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

[samanthaelizabeth]

4 minutes ago, Rosetta said:

Yes, eat.  You will feel better after you do.  

 

Samantha, you are sick.  You have MS, and you have a syndrome that is real whether the doctors you meet will admit it or not.  Some doctors do admit it.  They have written books about it.  They have put their careers on the line to expose it.  

 

Your husband is going to have to accept that 30 years of financial contribution to the household is enough for now.  You are in an anxiety spiral, and you need to sit down and breathe.  You should not be driving.  

 

The pressure you are putting on yourself is not necessary, and it's very harmful.  You are going to have to stand up for yourself -- for your mental health.  If you do, you might find that your husband understands better than you think he does.  If not, then he had better start to understand.  

 

You are going to harm yourself with all this stress.  Stress is the last thing you need right now.  It is obviously too hard for you to search for a job.  Please be kind to yourself.  You are legitimately ill, Sam.  You don't need anyone, including your husband, to agree with that.  You know it.  I went through the same experience when I was still trying to work.  Exactly the same.  I couldn't meet people.  You can't.  It's ok.  This is the nature of the disease -- intense anxiety.  Forgive yourself and let your marriage vows remind you that you do not have to work if you can't.  Remember? In sickness and it health.  No one can expect you to work right now.  It's cruel if someone does.  

 

Rosetta

Thanks Rosetta, I will try, my husband is not happy with my eating habits.  I only really eat at night after I take Mirtazapine.  I sometimes feel I should call my Pdoc and tell him that i'm not doing good, but he'll just want me to switch to something else.  Maybe that is the right thing to do??  I don't know, i'm so confused with everything i've learned on this site and other people's experience when they do switch.  I just spoke to my husband and told him "I'm sorry I can't work right now"  he said "don't worry it's not your fault you have MS"  he thinks this is because of my MS when in reality it has to do with this drug mess from the last few months.  I used to have a solid foundation of who I was, not i'm scared of everything.  Should I just stay on the 200 mg and try to stablize?  I'm sorry, I know you are going through you own thing right now and by the way, you are doing great!  I'm so scared of these doctors now, afraid to tell them how I am feeling or anything.  I have an appointment with a new doctor tomorrow just to establish a relationship with him as I can never get in to see the same doctor with my old one.  What should I say to him?  Don't disclose anything?

[degen12]

Subclinical serotonin syndrome is 100% a real thing. Serotonin syndrome is on a spectrum, and the line between subclinical and problematic isn't well defined. and as Altostrata said some doctors aren't knowledgeable and won't recognize it unless you come in to the ER with a huge fever and big myoclonus.

 

Quote

Questions remain regarding the exact point at which serotonergic signs associated with therapeutic drug administration become the toxic reaction known as serotonin syndrome. The transition point likely depends upon an assessment of the risks and benefits of therapy. As an example, an individual treated for major depression with a serotonergic agent may develop mild tremor and hyperreflexia. Although technically meeting the diagnostic criteria for serotonin syndrome, the patient may benefit more (ie, be significantly less depressed) with continued administration of the agent, even though it produces obvious but tolerable signs of serotonergic excess. However, clinicians should be extremely careful not to add other serotonergic drugs to the regimen of such a patient, and must remain vigilant for any worsening in condition.

 

- From https://www.uptodate.com/contents/serotonin-syndrome-serotonin-toxicity

[Rosetta]

Sam, I wish I could help you.  I'm not a Mod, and I really don't know what you should tell your doctor.  You have MS, and you are taking meds for that.  I'm worried that that is a complicating factor not because I have any reason to think so, but because I feel cautious about these sorts of things.  I can't tell you to hide anything from your doctors because I don't know what sort of harm that might do.  Neither do I know what kind of harm an ignorant doctor might to do you if you told him you are tapering.  

