Rainbows: 14 year old son coming off sertraline

[Rainbows]

Hello to you all.

i have found this site after much research about tapering sertraline. My son (14) was put on 25mg sertraline to assist with anxiety. He has been on it 15 months. After months of therapy, he is doing much better and I am keen to help him come off the medication. His gp has said to reduce by 50% after two weeks then stop. We cut the dose to 12.5mg a week ago. Then I started researching tapering. My son has mild symptoms: intermittent headache half way through the day, a bit irratible. Having read everything here, I have decided to hold him at 12.5mg for another 3 weeks and then reduce the dose slightly. I would hate for my son to have difficulty coming off this medication so want to give him the best chance possible. I appreciate he has not been on a high dose nor for as long as most but he is so young by comparison. This medication and withdrawal is putting the fear of god into me. I want him off these meds for good and nowwish he had never started. I don’t think I have any questions just yet....just an intro really.

[Altostrata]

Welcome, Rainbows.

 

If your son's headache etc. diminish in a week or so, holding for a few weeks until they go away completely seems a reasonable path to me. He may be able to tolerate that first decrease of 50%.

 

If his headache and other symptoms get worse, I would updose immediately to 15mg. Even a small updose can help.

 

After that, I would decrease much more gradually.

 

Why taper by 10% of my dosage?

 

Tips for tapering off Zoloft (sertraline)

 

I would ask your doctor for a prescription for liquid sertraline so you can taper more gradually.

[Rainbows]

Thank you for your advice and the links.

 

I have probably spent too much time ‘googling’ and have sent myself into a bit of a tailspin coupled with complete guilt about agreeing to allow my son to start this medication in the first place. The prescribing physician never mentioned difficulty coming of the meds. We were told we could stop at any point. I am trying not to focus on the fact we were never told about this as if I do, I get quite cross.

 

I have managed to get an appt with a child psychiatrist who also specialises in an holistic naturopathic approach. I am hoping they can prescribe the liquid in the meantime and hopefully be fully aware of gradual tapering as well as provide some advice on gut health and generally looking after ones system.

 

My sons headache does not seem to appear more than once a day and does not last long. His irratibilty seems to have resolved.

 

I am grateful I have come across your site in the early stage of this process.

 

I am hoping that by following your suggested protocols that my son can avoid some of the symptoms so many of the other members here suffer with.

 

Sending good wishes and healing thoughts to all.

[Rainbows]

First of all, I should say I am not sure I entirely have a right to be on this forum as my son is not suffering wd......yet. The only reason I am here is that I have trawled the internet for info and this is the only reliable place I have found. If I had not come across this site, my son (14) would currently be jumping off 12.5mg without so much as a flinch. Likewise, if I had come across this site 15 months ago,  I doubt I would have agreed to medication. So - just to provide an update from my manic state of worry about my son tapering from sertraline with some facts gained today.

 

my son dropped from 25mg sertraline (15 months) to 12.5mg, 10 days ago as advised by GP (clueless). So far, apart from intermittent mild head ache and some irritability, he is coping well (but it is school holidays).

 

today, we saw his prescribing physician. I was not feeling very charitable given we had not been told about possible discontinuation issues. However....we are where we are.

 

Advice received was reasonable I think.

 

Stay on 12.5mg for 3 months whilst we sort out gut health and consider one other issue relating to strep b.

 

after some tests, we know my son is deficient in almost all b vitamins, magnesium and zinc. His gut absorption is poor and he requires probiotics. The dr we have seen believes in SSRI discontinuation syndrome which is a start! He has suggested that of the hundreds of patients he has seen only a small handful have suffered but admitted he has only recently acknowledged this. He believes there is a genetic predisposition but also suggested getting your gut in the best possible shape before tapering would give you a greater chance if discontinuing successfully.

 

the dr ran some blood tests relating to strep titres. Both his asot?? Titers were elevated. He has prescribed 2 weeks antibiotics as he is on a goose chase for a pans/pandas diagnosis. He has always suggested my sons anxiety has stemmed from a bacterial infection resulting in brain inflammation rather than a mental health issue. Pans/pandas is yet another issue that is widely refuted in the medical profession. For one reason or another, my sons strep results from 12 months ago fell down a rabbit hole until I chased everything today.

 

upshot is: hold the dose of sertraline 12.5mg for the next 3 months whilst we take 2 weeks of abx just in case it helps. Before the abx, my son has to provide a fecal sample over 3 days to check gut absorption. After the abx, more blood tests to check asot titers again to see if there is any difference and whether anxiety is related to strep b. Then introduction of vitamin b, magnesium, zinc and probiotics to ensure optimal gut health before tapering from sertraline which should be done incrementally from the liquid form which will be introduced over the next few weeks.

 

This all sounds conservative and sensible I think.

 

most of your members have already experienced wd prior to posting. It may be that this thread is irrelevant to the group. I thought I would post anyway and allow mods to decide. It may be that info before the event is as useful to members/future members as info after???? I found this site not because of wd symptoms but seeking information to be able to act accordingly in anticipation of wd.

 

i am happy to update the thread as we go if it would be of interest. Please advise so no offence is caused.

