lfran: withdrawal from Zoloft, continuing to fight

[lfran]

Hi all, I'm new and needing assistance. I was on antidepressants/stimulants for years and have managed to quit the stimulants, but am living through the hell of withdrawal from my SSRI, Zoloft after tapering too fast as you'll see below. This nightmare started in late May of 2020. I have some physical symptoms besides extreme fatigue, and the withdrawal itself is extreme anxiety, panic, depression, brain fog, confusion, poor memory... most of what is on the list of typical symptoms, and what I have come to understand is OCD. The crushing, breathless feeling of just having to get by minute to minute is like nothing I have ever experienced before. After reinstating Zoloft 12.5 mg in July, I seemed to stabilize a little bit after a few months, and withdrawal symptoms are just slightly better although the OCD is not budging. 

I need help/advice with moving forward with a taper. Right now I am not sure if I should wait a while and stabilize further since I just tried to stop the 12.5mg cold turkey less than two weeks ago and realized after 3 days it was a bad idea (although it did lead me to this site). I have been back on the 12.5mg Zoloft for a week. I was able to get liquid sertraline (Zoloft) from my doctor but I am unsure how to do the dosing. What I mean is, I recognize that I should reduce by 10% every 4 weeks, but I am unsure of how to dose this out from the liquid.

I would really appreciate some help with this and advice on how long I should wait until trying to reduce.

[manymoretodays]

Hi Ifran and welcome aboard,

 

Thank you for getting your signature done.

 

Sometimes slightly better is good. 

 

So you did a Vyvanse CT in April.  Did every other day dosing with Zoloft and then off of Zoloft in May.  Went down and up with Trazodone since March.

Added in some TMS treatments.

Tried 3 days off Zoloft recently.

 

And now are on 12.5 mg Zoloft and 75 mg Trazodone.

 

That's a lot of changes. 

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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal. 

 

The rule of 3KIS:Keep it simple, slow, and stable

and extracted from ^:

Do not suddenly quit taking your drugs. Do not skip doses to taper. These big, fast changes are the opposite of providing stability for your nervous system. Skipping doses causes the amount of the drug in your bloodstream to go up and down. Do not do this for any psychiatric drug.  See this graph which compares skipping days vs daily dosing.

 

On 11/12/2020 at 1:17 PM, lfran said:

I need help/advice with moving forward with a taper. Right now I am not sure if I should wait a while and stabilize further since I just tried to stop the 12.5mg cold turkey less than two weeks ago and realized after 3 days it was a bad idea (although it did lead me to this site). I have been back on the 12.5mg Zoloft for a week. I was able to get liquid sertraline (Zoloft) from my doctor but I am unsure how to do the dosing. What I mean is, I recognize that I should reduce by 10% every 4 weeks, but I am unsure of how to dose this out from the liquid.

I would really appreciate some help with this and advice on how long I should wait until trying to reduce.

 

Yes, it may be best to stabilize now, before attempting to taper again.  Give your nervous system a chance for some recovery and consistency.   6 months might be a good time frame, before tapering again.

 

Tips for tapering off Zoloft(sertraline)

you'll see about 1/2 down in ^ link, that once you measure your dose of Zoloft, then it has to be further diluted.  I'll extract that section:

Use Zoloft liquid concentrate to taper
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=52077:

Quote

Zoloft oral concentrate is available in a multidose 60 mL bottle. Each mL of solution contains sertraline hydrochloride equivalent to 20 mg of sertraline. The solution contains the following inactive ingredients: glycerin, alcohol (12%), menthol, butylated hydroxytoluene (BHT).

 

From http://www.nlm.nih.gov/medlineplus/druginfo/meds/a697048.html
 

 

Quote

Sertraline concentrate must be diluted before use. Immediately before taking it, use the provided dropper to remove the amount of concentrate your doctor has told you to take. Mix the concentrate with 4 ounces (1/2 cup [120 milliliters]) of water, ginger ale, lemon or lime soda, lemonade, or orange juice. Do not mix the concentrate with any liquids other than the ones listed. Drink immediately.

