will take some time and clog up your thread, so I will write something up in my thread and tag you in it when it's done. It will be about my reasons for tapering.

[samanthaelizabeth]

27 minutes ago, degen12 said:

There isn't much difference in serotonin transporter inhibition between 200 mg and 150 mg but there is a lot of other garbage that starts to become significant the higher you go with this drug. I would not be surprised if you got relief within days of a cut. I'm not saying that you should make a 50 mg cut to your sertraline, just that the effect on the serotonin transporter is not that different between those two doses. With that in mind a 5-10% doesn't seem as daunting.

 

 

I'm interested to know, where did you gather this information?  Why in hell would the doctor prescribe 200mg if there isn't a significant difference? I'm curious!  Thank you, you are very smart!

[samanthaelizabeth]

6 minutes ago, degen12 said:

 

I've taken all of them except Effexor and it's newer cousin Pristiq. Majority of the time was spent on Zoloft/sertraline. I am semi-functional, I have struggled with depression for years. This requires a long response and I'm glad to have found someone who wants to hear! However it will take some time and clog up your thread, so I will write something up in my thread and tag you in it. It will be about my reasons for tapering.

Thank you, i'm interested to hear.  My only goal is to not let these drugs ruin my life!  You are awesome!

[samanthaelizabeth]

Just now, samanthaelizabeth said:

Thank you, i'm interested to hear.  My only goal is to not let these drugs ruin my life!  You are awesome!

I did try Effexor for a day or too about the same week that I got diagnosed with MS.  Coincidence?  I think not, I think it triggered an auto-immune response in me.

[degen12]

7 minutes ago, samanthaelizabeth said:

I'm interested to know, where did you gather this information?  Why in hell would the doctor prescribe 200mg if there isn't a significant difference? I'm curious!  Thank you, you are very smart!

 

I'm an armchair pharmacist so take it all with a grain of salt. There is a difference and it comes down to a few percentage points of serotonin transporter inhibition. I think doctors always choose too high a dose when prescribing SSRIs and I think you get a little bit more efficacy but many more side-effects. Like 50 mg is actually an effective dose to treat depression but they will keep increasing the dose when the drug stops working even though there isn't any evidence that this is an effective strategy.

 

There is some evidence for a higher dose in panic disorder and OCD.

[samanthaelizabeth]

7 minutes ago, degen12 said:

 

I'm an armchair pharmacist so take it all with a grain of salt. There is a difference and it comes down to a few percentage points of serotonin transporter inhibition. I think doctors always choose too high a dose when prescribing SSRIs and I think you get a little bit more efficacy but many more side-effects. Like 50 mg is actually an effective dose to treat depression but they will keep increasing the dose when the drug stops working even though there isn't any evidence that this is an effective strategy.

 

There is some evidence for a higher dose in panic disorder and OCD.

I wish I could understand the mechanics of how this drug works.  So you think that a 10% drop, I would not see a difference?  I was thinking about only a 5% drop each time.

[samanthaelizabeth]

Oh no I'm very interested.  I wish that I knew then that they actually kill your receptors!  This makes me so angry!  My brain has always been one of my best parts about me!  I'm pissed that they have made it dysfunctional and possibly triggered my MS.

[degen12]

25 minutes ago, samanthaelizabeth said:

I wish I could understand the mechanics of how this drug works.  So you think that a 10% drop, I would not see a difference?  I was thinking about only a 5% drop each time.

 

I think you will. The reason I'm bringing up the dose-response relationship between SSRIs and the serotonin transporter is to try and show that the beginning of the taper is easier than the later part. The 10% rule on this site was partly created because of this but I still think 10% off of 200 mg is still less hard than say, 10% off of 50 mg, even though 10% off of 200 mg is a 20 mg drop and 10% off of 50 mg, is only 5 mg. Despite that, it's still a good rule. But this is based on my experience and I have a nasty habit of assuming my experience is what most others experience as well.

[degen12]

3 minutes ago, samanthaelizabeth said:

Oh no I'm very interested.  I wish that I knew then that they actually kill your receptors!  This makes me so angry!  My brain has always been one of my best parts about me!  I'm pissed that they have made it dysfunctional and possibly triggered my MS.

 

They don't kill your receptors. SSRI are actual anti-inflammatory and neuroprotective in some parts of the CNS. This isn't a reason to take them, just a reassurance that they aren't killing you.

[samanthaelizabeth]

4 minutes ago, degen12 said:

 

They don't kill your receptors. SSRI are actual anti-inflammatory and neuroprotective in some parts of the CNS. This isn't a reason to take them, just a reassurance that they aren't killing you.

Well they didn't protect me!  I have MS! thankfully not to the extent of not being able to walk, but still.

[samanthaelizabeth]

I wish scientists would come up with a way to reverse that damage done by these.  

[degen12]

6 minutes ago, samanthaelizabeth said:

I wish scientists would come up with a way to reverse that damage done by these.  

 

The damage so to speak isn't really damage but the result of homeostatic pressures and can be reversed over a long period of time.