 

You said there were lesions on your brain.  That is pretty serious.  When I was on 150 mg of Zoloft I was very sick.  I had many symptoms that are symptoms of serotonin syndrome: shaking, headaches, anxiety, confusion, insomnia, mania, and rapid heart rate.  So, I'm very concerned about your high dose of Zoloft and your symptoms.  To combine that with MS and MS medication is very concerning.  I think I would see a neurologist if I were you, but one who is recommended by one of the doctors who wrote books about WD syndrome.  

 

I feel that you need to see an neurologist who is an expert in MS who will work with a doctor who truly understands withdrawal syndrome.

 

Meanwhile, it does not matter  why your husband believes you can't work -- only that he does and he accepts it and that you can accept that he accepts it.  Give yourself a break.  You need rest.

 

Rosetta

[ChessieCat]

11 minutes ago, samanthaelizabeth said:

I just spoke to my husband and told him "I'm sorry I can't work right now"  he said "don't worry it's not your fault you have MS"  he thinks this is because of my MS when in reality it has to do with this drug mess from the last few months.

 

It doesn't matter if he thinks it's because of the MS.  As long as he is okay with you not looking for work, that is one less stress you have.

 

13 minutes ago, samanthaelizabeth said:

I have an appointment with a new doctor tomorrow just to establish a relationship with him as I can never get in to see the same doctor with my old one.  What should I say to him?  Don't disclose anything?

 

Think of this appointment as you interviewing the doctor.  Because you are under a lot of stress at the moment, I think it would be a good idea to write down a rough outline of what you are going to tell the doctor, including the drugs and doses you are taking.  You will need to tell him about the drugs you are currently taking, since you will need to continue getting prescriptions (you don't need to go to a psychiatrist to get your script).

 

You don't need to tell him straight away that you want to get off any of your drugs, but you could ask him that if in the future you want to get off Zoloft what is the best way to do that.  This way you can find out whether he is aware about withdrawal. If he suggests changing any (non-MS) drugs, I suggest you be assertive and say that you would prefer to stay on the drug/s you are currently taking.  Try and stay as calm as possible and not get upset.  Having written what you are going to say should help with this.  Doctors will generally want to try and fix the problem and generally the only way they know how is to write a prescription.

 

2 hours ago, samanthaelizabeth said:

I would have to go down to 180 mg, how would I accurately measure this from 2 100mg tablets?

 

It is possible and very easy to dissolve a 100mg Zoloft tablet in 100ml of water.  You leave it overnight then stir well the next morning then take out 20ml with a syringe and drink the remaining 80ml and take 1 x 100mg tablet so you get a 180mg dose.

[samanthaelizabeth]

4 minutes ago, Rosetta said:

Sam, I wish I could help you.  I'm not a Mod, and I really don't know what you should tell your doctor.  You have MS, and you are taking meds for that.  I'm worried that that is a complicating factor not because I have any reason to think so, but because I feel cautious about these sorts of things.  I can't tell you to hide anything from your doctors because I don't know what sort of harm that might do.  Neither do I know what kind of harm an ignorant doctor might to do you if you told him you are tapering.  

 

You said there were lesions on your brain.  That is pretty serious.  When I was on 150 mg of Zoloft I was very sick.  I had many symptoms that are symptoms of serotonin syndrome: shaking, headaches, anxiety, confusion, insomnia, mania, and rapid heart rate.  So, I'm very concerned about your high dose of Zoloft and your symptoms.  To combine that with MS and MS medication is very concerning.  I think I would see a neurologist if I were you, but one who is recommended by one of the doctors who wrote books about WD syndrome.  

 

I feel that you need to see an neurologist who is an expert in MS who will work with a doctor who truly understands withdrawal syndrome.

 

Meanwhile, it does not matter  why your husband believes you can't work -- only that he does and he accepts it and that you can accept that he accepts it.  Give yourself a break.  You need rest.

