Lauren90: history with sertraline

[Lauren90]

Today was difficult. 5:30AM cortisol surge wakeup. The surge did not abate today, neither did the akathisia. It was like 24/7 anxiety and panic. I took 3 separate long walks, totaling around 2.5 hours outdoors, then forced myself to go to the store, took a drive down the coast, and came home and vacuumed. Still panicking all the while. Started shaking in the grocery store. Called my mom 3 times just crying. Called my husband twice just crying. I feel pathetic. Like a shell of the person I used to be. 
 

I spoke to my psychiatrist last week and she wants me to take a benzo for 2 weeks straight to calm down my mind and try to calm down the akathisia as a result. I caved and decided to take it today. Survival mode. I don’t know how some people get through such intense periods naturally. I am really trying not to use any rescue doses and don’t want to do two straight weeks because I know benzo withdrawals are just as hellish. I tried everything in my book before taking the dose. Cold shower, meditation, yoga. first walk of the day outside. I just could not calm down!! I felt like I was losing it. Bawling crying, jumping out of my skin, pacing, intrusive looping thoughts (usually these severe panic episodes occur during my akathisia waves).  Please be gentle with any replies about benzo use, i know it’s frowned upon and I’m beating myself up about it, but I am currently all alone, no family around, and I really thought I was going to have to check myself in somewhere. I felt totally unsafe in my own body, especially being alone.

 

Anyways, back to the psych, she then wants me to do a cross taper from Sertraline to prozac. Now, I am meeting with her in two weeks to hear her reasoning, and while at first I really considered it, I don’t think there’s a way I can do a cross taper. I’ve read about some pretty unsuccessful attempts at a cross taper. Seeing how my body reacted to my previous reductions, I don’t see how reducing Sertraline and sticking a different SSRI in the mix is going to help me, unless she’s convinced it’s the Sertraline causing it (I personally think it’s withdrawal- I was completely fine on Sertraline for 20 years).  
 

I’ve actually gone ahead and made appointments with 3 different psychs to get opinions on what their thoughts are around withdrawal induced akathisia. (3 may be overkill but I’m desperate and I’m actually curious as to how wildly different all of their approaches will be). I’m sure they will all try to push more drugs on me, but I’m hopeful one may be informed. We shall see. Another psych, well, Shipko, a while ago told me if the akathisia didn’t go away I could try to updose. I plan to speak to him again soon as well. Would that be horribly stupid at this point? An updose? My last cut was in Feb. I thought I was getting better in Aug/sept but this wave is by far worse than any to date. I am grasping at straws here, obviously. 

 

It’s been such a rough time with my husband out of the country during this wave, that after two weeks of literal misery, I’ve asked my mom to fly in tomorrow. I don’t feel stable enough to be alone. I need support, more than just through facetime. (Serious props to all of you who live alone or don’t have supportive partners or family members as you go through this, you are stronger than I’ll ever be!!!)

 

Also to note: somehow despite all of the torment, right before bed I’m usually calm. Perhaps it’s my cortisol completely dropping by this time. Interestingly, I did have a cortisol blood test about a year ago and it was pretty high. The doc wanted to send me to an endocrinologist but I never got around to it. Wondering if I should look into that more. However I know it’s likely withdrawals- every time I’ve been to the doctor for any number of my symptoms there’s never an explanation. Except for mine: withdrawals.

 

if you got this far, thanks for reading. I’m a bit scatter brained from my lack of sleep. 
 

hugs to you all! 

[Shep]

6 hours ago, Lauren90 said:

Also to note: somehow despite all of the torment, right before bed I’m usually calm.

 

Lauren, I'm glad you're wanting to be careful with the benzo. Two weeks is definitely long enough to become dependent on it. You may want to only take it a couple of days to give yourself a break and then put the rest of the tablets away for an emergency. 

 

This is good that you're getting a break in the evening. How is your sleep? 

 

Also, how long have you been at 50 mg sertraline? When was your last reduction? 

