Morfs: Sertraline Help

[Morfs]

Hi all,

I'm attempting to taper from 100mg Sertraline starting July. I had been taking AD only since January so went relatively fast. Got down to 50mg by end July, 25mg mid August, 9mg about a month ago. I couldn't cut the tablets any smaller (the smallest available here in NZ is 50mg), so obtained some tapering strips from the pharmacy in the Netherlands to taper from 10mg to 0mg in 28 days.

 

After about a week I started feeling much more anxious and depressed, similar to how I was feeling when I was put on AD at the beginning of this year. I stopped the taper at 5mg and have now obtained some 2.5mg capsules from a compounding pharmacy in Auckland. Now trying to stabilize at 7.5mg/day but still feeling significantly worse than a month ago.

 

So, either I've gone too fast, or this drug was helping me in some way and I need to be on it for longer. I'm quite confused as I really don't want to depend on psych drugs but I need to try and avoid going back to where I was at the beginning of this year with A/D.

Thanks, Geoff  

[Gridley]

Welcome to SA, Morfs.  I'm sorry you're feeling so bad.  

 

You are suffering from withdrawal from a too-fast taper.  We recommend tapering by no more than 10% of current dose every four weeks.  Going slowly is especially important at the lower doses.

 

 http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

So you have a better understanding of what you're experiencing, here is some information on withdrawal.  Depression and anxiety are typical withdrawal symptoms.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

 The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

Unfortunately, there is no way to predict how long it will take you to stabilize.  I would hold where you are at 7.5 and make no further dose changes.  None of us want to depend on these drugs, but right now you need to let your system recover.  Once you have, you can begin a safe 10% taper.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  Again, welcome.

 

 

 

 

[Morfs]

Hi Gridley,

Thank you for the information and support. I will follow your advice and keep at 7.5mg for now. I was hopeful that I could taper quite quickly given I was able to get down from 100mg to 12.5mg without major problems and only having been on the drugs for less than a year. I am disturbed that many of the symptoms are similar to those that caused me to go on these drugs in the first place. So hard to know what is withdrawal and what is the underlying condition. 

Thanks again,
Morfs

 

[Altostrata]

Welcome, morfs.

 

Most likely, you are experiencing withdrawal symptoms. These should gradually lighten over the next few weeks. If they get worse, you may need to increase your dosage slightly, perhaps to 8mg. Please let us know how you're doing.

 

Are you still taking 1mg Valium? At what time of day? A common side effect of regular benzo intake is depression, anxiety can rebound when the benzo wears off.

[Morfs]

Hi AltoStrata,

Thank you so much for your response and support. I don't have any elsewhere. I had very severe anxiety and depression starting about a year ago. I started taking 2mg Valium first thing in the morning and supplemented with 0.5-1mg Lorazepam during the day as required. I was started on Citalopram, then switched to Mirtazapine and finally Sertraline in April this year. I managed to stop the Lorazepam CT in June and also reduced the Valium to 1.5mg and then 1 mg first thing in the morning.

 

As I've been tapering Sertraline I was advised to not discontinue the Valium any further. My GP seems to think the dose is so low it can hardly be having much, if any, effect. 

 

If I can stabilise at 7.5mg Sertraline, would you advise trying to get off the 1mg Valium next? These doses seem so low compared with what some people are dealing with, I think my GP thinks I should be able to just stop from these levels. I have a strong desire to cope with my issues without drugs, but this is harder than I thought it would be.

Thanks again,
Morfs. 

 

 

 

 

[Altostrata]

Your cold turkey from Ativan in June may be the reason you started to feel withdrawal symptoms when you were tapering sertraline in July. Benzo withdrawal symptoms are indistinguishable from SSRI withdrawal symptoms.

 

When your nervous system is destabilized by withdrawal, further drug changes can upset it more. That may be what happened to you.

 

If I were you, I would not make any more drug changes for a good while. You might try staying at 7.5mg for a couple of weeks more and see if your symptoms improve. Not sure if increasing the dosage will help if the symptoms are from Ativan cold turkey.

 

Are your symptoms worse any particular times of day? What times of day do you take diazepam, at what dosage? What time do you take your other drugs?

[Morfs]

On 11/14/2019 at 4:38 PM, Altostrata said:

Your cold turkey from Ativan in June may be the reason you started to feel withdrawal symptoms when you were tapering sertraline in July. Benzo withdrawal symptoms are indistinguishable from SSRI withdrawal symptoms.

