LizzieTish: Sertraline withdrawal and taper

[LizzieTish]

Greetings everyone! I'm hoping for some advice from my fellow members. I've been on Zoloft (50 mg) for 20+ years for depression. I tried getting off Zoloft twice during the past 5 years due to zombification (I was no longer crying or laughing) but both times experienced brain zaps and severe depression during the taper. (As an aside, my primary care physician, who knew I was tapering, told me to undergo a brain MRI because of the brain zaps. Neither of us realized the brain zaps were from the SSRI discontinuation.) Ten months ago, I decided to try to get off the poison once again. I've been tapering more slowly and am now down to ~10 mg/day but am feeling depressed again. No brain zaps this time. I take magnesium, fish oil, Vitamins B, C, and D. A week or so ago I started taking 5-HTP 100 mg at night to help boost my serotonin level now that I'm on a very low dose of Zoloft. Unfortunately, I'm now also experiencing acute anxiety, which I've never had before. Has anyone else experienced new onset anxiety either during SSRI withdrawal or from 5-HTP? I'm determined to succeed this time but am struggling immensely with crippling anxiety. I'm looking forward to death. Any help, including supplement or diet recommendation, would be greatly appreciated.

[Onmyway]

Dear @LizzieTish, 

welcome to SA. I am sorry you are struggling with anxiety. It is a common symptom of withdrawal. 

Can you please summarize your drug history in the your signature? Here are your instructions: 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

You are tapering too fast. At SA we recommend not tapering faster than 10% every 4 weeks. If you had been tapering at 10% a month you would be at around 18mg now on a 10 month taper. Even if you don't feel serious symptoms in the beginning, sometimes it can catch up with you. 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

The Brassmonkey Slide Method of Micro-tapering - Tapering - Surviving Antidepressants

Recording drug schedule and symptoms to track patterns and progress - Tapering - Surviving Antidepressants

 

If you want, you might want to up-dose slightly to your previous dose and stay there for an extra month or until your symptoms subside. This will allow your body to settled and then you can resume a slower taper. 

 

We also do not recommend any other psychoactive supplements during withdrawal - incl. alcohol, pot, street drugs, HTP, St John's Wort etc. Our nervous system is very sensitized and these substances can sometimes make withdrawal symptoms much worse. Some antibiotics can also cause adverse drug reactions in withdrawal.  Some vitamins can also do that - vit D and some of the B vitamins can be activating. If you want to take them, you might want to do so in the morning and at the lowest dose that serves your health needs. You can find the various threads on them on the SA website. We do recommend magnesium and Omega-3 which you are also taking. 

 

Here are a few other links you might find helpful. 

 

Non-drug techniques to cope with emotional symptoms - Symptoms and self-care - Surviving Antidepressants

Important topics about symptoms, including sleep problems - Symptoms and self-care - Surviving Antidepressants

 

Anxiety Self Help | Get.gg - Getselfhelp.co.uk

 

The Windows and Waves Pattern of Stabilization - Symptoms and self-care - Surviving Antidepressants

What is happening in your brain? - Symptoms and self-care - Surviving Antidepressants

How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

 

 

Hope you start feeling better soon, 
OMW

 

 

 

[LizzieTish]

Wow! Thank you so much for the great advice. I'm going to increase my dosage slightly, as recommended, and then resume tapering in 4 weeks. I'm also going to discontinue the 5-HTP. 🙂

[LizzieTish]

Becoming discouraged

 

I've just read some of the success stories posted by people who were taking SSRIs long term (10+ years), as is my case. Not all were encouraging. I knew there would be rough days during the tapering process and after finally clearing the last bit of poison from my system, which won't happen for quite a while (I'm 10 months into the tapering process). I didn't realize there might be protracted periods of hellish withdrawal for months afterward. Feeling very discouraged.