 

 

[labrat15]

I took a Benzo for 2 weeks in the summer during a taper and I definitely got some withdrawal from it but it wasn't terrible. Don't want to suggest taking any drugs but I have found that Benadryl helped me in times where I couldn't stand the withdrawal any longer. I'd would take half of the pill and it would calm me down a bit. I wouldn't take it for more than 3 days and there were no negative effects. I'd ask the staff here first but it provided me some relief and it is definitely better than a benzo... 

[Lauren90]

Hi @Shep! Yes I’m trying to be very careful with the benzo but I did take them two days a week for the past three weeks. Then again yesterday. I’ve really tried to abstain but the days become unbearable sometimes. I desperately do not want to add on to my current withdrawals, however I have to get through the days somehow. 
 

My breaks in the evening used to be longer actually. Lately they are seeming to occur just before bed. I don’t want to jinx it but my sleep remains ok. It is my only reprieve, and for that I am so so very thankful. I just get woken up by extreme surges right before or as soon as the sun rises each morning. I used to still average 8-9 hours, this past week it’s been about 5-6 but the last hours are extremely restless. 
 

I’ve been at 50mg sertraline since last February (‘22) and things just seem to be getting worse. I’m not sure what is happening but this isn’t sustainable, living like this for months and months or years and years waiting to recover or stabilize. I’m not sure how others do it. I am miserable. 
 

@labrat15 Thank you for your suggestion. I do have to take Benadryl from time to time due to my allergies, but I refrain right now because of the akathisia and people say it can make it worse. I’m a little fearful of that right now :/. I guess I could always try. It’s something my therapist recommended as well. 

[labrat15]

Yeh I've heard that it can make akathisia worse for some and better for others. At times it would make my akathisia better and sometimes it would make it worse it was kind of unpredictable I'd try like a quarter of a pill at first if you do try it. I definitely had some withdrawal from taking the benzo in the summer though so I'd be careful with that. This is just a crappy thing but everything I read says that people eventually recover. I'm in a wave right now and it just feels like you'll never get better but then you get some periods of feeling better and you get more confident. I just eat a crap ton of sugar during the crappy periods and seems to improve the mood. I feel shameful after but overall seems to help.

[Shep]

1 hour ago, Lauren90 said:

I’ve been at 50mg sertraline since last February (‘22) and things just seem to be getting worse. I’m not sure what is happening but this isn’t sustainable, living like this for months and months or years and years waiting to recover or stabilize. I’m not sure how others do it. I am miserable. 

 

Outside of periodic benzos, have you had any other drug changes since February? 

 

1 hour ago, Lauren90 said:

Yes I’m trying to be very careful with the benzo but I did take them two days a week for the past three weeks. Then again yesterday.

 

Is the benzo you're taking bromazepam, which you have listed in your signature in the 2021 timeframe? 

 

If so, you may be getting interdose withdrawal. That benzo has a half-life of 12–20 hours, depending on how fast you metabolize it. 

 

Also, you mentioned that you stopped drinking in the second post in your thread. Are you still abstaining from alcohol? Are you finding non-drug ways of coping and learning to distract? This is extremely important, especially for people who went on these drugs at a young age and therefore don't have as much practice in regulating emotions. 

[Rhiannon]

1 hour ago, Lauren90 said:

Hi @Shep! Yes I’m trying to be very careful with the benzo but I did take them two days a week for the past three weeks. Then again yesterday. I’ve really tried to abstain but the days become unbearable sometimes. I desperately do not want to add on to my current withdrawals, however I have to get through the days somehow. 
 

 

My heart goes out to you, withdrawal is such intense and indescribable suffering. My thoughts right away when I read this were like Shep's. If you've been taking a benzo two days a week for three weeks it is possible you already have some dependence, which may be aggravating your other symptoms.

 

It's hard to say and it's quite tricky, the body and nervous system are so complex and the simplistic mechanistic attitude towards these drugs that mess with multiple hormone and neurotransmitter systems is just one of the major errors of modern psychiatry. (Really, I can't have much respect for the intelligence of psychiatrists. It doesn't take a genius to figure this stuff out.) These drugs don't always act in predictable ways, especially once there's a history of having our neurochemistry already perturbed to begin with.