 
US order code for Zoloft 20mg/ml Concentrate Solution NDC 000494940

 

Unlike other oral liquid antidepressant preparations, Zoloft liquid should be mixed with water because if it is taken directly from the bottle, it is likely to cause a burning sensation in the mouth.

As it is in a 20mg per mL concentration, this means using an oral syringe to measure out the proper amount. If you wish to take 50mg, you would take 2.5mL from the bottle, drop it in a small glass of water, etc., and drink it all.
 
If you are taking 50mg and wish to reduce by 10% (5mg), you would take 2.25mL (45mg) from the bottle, drop it in a small glass of water, etc., and drink it all.

Personally, I would use water rather than fruit juice or soda so I can see what's left in the glass. I might even drink the mixture, fill the glass again, swirl it a bit, and drink that to make sure to get all the Zoloft out of the glass.

 

If you are using the 20 mg/ml concentrate, then 12.5 mg would be 0.625 mL(millileter).  You'll do best, using a 1 mL oral syringe to measure your dose prior to any further dilution. 

Using an oral syringe and other tapering topics

you'll see an image of a 1 mL syringe, in the 2nd or 3rd post ^

 

 

When do you take your Zoloft each day?

When do you take your Trazodone?

  

On 11/12/2020 at 1:17 PM, lfran said:

The crushing, breathless feeling of just having to get by minute to minute is like nothing I have ever experienced before. After reinstating Zoloft 12.5 mg in July, I seemed to stabilize a little bit after a few months, and withdrawal symptoms are just slightly better although the OCD is not budging. 

 

And oh my, yes, I'm glad WD(withdrawal) symptoms have abated a bit, even if just a little.

Dr. Glenmullen's withdrawal symptom checklist

What is withdrawal syndrome?

 

And I'm going to add one more link, I think you will like, and it may help you with ideas for non-drug coping too:

 

Obsessive compulsive disorder or OCD: Repetitive intrusive thoughts, compulsive behaviors

 

Welcome aboard again Ifran.  I hope I covered most of your questions. 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

 

Best, L, P, H, and G,

moderator manymoretodays(mmt)

 

 

 

 

Edited November 15, 2020 by manymoretodays
links, and added a bit more

[lfran]

I take the sertraline in the morning and the trazodone at night. I am so appreciative of all your help. Thank you. 

[lfran]

As I start to move below 1mg in my taper, I’m finding it difficult to be exact with the measurements using the 1.0mL syringe I have. The liquid I am using is a 20mg/mL liquid sertraline from the pharmacy; .05mL is 1mg- as you can see it makes going down to .9mg a challenge. Is there a way I can mix this liquid with water to create a less concentrated mixture (I realize I would need to shake before use as the medication settles) in order to make going down to lower amounts more feasible? I apologize if there is already a post about this, I wasn’t able to find it. 

[Go2zero]

I moved your last post from the tapering directory to this thread. Please post your questions and comments only in this thread. We allow only one thread per member so that we have all information together then. Thank you!

[Go2zero]

The liquid (oral concentrate) form of sertraline must be diluted before you take it. To be sure you get the correct dose, measure the liquid with the medicine dropper provided. Mix the dose with 4 ounces (one-half cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Do not use any other liquids to dilute the medicine. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

 

Source: https://www.uofmhealth.org/health-library/d00880a1

 

As far as I understand it SHOULD be diluted and not be taken pure! So the answer to your question is: Yes it can (SHOULD) be diluted!

 

[lfran]

23 hours ago, Go2zero said:

The liquid (oral concentrate) form of sertraline must be diluted before you take it. To be sure you get the correct dose, measure the liquid with the medicine dropper provided. Mix the dose with 4 ounces (one-half cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Do not use any other liquids to dilute the medicine. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

 

Source: https://www.uofmhealth.org/health-library/d00880a1

 

As far as I understand it SHOULD be diluted and not be taken pure! So the answer to your question is: Yes it can (SHOULD) be diluted!