 

When your nervous system is destabilized by withdrawal, further drug changes can upset it more. That may be what happened to you.

 

If I were you, I would not make any more drug changes for a good while. You might try staying at 7.5mg for a couple of weeks more and see if your symptoms improve. Not sure if increasing the dosage will help if the symptoms are from Ativan cold turkey.

 

Are your symptoms worse any particular times of day? What times of day do you take diazepam, at what dosage? What time do you take your other drugs?

Hi again AltoStrata

 

I tapered from 100mg Sertraline to 9Mg from July until October. It wasn't until I went from 9mg to 5mg (using tapering strips) that these latest symptoms developed. I am currently taking 1mg Diazepam and 7.5mg Sertraline both around 9AM in the morning.

Still hoping the 7.5mg Sertraline will stabilise in the next couple of weeks.

[Altostrata]

13 hours ago, Morfs said:

It wasn't until I went from 9mg to 5mg

 

When did you do this?

 

Why do you take diazepam and sertraline at the same time in the morning? Are your symptoms worse at any particular times of day?

[Morfs]

5 hours ago, Altostrata said:

 

When did you do this?

 

Why do you take diazepam and sertraline at the same time in the morning? Are your symptoms worse at any particular times of day?

I started the taper from 9mg using tapering strips about a month ago, hoping to get off in 28 days. After about 10 days I started feeling significantly worse, increased anxiety, depressed feelings. These had never completely gone away but I was coping much better. I had tapered to 4mg but now trying to stabilise at 7.5mg. I have a lot of emotion tied up in this as I was (am?) so desperate to get off Sertraline. That said, I really can't face falling back into the state of almost non-functioning that I was in at the beginning of this year. 

 

I fell into the habit of taking 2mg Diazapam in the morning about a year ago to take the edge off the anxiety that I was experiencing. I was supplementing with Lorazepam until early June and then stopped that (I was on 100mg Sertraline by then). I adjusted down to 1.5mg then 1mg but didn't make any further change as I was tapering Sertraline. I'm not sure what, if anything, it is doing for me at this point.

 

I've always taken the Anti-depressant in the morning, I didn't think it mattered much.

 

My symptoms are generally worse in the mornings, particularly the Anxiety and Depression. Evenings tend to be a bit better. As much as I don't want to admit it I was doing better on 12.5-20 mg Sertraline than I am now, although I was OK at 9mg after a couple of weeks of adjustment.

 

Thanks again for responding. 

[Altostrata]

31 minutes ago, Morfs said:

I fell into the habit of taking 2mg Diazapam in the morning about a year ago to take the edge off the anxiety that I was experiencing.

 

Did you feel this anxiety before or after you took your morning sertraline?

[Morfs]

21 hours ago, Altostrata said:

 

Did you feel this anxiety before or after you took your morning sertraline?

Hi @Altostrata I was taking a combo of 2mg Diazepam and 0.5mg Lorazepam daily from about Oct 2018 until Jan 2019 with no AD. One of the catalysts for the anxiety was an overseas trip I had to take in December last year. When I returned,it got worse and I spiralled into a severe depression. At the end of Jan I was desperate and agreed to go back on AD, first Citalopram, then Mirtazapine and finally Sertraline. After reaching 100mg/day Sertraline I made a partial recovery over a period of several months and felt that I wanted to reduce or eliminate the Setraline. It wasn't a smooth ride but I got it down to 9mg/day about a month ago. 

 

I wouldn't say the anxiety is better or worse after I take Sertraline. Sertraline gives me thumping headaches and very unpleasant gut problems, but I'm seriously going to have to evaluate if these are a price worth paying if (as seems possible) they do help with my anxiety/depression issues.

 

Still persisting at 7.5mg/day Sertraline and 1mg/day Diazepam.

 

[Altostrata]

2 hours ago, Morfs said:

Hi @Altostrata I was taking a combo of 2mg Diazepam and 0.5mg Lorazepam daily from about Oct 2018 until Jan 2019 with no AD. One of the catalysts for the anxiety was an overseas trip I had to take in December last year. When I returned,it got worse and I spiralled into a severe depression. At the end of Jan I was desperate....

 

That sounds like benzo withdrawal syndrome, which is misdiagnosed all the time as "depression." The "anxiety" you experienced around the time of your trip might have been from overuse of the benzos, interdose withdrawal, or accidentally skipping doses.

 

My question was:

 

On 11/15/2019 at 5:46 PM, Altostrata said:

Did you feel this anxiety before or after you took your morning sertraline?