 

The best way to take benzos is very rarely (like not more than once every week or two and even once a week can be problematic for some of us). The second best way is to take them, like any other psych med, as regularly as possible to maintain a steady chemical state, so that our nervous systems can stabilize and not be perturbed and confused further. Some of them are very short acting (like Xanax) so they have to be taken multiple times a day to provide this kind of stability. Others are longer-acting and can be taken once a day. The idea is to keep your chemistry steady rather than bouncing up and down.

 

Regardless, if you take benzos regularly, you will develop tolerance to them pretty fast (in a matter of weeks at most). Then they will be less helpful for the thing you were originally taking them for and will mostly be preventing withdrawal symptoms. If you take them erratically, that's less of a problem, but as I said, that has to be pretty rarely, especially for those of us whose systems are already disrupted by psych med use and withdrawal.

 

 

I'm sorry this isn't a simple helpful solution or bit of advice. There aren't easy answers with these things, as you already know. However if you do decide to use a benzo, and I certainly wouldn't judge you harshly for that given your suffering, it's best to understand and respect how powerful they are, so I wanted to give you that information.

 

All my best to you.

 

--Rhiannon

 

[Rhiannon]

Just one more thing--after reading over that it may have sounded like I was approving of using benzos for withdrawal. I want to make sure that any readers know that I think benzos are VERY VERY nasty and dangerous drugs and I actually wouldn't recommend them even in this case. I do think it's possible that your already-existing benzo use is complicating your withdrawal, and if you're already dependent/tolerant to the benzo, probably getting to a more steady state type situation is the best solution for you. But I really don't ever recommend that people START a benzo if they aren't already dependent.

[Lauren90]

@Shep,

All of my drug changes are up to date in my signature, except for periodic benzo use over the month because I don’t have enough lines in my signature to add that. So I started and stopped propranolol and stopped birth control (in signature). Oh! I was taking a multi vitamin as well for some time but I stopped that about a week ago because I ran out. Strangely I felt like it helped and never hurt me so maybe there is a vitamin deficiency somewhere. 
 

The benzo I was periodically taking was bromazepam, but I’m now back in the US and I no longer have any more. So yes, up until yesterday that was the benzo. Yesterday was my first time using Diazepam and I don’t even think it helped. The equivalency I found was 5-6mg bromazepam = 10mg diazepam. I would take 3-4.5mg bromazepam which would mean I need way more than a 2mg Valium the doctor prescribed. Yesterday was so horrible I took 6mg in the morning and 6mg in the evening. I have yet to take any today. I’m just walking around pacing. I know I’m complicating things, it all sounds like so much change as I’m writing it out, but I’m desperate for relief. I am going to write below approximate days and dosages I took each benzo in the past few weeks. For reference around Nov 14 my akathisia came back with a vengeance and the week prior my anxiety was at all almost all time high. 
 

I’m not sure if I took any benzos in the month of October. Maybe a couple times in September? 

Nov 10- 4.5mg bromazepam

Nov 15- 3mg bromazepam 

Nov 18- 4.5mg bromazepam

Nov 23 -4.5mg bromazepam

Nov 28- 4.5mg bromazepam

Dec 1- 4.5mg bromazepam

Dec 4- 4.5mg bromazepam 

Dec 8- 4.5mg bromazepam 

Dec 10 - 2mg diazepam 6am (didn’t work) 4mg diazepam 12pm (worked a tiny bit) 6mg diazepam 5:30pm (worked a tiny bit)

Today Dec 11- nothing so far. 

the problem, or perhaps blessing, with this is the doctor only wrote me a prescription for 30 2mg pills of diazepam and I am now out of bromazepam. Yesterday I almost took half of what she prescribed because she obviously doesn’t understand equivalencies between medications. This is the chart I have been referring to: https://www.benzo.org.uk/bzequiv.htm

so if I did need to taper down, at this point I think I’m screwed. I left them a message to explain Diazepam is not working how they prescribed it so maybe I can talk to her to get more if you think I need to do a rapid taper off. 
 