 

Rosetta

Thank you Rosetta,  I spoke with my MS lawyer and told him of my anxiety and problems with focusing at work these last 2.5 years.  He said if my neurologist is on board with me going on disability he would take my case.  I hate the idea of not working, but I have to bring in money some way.  Of course, he doesn't know that this was due to the Wellbutrin, that would get to complicated for him.  I don't know if i'm in withdrawal since I reinstated quickly, so bringing it up to my Neurologist, well I just think that none of these doctors are informed about any of these drugs. It's said that they have been so brainwashed by BigPharma.  I don't even know if my shots for MS are doing anything, to prevent progression.  They are probably just another money making racket.  Just so you are aware, my MS doesn't affect my ability to walk or anything like that as I don't have any lesions on my spine.  My last relapse was in 2012, when I went out for the evening and couldn't speak properly to the waitress.  I waited for a few days, when I couldn't even write anymore ( it was like the writing of a stroke patient) I went to the E.R they did an MRI and found multiple large lestions (tumor like) and said that I have Tumefactive M.S. put me on IV steroids for 5 days and eventually I got better and back to work.  My medicine are shots that I give myself 3 x a week and they are basically amino acids that act as a decoy so my immune system attacks that instead of the Myelin sheath surrounding  the nerves. So i'm not sure if there is a danger with the AD's, who knows?  Doctors seem to not know anything anymore, they are playing with people's lives with all the drugs they prescribe an no knowledge of them.  

[ChessieCat]

1 hour ago, samanthaelizabeth said:

I cannot eat, should I just force myself?

 

It is best to eat small amounts of food throughout the day.  This helps to keep your blood sugar levels consistent.  Some members find that smoothies are a good way to get nutrition when they have trouble eating.

[samanthaelizabeth]

2 minutes ago, ChessieCat said:

 

It doesn't matter if he thinks it's because of the MS.  As long as he is okay with you not looking for work, that is one less stress you have.

 

 

Think of this appointment as you interviewing the doctor.  Because you are under a lot of stress at the moment, I think it would be a good idea to write down a rough outline of what you are going to tell the doctor, including the drugs and doses you are taking.  You will need to tell him about the drugs you are currently taking, since you will need to continue getting prescriptions (you don't need to go to a psychiatrist to get your script).

 

You don't need to tell him straight away that you want to get off any of your drugs, but you could ask him that if in the future you want to get off Zoloft what is the best way to do that.  This way you can find out whether he is aware about withdrawal. If he suggests changing any (non-MS) drugs, I suggest you be assertive and say that you would prefer to stay on the drug/s you are currently taking.  Try and stay as calm as possible and not get upset.  Having written what you are going to say should help with this.  Doctors will generally want to try and fix the problem and generally the only way they know how is to write a prescription.

 

 

It is possible and very easy to dissolve a 100mg Zoloft tablet in 100ml of water.  You leave it overnight then stir well the next morning then take out 20ml with a syringe and drink the remaining 80ml and take 1 x 100mg tablet so you get a 180mg dose.

How would I measure this 100 ml of water and what kind of syringe?   What if he tells me to go fast?  Why do we have to be scared of doctors like this?  Good Grief, this world has gone insane!

[samanthaelizabeth]

I am afraid to taper, I'm already depressed.  What if I get worse?

[samanthaelizabeth]

So, i'm not sure that I have stabilized on 200MG yet. Why am I even considering a taper?  I don't know that the zoloft is ever going to make me happy again, especially with everything that has happened from the Wellbutrin.  My behavior on the wellbutrin was attrocious!  I can't believe that was me making those horrible decisions, I thought I was anxious and not happy with our move to another state!  Should I just stay on it or risk everything by tapering off of it?

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[Altostrata]

If you don't trust the psychiatrist, don't go to him for help. Ask another doctor to help you instead. How about the neurologist? You might say you feel the Zoloft is too high a dose for you and you want to take a bit less. Ask for a Zoloft liquid prescription and 100mg tablets.

 

15 hours ago, Altostrata said:

Please read this Tips for tapering off Zoloft (sertraline)  It explains how to make a liquid.

 

You might ask your doctor if you can take 100mg Zoloft in the morning and 100mg in the evening, to reduce side effects. Then you can take 100mg in tablet form and then 80mg in liquid form.