 

As you take sertraline and diazepam together, any uncomfortable symptoms after you take them in the morning could be adverse effects of either or both.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

2 hours ago, Morfs said:

Sertraline gives me thumping headaches and very unpleasant gut problems

 

How do you know this is from sertraline?

 

Sertraline may not be treating your "depression" at all, the benzos you've been taking are relieving benzo withdrawal syndrome.

 

On 11/12/2019 at 12:53 AM, Morfs said:

After about a week I started feeling much more anxious and depressed....

 

What was the approximate date this happened? Was it after you cold-turkeyed Ativan? FYI @Shep

[Shep]

It looks like you may have set up your signature when you first joined the forum in July of 2019, but you didn't start posting until recently. Please update your signature to reflect the changes you've made since June 2019. A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

Have you taken any Ativan since June 2019? Have you been consistently on 1 mg of Valium since June 2019? You're now on 7.5mg sertraline, so please update your signature to reflect this change.

 

[Altostrata]

Morfs, can you summarize your benzo intake since October 2018? It sounds like you were taking diazepam daily with Ativan "as needed", correct?

 

What times of day and how often did you take Ativan "as needed"?

 

On 11/15/2019 at 5:14 PM, Morfs said:

I fell into the habit of taking 2mg Diazapam in the morning about a year ago to take the edge off the anxiety that I was experiencing.

 

18 hours ago, Morfs said:

Hi @Altostrata I was taking a combo of 2mg Diazepam and 0.5mg Lorazepam daily from about Oct 2018 until Jan 2019 with no AD. One of the catalysts for the anxiety was an overseas trip I had to take in December last year. When I returned,it got worse and I spiralled into a severe depression. At the end of Jan I was desperate and agreed to go back on AD, first Citalopram, then Mirtazapine and finally Sertraline. After reaching 100mg/day Sertraline I made a partial recovery over a period of several months and felt that I wanted to reduce or eliminate the Setraline. It wasn't a smooth ride but I got it down to 9mg/day about a month ago. 

 

What were the symptoms of your condition at the end of January?

 

My guess is in January 2019, you started having symptoms from taking the benzos irregularly -- blood level variation from intermittent Ativan wearing off from day to day. Rebound or interdose anxiety may have appeared coincidentally with your preparations for your trip. If traveling caused you to vary your drug schedule, this may have further exacerbated the adverse benzo effects.

 

Why did you switch from citalopram to mirtazapine to sertraline? What was the effect of sertraline when you started it in April? What was the nature of your "partial recovery"?

 

After you started on antidepressants in January, did your benzo intake change? Did you take Ativan less frequently? Why did you cold-turkey Ativan in June? Why did you decide to go off sertraline at the same time?

[Morfs]

5 hours ago, Shep said:

It looks like you may have set up your signature when you first joined the forum in July of 2019, but you didn't start posting until recently. Please update your signature to reflect the changes you've made since June 2019. A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

Have you taken any Ativan since June 2019? Have you been consistently on 1 mg of Valium since June 2019? You're now on 7.5mg sertraline, so please update your signature to reflect this change.

 

Thanks @Shep I have updated my signature. Correct, I have not taken any Ativan since June 2019. I cut Valium to 1.5mg at the end of July and 1mg mid August. 

[Morfs]

3 hours ago, Altostrata said:

Morfs, can you summarize your benzo intake since October 2018? It sounds like you were taking diazepam daily with Ativan "as needed", correct?

 

What times of day and how often did you take Ativan "as needed"?
 

I started taking Ativan in Oct 2018, either 0.25mg or 0.5mg/day as needed.  I continued to do this during December while I was on a family trip to the US for 5 weeks. During that time, I supplemented with 2mg Valium daily, which had helped me during a previous major anxiety/depressive episode in 2017. 
 

What were the symptoms of your condition at the end of January?
When I returned to NZ on Jan 1 I thought the anxiety was being caused by the stress of the trip but I spiralled downwards after returning to work and lapsed back into a severe depression, suicidal thoughts, almost total loss of energy/motivation, inability to concentrate etc. This was almost identical to a previous breakdown that I had in 2017, which was brought on by a series of adverse life events. In particular, I suffer from severe Tinnitus (8 years).

 

My guess is in January 2019, you started having symptoms from taking the benzos irregularly -- blood level variation from intermittent Ativan wearing off from day to day. Rebound or interdose anxiety may have appeared coincidentally with your preparations for your trip. If traveling caused you to vary your drug schedule, this may have further exacerbated the adverse benzo effects.