As for the drinking yes I am still trying to abstain. It’s very hard. I think I’m coming to the realization that I also have a problem with drinking to cope. I never got blackout but there were years that I never went one day without a glass of wine. Over the past two years I’ve drank far less, but definitely used it to cope. I don’t touch street drugs or weed, however I previously smoked weed for a very long time (daily for probably 7 years) a few years ago, but it’s been years since I have. Actually tried once in September and had a full blown panic attack with derealization. So no more for me. ….So yes I’ve always had a substance helping me cope. 
 

@RhiannonI am tagging you here as well because I think this post will give you more insight to my benzo use. 
 

Thoughts on how to proceed? Should I take a low dose daily to stabilize and rapid taper off? White knuckle it this week and try to tough it out with nothing before I develop a full blown dependency? Then my question is if I do a rapid taper using what I have left, what do I do when I need a rescue dose because some days things are BAD, like, considering hospital bad. I do try natural coping techniques, but sometimes I’m too far gone for that to work.
 

Any thoughts on an updose on Sertraline? I mean my anxiety, since before the benzo use in November, has been so high I don’t know what to do, and the akathisia. I have seen severe cases and I wouldn’t say I’m that, I would say I have either very severe agitation or mild to moderate akathisia.. idk the difference. 
 

thank you both for your time and patience. Writing all of this out helps me see some of the self sabotage. However, it really and truly comes from a place of truly just wanting to feel better.

 

Oh, and my mom flies in today, so hopefully that will give me some peace so I am not thousands of miles from my nearest loved one anymore. I am looking forward to that and I am also looking forward to the work week, even if work causes me stress, it distracts me from my turmoil most days. Weekends are the hardest.

[Lauren90]

1 hour ago, Rhiannon said:

Just one more thing--after reading over that it may have sounded like I was approving of using benzos for withdrawal. I want to make sure that any readers know that I think benzos are VERY VERY nasty and dangerous drugs and I actually wouldn't recommend them even in this case. I do think it's possible that your already-existing benzo use is complicating your withdrawal, and if you're already dependent/tolerant to the benzo, probably getting to a more steady state type situation is the best solution for you. But I really don't ever recommend that people START a benzo if they aren't already dependent.

Oh yes, don’t worry, I completely understood what tou were trying to convey. I know you’re just trying to give me the best advice based on my current situation of already using benzos to cope. I hope my precious post gives you a little more insight. 
 

thank you for your kind replies ❤️ btw- Rhiannon - anything to do with Fleetwood Mac song? I’ve always wondered. 

[Lauren90]

10 hours ago, labrat15 said:

Yeh I've heard that it can make akathisia worse for some and better for others. At times it would make my akathisia better and sometimes it would make it worse it was kind of unpredictable I'd try like a quarter of a pill at first if you do try it. I definitely had some withdrawal from taking the benzo in the summer though so I'd be careful with that. This is just a crappy thing but everything I read says that people eventually recover. I'm in a wave right now and it just feels like you'll never get better but then you get some periods of feeling better and you get more confident. I just eat a crap ton of sugar during the crappy periods and seems to improve the mood. I feel shameful after but overall seems to help.

Oh so you’re having an akathisia wave too? How long do yours typically last? My last one was about three and a half months and then I had about a two and a half month break with some inner restlessness sprinkled in every now and then. This one has been going on for almost a month now. It really does make you think it’ll never go away 😭. I’m envious you can just eat a ton of sugar! I feel like it makes my akathisia go crazy!! 

[Lauren90]

6 hours ago, Lauren90 said:

Oh yes, don’t worry, I completely understood what tou were trying to convey. I know you’re just trying to give me the best advice based on my current situation of already using benzos to cope. I hope my precious post gives you a little more insight. 
 

thank you for your kind replies ❤️ btw- Rhiannon - anything to do with Fleetwood Mac song? I’ve always wondered. 

