Kernol: was doing well on my sertraline taper but now in hell and doc reinstated

[Altostrata]

I don't know what the effect of bioidentical hormones might be. Be sure to try a very tiny dose.

 

It could very well be that increased diazepam has increased blood level of sertraline, their interaction being a major concern. This would occur an hour or so after a dose of diazepam.

 

It is possible a reduction in sertraline would reduce this.

 

 

[Kernol]

Thanks @Altostrata I am not sure I can consider a reduction in sertraline at the moment I am so sick as it is I am scared of what that might do. I have to lie down all afternoon as the nausea is so extreme -  lying down seems to help a bit. 
 

Will the genetic results help to determine if there is a likely interaction or not going on between the two?  I hope to get the results next week. It would be great to know if that is a major issue or if it is just that diazepam only masks my sertraline symptoms a tiny bit and for a short period of time as it doesn’t seem to make a difference whether i take a 1mg or 2mg dose - the relief is only ever 1.5 hours. 
 

re the hormones -, I will consider a low dose of estrogen and if it doesn’t suit me I will just stop it. I will have my hormones tested again this week as well to see if there are any clues there. I have already been given progesterone cream by a doctor but I only put it on once as I got scared as I read it can cause a withdrawal like a Benzo. When I did put the cream on, I definitely noticed a slight calming effect on the anxiety but it only lasted an hour or so - almost like I had taken a short acting Benzo? Maybe I should have kept using it but I got too scared about it not working and then having a withdrawal from that to deal with... 

[Altostrata]

The genetic results will indicate if you have an absolute inability to metabolize sertraline. My intuition is sertraline is causing adverse effects and should be reduced.

[Kernol]

Thanks @Altostrata - if I took the drug and did well on it for 11 years,  it worked therapeutically without a doubt and I had no real side effects on it all those years whilst on it  would that not rule out the possibility I can’t metabolise sertraline or have i got that wrong?? Sorry it’s all a bit beyond me

[Altostrata]

Did you take sertraline with other drugs at the same time?

[Kernol]

Hi @Altostrata only for the first 10 months I took lorazepam 1mg with it for the first 3 months and then cross tapered to diazepam for 7 months and came off it and was fine but of course I did not have withdrawal syndrome then 

[Altostrata]

Did you take the benzos with sertraline because you had adverse effects when you were starting it up?

[Kernol]

Hi @Altostrata No I don’t think so that I can remember it was because I had a bad nervous breakdown and they wanted to calm me down however it could well have masked the activating symptoms that I have had when starting other ssris in the past 

[Altostrata]

Whatever your sensitivities to SSRIs, it seems possible that sertraline is aggravating them.

[Kernol]

Hi @Altostrata I’m certainly sensitive to it now that’s for sure but getting off it seems like an impossible task for me - I get sicker the lower the dose gets. If only I hadn’t been put back on it in 2018 I expect I would be well by now - 2 years off it.  Kindled right? That’s why this second withdrawal is so much harder than  the first? 
 

I am still bed ridden with the extreme nausea and flu symptoms - I have been like this for weeks On end now and no sign of it letting up yet. I really hope it will settle a bit soon and the awful mental symptoms.  I will take 10 or 20% better right now!! 
 

 

[Altostrata]

Are these symptoms still worse a couple hours after you take diazepam?

[Kernol]

Hi @Altostrata It tends to get worse in between doses of diazepam apart from in the evening it isn’t so marked so I just get very short and very weak dampening down of symptoms from the diazepam. That‘a been the case the whole time. It’s also very bad before the first diazepam dose in the morning so I don’t think it points to an interaction particularly? 

[Altostrata]

Please post daily notes with your symptom pattern.

[Kernol]

Hi @Altostrata daily notes from yesterday - follows same pattern for some weeks 

 

5am wake with strong cortisol rush and burning skin head tingling and teeth smashing 

5am-7am a bombardment of bizarre sounds and random memories and hallucinations whilst falling in and out of sleep along with extremely strong emotional pain and dark depression. So intense I can’t describe. As I wake I feel disorientated time travelled into the past I feel psychotic delirious 

8.00am get up have shower - nausea starts emotional pain depression random memories still feel very ungrounded 

9.00am take 1.5mg diazepam 

10.40am nausea feels tiny bit better all mental symptoms stay same - intense and unrelenting 

12.45pm chills and whole body shivers start and nausea ramps up to extreme

1.00pm take 1.5mg diazePam

1.30pm no change nausea still extreme chills bad must lie down

2.00pm in bed breathing with extreme nausea all afternoon Mental symptoms still intense 

5.30pm take 1.75mg diazepam. 
6.30pm nausea finally lessens.