• Do most people who have used SSRIs long term fail to permanently get off them even with a very slow taper?
• Do supplements (5-HTP, St. John's Wort, etc) help after complete withdrawal?
• Has anyone had success with the "Prozac bridge" after long-term use of Zoloft?
•  

Edited February 14, 2022 by ChessieCat
added topic title before merging with Intro topic - moved from Success stories forum

[LizzieTish]

Length of taper from 50 mg starting dose?

 

Please help! I'm a bit confused about the tapering schedule (monthly 10% decreases from a starting dose of 50 mg). The sample schedule I just looked at shows 5+ years of tapering. By the time someone is down to 7 mg (which would be Month 19), the next doses would be approximately 6.75, 6, 5.5, 4.5, 4, 3.5, 3, 3, 2.6, 2.4, 2.1, 2, 1.75, 1.4, 1.25, 1,1, etc. Is this correct? Or can you taper by 1 mg every month at the end? I was hoping to complete my taper within 2 years.

 

Edited February 14, 2022 by ChessieCat
added topic title before merging with Intro topic

[Onmyway]

2 hours ago, LizzieTish said:

Becoming discouraged

 

I've just read some of the success stories posted by people who were taking SSRIs long term (10+ years), as is my case. Not all were encouraging. I knew there would be rough days during the tapering process and after finally clearing the last bit of poison from my system, which won't happen for quite a while (I'm 10 months into the tapering process). I didn't realize there might be protracted periods of hellish withdrawal for months afterward. Feeling very discouraged.

• Do most people who have used SSRIs long term fail to permanently get off them even with a very slow taper?
• Do supplements (5-HTP, St. John's Wort, etc) help after complete withdrawal?
• Has anyone had success with the "Prozac bridge" after long-term use of Zoloft?
•  

Hi @LizzieTish, 

sorry you are feeling discouraged. Many of the people who have suffered for a very long time have been cold turkeyed which is not your case. The goal of slow tapering is to have minimal to no withdrawal symptoms while tapering or after. The slower you go, the better your body gets to adjust to the changes in your system. This allows you to live life with minimal disruption. If you updose now and stabilize for a few months you will be able to resume a slow taper which may be long but hopefully will be without symptoms or with minimal symptoms. 

 

Most people who discontinue SSRIs recover - it may take a while but the brain is plastic and we heal. I don't know of a single person who has not recovered with enough patience. It may take years but we heal. 

Supplements may not be a good idea after withdrawal at least for a while. We find that many people remain sensitive to psychoactive substances for quite a while - alcohol, pot, supplements, some antibiotics, some vitamins. We recommend non-drug techniques to deal with emotional issues including therapy. 

 

We do not recommend the prozac bridge unless one is on one of the most difficult drugs to get off of (venlafaxine, paroxetine) and has exhausted all other options. Each drug leaves specific signature changes in the brain, another drug may not fit in the same way and compensate for the same changes thus failing to prevent withdrawal symptoms. The prozac bridge is a measure of last resort. 

 

Regarding the length of tapering - yes, we recommend long tapers especially for people who have been on the drugs for a long time. If one does not get withdrawal symptoms after a few cuts of 10% a month, then they can do 10% every three weeks. If that is still tolerable, they can go 10% every 2 weeks. The tradeoff here is between symptoms and speed - you may need to go very slowly to be successful. The alternative is either having to go back (and sometimes going back to the original dosage makes things even worse) or suffering a lot.

 

Here we provide information and advice. What you end up doing is up to you. However, when things go bad and the nervous system is unsettled profoundly from fast tapers, we don't really have tools to help. 

 

You are suffering now mostly because you are cutting too fast. If you cut by smaller amounts you may not suffer this much so the whole tapering experience may not be this grueling even if long. 

 

Hope this helps, 
OMW

 

Edited February 15, 2022 by Onmyway

[LizzieTish]

@Onmyway, thank you so much for responding. I'm feeling a little better now that I've increased my dosage as recommended. I'm guessing my taper should last ~2 years since I've been taking sertraline for 20 years. Does that sound about right to you?