And by precious I meant previous* lol 

[labrat15]

No I'm not having an akathisia wave right now. I feel some restlessness here and there but nothing like when I was having full blown akathisia. I was the same as you, it would last about 3 months and it was awful. I thought I was totally screwed as well but I always got better. Its doesnt matter how many times I do a taper and come out ok I still get thoughts that I'm permanently screwed while in the middle of a taper. Thats probably the worst part its pretty scary. Hopefully we both get better here soon cuz I know that I've had enough suffering for a while... I can't even have coffee anymore and I'm pissed right off about it.  

[labrat15]

The sugar is great though not gonna lie lol. But honestly the Benadryl only helped me when I was experiencing mild restlessness. When it was full blown akathesia it make me worse so I don't know if its worth trying. I actually found that Sudafed helped a lot which is weird because it is a stimulant but it would also cause some pretty bad withdrawal after I stopped taking it and I would feel restless for 3 days after stopping. I ended up taking it for like 3 months straight until the akathisia was totally gone but that was probably not great.

[Lauren90]

2 hours ago, labrat15 said:

The sugar is great though not gonna lie lol. But honestly the Benadryl only helped me when I was experiencing mild restlessness. When it was full blown akathesia it make me worse so I don't know if its worth trying. I actually found that Sudafed helped a lot which is weird because it is a stimulant but it would also cause some pretty bad withdrawal after I stopped taking it and I would feel restless for 3 days after stopping. I ended up taking it for like 3 months straight until the akathisia was totally gone but that was probably not great.

I feel you just grasping at straws trying to feel better when the akathisia hits. It’s what I’ve been doing. I realized today after writing in my post all of my benzo use over the last month I was averaging decent doses 1.5-2 times a week. I managed to not take any today and I think that’s going to be my plan going forward, I’m going to try to just not take anything. My mom gets in town tonight  and is staying until my husband gets back into the country so hopefully her presence brings me a little peace and calm, because I could really use that right about now. I can’t continue to use benzos then withdraw off benzos on top of this. 

[labrat15]

Yeh that's probably the best choice. I wish there was something that could help but honestly anything just makes the situation worse. Hang in there it goes away just have to tough it out. 

[Shep]

16 hours ago, Lauren90 said:

I’m not sure if I took any benzos in the month of October. Maybe a couple times in September? 

Nov 10- 4.5mg bromazepam

Nov 15- 3mg bromazepam 

Nov 18- 4.5mg bromazepam

Nov 23 -4.5mg bromazepam

Nov 28- 4.5mg bromazepam

Dec 1- 4.5mg bromazepam

Dec 4- 4.5mg bromazepam 

Dec 8- 4.5mg bromazepam 

Dec 10 - 2mg diazepam 6am (didn’t work) 4mg diazepam 12pm (worked a tiny bit) 6mg diazepam 5:30pm (worked a tiny bit)

Today Dec 11- nothing so far. 

 

Please work on your signature so you can include a line that states something like "Took bromazepam a couple times a week in Nov and Dec 2022 and diazepam on Dec 10, 2022" Please see:

 

How to Summarize Your Drug History in Your Signature

 

You can get more lines in your signature by removing the some of the narrative. Keeping up with your benzos is important, as these types of abrupt changes affect your nervous system. Please see:

 

Hypersensitivity and Kindling

 

16 hours ago, Lauren90 said:

Any thoughts on an updose on Sertraline? I

 

Please don't make any changes just yet, Lauren. Look at the number of changes you've made already by taking bromazepam and then adding in a day of diazepam. You need to hold and let your nervous system process these changes. Diazepam has a half-life of up to 200 hours (8 days), so it's going to take awhile for that drug to clear your system. 

 

16 hours ago, Lauren90 said:

As for the drinking yes I am still trying to abstain. It’s very hard.

 

When is the last time you had a drink? I would really encourage you to read the "hypersensitivity and kindling" link. Alcohol and benzos both affect the neurotransmitter GABA and you're setting yourself up for kindling. 