 

Alternatively, you might remove your psychiatrist from the payroll and ask your GP or other doctor to prescribe 100mg tablets and Zoloft liquid so you can take 100mg + 80mg in liquid form.

 

^What I meant here was that although your doctor would prescribe Zoloft for you in divided doses (for insurance coverage), you would take it the 100mg tablet and 80mg liquid at the same time. I agree that you shouldn't take it with mirtazapine.

 

Unfortunately, you have a difficult choice: Whether to stick with drug adverse effects or reduce and see what happens. It does not seem that Zoloft is treating your "depression" anyway.

 

How exactly do you experience "depression"?

[samanthaelizabeth]

Sorry, I can't even spell anymore!  

[degen12]

My personal experience has been that titrating mirtazapine below 15 mg is very painful unless done very slowly.

 

When I used to take sertraline, I noticed that, similar to Cipralex, most of the effect actually occurred at the lower end of the "therapeutic" dose. When I was titrating it looked like this (not recommended, I had no knowledge at the time):

 

200 mg - > 150 mg. Absolutely no withdrawal. 150 -> 100 mg. Maybe some mild withdrawal. Not very noticeable. 100 -> 50 mg. Oh boy. It begins. Tolerable but absolutely the beginning of withdrawal. 50 -> 25 mg. Holy ****. All of a sudden the withdrawal went from like a 2 to a 7. Even though it was only a 25 mg cut and I had been doing 50 mg cuts no problem. Once I made it to 25 mg I opened the capsule and started making micro cuts. A couple mg would honestly make a huge difference.

 

Now don't get me wrong. I'm not saying "Go chop 50 mg off your dose!". This site has its guidelines and although I don't always follow them, I probably should, and they're there for a good reason. Although you are supersensitized to any changes in this drug now, sertraline seems to follow a lot of SSRIs in that it's action on the serotonin transporter seems mostly to have already happened at the lower end of "therapeutic" doses. This gives a bit of leeway to play with your dose at the higher level without as many side effects from making cuts at lower doses. Like cutting 20 mg off of 100 mg is exponentially harder than cutting 20 mg from 200 mg.

[samanthaelizabeth]

1 minute ago, Altostrata said:

If you don't trust the psychiatrist, don't go to him for help. Ask another doctor to help you instead. How about the neurologist? You might say you feel the Zoloft is too high a dose for you and you want to take a bit less. Ask for a Zoloft liquid prescription and 100mg tablets.

 

 

^What I meant here was that although your doctor would prescribe Zoloft for you in divided doses (for insurance coverage), you would take it the 100mg tablet and 80mg liquid at the same time. I agree that you shouldn't take it with mirtazapine.

 

Unfortunately, you have a difficult choice: Whether to stick with drug adverse effects or reduce and see what happens. It does not seem that Zoloft is treating your "depression" anyway.

 

How exactly do you experience "depression"?

I'm just so hard on myself, dissappointed in myself, I can't eat and scared that my husband will leave.  I have been with him since 1983 since I was 17.  The only problem with asking my neurologist to taper is she is very hard to get in touch with, i'm afraid about refills.  I'm just going to ask my Pdoc, he is pretty nice and he does agree that I shouldn't be on all this medication.  Thank you so much for all of your help, this is scary. I wish this site was around in 1999 then I would have known what was happening to me and reinstated Ativan (horrible drug) and then tapered off.  I really felt like I was losing my mind, and then the depression and SI by the time I got to a doctor I really did believe that I needed AD's.  

[samanthaelizabeth]

4 minutes ago, degen12 said:

My personal experience has been that titrating mirtazapine below 15 mg is very painful unless done very slowly.

 

When I used to take sertraline, I noticed that, similar to Cipralex, most of the effect actually occurred in the first 50 mg or so. When I was titrating it looked like this (not recommended, I had no knowledge at the time):

 

200 mg - > 150 mg. Absolutely no withdrawal. 150 -> 100 mg. Maybe some mild withdrawal. Not very noticeable. 100 -> 50 mg. Oh boy. It begins. Tolerable but absolutely the beginning of withdrawal. 50 -> 25 mg. Holy ****. All of a sudden the withdrawal went from like a 2 to a 7. Even though it was only a 25 mg cut and I had been doing 50 mg cuts no problem. Once I made it to 25 mg I opened the capsule and started making micro cuts. A couple mg would honestly make a huge difference.