 

Yes… I always dilute my dose- once it’s measured I always mix it with water. I think you misunderstood… my question is, can I dilute all of my medication so that rather than .05mL equaling 1mg, 1mL (or more) equals 1mg? This would make measuring easier and more exact. I’m thinking this could be done by mixing it all with water, I just don’t know how much. 

[lfran]

@Go2zerothe problem with having this under my thread is that no one is going to see it… I’m on day three of having inaccurate dosage measurements and so this is pretty urgent to me. How can I get someone to take a look at this post? I’ve scoured the forums and spoken with two pharmacists, no help so far… Suggestions for getting quicker answers are welcome. 

[lfran]

@brassmonkey can you help me with this? Not sure if you have any experience with diluting liquid medications…

[Go2zero]

57 minutes ago, lfran said:

@Go2zerothe problem with having this under my thread is that no one is going to see it… I’m on day three of having inaccurate dosage measurements and so this is pretty urgent to me. How can I get someone to take a look at this post? I’ve scoured the forums and spoken with two pharmacists, no help so far… Suggestions for getting quicker answers are welcome. 

It seems you have found a solution for getting attention for your questions

 

Brassmonkey will surely be able to advice you  Maybe me too, but your question i still not fully clear to me. Do you mean you want to add water to the bottle with the liquid med itself? If you would do so, I guess this may have a negative influence on the shelf life....

[brassmonkey]

All the moderators try to look over any new posts as they appear, but sometimes a question will get lost in the mix. If something is urgent then using the @ sign like you did above is the best way to flag a moderator. It does take us time to get back to people but we try to be as quick as possible.

 

Questions about diluting a liquid can be very easy to misunderstand, especially if that liquid needs to be diluted after measurement and before taking. Luckily this is pretty straight forward.

 

From your earlier posts you appear to be using a commercial liquid that has a strength of 20mg/mL. I can see how that would be a problem with trying to measure the smaller doses. According to the manufacturer the dose must be diluted after measuring and before taking. This can be done with a variety of other liquids. Water is going to be the easiest and safest one to work with.

 

You can prepare a 1:1 (1mg active ingredient to mL of liquid) by measuring mL of the liquid medication and adding it to 19mL of water. This will give a total of 20mL of liquid that contain 20mgai. That reduces down to a 1:1 ration. To get a dose of 0.9mg you would measure out 0.9mL of the liquid.

 

The diluted liquid can only be kept for 4-5 days before it should be thrown away. I would suggest using 0.25mL of liquid medication mixed with 5mL of water. This will give the same strength and waste a lot less medication.

Edited August 26, 2021 by brassmonkey

[lfran]

@Go2zero @brassmonkeyYes, I finally got a call back from a pharmacist who said the same thing about mixing it with water- that it would reduce shelf life to 4-5 days. I figure I could just mix a little at a time as you said brassmonkey- thanks so much for the detailed breakdown. Do you happen to know if using an over the counter suspension liquid would help it to keep longer? 
Thank you both for your responses… I was definitely in a bit of a panic. The “no one gives a sh*t about you” voice has been very strong in my head, and very convincing. Thanks, too for the information about how you respond to users’ posts, that will definitely ease my mind in the future. I’m beyond thankful for the support. 

[brassmonkey]

Using a suspension liquid might add a couple of days to the time, but most home diluted liquids tend to spoil quickly. So it wouldn't be worth the added expense.

[lfran]

@brassmonkey when I look at the ratios you gave, 19mL of water to 1mL of medication and 5mL water to .25mL of medication it doesn’t quite match up. Wouldn’t it be 4.75mL of water to .25mL of medication? I want to be extra sure before I start messing with my dosages. Thanks. 