 

Check this out:

 

This study here is also highly motivational and helps us long-term SSRI users understand how we got to where we are today:

 

 

[samanthaelizabeth]

Besides the profuse sweating I'm also having tinnitus (ear ringing) Since reinstatement....

[samanthaelizabeth]

At the dentist now ready for some anxiety producing novacain!

[Shep]

27 minutes ago, samanthaelizabeth said:

At the dentist now ready for some anxiety producing novacain!

 

Just a reminder about carbocaine:

 

http://survivingantidepressants.org/topic/16808-samanthaelizabeth-how-do-you-manage-to-keep-working-while-taper-off/?do=findComment&comment=332137

 

Please ask your dentist, since you've already experienced problems with Novocain. There are good alternatives. No need to suffer needlessly. 

[apace41]

2 hours ago, samanthaelizabeth said:

See i'm not willing to risk this- I would just like to see if I could taper to a lower amount.  I don't see any true success stories on here, at least where someone didn't go back on an SSRI even after a long 4 year taper and at 20 months they are back on a drug.  Who here is truly happy after their long taper without a relapse?

 

What you ultimately decide to do is your decision.  Degen has given you very good information and advice.  I will say, however, that there are definitely success stories on this site and others. The suggestion that  nobody heals after tapering is not accurate and serves to unnecessarily scare members. 

 

Best,

 

Andy

[samanthaelizabeth]

2 minutes ago, apace41 said:

 

What you ultimately decide to do is your decision.  Degen has given you very good information and advice.  I will say, however, that there are definitely success stories on this site and others. The suggestion that  nobody heals after tapering is not accurate and serves to unnecessarily scare members. 

 

Best,

 

Andy

Just my observation is all

[apace41]

2 minutes ago, samanthaelizabeth said:

Just my observation is all

 

Have you read the Success Stories?

[samanthaelizabeth]

1 minute ago, apace41 said:

 

Have you read the Success Stories?

Yep and some aren't even success stories as they are now back on an SSRI after a Long slow taper and 20 months out

[apace41]

4 minutes ago, samanthaelizabeth said:

Yep and some aren't even success stories as they are now back on an SSRI after a Long slow taper and 20 months out

 

You are free to take the several stories there that didn’t work out and highlight them over the ones that are, in fact, success stories. That is your choice and I would not presume to deny you that right.  There are many on there, however, that you have mischaracterized which is unfortunate.  

[Downbutnotout]

On 2/17/2018 at 3:15 PM, degen12 said:

 

I am reading your posts, even if you don't see me respond to all of them.

I am reading your posts too. I understand how desperate you feel. It must be difficult to have a husband who is so upset that you feel he’s not being supportive. You have to see it from his point if view. He’s suffering too. You’re really not in this by yourself. He just wants it to be over with too. He wants you to be yourself just as much as you want it to happen. I may be wrong, but if he’s sticking by you through this, he must love you. I really feel your desperation and pain. I appreciated when you answered me. I understand how much we need others to carexehen we’re suffering. 

[samanthaelizabeth]

2 hours ago, apace41 said:

 

You are free to take the several stories there that didn’t work out and highlight them over the ones that are, in fact, success stories. That is your choice and I would not presume to deny you that right.  There are many on there, however, that you have mischaracterized which is unfortunate.  

Do I not have the right to express my self on my own thread? Sorry you took offense.

[Downbutnotout]

What is the reality? Does anyone know? 

[samanthaelizabeth]

7 minutes ago, Downbutnotout said:

What is the reality? Does anyone know? 

Not sure what the reality is.  But aside from being "spellbound" from the AD.  I also don't want to become "spellbound" with grandiose ideas of tapering and how that will make my life better.  But i'm probably not allowed to say that....I just want my life back and will not suffer just to prove the point that I don't need this medication.  It's too late for that now, and I have resigned myself to the fact that I will be on this medication (hopefully at lower dose) for the rest of my life.  Sad but true.

 

[Downbutnotout]

7 minutes ago, samanthaelizabeth said:

Not sure what the reality is.  But aside from being "spellbound" from the AD.  I also don't want to become "spellbound" with grandiose ideas of tapering and how that will make my life better.  But i'm probably not allowed to say that....I just want my life back and will not suffer just to prove the point that I don't need this medication.  It's too late for that now, and I have resigned myself to the fact that I will be on this medication (hopefully at lower dose) for the rest of my life.  Sad but true.

 

I guess if you can tolerate and it helps you, you’re lucky. My body finally rejected it. Now I’m totally scared of trying anything else. I think my time ran out on this stuff. 

[samanthaelizabeth]

8 minutes ago, Downbutnotout said:

I guess if you can tolerate and it helps you, you’re lucky. My body finally rejected it. Now I’m totally scared of trying anything else. I think my time ran out on this stuff. 

I think my rime has run out on this as well.  But I'm not going to risk switching.  The only thing I can do is try to taper down and also get off of the remeron.