 

Now don't get me wrong. I'm not saying "Go chop 50 mg off your dose!". This site has its guidelines and although I don't always follow them, I probably should, and they're there for a good reason. Although you are supersensited to any changes in this drug now, sertraline seems to follow a lot of SSRIs in that it's action on the serotonin transporter seems mostly to have already happened at the lower end of "therapeutic" doses. This gives a bit of leeway to play with your dose at the higher level without as many side effects from making cuts at lower doses. Like cutting 20 mg off of 100 mg is exponentially harder than cutting 20 mg from 200 mg.

You mean you have also been on Zoloft since 1999? And you were on the max dose as well?

[degen12]

1 minute ago, samanthaelizabeth said:

You mean you have also been on Zoloft since 1999? And you were on the max dose as well?

 

No I have been on one SSRI or another since 1999. I'm taking Cipralex now. I was taking 250 mg sertraline for a while. As a child.

[degen12]

Also about the capsules. Although the powder doesn't dissolve in water all that well, it's not really a problem because you just keep readding water to your glass and stirring and drinking until you've got all the powder down. It wasn't optimal and obviously not as good as a liquid but it was doable.

 

I used to empty the capsule out onto a piece of paper and eyeball it and split it with a credit card. Maybe not as accurate as it should be. My mom helped me a lot with that and she had a good eye.

[samanthaelizabeth]

14 minutes ago, degen12 said:

 

No I have been on one SSRI or another since 1999. I'm taking Cipralex now. I was taking 250 mg sertraline for a while. As a child.

250 setraline?  The max dose is 200MG??

[degen12]

Just now, samanthaelizabeth said:

250 setraline?  The max dose is 200MG??

 

I don't know if it's still a trend but my diagnosis was OCD and the belief back then was that higher than normal doses of SSRIs were needed to properly treat it.

[samanthaelizabeth]

2 minutes ago, degen12 said:

 

I don't know if it's still a trend but my diagnosis was OCD and the belief back then was that higher than normal doses of SSRIs were needed to properly treat it.

Quote

 

 

 

How long have you been on Mirtazipine?  Are you tapering this also?  I eventually want to get off this as well, but it will take me years to get off the zoloft.

[degen12]

9 minutes ago, samanthaelizabeth said:

How long have you been on Mirtazipine?  Are you tapering this also?  I eventually want to get off this as well, but it will take me years to get off the zoloft.

 

Some time in 2015. I didn't start to properly track my dosages and changes until 2016. I am not currently tapering mirtazapine. Last year I tapered to 7.5 mg but found that any lower would require very slow and disciplined tapering. I did 15 mg -> 7.5 mg and it was far too large a cut, although I got through it in the end.

 

Yes it will take us years to get off of our SSRIs. Nothing we can do about it. Thankfully the initial cuts are a little easier than the later ones in my experience. And those initial cuts can bring some relief to the worst of our side-effects. (I almost got off of SSRI in my adolescence, then had a breakdown during my parents divorce and ended up on high dose SSRI again and a slew of other drugs)

[samanthaelizabeth]

Mods- Is it okay for me to take Melatonin at night? My Mirtazipine is not keeping me asleep all night, I have been waking up at 3 am and then again at 6am.  Thanks!

[samanthaelizabeth]

52 minutes ago, Altostrata said:

If you don't trust the psychiatrist, don't go to him for help. Ask another doctor to help you instead. How about the neurologist? You might say you feel the Zoloft is too high a dose for you and you want to take a bit less. Ask for a Zoloft liquid prescription and 100mg tablets.

 

 

^What I meant here was that although your doctor would prescribe Zoloft for you in divided doses (for insurance coverage), you would take it the 100mg tablet and 80mg liquid at the same time. I agree that you shouldn't take it with mirtazapine.