7.00pm manage small meal. Mental symptoms reduced by 20% 

8.30pm restless leg syndrome 

9.00pm take 11.37mg sertraline
10.00pm fall asleep

2.00am wake with nightmares and nightsweats With a chemical dark emotion I can’t even put a name to

5.00am wake with strong cortisol rush and burning sizzling skin all over my side and legs and burning brain. Random memories and strange songs and hymns in my head that sound like they are actually outside my head but are not. 

 

 

Should I ask the doctor to prescribe something for the extreme nausea? I have tried ginger and I have tried the pink pepto bismol but did nothing.  It is every day and i have to go to bed with this flu feeling all afternoon. I am finding it so hard to keep anything down even liquids apart from in evening. This started at end of August and has just got worse and worse

[Altostrata]

When did you move sertaline to 9 p.m.?

 

7 hours ago, Kernol said:

2.00am wake with nightmares and nightsweats With a chemical dark emotion I can’t even put a name to

5.00am wake with strong cortisol rush and burning sizzling skin all over my side and legs and burning brain. Random memories and strange songs and hymns in my head that sound like they are actually outside my head but are not. 

 

Was this different from your usual nighttime pattern?

[Kernol]

Hi @Altostrata in April as I was having  lots of issues with getting to sleep. It did help I can get off to sleep better now. 

[Kernol]

16 hours ago, Altostrata said:

When did you move sertaline to 9 p.m.?

 

 

Was this different from your usual nighttime pattern?

hi @Altostrata no it’s no different from my usual nighttime pattern really. 

[Altostrata]

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019839s070,020990s032lbl.pdf

Quote

peak plasma concentrations (Cmax) of sertraline occurred between 4.5 to 8.4 hours post-dosing.

 

Since you seem to get more intense symptoms after you take sertraline, they do not appear to be sertraline withdrawal symptoms, they appear to be adverse effects of sertraline.

 

If I were you, I'd reduce to 11mg.

 

 

[Kernol]

Hi @Altostrata I had a similar pattern though when I took it during the day and sometimes my worst symptoms are in the afternoon plus if it was an adverse reaction why would I be so much worse now having reduced the drug down over the past months. Surely it would have relieved some of it not crashed my system into such a bad destabilisation? I honestly don’t know what to do. 

[Altostrata]

Many things could be going on here, but sertaline withdrawal seems less likely, because your symptoms do not get even a little better after you take sertraline.

 

Can you increase diazepam a bit?

[Kernol]

Hi @Altostrata yes I can increase it but to be honest I think I would need to double what I am currently on to provide any relief. When I took the lorazepam rescue doses of 1mg were the only days I did not have the extreme nausea and vomiting - I still had nausea but it was tolerable and it muted the mental symptoms a bit more. 
 

the gp is suggesting an anti-emetic for the nausea and vomiting as I have lost so much weight but I am concerned they all seem to affect either dopamine or sertraline blockers in the brain? I am a bit concerned about this but I obviously can’t go on with this every day it has been 2 months now

[Altostrata]

Increasing the benzo would be your best bet, not adding in another drug which, as you have observed, can throw yet another spanner into the works.

[Kernol]

Ok @Altostrata I will try it but the small increases I have made in the diazepam have not made any difference so far so what schedule should I increase by to on one hand to hopefully provide some level of relief as soon as possible whilst balancing the risk of kindling myself on it?  

[Altostrata]

As diazepam has a very long half-life, I would go up gradually, not faster than 0.5mg every 2 weeks, see what it does.

 

If you have withdrawal from lorazepam and sertraline, this may help.

