PapaSmurf: getting off of sertraline

[PapaSmurf]

Hi everybody.  Finding this group is like being raised by robots and then stumbling into a human encampment.  Suddenly, things make more sense.

 

I've been taking Sertraline continuously for 15 years for anxiety, panic attacks and IBS.   It was originally prescribed by my primary care physician just for the panic attacks, which were triggered most often by over-stimulation by continuous loud noises, physical jostling and/or strong flashing lights.  The worst would happen while driving, in crowds or on a boat or plane.

 

Within a few weeks of taking Sertraline 50mg, the IBS miraculously abated (as did the panic attacks).  I'd suffered with always uncomfortable and frequently debilitating IBS since 1980 and had been to numerous specialists and had numerous medical tests with no effective relief until the Sertraline, so to me it was like a miracle.  I credit the Sertraline with saving my career and possibly even my marriage.

 

After almost 10 years on the Sertraline, I began to feel apprehensive about taking it for such a long period of time and curious to how much I still needed it.  I tried tapering on two occasions, about a year apart, but without support or a plan, failed.  Usually the stomach issues make themselves known before the anxiety and then the IBS drives the anxiety even harder which makes the IBS worse; lather, rinse, repeat.

 

I'm in my 60s now and found I was able to move into a lower paying but much less stressful job and kids are grown and out on their own so less demand and worry.  With changes in my body from aging and the less stressful environment, I began to feel I had a better chance of eliminating the Sertraline with a slower, more methodical plan, support of my Primary Care physician and of people who understand the process and problems.  And that's how I find myself here, today.

 

I've been taking the "recommended" 50mg dose but I'm very sensitive to all medications so it may have been more than my body actually required all this time.  I've been tapering for 6 months now.  I would cut my dosage in half, suffer through the worst of the withdrawal symptoms for a few weeks, then if symptoms decreased or at least didn't get any worse after another 3-4 weeks and were tolerable, cut it in half again, etc.  I recognize now, that's too fast.  I'm still experiencing frequent brain zaps (I didn't know what to call those; I was calling it "elevator head"), mood swings  and easily-triggered bad temper.  I can actually physically feel an internal tornado of turmoil in the core of my body when I get angry.  It's awful.  I feel like an emotional ping pong ball.  And I don't even get to be The Hulk.

 

Anticipating the stomach and mood issues, I got a medical cannabis card.  I have to say, a combination of CBD and low-THC cannabis has kept the stomach issues at bay.  I microdose .5mg to 1mg of a 3:1 mixture of CBD to cannabis daily; that's about 3 hits.  If I get twisted up in knots over something, a hit of indica does settle me (vaped organic dry flower only).  I tried ingesting CBD tinctures but they kill my stomach.  My physician didn't object to this approach, although he thinks I'm too concerned about the long-term effects of the Sertraline.  I think this struggle of just trying to get off of the Sertraline is justification enough.

 

The 50mg tablets are too small to cut into more than fourths, so after 5 weeks at 12.5mg, I stopped altogether; that was 30 days ago and the withdrawal symptoms still persist with no further reduction.  After spending some time here, I now recognize I'm going too fast.  I need to slow down a lot and seek wisdom from those who have made it through this.

 

I've just sent a request to my physician to change my Sertraline prescription from tablet to oral solution so I can dilute it and get finer resolution on the tapering dosages.  My current plan is to restart the Sertraline at 12.5mg, where I left off, stabilize or slowly increase until stable for at least a month (more?), and then reduce 1mg at a time for as long as it takes.

 

Thanks for listening.  I've got no one else to talk to who will understand.  I'm so glad to be here.

 

 

PapaSmurf (my son called me that after he grew taller than me, and it stuck)

[PapaSmurf]

I reinstated at 12.5mg (quarter of a tab) 3 days ago and now, not a single brain zap all day; first time in months.  Huge relief on the one hand but on the other, feel like I lost ground.  I know...patience.

 

My physician called in a prescription for oral solution.  My question now is, how long to stay at 12.5mg without withdrawal symptoms before dropping to 10mg?

 

[PapaSmurf]

Clarifying my question "how long to stay at 12.5mg without withdrawal symptoms before dropping to 10mg", I'm referring to the initial drop as opposed to the tapering drops over time.  It's my intention to start with the Brassmonkey slide taper but in order to start at the lowest dosage that doesn't result in withdrawal symptoms, I think I'd want to find out what that lowest dosage is.  Before getting the oral solution, the lowest dose I could measure was 12.5mg but I can pretty much dial up whatever is needed now.