 

Unfortunately, you have a difficult choice: Whether to stick with drug adverse effects or reduce and see what happens. It does not seem that Zoloft is treating your "depression" anyway.

 

How exactly do you experience "depression"?

Hello Alto,  What do you mean by divided doses? Right now I am prescribed 200mg which is 2 x100mg every morning (6 am)

[ChessieCat]

I think it would be better to try non drug techniques.  The fact that you are sleeping and also getting back to sleep is a good thing.  Many members experience extreme insomnia.  I don't sleep all through the night.  It's not uncommon.  Adding in something new can be an issue.  If you start experiencing issues you will not be able to work out what is causing the problem.

 

Q:  Are you practising good sleep hygiene?

 

Sleep problems - that awful withdrawal insomnia

 

Sleep Hypnosis, Guided Meditations, Calming Videos
 

Here is SA's topic:  Melatonin

[samanthaelizabeth]

I almost forgot what I was going to ask. Oh, I need to quit smoking as well, any advice?

[Altostrata]

Divided doses means taking a drug more than once a day.

 

Why do you need to quit smoking? Not that this isn't a good idea for anyone, but why now?

[samanthaelizabeth]

8 minutes ago, Altostrata said:

Divided doses means taking a drug more than once a day.

 

Why do you need to quit smoking? Not that this isn't a good idea for anyone, but why now?

Because I'm not working and it costs too much.  @Altostrata, do you think I am stable enough to start my taper or Zoloft? How exactly do I ask my doctor for the 100 MG tablet form and the rest in liquid?  Wouldn't that be in a very large bottle to last me for 30 days? I'm sorry, this is confusing to me.  Thank you for your help.

[samanthaelizabeth]

I am starting with a new GP tomorrow and want to be prepared.

[samanthaelizabeth]

I wish I would have found this board before I jumped back up to 200MG of zoloft. Maybe I could have stabilized on less and not had so far to go with my taper.

[samanthaelizabeth]

2 hours ago, samanthaelizabeth said:

2 hours ago, ChessieCat said:

 

How would I measure this 100 ml of water and what kind of syringe?   What if he tells me to go fast?  Why do we have to be scared of doctors like this?  Good Grief, this world has gone insane!

Please someone, I see my new doctor tomorrow?  How exactly do I ask my doctor for the 100 MG tablet form and the rest in liquid?  Wouldn't that be in a very large bottle to last me for 30 days? I'm sorry, this is confusing to me.  Thank you for your help.

[samanthaelizabeth]

If I do good on the 180mg How do I cut again to 162 mg?  Then get another prescription for that?  @ChessieCat

[samanthaelizabeth]

I think i'm going to ask for 9 ML a day which is 180MG. The insurance won't pay for this (only for children)  But, i'm going to ask my doctor to write the prescription and say that because of my MS I cannot swallow the pills properly.  What do you think of this? Maybe this way the insurance will cover it. 

 

20MG =1ml

 

[samanthaelizabeth]

@Altostrata Would you please change my screen name to CaliGirl ?  My husband is no aware of this site and will recognize my current name.  I have just spoken to him about tapering.  Thank you!

[ChessieCat]

50 minutes ago, samanthaelizabeth said:

If I do good on the 180mg How do I cut again to 162 mg?  Then get another prescription for that?

 

One thing at a time.  No need to worry about that for now.

[samanthaelizabeth]

@ChessieCat- Okay, thank you!  So happy I found you guys! I am going to request my liquid tomorrow.

[ChessieCat]

18 minutes ago, samanthaelizabeth said:

My husband is no aware of this site and will recognize my current name.  I have just spoken to him about tapering.  Thank you!

 

If he reads your Intro topic he may have a better understanding of what you are going through and therefore be more supportive.

[samanthaelizabeth]

Just now, ChessieCat said:

 

If he reads your Intro topic he may have a better understanding of what you are going through and therefore be more supportive.

No, I don't want him to. He warned me about this along time ago.