[Kernol]

Hi @Gridley I hope you can help. I saw someone mentioned you talking about extreme swings between good short windows and bad waves not being a good sign and this seems to be the case for me. I am hoping you might be able to shed some light on what has happened:

 

after high reinstatement of sertraline in Nov 2018 I have reduced it a second time (I believe the reinstatement kindled me) over the last 2 years. When I got to the lower doses under 25mg last September I went too fast and then updosed and my symptoms became much worse like a permanent bad acid trip and severe Bruxism and many more developed etc so I live in survival mode every day. I held for 8 months both sertraline at 16.76mg and did not reduce diazepam further. I also came off vortioxetine which I was put on to help me get off sertraline. I don’t believe the vortioxetine did much either way to affect my withdrawal. I did have a one week window after finishing it last December (my first window). I never stabilised during holding unfortunately.
 

So as holding did not help in April this year  I started to taper the sertraline again at 10% a month and I started experiencing windows of much reduced symptoms within days but only in the Second half of my hormonal cycle then I would go into a bad wave in the first half of my cycle and this continued for 3 months with each wave getting worse than the last. The last window I had was my longest in July for 3 weeks then as my hormonal cycle ended I completely crashed and here I am 3 months later still the worst wave of my 2 year journey with much worse mental symptoms and new physical symptoms constant nausea vomiting and chills. No let up and no more strange windows. Every time I got a window I would sneeze on waking every morning but no more sneezing since. I don’t know what the sneezing means but I don’t get a window without the sneezing happening.

 

i stopped the taper but I am intrigued into whether you think those strange windows were actually a sign of destabilisation and I was about to crash? I don’t know what this means for my future tapering and if there is anything I can learn? 
 

thank you 

[Gridley]

21 minutes ago, Kernol said:

saw someone mentioned you talking about extreme swings between good short windows and bad waves not being a good sign

No, this is normal for waves and windows.

 

21 minutes ago, Kernol said:

strange windows were actually a sign of destabilisation and I was about to crash?

I don't think they're a sign of destabilization.  A lot of it is tied in with the hormonal cycle and a lot of it is just out of the blue.  The fact that you experienced very good windows is a sign of healing.  It's impossible to predict how the waves and windows are going to manifest because there is so much we don't know about withdrawal.  You've probably read this link, but in case you haven't, here it is and it would probably be worth a re-read.

 

The Windows and Waves Pattern of Stabilization

 

Edited October 29, 2020 by Gridley

[Kernol]

Thanks so much @Gridley that is reassuring. I was just concerned because my baseline was getting worse in each wave following these windows with new symptoms etc. 
 

do people that have been kindled like me and are finding it almost impossible to get off the drug a second time always go on to have a protracted withdrawal? I have seen many people saying this and I am scared this is my fate. I know we can’t predict but it would sure help to see people who have been in acute for so long tapering that did not go on to have a protracted post withdrawal. I feel quite lost as to what to do next. 

[Gridley]

22 minutes ago, Kernol said:

 

do people that have been kindled like me and are finding it almost impossible to get off the drug a second time always go on to have a protracted withdrawal?

I wish I could give you a definite answer, but there is just no way to predict who will go on to paws and who won't.

 

24 minutes ago, Kernol said:

I am scared this is my fate.

The best approach is to assume the best.  Worrying causes stress which makes you feel worse.

[Kernol]

Hi @Altostrata I finally got my genetic testing results. I can’t seem to attach them as file size is too big? It shows am intermediate metaboliser for CYP2B6 and CYP2C9 and a risk of elevated serum levels. CYP3A4 is normal. I note I have double MTHFR gene which I am freaking out about. Should I be testing my methyfolate if that is even possible to see if any deficiency might be making my symptoms even worse? Thanks so much for all your help 

[ChessieCat]

  

On 4/25/2012 at 3:47 AM, Altostrata said:

Taking a folate supplement in the form of L-Methylfolate and sublingual B12 or shots alleviates the risk caused by an MTHFR mutation.

 

[Kernol]

13 hours ago, ChessieCat said:

  

 

thanks @ChessieCat is it okay to take the l-methylfolate whilst tapering? I would like to try it is possible in case it helps. 

 

@Altostrata did the genetic results give you any clues regarding metabolising the diazepam and sertraline or was it not really telling us anything? 

[ChessieCat]

9 hours ago, Kernol said:

is it okay to take the l-methylfolate whilst tapering? I would like to try it is possible in case it helps. 