 

If you feel it would help to work with a trauma-informed therapist (someone who can't prescribed), please seek one out, if you don't already have one. Not drinking is very important to your recovery. 

 

You can do this, Lauren, but set up a long-term strategy for getting out of this chemical mess, not just daily tries at using benzos or alcohol to get through the day. You're still very young and have a shot at a great life off these drugs. 

[Lauren90]

10 hours ago, labrat15 said:

Yeh that's probably the best choice. I wish there was something that could help but honestly anything just makes the situation worse. Hang in there it goes away just have to tough it out. 

How long did you have akathisia for?

[labrat15]

It would last about 3 months. My last episode lasted only 2 months though. I’m getting random waves of restlessness with my current taper that last a couple hours but it hasn’t been anything like previous episodes. 

[Elaine5]

Hey, have cold showers helped with the akithetic feelings? What helps distract you? 
 

doyou have any other sorts of sensations along with the akithisia when you notice it’s bad? 
 

hope you’re doing a little bit better every day 

[Alice1]

On 12/11/2022 at 12:56 AM, Lauren90 said:

I thought I was getting better in Aug/sept but this wave is by far worse than any to date

 

Any idea what may have caused it ? For me chemicals exposure always throws me into a wave .

[Lauren90]

23 hours ago, ElaineBenes5 said:

Hey, have cold showers helped with the akithetic feelings? What helps distract you? 
 

doyou have any other sorts of sensations along with the akithisia when you notice it’s bad? 
 

hope you’re doing a little bit better every day 

So I guess cold showers help in the moment… other distraction that helps a lot is work. Some days I can’t concentrate enough to get through it but I try really hard because it really seems to help when I can be a functioning member of society. … and idk the akathisia sensation is pretty much just the sensation I deal with. An extremely uncomfortable inner tickle, restlessness, discomfort. And sometimes it burns. I feel like I have a ball of energy in my chest and throat and arms, sometimes even my vagina, that I can’t get rid of. I had a really trying three weeks to four weeks. Pretty much a total breakdown. I couldn’t keep it together. Because of this I have chosen to make a few changes to my regiment but will update on my thread once I know how the changes have affected me. For now I’m trying to limit outside influence on the decisions I have made with hopes I’ll get to a place where I can stabilise then share more publicly ❤️

[Lauren90]

3 hours ago, Alice1 said:

 

Any idea what may have caused it ? For me chemicals exposure always throws me into a wave .

I have no idea, stress and traveling. I had a lot going on and extreme stress is pretty much the common denominator when I get a bad flare. Then I feel like I get stuck in a loop that’s hard to get out of, until something my mind perceives as worse in the moment comes along and my mind focuses on another symptom. 

[Alice1]

On 12/30/2022 at 11:15 PM, Lauren90 said:

extreme stress

 

Bingo !!    JMO

[labrat15]

Hey @Lauren90 how are you feeling?

[Lauren90]

On 1/11/2023 at 1:22 PM, labrat15 said:

Hey @Lauren90 how are you feeling?

Hey! I’m doing alright. Definitely better than I was. Trying to keep calm. How are you?

[labrat15]

Nice good to hear. I have been really up and down. I'm getting waves so that's good but I'm biking a couple days a week now so hopefully the exercise will help out. It's slow which is frustrating but I'm trying to stay calm as well. 

[SertralineIssues29]

Hey @Lauren90 I see you went back on sertraline, I'm wondering how that's working out for you, I'm suffering alot of horrible symptoms now and really don't know what to do

 

SI xx 

[Lauren90]

On 4/13/2023 at 10:33 AM, SertralineIssues29 said:

Hey @Lauren90 I see you went back on sertraline, I'm wondering how that's working out for you, I'm suffering alot of horrible symptoms now and really don't know what to do

 