 

Why did you switch from citalopram to mirtazapine to sertraline? What was the effect of sertraline when you started it in April? What was the nature of your "partial recovery"?

I started Citalopram on Feb 1 2019. My depressive symptoms were severe and I was desperate. After about a month I wasn't improving and was not sleeping much at all. (I was taking Zopiclone to help with that). My GP switched me to Mirtazipine which helped me sleep but made me zombified during the day and didn't help much with the depressive symptoms. In April I was still desperate and the GP referred me to a psychiatrist who said she did not think I had long enough on Citalopram to prove that an SSRI would not work. She prescribed 150mg Sertraline. I titrated up to 100mg but did not go above that due to the side effects (Gut/headache). I stayed on 100mg for just over a month and did begin to feel a bit better (decrease in suicidal thought, energy levels and appetite higher, concentration better).
As I have a strong aversion to taking psych drugs I decided to start reducing the dose at the end of June, which I have been doing since.  

 

After you started on antidepressants in January, did your benzo intake change? Did you take Ativan less frequently? Why did you cold-turkey Ativan in June? Why did you decide to go off sertraline at the same time?

Not straight away. I  continued to take 0.25mg-0.5mg Ativan daily, basically enough to allow me to function on the day. In June, my Ativan intake dropped a bit, so my anxiety levels were down. I stopped it altogether in mid June. As I felt I was slowly recovering I felt I could reduce Sertraline at the same time as I had only been on it for a relatively short while.

  

 

[Morfs]

I'm adding some extra background to my story as it surely relates to my psych drug use. I am now 59 years old, had some serious episodes of panic/severe anxiety in the long distant past (1991 - onset of T1 diabetes, 1998 - marriage breakup). I never took AD, but had a few benzos to get through these episodes. Although anxiety lurked in the background after that from time to time, I felt that I was pretty much in control of it and had the life skills to cope if required (exercise etc.). I would not have said that I suffered from depression during this time.

 

In 2011 I had a sudden onset of loud, intrusive Tinnitus, which traumatized me and was a game changer in terms of ongoing mental health. In 2016, some other stressful external life events occurred and I suffered a severe anxiety/depressive breakdown. I'd never experienced anything remotely like it before and I didn't think I would survive it. I was prescribed AD for the first time (Citalopram) and despite my aversion to it, it may have been a  factor in my recovery. It didn't feel like it at the time but I "recovered" relatively quickly (5 months) and was able to stop AD and benzo with relative ease. 

 

I thought this was a one-off episode but in Oct 2018 I started experiencing bad anxiety again (perhaps prompted by an upcoming family overseas trip) and resumed benzos. The pattern appears to be anxiety which after a while results in a depressive meltdown. There are lots of factors and I have been in counselling all year to try and understand where this all comes from.

 

I have a strong aversion to psych drugs as I watched my mother be destroyed by them in the 1970's. I am really motivated to try and find non drug solutions, but as I think Mike Tyson once said, "everyone has a plan until they get punched in the face". 

Thanks to everyone here providing insight and advice.
Morfs 

[Altostrata]

Morfs, we don't put much stock in psychiatric diagnoses or jargon.

 

When you were taking Ativan, how often did you take it in a day? Was there any particular time of day you often took it?

 

52 minutes ago, Morfs said:

When I returned to NZ on Jan 1 I thought the anxiety was being caused by the stress of the trip but I spiralled downwards after returning to work and lapsed back into a severe depression, suicidal thoughts, almost total loss of energy/motivation, inability to concentrate etc.

 

Very good description of benzo withdrawal syndrome. Did you by any chance cut back on your Ativan and Valium intake after you returned home from your trip in January 2019?

 

54 minutes ago, Morfs said:

I started Citalopram on Feb 1 2019. My depressive symptoms were severe and I was desperate. After about a month I wasn't improving and was not sleeping much at all. (I was taking Zopiclone to help with that). My GP switched me to Mirtazipine which helped me sleep but made me zombified during the day

 

What were the "severe depressive symptoms"? Believe it or not, everyone describes these differently.

 

Did your sleep get worse after you started citalopram?

 

Please include zopiclone in your signature. Were you taking it nightly? For how long, at what dosage? How did you go off?