 

As you probably already know after having been a member here for 2 years, there are a lot of existing topics.  Do a search for the SA topic.  Use a search engine and add: site:survivingantidepressants.org to the search term.

 

And you are probably already familiar with this topic:

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

[Kernol]

17 hours ago, ChessieCat said:

 

As you probably already know after having been a member here for 2 years, there are a lot of existing topics.  Do a search for the SA topic.  Use a search engine and add: site:survivingantidepressants.org to the search term.

 

And you are probably already familiar with this topic:

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

thanks @ChessieCatyes I did have a search - seems that maybe lots of green veg might be good enough so I will have a think - thanks so much 

[ChessieCat]

My mother and sister have both been low in B12.  When I asked my doctor about it being hereditary he didn't seem concerned.  However, once I learned more here at SA I decided to take it.

 

Every second day I take a sublingual methyl B12 tablet and a folate tablet.  From what I understand they are both water soluble and excess of both of these is excreted in the urine.

[Altostrata]

On 12/1/2020 at 5:50 AM, Kernol said:

Hi @Altostrata I finally got my genetic testing results. I can’t seem to attach them as file size is too big? It shows am intermediate metaboliser for CYP2B6 and CYP2C9 and a risk of elevated serum levels. CYP3A4 is normal. I note I have double MTHFR gene which I am freaking out about. Should I be testing my methyfolate if that is even possible to see if any deficiency might be making my symptoms even worse? Thanks so much for all your help 

 

Does "double MTHFR gene" mean you are homozygous? That means you have a pair that are the same. This can cause some problems in pregnancy; obstetricians would recommend folate.

 

However, we find that for people who are sensitized, the B vitamins, including vitamin B12 and folate, can be activating. If you want to take them, you might start with a very tiny crumb of a tablet and increase gradually.

 

I suppose the genetic results might indicate that sertraline's inhibitory effect on CYP2B6 and CYP2C9 effectively knocks those two out of commission, but both sertraline and diazepam rely more on other enzymes for their metabolism.

 

So the hypothesis that you do better with lorazepam, which does not depend on those 2 enzymes at all, than diazepam might hold water. Sertraline may be blocking the metabolism and therefore the conversion of diazepam into its active metabolites, nordazepam, temazepam, and oxazepam, thus reducing diazepam's effect.

 

How are you feeling now? Did you increase diazepam?

[Kernol]

Thanks so much @Altostrata I think I have one of each it says: 

 

C677T: C/T

A1298C: A/A ( intermediate activity )

I am not sure if this means I need l-methyl folate or not.  I saw having the gene can affect the body’s ability to produce serotonin, dopamine  etc by 50%  which made me really anxious not sure if this is the case, the information on the internet is quite confusing! 

 

I am doing pretty badly with a few days here and there that things seem less intense then I am thrown back into deep despair again. Pretty sure it’s hormonal influence - I have low progesterone / high testosterone / high prolactin. My hair is falling out everywhere except for a couple of days when progesterone would be at its highest. I tried the progesterone cream for a few days but I got scared with the whole cross tolerance to gaba receptors and feared a withdrawal coming off it. I believe when I had the windows during my progesterone part of my cycle in the summer I was experiencing a severe withdrawal from the drop in my own progesterone in the first half of my cycle. This has now changed and I seem to be suffering more in my second half of cycle now maybe because my progesterone is now lower. I was also prescribed HRT last week but took one capsule of the micronised progesterone and I felt very depressed after an hour of taking it so didn’t take another one. It’s so frustrating as I know my hormonal fluctuations are affecting my withdrawal symptoms but I am too fearful to add anything. I try and eat as healthily as possible and having sunflower seeds to help progesterone production but it doesn’t seem to have made any difference yet!
 

as for the sertraline, I have done smaller drops 2 weeks apart of 2.5% - so am now at 9.5mg  I am not sure if things are any worse just as bad as before so I guess I keep going as holding never seems to stabilise anything. The diazepam I have kept at 4.5mg except for days when I am suicidal and in crisis then I take a rescue dose of lorazepam - I know this is not ideal but taking a larger dose of diazepam just doesn’t help on those days.