Any harm in starting with, say, a 20% drop (so 10mg) for a week and if no symptoms, do that again until the onset of WD and then bump it back up a little at a time until symptoms disappear again.  Trying to find that threshold and then start the slide from there.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  

 

Can you please give us specific information in your signature about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Sertraline/Zoloft

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

I'm glad to hear that your reinstatement to 12.5 mg of Sertraline helped you.  Here is som information about reinstatement. 

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

My suggestion would be to stay on the 12.5 mg for a while, as in at least several months, since you did a faster taper than what we suggest.  Your nervous system needs lots of time to adjust to the tapering you have done.  If you do this, you should be able to eventually taper off of this in the future with significantly fewer withdrawal symptoms.  After several months go by, and you feel reasonably stable, then you could resume a taper.  I would not do a 20% drop - that is too fast.  At most, so a 10% drop, as suggested previously.  If you do the Brass monkey micro taper, you would be reducing by only 2.5% a week for 4 weeks, then holding for 2.  

 

I'm glad you found us.  Keep us posted. 

[getofflex]

We do not suggest that you use CBD or cannabis or any other mild altering substances during withdrawal and tapering.  These things can further destabilize and confuse your nervous system, and make things worse.  Please read altostrata's quote in this link:  

 

Cannabis, THC, CBD, etc.

[PapaSmurf]

3 hours ago, getofflex said:

My suggestion would be to stay on the 12.5 mg for a while, as in at least several months, since you did a faster taper than what we suggest.  Your nervous system needs lots of time to adjust to the tapering you have done.  If you do this, you should be able to eventually taper off of this in the future with significantly fewer withdrawal symptoms.  After several months go by, and you feel reasonably stable, then you could resume a taper.  I would not do a 20% drop - that is too fast.  At most, so a 10% drop, as suggested previously.  If you do the Brass monkey micro taper, you would be reducing by only 2.5% a week for 4 weeks, then holding for 2.  

Thanks very much for the feedback, getofflex; much appreciated.  I'm going to take your advice but want to clear up that I wasn't talking about doing a faster taper (learned that lesson) but finding a dosage starting point so I'm not taking more Sertraline than I have to up front of the taper.  The 12.5mg I'm taking now is pretty arbitrary because it's the smallest I was able cut up the tablet (fourths).

 

4 days back on 12.5mg now and all WD symptoms have completely vanished.  I'll hold here for at least 4-8 weeks and not make any changes until there are no recurrences for that amount of time and if there are, I'm certainly willing to incrementally increase if necessary to establish that longer stable baseline.

 

[PapaSmurf]

3 hours ago, getofflex said:

We do not suggest that you use CBD or cannabis or any other mild altering substances during withdrawal and tapering.  These things can further destabilize and confuse your nervous system, and make things worse.  Please read altostrata's quote in this link:  

 

Cannabis, THC, CBD, etc.

I'm certainly not advocating getting stoned while trying to taper.  As I said in my post, I've been micro-dosing (1mg and less by weight, not strength) a 3:1 combo of CBD and THC, both of which are under 20% potency (so that's about .05mg of THC, once or twice a day). That's not nearly enough to get high but I found it more effective than CBD alone and it has provided me with temporary relief from brain zaps and has so far short-circuited the stomach issues I'm susceptible to and has also helped with getting enough sleep.  All was discussed with my physician.  I'm in a legal [medical] state so the exact potency and terpene content is specified for every batch of every strain so you know exactly what and how much you are ingesting.  If you can only acquire your cannabis on the illegal market, it would be a big mistake. 

 

I consume no alcohol.  Since reducing the Sertraline, I've found any amount of alcohol puts me into a seriously unpleasant brain fog that takes hours to wear off.  I don't miss it at all.

 

Thanks for the link here and the many links in your previous post.  I'm working my way through them now.

 

 

[getofflex]

18 hours ago, PapaSmurf said:

want to clear up that I wasn't talking about doing a faster taper (learned that lesson) but finding a dosage starting point so I'm not taking more Sertraline than I have to up front of the taper.  The 12.5mg I'm taking now is pretty arbitrary because it's the smallest I was able cut up the tablet (fourths).

If you had not yet reinstated, I would have suggested a reinstatement amount of 5 mg of Zoloft.  However, it's not good to jump around on our doses every few days.  That tends to further confuse the nervous system, and put you at risk of going into significant withdrawal again.  Since you are doing so well on this 12.5 mg, I hate to upset the apple cart, and have you change your dose again.  As the trite ole saying goes, it it aint broke, don't fix it.  

 

Can you please update your drug signature to show your recent tapering of your sertraline, and your reinstatement, as requested in my first post? Thank you. 