SI xx 

Hi, yes. I did. The akathisia was too much at one point. I need to update my signature but since this is a withdrawal website I wanted to wait. But for the sake of being honest and tracking my story… I ended up going on Ativan, benztropine, and upped my dose of Sertraline. Benztropine did nothing but give horrible side effects. I am off that now. Ativan helped me basically not get admitted to the psych ward and I am almost off of that. I went back to 100mg Sertraline. It didn't seem to make things worse, which is positive? I feel a little better overall. I still have windows and waves of akathisia (my worst symptom). I’m not sure if it’s helped the akathisia a ton, but I seem to be -dealing- better for the most part. At least for now. One day I will try to get off by micro, MICRO tapering, but I will not do that until I stabilize further. Protracted withdrawal threw me into a mental and physical space I can’t put into words. I’m doing all I can to stabilize now and to keep the akathisia at bay. I’m so sorry to hear you’re not doing well and I’m sorry I’m not a well of positivity but every day is not awful for me. I have akathisia most of the time but I have beautiful moments in the days, as well as miserable moments. I’m trying my best to just accept the circumstances. Ill have to check out your story. How long have you been on/off/tapering? What are your worst symptoms ? 
 

edit: I just saw your post about suicidal/homicidal ideation. Don’t do what I did and jump to a larger dose like me if the drug is what gave you those thoughts in the first place. I would not compare your situation to mine in this case. We are all so very different. And definitely listen to someone more experienced than I am, whether on this site or not. I don’t know what I’m doing, just like almost everyone here. I’m just doing the best I can with what I have. Again I am so sorry to hear of your struggles.

[Lauren90]

If you read my post history you’ll see I was struggling in December from akathisia for 7 months and it was only getting worse. As a result I decided to updose to 100mg sertraline over a one months period, added benztropine (did nothing), and added Ativan (helped so much). I stopped benztropine (see signature for dates) and tapered the Ativan. I was still struggling with akathisia but things were getting better. I started transcendental meditation and I really felt things were looking up. But after three months there was just no change and I was still having mild akathisia all day. So I decided to take a chance and up my dose again to 125mg in May, about 3.5 weeks ago. The side effects were awful. Absolutely horrible. And then the akathisia came back stronger. I am not stabilizing. I take Ativan during emergencies which makes me want to at least live, but I feel so stuck. I have no idea what to do. I cannot live with this akathisia for the many many years it will take me to taper off of this. I couldn’t even taper faster than 3.5% without getting extreme restless body every night during my drops in the years prior. 
 

I know it’s not generally advised to updose. It was a Hail Mary. The akathisia was and is unbearable. I had to take off work in December and now I am applying for short term disability. This is a nightmare that I don’t know how to get out of. I know it’s not advisable that I changed my meds but I had to try something. I was wasting away. I tried to hold with no changes for 7 months. I lost twenty pounds in two months. Couldn’t stop moving. Couldn’t stop crying. 
 

Is it the “start up effects”? Is it the Sertraline? I was fine on Sertraline for twenty years. Only when I tapered were things so bad. And now updosing isn’t helping. What do I do? I can’t continue like this for years. I’m 32, I want a family. I want to feel comfortable sitting on the couch! I want to enjoy the beach!

 

i haven’t added it to my signature but in the past two weeks I tried gabapentin, didn’t work, and am not back on propranolol. Tbd if it helps. 

 

thank you for reading if you made it this far. 

[Shep]

On 12/11/2022 at 2:36 PM, Lauren90 said:

As for the drinking yes I am still trying to abstain. It’s very hard. I think I’m coming to the realization that I also have a problem with drinking to cope.

 

12 hours ago, Lauren90 said:

So I decided to take a chance and up my dose again to 125mg in May, about 3.5 weeks ago. The side effects were awful. Absolutely horrible. And then the akathisia came back stronger. I am not stabilizing. I take Ativan during emergencies which makes me want to at least live, but I feel so stuck. I have no idea what to do.

 

12 hours ago, Lauren90 said:

i haven’t added it to my signature but in the past two weeks I tried gabapentin, didn’t work, and am not back on propranolol. Tbd if it helps. 