[lfran]

Hi everyone,

 

I need some help calculating a liquid solution with a lower concentration of liquid medication. I'm currently taking .03mg of liquid sertraline at a time; I do this through a 1mL syringe- taking .03 mL. Obviously my current solution is 1mg/mL- I make this by mixing 4.75mL of water with .25mL of the medication. The medication itself is 20mg/mL. I want to decrease the concentration of the liquid medication in the solution so that I can measure it in smaller amounts (thousandths) and continue to drop by 10%. My other option is to jump off from .03mg, which I am a bit nervous to do. @brassmonkeyI thought maybe you might have some ideas? Any help is appreciated.

[brassmonkey]

Hi Ifran-- further diluting your liquid may not be necessary, it all depends on how you are currently reacting to each reduction. If you are experiencing any symptoms, then continuing to taper would be a good idea. If the reductions are event free, then you could hold at this level until your body, not your mind, tells you it is time to jump. According to calculations for your medication and starting dosage your Theoretical Exit Dose would be 0.06mg. So, it is all up to your body as to when you can make the jump.

 

If you wish to continue to taper, then you will need to dilute your liquid to be able to make the measurements required. This can be done by adding more liquid, typically water, to your solution. To start reducing by 1000th of a mg would require a 10X increase in the volume of your liquid, while keeping the amount of active ingredient the same. This would require a 10X increase in the size of your dose at the same time.

 

To maintain your current dose, you would increase the amount of liquid to a total of 50mL. So, you would use 49.25mL of water and 0.25mL of your liquid zoloft. You would then take a dose of 0.3mL. As long as you maintain the same ration you can mix any volume you like. For example, you could use 4.95mL of water and 0.05mL of zoloft and get the same result but you have to keep the dose at 0.3mL. Doing a 10% reduction using this solution your next dose would be 0.3 X 0.9 = 0.27mL.

[lfran]

Thanks so much for your detailed reply. I am very nervous to jump off still… I am at “WD normal” but the possibility of experiencing anything like the original withdrawal absolutely terrifies me. The info about the Theoretical Exit Dose is very comforting. I’m at half of .06mg already and by and large have been doing alright. Thanks again. 

[lfran]

Just posting because I’m feeling like I’m at an all time low today. I did a decrease and am feeling so incredibly depressed and hopeless. I almost always keep it to myself but today I am feeling particularly desperate. Im looking at everyone around me who is my age with spouses and children, traveling or engaging in various hobbies. My life is so meaningless and empty right now. It is very tough not to feel suicidal. If anyone has any words of encouragement I would be very grateful. 

[methuselah]

Hi Ifran,

 

I read through your thread here and thought I’d chime in.  You are doing so well and so close to the finish line.  It’s amazing to me how strong you are and how far you’ve come.  Many people, including me, post on here often freaking out about this symptom or that.  You’ve done none of that, just pushed through and made it happen.  You can do this, you’re almost there!  Just keep pushing and keep fighting with the same strength you’ve shown so far and i know you will be alright.  Just do not give up!  Do not give up!

[lfran]

Looking for advice here.. I reduced from .023mg to .021mg a couple weeks ago and haven't experienced any symptoms- stayed at WD normal the whole time and even had a nice window for a day. I'm feeling like it is a good time to jump off, but am wondering if there are other steps I can take to make sure it's the right time? @brassmonkey your input is welcome!

[RachelSusan]

@Ifran

 

Hi Ifran,

 

I wanted to congratulate you on tapering off the Zoloft. You did a marvelous job of it. I jumped off at .023, and at the time I jumped I hadn't felt any symptoms for the previous five months. Not even withdrawal normal. It was very frightening for me to jump, I didn't know if any symptoms would come back, but since the jump (Jan. 1, 2022) there haven't been any problems.  I wish you luck and hope your jump is as easy as mine was.