[Onmyway]

Hi @LizzieTish,

Glad the updosing is working. I find that setting timelines is not the right way to think about this, rather it's best to listen to your body. It will tell you what it can tolerate. Some people get symptoms at a certain dosage and need to hold for months. The point is to get you through this in the least traumatizing and disruptive way rather than chase a timeline.

 

On your profile I just read that your are taking your medicine only 5 days out of 7. Is that correct or am I misunderstanding? That is one of the worst things you can do to your body and brain. By withdrawing the drug for a be few days every week you're basically sensitizing yourself and setting yourself up for withdrawal symptoms. Even if your doctor told you to do it, it is still wrong.

 

Please let me know if that is the case.

OMW

 

[LizzieTish]

@Onmyway, thank you again! You've been so generous and kind. 🙂 I've learned a lot in the last few days, thanks to you and SA. Since you suggested I increase my dose, I've been taking sertraline every day. Specifically, I'm now taking 12.5 mg 6 days a week and 25.0 mg once a week (on Saturday). The total weekly dose is now 100 mg, up from ~60 mg. I also discontinued my 5-HTP supplement, which seems to have exacerbated my withdrawal symptoms, and stopped drinking my nightly 2 glasses of wine. I'm feeling much better now. I plan to stay on my current dose for 4 weeks before tapering again and will liquify the drug so that I can take the correct dose (and the same dose everyday) according to the 10% rule from that point on. God bless you!

[Onmyway]

Hi @LizzieTish, 

it's great that you are feeling better after the changes you have made. 

May I suggest that you not take a higher dose 25mg even if it is one day a week. Your brain likes consistency and not jumping around. 

 

Since you've JUST changed, I would suggest that you take 11mg 7 days a week at the same time every day. You have increased from 10mg to 12.5mg and that is 25% increase to which your brain has to adapt and we want to treat the brain as gently as possible. It may be better to go to 11 and see if that will be sufficient to take away the withdrawal symptoms and leave you with a lower burden to come off of. Also, it is important to take the same dose at the same time every day. 

 

How are you measuring your dosage? The thread below has some tips. It is important to be precise and not rely on rough measurements as the body gets sensitive to  these dosage changes as you go lower. You can get a liquid version of zoloft/make your own liquid/get a compounding pharmacy to create special dosages for you/measure using precise scales. Note that if you are measuring using scales, the weight of the pill will be larger than the mg of active ingredient - so a 50mg zoloft pill may weigh 400mg because it has fillers. If that is the system you're going to use then I can help with measurements.  

 

Tips for tapering Zoloft (sertraline) - Tapering - Surviving Antidepressants

https://www.survivingantidepressants.org/topic/1596-using-a-scale-to-weigh-and-measure-doses/?do=findComment&comment=15151

 

Hope things stay good for you and do not hesitate to ask any questions!

OMW

 

 

 

[LizzieTish]

@Onmyway, thank you for your support!  I was actually taking 12.5 mg (half of a 25 mg tablet) 5 days a week for a total weekly dose of 62.5 mg when my withdrawal symptoms peaked. Per your earlier messages, I had tapered too fast and should have been on around 18 mg/day. For convenience, do you think 12.5 mg 7 days a week (87.5 mg weekly total with no 25 mg dose) might be okay? I don't have a liquid formulation or mg scale yet. I figured I would stick with this dose for a few weeks before going down to 11 mg/day.

 

I'm curious... does one's brain health/neurogenesis improve if they've decreased to a lower dose? In other words, let's say I can never completely be Zoloft free. Will I be better off on a very low dose (say 5 mg/day) than a high dose (50 mg), or is it all-or-nothing? Sorry for the brain fog. Hope that makes sense.

 

 

[Onmyway]

Hi @LizzieTish, 

we generally recommend going back to the previous dose on which symptoms were tolerable. What was that dose dose for you? Either way, if you are comfortable with 12.5/7 days a week, that is OK with me. In the meantime you can get a scale to make more precise measurements or figure our alternative ways for precise measurements. With Zoloft you can get the liquid version prescribed from your doctor. We prefer not to change the dose for a full month when switching to a different formulation (i.e. pill to liquid). The other option would be to measure using the scale and a third option would be to dissolve the tablet in water. Not all tablets dissolve in water, however, those that don't dissolve can be crushed really small and suspended in the liquid. 