 

58 minutes ago, Morfs said:

My GP switched me to Mirtazipine which helped me sleep but made me zombified during the day and didn't help much with the depressive symptoms. In April I was still desperate and the GP referred me to a psychiatrist who said she did not think I had long enough on Citalopram to prove that an SSRI would not work. She prescribed 150mg Sertraline. I titrated up to 100mg but did not go above that due to the side effects (Gut/headache).

 

Too bad it didn't occur to your GP to lower the mirtazapine dosage. Too bad you got adverse effects from the subsequent sertraline.

 

59 minutes ago, Morfs said:

I stayed on 100mg for just over a month and did begin to feel a bit better (decrease in suicidal thought, energy levels and appetite higher, concentration better).

 

What exactly was your benzo intake from January through April? What times of day did you take diazepam, at what dosages? What times of day did you take Ativan, at what dosages?

 

1 hour ago, Morfs said:

I  continued to take 0.25mg-0.5mg Ativan daily, basically enough to allow me to function on the day. In June, my Ativan intake dropped a bit, so my anxiety levels were down. I stopped it altogether in mid June. As I felt I was slowly recovering I felt I could reduce Sertraline at the same time as I had only been on it for a relatively short while.

 

What do you mean, "my Ativan intake dropped a bit, so my anxiety levels were down." You mean your anxiety went down AFTER you reduced Ativan, or the other way around?

 

[Morfs]

32 minutes ago, Altostrata said:

Morfs, we don't put much stock in psychiatric diagnoses or jargon.

 

When you were taking Ativan, how often did you take it in a day? Was there any particular time of day you often took it?
Generally 0.25mg or 0.5mg in the morning. If 0.25mg, often topped up with another 0.25mg dose late morning or early afternoon.  Occasional evening use on bad anxiety days.

 

Very good description of benzo withdrawal syndrome. Did you by any chance cut back on your Ativan and Valium intake after you returned home from your trip in January 2019?
I don't recall that well. I always tried to take the minimum I felt that I could. I probably did try to cut back (unsuccessfully) but the stress of going back to work quickly stopped that.

 

What were the "severe depressive symptoms"? Believe it or not, everyone describes these differently.
suicidal thoughts, almost total loss of energy/motivation, inability to concentrate, frequent crying spells, anhedonia, agorophobia, sleeplessness, exhaustion, racing thoughts.

 

Did your sleep get worse after you started citalopram?
I wasn't sleeping well before that but yes, I think it did. When I switched to Mirtazapine it knocked me out. Once I started on Sertraline my sleep did slowly improve. It has become more of an issue since I tapered below about 20mg and particularly since my recent taper from 9mg.

 

Please include zopiclone in your signature. Were you taking it nightly? For how long, at what dosage? How did you go off?
I started taking it when the anxiety ramped up in Oct 2018. I took it probably 5 nights out of 7 at 3.75mg. From Jan 2019 until March 2019 I took it most nights. I stopped it when I switched to Mirtazapine and haven't taken any since. Unless sleep is really bad I just put up with it.

 

 

Too bad it didn't occur to your GP to lower the mirtazapine dosage. Too bad you got adverse effects from the subsequent sertraline.

 

 

What exactly was your benzo intake from January through April? What times of day did you take diazepam, at what dosages? What times of day did you take Ativan, at what dosages?
See above for Ativan. I took 2mg Diazepam Dec 2018-July 2019. 1.5mg for a month then 1mg since Aug 2019. Always around 8AM.

 

 

What do you mean, "my Ativan intake dropped a bit, so my anxiety levels were down." You mean your anxiety went down AFTER you reduced Ativan, or the other way around?
I would say my anxiety levels went down which enabled me to cope with less Ativan

 

 

[Altostrata]

Morfs, I am reading your drug history since at least March 2017 as a prescription cascade to treat benzo withdrawal effects, not "depression."

 

Your description of your condition is classic benzo withdrawal syndrome.

 

My guess is we should proceed under the assumption you are still suffering from or are vulnerable to benzo withdrawal syndrome, not necessarily sertraline withdrawal (though that might be a more recent factor).

 

A record of your benzo intake is crucial.  Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

For the time being, I would not make any more drug changes.

[Morfs]

5 minutes ago, Altostrata said:

Morfs, I am reading your drug history since at least March 2017 as a prescription cascade to treat benzo withdrawal effects, not "depression."

 

Your description of your condition is classic benzo withdrawal syndrome.

 

My guess is we should proceed under the assumption you are still suffering from or are vulnerable to benzo withdrawal syndrome, not necessarily sertraline withdrawal (though that might be a more recent factor).