 

Warm wishes,

Rachel

[lfran]

@RachelSusan thanks so much for the kind words and encouragement. When you say 

17 hours ago, RachelSusan said:

I hadn't felt any symptoms for the previous five months. Not even withdrawal normal.

do you mean that you were in a continuous window for 5 months? I’m not sure what you mean by not feeling withdrawal normal. If that’s the case I should probably wait quite a while before jumping off… my windows are not all that frequent. What was it like for those 5 months before jumping for you?

[RachelSusan]

@Ifran

 

Hi Ifran,

 

Yes I was in a continuous window for the five months before for I jumped off. I was tapering each month but from August 2021 until I jumped off in Jan of 2022 I had no symptoms.  I though of jumping off in August but I felt it was like insurance to hang on a while longer before I jumped off.

 

Ifran, we are all different in what we can tolerate in symptoms and how we react to a slight cut of the medication and eventually a jump.  What works for me may be different than what works for you.  I hated the symptoms of withdrawal so much that I took a lot of time to get off.  I first had problems in 2016, when I went cold turkey and then reinstated, and didn't get completely off until January 1 of 2022.

 

I hope whatever you decide to do it all goes well for you.

[brassmonkey]

.021mg would be a good place to jump from. I wouldn't rush things but continue to take this dose until your body says, "enough of this already", and then make the jump.

[lfran]

Hello everyone, I am in a bit of a dilemma... I found out yesterday that my medication has been expiring for the last 6 months. I filled a liquid sertraline script on May 20, 2021 and after a couple of months of daily use, the writing on the label wore off... including the expiration date. So, I called the pharmacy to ask about the expiration date and was told the script would be good for a year, meaning it would not expire until May 20, 2022.

 

In February, after a particularly brutal wave, I suspected that the medication wasn't working (just a gut feeling), so I called and asked if it was possible that the medication was expired, and was told no, that it was good for 12 months.

 

This past weekend (May 14-15), I experienced a horrible wave and again had a gut feeling that the medication wasn't working the same. Since it is so close to May 20th, the 12 month mark, I once more called my pharmacy to see if it was possible that maybe the medication was starting to lose potency as it was so close to the 12 month mark. To my horror I was told this time that the medication starts to expire after 6 months... I was so shocked that I made them verify with the pharmacist and she confirmed. That means that when I had called in February, the medication had already been expiring for 3 months, and I've continued to take this expired medication all this time. In other words, the past 6 months I've been weaning off of medication that is slowly expiring on its own, meaning my small, meticulous decreases have not been the exact calculations I thought they were.

 

I am very upset to find this out, and am hoping that I didn't cause too much damage doing this. I don't think I should fill a new script because I have no way of knowing how much stronger it will be than the current liquid I have. Does anyone know if 12 month old liquid sertraline has any potency at all? I am thinking this is a "divine intervention" for me to just jump off now.

 

Also, for anyone who is wondering, I did go in and make a complaint with the pharmacist, since two members of her staff gave out information that was not only negligent but outright harmful. 

[lfran]

Just posting on here to say I “jumped off” a week ago today. So far I haven’t had any horrible symptoms, just some classic depression creeping in since Saturday and feeling pretty tired. I’m hoping that it abates in the next few days. I think I might have created a problem by drinking a collagen-based protein drink the last few days… apparently studies have shown that collagen reduces the uptake of tryptophan and thus inhibits serotonin production. The good news is that it should resolve quickly if it did in fact play a role in my mood right now. Anyway I did it. I got off the meds. I just keep telling myself that if I made it through that hell two years ago, it can only get better and better from here on out. 

[RachelSusan]

@lfran

 

Congratulations on the jump off. I am so happy for you. I jumped off 1/1/22.  It is an exciting place to be.  I hope you appreciate how hard you worked for this and congratulate yourself as well.

😀

[lfran]

Thank you so much @RachelSusan. It hasn’t really sunk in yet. My life is still in shambles and I’ve had some ups and downs but have hovered around WD normal for the past few weeks since being off. Today I had the onset of extreme exhaustion with some pretty heavy depression so I’ve been bed ridden and just trying to sit with the feelings. I just want my life back, whatever is left of it. How are you doing since jumping off? 