In short: 

If you were to use the measuring by scale method, you'd measure 6 pills and divide the total measure by 6 (to find the average weight of a tablet). If the tablet weighed X mg you would divide the tablet weight by the active ingredient weight - i.e. divide X by what your pill dosage says i.e. 50mg zoloft. So let's say a 50mg zoloft pill weighs 300mg. That means that 1mg active ingredient zoloft is 6 mg pill weight. So if you wanted to take 12.5mg zoloft, you'd multiply that by 6 --> 12.5mg  x 6=75mg, so you'd take 75mg pill weight (what the scale says). This is an example. Your pill may weigh 500mg or 1g or something else. 

 

If you were using the water dissolving method, you'd dissolve one 50mg pill in 50ml of water. Then each ml of water would be 1mg pill. So to take 12.5mg you'd take 12.5ml of the solution/suspension. You need to get 10ml and 1ml syringes for this. You can keep the solution in the fridge and use it over 4 days. When you lowered your dose by 10% then, you'd measure 0.9*12.5 (90% (100% - 10%) of 12.5)=11.25ml of the solution and so on. 

 

I have no doubt that you can come off of the medicines and lead a life without the pills. In general, every medication has side effects - it changes other things in the body as 1) these pills target multiple body receptors and 2) the things that they target (i.e. serotonin receptors for example) are everywhere in the body so they in turn impacts multiple systems. Some of the long term effects of these drugs are unpredictable and not studied so ideally, it is better to not be on any drugs that one does not need. For those people who have more noticeable side effects lowering the dosage definitely lowers the side effects, often improves mood. In your case as you come down on the drug, you will likely see less 'zombification' as you wrote earlier. Some people report a new found zest for life. However, for that to happen we need to make sure that withdrawal effects don't kick in so need to proceed as carefully as possible and as slowly as the body will allow. If you haven't yet seen much improvement, it's probably due to the fact that these drugs are more potent at the lower doses. For my drug for example - it occupies 85% of serotonin transporter receptors at 40mg but 50% at 5mg, so when you lower at the higher doses, the effect is not as strong and as a result the withdrawal effects may not be as strong. (So going down from 40mg to 5mg 'releases' about 35% of the receptors whereas going down from 5 to 0 would impact about 50%). That is why we need to be extra careful at the lower doses. But that is why you would expect that the side effects such as zombification would also lift at the lower doses.

 

If you are worried that the drugs are what keep your mood regulated, the scientific evidence says that these drugs are no better than placebo when all of the evidence is considered. Yes, that is true. The FDA requires only 2 positive trials to approve a drug even if there are 10 other trials that say that the drug does not work. They just ignore the negative trials. Here is an article by a Harvard MD who has studied the placebo effect. Antidepressants and the Placebo Effect (nih.gov) This one is written in an easy way to be understood by non-scientists even though it is in a scientific journal. There is also no evidence that increasing serotonin in the brain is effective to lift people's mood. Or that there is a so called 'chemical imbalance' in people who are depressed. I can give you more scientific sources on that one if you'd like. But maybe it will help to know that some antidepressants 'work' by decreasing serotonin and have the exact same effect as those that increase serotonin.

 

Hope this helps. You are in the right place to do this successfully this time and I have no doubt that will do well if you follow your body and hold your current dosage rather than continue tapering when it protests during the withdrawal process. There is a lot to learn on this journey so pls feel free to ask any questions that you may have  

OMW

Edited February 16, 2022 by Onmyway

[LizzieTish]

@Onmyway, I can't thank you enough. You're truly a blessing to me and others 😇. I will buy a mg scale and taper 10% each month as recommended. 