 

A record of your benzo intake is crucial.  Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

For the time being, I would not make any more drug changes.

Thanks @Altostrata I am not making any further changes at the moment unless the WD symptoms get worse in which case I may be forced to updose the Sertraline. One thing I have not mentioned here is alcohol use. I was a long time user and it helped me to cope with my Tinnitus. Whenever I have quit alcohol CT, it has usually increased my Tinnitus and resulted in increased anxiety. This was a factor in the latest episode starting Oct 2018 after I quit alcohol use in Sep 2018. I have not used alcohol this year. It would just make things so much worse at this point. 

[Altostrata]

Just as well, Morfs, alcohol use probably will set you back.

 

Recovery from your sertraline changes probably will be very gradual. It's important you take your drugs at the same times and dosages each day.

 

Please post your daily drug and symptom notes. I would not necessarily updose sertraline when your benzo intake might be the source of the problem.

 

[Morfs]

1 minute ago, Altostrata said:

Just as well, Morfs, alcohol use probably will set you back.

 

Recovery from your sertraline changes probably will be very gradual. It's important you take your drugs at the same times and dosages each day.

 

Please post your daily drug and symptom notes. I would not necessarily updose sertraline when your benzo intake might be the source of the problem.

 

Altostrata, would you mind clarifying "your benzo intake might be the source of the problem"? I've been taking only a very low dose of Valium, stable at 1mg/day since August. The only changes I have made have been to the AD. Are you saying that the prior benzo use (Ativan earlier this year) may be contributing to the current issues I am experiencing?

 

I would really like to stop the benzo altogether so there is only 1 drug in the system but I will continue to hold both at current levels. I will see if I can put together some symptom notes soon.

Thanks again. 

 

[Shep]

13 hours ago, Morfs said:

I am now 59 years old, had some serious episodes of panic/severe anxiety in the long distant past (1991 - onset of T1 diabetes, 1998 - marriage breakup). I never took AD, but had a few benzos to get through these episodes.

 

Were you on benzos prior to 2017? If so, please update your signature to include the years, names of the benzos, and any information about the dose if you have that information. 

 

11 hours ago, Morfs said:

Altostrata, would you mind clarifying "your benzo intake might be the source of the problem"? I've been taking only a very low dose of Valium, stable at 1mg/day since August. The only changes I have made have been to the AD. Are you saying that the prior benzo use (Ativan earlier this year) may be contributing to the current issues I am experiencing?

 

Altostrata may stop by to clarify what she meant, but I'll add this: the reason I'm trying to get more information about your benzo use is because I'm coming to the same conclusion as Alto. So I think an explanation about how benzos contribute to symptoms such as depression, anxiety, and insomnia may be helpful: 

 

Whether you're taking a daily benzo or just using it a few times a week, you can still develop a dependency in 2 - 4 weeks. I've even met a few people on benzo forums who developed a dependency in as little 10 days. Benzo dependency can cause all sorts of problems, including depression, lowering your ability to handle stress, emotional liability, etc. due to interdose withdrawal, rebound anxiety, and paradoxical reactions. Many people report having a so-called "nervous breakdown" after being on a benzo. It can be that severe. Or it can simply lead to living a life of quiet desperation - benzos are, after all, nervous system depressants. 

 

Many people end up on an antidepressant after being on a benzo, even with periodic use. Periodic use can be more problematic than daily use in some ways because of abrupt, off-and-on dosing that can lead to kindling. Kindling means your nervous system becomes traumatized by the bouncing around of dosing. A more thorough read is here:

 

KINDLING: What is the kindling phenomenon that occurs with benzodiazepines?

 

Because of your prior use of coming off and on benzos, I'm concerned that any more movement may set you up for more kindling, which means a more traumatized nervous system. 

 

 

11 hours ago, Morfs said:

I would really like to stop the benzo altogether so there is only 1 drug in the system but I will continue to hold both at current levels. I will see if I can put together some symptom notes soon.

 

This sounds like a good plan.

 

Below are the instructions for keeping daily drug and symptom notes. 

 

Please also include:

• How many hours you sleep each night
• Any supplements you take. Please include the name and dose. 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

[Altostrata]

Morfs, what you interpret as psychiatric symptoms or withdrawal symptoms might be adverse effects of your benzo usage.

[Morfs]

4 hours ago, Altostrata said:

Morfs, what you interpret as psychiatric symptoms or withdrawal symptoms might be adverse effects of your benzo usage.