[RachelSusan]

@lfran

 

I am doing really well since tapering off.  It took me a while to rebuild my life.  In fact I don't think it is rebuilt yet but I am working on it.  There was so much that I neglected for a long time. I especially neglected friends and family.  I know it takes patience and hard work but I am sure those relationships will be rebuilt.

 

I am also exercising again.  I don't know if you are able to do so with the extreme exhaustion, but I know it helped me. I had to start very slowly though. 

 

Warm wishes.

[Greatful]

@lfran Hi, congratulations.  Med free Wow. Hang in there and continue to be kind and patient with yourself. 

I suffer with depression or should I say low moods throughout my tapering.  Try to remember they lift.  How is you ocd?  I struggle with obsessing thoughts and underlining fear. 

 

Keep reaching out for encouragement.  You have come so far and now let the real healing from these drugs begin🤗

[RachelSusan]

@lfran Hi Lfran,

 

How is drug free life going for you?  I was fortunate that I had no issues once I jumped. I hope your life continues to get better and better for you.

[lfran]

@Greatful @RachelSusan I had a really tough couple of weeks with the OCD symptoms along with some others, mainly low mood, feelings of dread, heart pounding, exhaustion, no motivation. It’s still nowhere near as bad as it was in 2020. I keep telling myself I’m getting through the last of it. I’ve done a LOT of sleeping and like Greatful so kindly reminded me I’m trying so hard to be very gentle with myself. I have complex ptsd from a very difficult childhood so this in and of itself is part of my “work” right now. In many ways the WD process has brought to light so many other areas in need of healing that were hidden in the shadows.
I hit a really strange shift yesterday where I had a bit of a window for a few hours followed by what felt like hypomania. Today I still have the same overstimulated feeling while being very disconnected from my emotions. Whatever comes my way I’m just along for the ride at this point. 
Thank you both so much for checking in on me- encouragement means the world to me right now. How are things going for both of you? RachelSusan it must be such a joy to be back to living again. 

[RachelSusan]

@lfran Oh my gosh, it is wonderful to be back in the land of the living.  I never really did have windows or waves but I did experience at one point the hypomania that you mentioned. I did not like it at all.

 

I am glad you are being gentle with yourself. You have so much going on, it must be difficult.

 

I will check in on you again.  I wish you the luck and even though your recovery is slow it does appear like you are improving.

[lfran]

Wow@RachelSusanthat is so amazing that you were able to come off without experiencing any waves! I was deeply depressed and suicidal WHILE on meds so I don’t think that was ever an option for me- it only got worse lol. I find it fascinating that I’ve had much fewer physical symptoms than you did- mine are overwhelmingly psychological; on the other hand your symptoms seemed to be overwhelmingly physical. Just goes to show how differently these drugs effect us. 

[lfran]

I just wanted to come on here and congratulate myself because there is nowhere else I would be able to openly say this: I finally healed the eating disorder I’ve lived with for almost 20 years. It’s been almost a year and a half since I was symptomatic. I was put on the meds at 15 years old due to the onset of my eating disorder, which was severe (a result of ongoing trauma in my household). During my taper these past few years I dove deep into addressing my trauma, which led to the healing I needed to release the disorder once and for all. 
It occurred to me that I never took the time to appreciate what a big deal that is- I just had my nose to the grindstone all this time. Today it really dawned on me. I’m really, really proud of myself and I’m thankful SA gave me a space to share that. 

[RachelSusan]

@lfran Oh my gosh, congratulations on healing your eating disorder. This is amazing.  Please do take a moment to realize what a huge deal this is. I am so happy that you experienced healing. Please just sit with how amazing this is and how amazing you are.

 

I think in my last post I misspoke.  What I was trying to say was that while I did not experience any waves, I did not experience any windows either. I was trying to say I had no big ups or downs, it was just one long down. For months and months and months. Happy to report that I am doing really good now though.