[LotusRising]

18 hours ago, Onmyway said:

For my drug for example - it occupies 85% of serotonin transporter receptors at 40mg but 50% at 5mg, so when you lower at the higher doses, the effect is not as strong and as a result the withdrawal effects may not be as strong. (So going down from 40mg to 5mg 'releases' about 35% of the receptors whereas going down from 5 to 0 would impact about 50%). That is why we need to be extra careful at the lower doses

Hi @Onmyway

 

I just read this in your post and am assuming this is also the case for benzodiazepines. Do you know where I might find this information for clonazepam? I am starting to get lower down in my taper and this info would be helpful.  Thanks in advance for any info you can offer me   

[Onmyway]

Hi @MedRN

this is the link to the Horowitz and Taylor, 2019 study. They have a subsequent one on antipsychotics.

Tapering of SSRI treatment to mitigate withdrawal symptoms - PubMed (nih.gov)

It relies on a principle of human physiology and pharmacodynamics. They had a name for it but I can't remember now. You can have a look at the articles that they cite and those that cite them to see if there is stuff on benzodiazepines. You can also search on pubmed if such studies exist on clonazepam. The idea is the same though. I don't know if the specific numbers/percentages matter. The shape of the graph is what matters. Here is the citalopram function. 

 

 

They cite: Brouillet E, Chavoix C, Bottlaender M, et al. In vivo bidirectional modulatory effect of benzodiazepine receptor ligands on GABAergic transmission evaluated by positron emission tomography in non-human primates. Brain Res 1991; 557: 167–76

Hope this helps, 

@MedRN

OMW

[Onmyway]

2 hours ago, LizzieTish said:

@Onmyway, I can't thank you enough. You're truly a blessing to me and others 😇. I will buy a mg scale and taper 10% each month as recommended. 

Thank you for your kind words @LizzieTish. 

Looking forward to seeing you all better and writing your success story!

OMW

Edited February 16, 2022 by Onmyway

[LotusRising]

Thanks so much for all the above info @Onmyway! I will definitely take a look at it.

[LizzieTish]

Hangover feeling in the morning

 

I've been tapering off sertraline since April 2021 (went from 50 mg to 8 mg/day). Almost every morning I wake up feeling mildly hungover even though I haven't had any alcohol. Is this common during tapering/withdrawal?

 

Edited June 15, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Q:  Have you made any reductions whilst still experiencing withdrawal symptoms?

 

You made a huge reduction back in February this year:

 

Sertraline February 13, 2022 (12.5 mg/day)

Sertraline April 2022 ~10 mg/day          20% decrease

Sertraline May 2022 ~9 mg/day            11.1111% decrease

Sertraline June 2022 ~8 mg/day          

 

If you reduce to 7mg for your next drop it will be:  12.5% decrease

 

SA's recommended taper rate is no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

In my opinion it is not worth trying to taper too quickly.  And it has nothing to do with how strong or determined you are as a person.  It is to do with the brain adapting to the reduced dose.  It is better to go as slow as the brain needs you to go.  We have members of SA who have tried to go faster and it has ended up taking them longer than if they had just stuck with a nice steady taper.  Some have ended up changing to a different drug, which doesn't always work, and some have ended up on an additional drug which then needs to be tapered.

 

It took my 6 years to get off 100mg Pristiq (and only experienced mild withdrawal symptoms) and I have been off successfully for 7 months now.  Even though it was frustrating at times I am glad that I took the time and did it carefully because I was able to live my life fairly normally whilst tapering and don't feel that I have delayed withdrawal symptoms now.

 

Why taper by 10% of my dosage?

 

Many members find that as their dose gets lower they need to go slower (than the recommended taper rate) by reducing less and/or holding longer.

 

There are links in Post #1 of this topic which helps to explain why people might need to slow down.

 

Why taper paper: dose-occupancy curves

 

I think it would be a good idea to do a nice long hold and not reduce again until at least September AND when you do reduce again to only reduce by 10% of less.  If reduce again in July (even at 10%) and definitely if you reduce to 7mg, I think you will end up with bad withdrawal symptoms.