[Rainbows]

Update - 20 days post first taper (25mg sertraline to 12.5mg sertraline as advised by Gp (prior to learning about 10% rational))

 

All appears stable. No continued complaints of headache or irritability as yet. Mind you, it is mid-school holidays so no need for my 14yo to get out of bed at 6:30am and have a 12 hour day. No stressors interfering. Bring in April 25 😫.

 

i have decided on my sons behalf to hold for 2 months (just to be sure).

 

FYI as a side note: having read many of the wd side effects, I can confirm that I (having no AD history) have been able to check the boxes of atleast 7 side effects from wd (although obvs not wd.....highlighting the complexity of tapering and worrying). I know the mods are very clear about managing anxiety through this process and I cannot agree more. Insomnia, nausea, agitation, racing heart, ruminating thoughts, restlessness, vision issues, ...all symptoms I have suffered as a direct result of worrying about my sons wd from sertraline. I know it’s pointless worrying about my son’s taper but I cannot help it. I feel responsible for him being on

meds in the first place. However, it makes me so concerned about how difficult it is to cope with wd and this amount of worry as well.  From what I have read, the moderators are firm, fair, supportive and very honest with their knowledge sharing. It’s an amazing job well done.  I am glad to have found this forum. I can only hope I only ever need to post updates and never need to raid the fountain of knowledge and experience that amasses here. Irrespective, thank you and ....we will see.

 

Good wishes to you all.

 

Gx

[Rainbows]

So my son has been holding at 12.5mg comfortably since March. In this time, there have been a number of tests run. He has very low vit d, very low b vitamins and folate, and strep had been located in his gut. Antibiotics will hopefully have cleared his gut of strep.....my son has since had no anxious episodes and I have a b vitamins and a good quality probiotic for him to start. So the time has come to get off the sertraline once and for all. My GP absolutely will not prescribe a liquid preparation and continues to recommend just jumping off at 12.5mg....the psychiatrist supports this suggesting that 12.5 is “almost homeopathic” therefore I will make my own liquid from the tablets we have.

 

Question 1: As the liquid will be made from the meds my son currently takes, is it ok to go from 12.5mg in tablet form today to 11.25mg in liquid form tomorrow without introducing the crossover protocol recommended for switching to a liquid suspension provided by a pharmacist?

 

Many thanks in advance for any advice.

[ChessieCat]

It is best to make only one change at a time, so do not make a reduction at the same time as changing form.

 

When changing form of drug it is best to do a crossover, taking each combo for 3 to 7 days (or longer) 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4.  This is gentler on the system.

 

Keep it Simple, Slow and Stable

[Onmyway]

Hi rainbows, I'm not a moderator and don't have a lot of experience in wd but if things are going well, I would not worry that much. Not everyone has severe wd effects. Perhaps most people have mild effects and you see us the unlucky ones here. It's probably a distribution. It's good that you are proactive and do tapering slowly but I would not necessarily assume your son's experience will be as bad. 

[Rainbows]

Thanks @ChessieCat. I will not change dose whilst switching to home prepared liquid and will attempt a crossover protocol but I am currently cutting 50mg tablets to get 12.5mg which is tricky enough and certainly not precise, perhaps I can attempt to do a 50:50 with tablet and home liquid although I completely appreciate this is not your recommendation. Cutting the tablets any smaller than 12.5 will become arbitrary unless I purchase one of the scales I suppose! (Perhaps this is the way forward).

 

@Onmyway. Thank you, I hear you. Essentially I am wanting to ensure that any withdrawal effects are kept to an absolute minimum....even the mild effects appear to be unpleasant. Warm wishes for continued success with your journey.

[ChessieCat]

9 hours ago, Rainbows said:

I am currently cutting 50mg tablets to get 12.5mg which is tricky enough and certainly not precise, perhaps I can attempt to do a 50:50 with tablet and home liquid

 

This is a tough decision, because you need to take accuracy into consideration.

 

If you do the 50:50 combo stay on each combo for longer, 1 to 2 weeks, and of course watch to symptoms.

 

Another option, which is just me thinking of alternative for better accuracy, would be to switch straight over to liquid but, because liquid will be absorbed into the system quicker (called dose dumping), split the dose into 2 (or 3), taking first dose in the morning (which I am assuming is the current time) and then take the second dose at lunch time or at the latest mid afternoon so it would hopefully not affect sleep.  Do that for about 3 days and then for the next 3 days take second dose 1 hour earlier, and continue doing this until there is only 1 full dose.

 

If you split into 3, you would move both doses earlier by one hour, then the third dose earlier by 1 hour.

 

I hope that gives you some ideas.

[Rainbows]

Just to provide an update for info in case anyone is remotely interested. Since taking a course of antibiotics in early June my son has had no anxious episodes or symptoms. He was officially diagnosed with Pandas and has responded remarkably well to the treatment. He had been tapering Zoloft slowly and effectively with minimal side effects. Whilst I wanted him to continue with a gradual taper, he decided to jump at 9mg after stabilising on this dose. He has been 31 days on 0mg. WD Symptoms have been mild with dizziness being the main one but not debilitating. Perhaps some agitation and tiredness (although he is a teenager so hard to tell if related to wd).  He claims to have been clear of symptoms for 10 days or so. Let’s see what the coming weeks bring.