 

18 hours ago, PapaSmurf said:

4 days back on 12.5mg now and all WD symptoms have completely vanished.  I'll hold here for at least 4-8 weeks and not make any changes until there are no recurrences for that amount of time and if there are, I'm certainly willing to incrementally increase if necessary to establish that longer stable baseline.

I'm very glad that your symptoms have gone away.  This sounds like a good plan.  Please take your 12.5 mg dose each and every day, at the same time of day.  Please don't change your dose if you have an uptick in symptoms until we discuss it here in the forum.  Remember windows and waves are very common, and part of the healing process. 

 

Reaching stability doesn't mean a complete absence of symptoms.  This link describes what we mean by stability: 

 

Stability

 

17 hours ago, PapaSmurf said:

I'm certainly not advocating getting stoned while trying to taper.  As I said in my post, I've been micro-dosing (1mg and less by weight, not strength) a 3:1 combo of CBD and THC, both of which are under 20% potency (so that's about .05mg of THC, once or twice a day). That's not nearly enough to get high but I found it more effective than CBD alone and it has provided me with temporary relief from brain zaps and has so far short-circuited the stomach issues I'm susceptible to and has also helped with getting enough sleep.  All was discussed with my physician.  I'm in a legal [medical] state so the exact potency and terpene content is specified for every batch of every strain so you know exactly what and how much you are ingesting.  If you can only acquire your cannabis on the illegal market, it would be a big mistake. 

 

Yes, I see.  All we are saying, is that using CBD, THC, etc can destabilize some people, and worsen symptoms.  But for you, it may not be a problem.  I realize you were not trying to get high. It's good that you are using a quality product, and are aware of the strength of it.  I'm glad to hear you are reading the information in the links.  Let us know if you have any questions.   

[PapaSmurf]

Just a brief update.  My doctor kindly switched my prescription to liquid form so I could get better resolution on dosage (with a pipette).  I'm now at 6mg/day.  I've had zero withdrawal symptoms with some situational increases in anxiety but so far, manageable.  I had a vision-related health emergency over the holiday and was scheduled for surgery.  After enduring the most severe anxiety I've experienced since going on the Sertraline, I decided it was in everyone's best interest that I take a fast ramp back up to my original dosage and was glad I did.  I don't think I would have made it through surgery day, otherwise.  Afterwards (all ended well), I let the 24 hour half-life settle me back down to 6mg over a 3 day period.  I was concerned that this could set me back but it doesn't seem to have made any impact so carrying on.  One thing that stood out over this short ordeal was that in all the seemingly endless medical history forms I filled out over several days, there was never a checkbox for anxiety.  I'd think this would be critical information for a doctor about to treat someone they've never treated before.  And no one ever asked what I was taking Sertraline for.

 

 

[Altostrata]

Hello, @PapaSmurf Did you take 50mg sertraline again through your surgery? Then you dropped down to 6mg?

[PapaSmurf]

Hi @Altostrata.  I took 25mg the evening before and another 25mg the morning of.  Afterwards, I took nothing for 3 days, letting the Sertraline half-life settle back down to 6mg. 

[Altostrata]

Good to hear there were no adverse effects of this.

 

Please update your signature with more information about your taper down to 6mg.

[PapaSmurf]

To provide some closure...

By the beginning of last May, I had successfully tapered down to 0 and by successfully, I mean without significant withdrawal effects.  All told, it took a year of tapering and in the end, I hadn't been so miserable since starting on Sertraline in the first place.  The anxiety built back with a vengeance, well before tapering to 0 and nothing I tried made a big enough dent. My doctor offered alternatives to Sertraline but all still some family of antidepressant.  A few tortuous months completely off of meds and I came to accept that, whatever the cause, my brain just won't function properly without chemical help so, with my doctor's support, I tapered back up to the original dose.  Within 2 weeks I was completely back to "normal" and I've resigned myself to spending the rest of my life on Sertraline.  At least now I don't have to wonder if I really need to still be on meds and I credit this forum with giving me the tools to find out.  I'm sure there are plenty of doctors that just casually prescribe antidepressants but I'm lucky to have had 2 really good, supportive physicians that helped me draw my own conclusions.  I'm grateful to this forum for the advice and support this past year.  Thanks and best of luck to all those traveling a similar road, wherever it leads.

[Altostrata]

16 hours ago, PapaSmurf said:

The anxiety built back with a vengeance, well before tapering to 0 and nothing I tried made a big enough dent.

 

This may have been withdrawal symptoms that emerged while you were tapering. Anxiety is a very common withdrawal symptom.

 

Good to hear you're satisfied with the resolution provided by your doctors.