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

 

It is possible to make a liquid from sertraline tablets.  Post #1 of this topic explains how to get non standard doses:

 

Tips for tapering off sertraline (Zoloft)

 

Please also be aware that SA suggests going very low on your dose before you stop taking you drug.  The dose is approximately 0.025mg.  But like everything taper related it is important to listen to your body/symptoms.  I ended up going down to 0.0025mg Pristiq because I had other health issues that I was dealing with at the same time I was due to stop.  Even though it seemed like forever, I have no regrets about going slow.

 

When to end the taper and jump to zero?

[LizzieTish]

@Chessiecat, Thanks for your reply. I've had a mild hangover feeling for many months; this is nothing new. I'm feeling pretty good overall.

 

BTW, I made the huge reduction in February before I had discovered this website. I have since been trying to taper roughly 10% every 4 weeks.  I bought the recommended scale but found it wasn't accurate at the lower weights, so I returned it. I'm now taking liquid sertraline using a 3 mL graduated pipette, which is not precise. 

[LizzieTish]

Hi. I've been on 5 mg of sertraline for the past 5 months or so, which is a 90% reduction from my starting dose of 50 mg (I began tapering in April 2021). I realize I tapered too fast. I was planning to stay on the 5 mg dose for at least 6 months before considering further tapering. By now I had hoped to stabilize on the 5 mg dose but I'm suffering from persistent acute anxiety and depression, which are much worse than before I began taking an SSRI 20+ years ago.

 

Should I consider increasing my dose to 5.5 or 6 mg or wait it out? Would taking a very low dose of Xanax or Valium PRN be a bad idea? I take fish oil, Vitamin D, and magnesium supplements. I used to enjoy a glass or two of wine at night to relax but I can't drink wine anymore because it worsens my insomnia. In retrospect, I feel like I was better off with emotional blunting but I don't want to give up, even if it takes me 5-6 years to complete the taper. I'm hoping to be able to laugh again someday and enjoy life. Thanks, in advance, for your advice. 

[manymoretodays]

Hi LizzieTish, @LizzieTish

In reference to should I reinstate, now above this post.

It's always best to post right here in your somewhat abandoned topic, your Introduction.

Are you still on 5HTP as your title here suggests?

I would not updose if that was the case, I'd work my way off the 5HTP first.

 

Have symptoms recently increase? and if so is there anything outside of withdrawal going on to account for them?

Things like drinking alcohol, stress at school or work, recent deaths, etc. 

 

If the symptoms have just persisted, and you are not on anything else right now.......yes you could try an updose.

I see 6 mg in November of sertraline. 

You could try just going up 1 mg, or back to 6 mg and giving it a good week trial to see if you notice any improvement. 

If you don't like blunting I'd stay away from the benzos.  Benzo's are drugs like Valium and Xanax.

 

Please report back what you decide to do, and keep us updated right here.

 

And best.

L, P, H, and G,

mmt

 

 

 

 

 

 

 

[LizzieTish]

I'm sorry I posted my question in the wrong area. I haven't taken 5-HTP. My symptoms increased after my last reduction a few months ago. The crying spells have subsided, but the anxiety and depression persist. There haven't been any major life stressors since last summer. I will increase my dosage to 6 mg if I'm not feeling markedly better by the end of the month and not take any benzos. Thank you for your kindness and support. 

[LizzieTish]

Need some advice, please. This is my third attempt at withdrawing from Zoloft, which I've been taking for more than 20 years for mild depression. The first 2 times I was unaware I was withdrawing too fast. During this third attempt I discovered SA.org and slowed down my tapering. I've now been tapering for 2 years and 3 months. I'm basically stuck at a dose of ~5.5 mg (down from 50 mg). I can't stabilize; I'm suffering tremendously. I have almost no friends or family or support. If I weren't Christian, I'd commit suicide. 

 

Is there a point where someone in my shoes should accept the fact that he or she may never be able to be off psych drugs? My life was much better on a higher dose of Zoloft (except for emotional blunting) than it has been for the past 2+ years due to unrelenting deep emotional pain. I hate to give up but I'm not sure I can endure much more. Thank you, in advance, for your help.