Thank you, both of you. I accept what you are saying about the possibility of benzo use being a contributing factor. If I go back to when my latest symptoms started though (Oct 2018), it seems much more likely that alcohol withdrawal may have been a bigger factor at that time as I had not had any benzo for well over a year at that time. I am where I am now, so will have to deal with the consequences of all of it. Part of the frustration of all this is not knowing what is contributing to the current situation. Certainly, I felt better a month or so ago in terms of anxiety/depression (albeit with side effects from Sertraline) and have made no changes to benzo (and no alcohol use). I find it all very confusing, I'm sure I am not alone in that respect.

[Morfs]

This is a typical work day at the moment. My sympoms do not generally vary much throughout the day. 

 

5:30-6 a.m. Woke early. Mild/Moderate anxiety-depression. Tinnitus starts for the day

7 a.m Relaxation meditation in bed 
8 a.m. Got up. Took 1 mg Diazepam

8:30 a.m Ate breakfast. Took 7.5mg Sertraline, Statin, Baby Aspirin, Fish Oil, Vitamin Supplement
9.00 a.m. Drive to work. Headache worsens, anxiety, depression persist. Try and keep occupied at work.
12:00 p.m. Ate lunch
5 p.m. Drive home
5:30-7 p.m. Family time/dinner etc. Feel very tired
7 p.m Meditation (1/2 hour)
8 p.m keep busy usually on computer. Feel better if productive
9 p.m. shower
11 p.m. Bed. Guided meditation practice.
12am-1am Fall asleep
 

[Altostrata]

54 minutes ago, Morfs said:

Certainly, I felt better a month or so ago in terms of anxiety/depression (albeit with side effects from Sertraline) and have made no changes to benzo (and no alcohol use).

 

It is confusing. Withdrawal symptoms tend to fade with time, so your improvement might have been from that natural progress rather than action of the drugs.

 

40 minutes ago, Morfs said:

9.00 a.m. Drive to work. Headache worsens, anxiety, depression persist. Try and keep occupied at work.

 

When does that headache start?

 

You're also takng a statin? When did you start it? Why do you take it with the other drugs in the morning? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

[Morfs]

1 hour ago, Altostrata said:

When does that headache start?
It is there all the time but seems to get a bit worse an hour or so after waking. Probably not significantly so. I've had a constant headache (actually more of a throbbing than an ache) since first starting ADs back in January. It was significantly worse on the higher dosages of Sertraline 50-100mg. 

 

You're also takng a statin? When did you start it? Why do you take it with the other drugs in the morning? Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

I've been taking a statin since August 2018, as recommended by my diabetes specialist. It did cross my mind that there could be some relationship between that and the onset of anxiety a few months later but I haven't been able to find much correlation between that and I'm pretty sure other life factors were more significant. As far as I am aware, time of day taking the statin does not matter.

 

 

Here is a link to the drug interactions: Here is a link to the drug interactions: https://www.drugs.com/interactions-check.php?drug_list=276-0,243-3197,862-0,2057-0

[Shep]

12 hours ago, Morfs said:

If I go back to when my latest symptoms started though (Oct 2018), it seems much more likely that alcohol withdrawal may have been a bigger factor at that time as I had not had any benzo for well over a year at that time.

 

You may already be aware of this, but it's so important, I want to make sure. Both alcohol and benzos affect the same GABA receptors. In fact, benzos are sometimes referred to as "alcohol in a pill."

 

So coming off alcohol may have sent you back into benzo withdrawal. That's not uncommon for people who are drinking during a benzo taper, start to recover from benzo withdrawal, and then come off of alcohol.

 

It's good you're no longer drinking. That will serve you well for the rest of your taper. 

 

10 hours ago, Morfs said:

I've been taking a statin since August 2018, as recommended by my diabetes specialist.

 

Are you taking any medication for diabetes or are you controlling it with diet? 

 

12 hours ago, Morfs said:

Vitamin Supplement

 

Please post the name of the vitamin supplement. Some vitamins can cause upticks in symptoms, so it's important to take all of this into consideration.

 

12 hours ago, Morfs said:

8:30 a.m Ate breakfast. Took 7.5mg Sertraline, Statin, Baby Aspirin, Fish Oil, Vitamin Supplement
9.00 a.m. Drive to work. Headache worsens, anxiety, depression persist.

 

According to the drug interaction link you posted, there's a moderate interaction between sertraline and aspirin and one of the symptoms of this interaction is a headache. 

 

You may want to separate the aspirin from the sertraline by a few hours and see how you feel. You can do this by gradually moving the drug one hour per day. This gradual move is gentlest on your nervous system. Unless there's a specific reason for taking the aspirin in the morning, you may want to move the aspirin to later in the day. 

 

I'm not sure if this will solve the problem or not, but even if it's the sertraline or diazepam causing the headache, by separating the drugs that have a known interaction, you may be able to reduce the pain. 

[Morfs]

Thanks @Shep The support here is so welcome when most people are so uncaring of what we are going through. Answers to your questions below:

 

Alcohol withdrawal may well be at least as big, if not bigger factor than benzo withdrawal for me. I used alcohol almost daily for most of my adult life with considerable binge drinking particularly when younger. Highly functioning throughout. After I had sudden onset of Tinnitus in 2011 I used alcohol to help me cope. It was somewhat successful but eventually I wanted to stop as I felt it was affecting my overall health. I would try and stop about once a year, but my Tinnitus seemed to increase in volume and I would get quite anxious about it. Eventually I went back to daily alcohol as a coping mechanism (as well as distracting myself with work). 3 years ago, I had a massive life stress around a house move that went badly wrong and stopped alcohol as I thought it would be best. The whole thing tipped me over the edge into severe anxiety/depression which is where my recent journey with prescription drugs began. I was almost unable to function for several months. Somehow I pulled through and stopped drugs but resumed daily alcohol again not too long afterwards. Last year, I quit alcohol again, my Tinnitus spiked and the entire anxiety/depression cycle started again.  I'm now starting to accept that alcohol can play no further part in my life or coping mechanisms. This is difficult as my entire social and home life revolved around it. My wife still drinks wine every day. Sometimes I wonder if daily alcohol use was the least bad option as mostly I was able to cope, but if I drank alcohol now I think it might put me in the hospital the day after.

 

Diabetes: I have had Type 1 for 30 years and have a constant insulin regimen to manage it.

 

Supplements: I am taking fish oil, magnesium and a male multi-vitamin supplement (mainly B vitamins, but others too ). I was taking Ashwaghanda and Turmeric as well, but I have stopped these as I've no idea what if anything they do, so one less variable.

 

Timing: Currently, I am taking all the drugs, supplements etc. in the morning, mainly out of convenience. It has crossed my mind to split the Sertraline into 5mg morning, 2.5mg evening and Diazepam 0.5mg morning and evening, to try and even things out a bit and maybe help with the next reduction whenever that comes.

 

Thanks for reading this far!

 

[Altostrata]

22 hours ago, Morfs said:

8 a.m. Got up. Took 1 mg Diazepam

8:30 a.m Ate breakfast. Took 7.5mg Sertraline, Statin, Baby Aspirin, Fish Oil, Vitamin Supplement
9.00 a.m. Drive to work. Headache worsens, anxiety, depression persist. Try and keep occupied at work.

 

Morfs, please continue to post at least 24 hours of daily notes at a time. Effectively, you're taking all your drugs at the same time in the morning. Like Shep, I suspect something you're taking in the morning is causing the headache, if you tend to get it at the same time each day.

 

Can you describe how you feel "anxiety" and "depression" in the morning? Everybody feels these differently.

[Morfs]

26 minutes ago, Altostrata said:

Can you describe how you feel "anxiety" and "depression" in the morning? Everybody feels these differently.

Hard to describe. I find it difficult to separate the thoughts and feelings that arise from these labels. I don't tend to experience too much in the way of physical symptoms (e.g. shortness of breath, racing heart) other than ongoing headache. My experience is much more mental/emotional. Racing thoughts, generally negative, feelings of not being able to cope, general feeling of unease, feelings of hopelessness, difficulty concentrating, constant fatigue. I don't just experience them in the morning although they often seem a bit more intense at that time. These feelings intensified about a month ago after I tapered my Sertraline below 9mg which prompted me to start posting here for advice.

[Altostrata]

Have you always taken diazepam at the same time in the morning? I see you halved it at the same time you tapered sertraline.

[Morfs]

17 minutes ago, Altostrata said:

Have you always taken diazepam at the same time in the morning? I see you halved it at the same time you tapered sertraline.

Yes, always in the morning. It wasn't exactly at the same time, I went from 2mg to 1.5mg in July and 1.5mg to 1mg in August. 

[Altostrata]

When you change two drugs at the same time, you can get withdrawal symptoms from either or both.

 

How much did you vary your diazepam schedule? In the last 2 weeks, how much has this varied?