 

@Lauren90 You've mentioned alcohol being a problem. When is the last time you're had a drink? Have you reached out to a trauma-informed therapist and / or joined an AA program? 

 

Please note until you're able to stabilize on your drugs, we can't help you taper. You're still adding in more drugs. Please note we're not able to handle medication management here. Please work with your doctor. 

 

Once you have the alcohol issue resolved and you've been on the same cocktail of drugs for several months and feel stable, then please come back to the forum and we can help you set up a careful taper. 

[Lauren90]

My alcohol consumption was purely to numb the akathisia and distress.

 

no alcohol in months. 

[Lauren90]

Hello,

 

Just checking in here. I reduced my dosage to 112.5mg Sertraline on July 5 and things have calmed down, except now I’m left with an additional limb that has akathisia, my right leg. Before (for the last year) it was -mostly- just in my chest and my armpits. I’m constantly having to move this right leg. This happened after the updose. For this month I’ve already reduced about 10% to get to 112.5mg. I also reinstated a small dose of Ativan that I jumped from during the time of my updose. I want to get back to 100mg Sertraline first and foremost. Is it too risky to go ahead and drop down to 100? It’s obvious that the updose increased my akathisia and I want to get back to my baseline desperately. I didn’t notice any bad effects dropping from 125 to 112.5. I know these can be delayed though, as my akathisia was when I first got it so I don’t want to rock the boat. I’m just scared the longer I stay at this dose the more likely the extra restlessness will stick around. Signature has been updated.
 

My current med schedule:

 

9am- 112.5mg sertraline, 20mg propranolol, .03125mg Ativan, 50mg B6

 

6pm- 20mg propranolol, .03125mg Ativan, 400mg magnesium glycinate, coq10

[Shep]

12 hours ago, Lauren90 said:

I reduced my dosage to 112.5mg Sertraline on July 5 and things have calmed down, except now I’m left with an additional limb that has akathisia, my right leg. Before (for the last year) it was -mostly- just in my chest and my armpits. I’m constantly having to move this right leg. This happened after the updose. For this month I’ve already reduced about 10% to get to 112.5mg. I also reinstated a small dose of Ativan that I jumped from during the time of my updose. I want to get back to 100mg Sertraline first and foremost. Is it too risky to go ahead and drop down to 100? It’s obvious that the updose increased my akathisia and I want to get back to my baseline desperately. I didn’t notice any bad effects dropping from 125 to 112.5.

 

When did you add the Ativan back in? Was that back in May? Please add the date to your signature. 

 

From your signature, it looks like you added in propranolol at the same time you updosed the Sertraline. Some of your symptoms may be drug interactions because you're taking all of them at the same time.

 

Drug Interaction Report - sertraline, propranolol, and ativan

 

I wouldn't drop from 112.5 mg down to 100 mg because that's an 11.12% decrease, higher than the 10% per month reduction (based on the prior month's dose) that we recommend. And how much of your symptoms are due to the sertraline updose and how much are due to adding in other drugs is unknown. 

 

You may want to separate your drugs out so you're not taking them at the same time of the day, which increases the likely of drug interactions. You would do this by moving them at least 2 hours apart. The best way to do this is to only move them one hour per day, so it will take two days to get them 2 hours apart. 

 

I would try that first before making any reductions. 

 

[Lauren90]

On 7/25/2023 at 3:31 AM, Shep said:

 

When did you add the Ativan back in? Was that back in May? Please add the date to your signature. 
 

Yes, I jumped off of .025mg Ativan and almost immediately added it back at a higher dose because of my bad reaction to Sertraline updose. When akathisia flares to severe levels it’s the only thing that keeps me from the hospital. I did a very quick taper and am now back to .0125mg morning and .0125mg evening again. Once I get back to 100mg Sertraline I will jump from the Ativan. I will add this to my signature. 

 

From your signature, it looks like you added in propranolol at the same time you updosed the Sertraline. Some of your symptoms may be drug interactions because you're taking all of them at the same time.

propranolol was added about 3 weeks after the updose. If anything it helped my adrenaline surges in the morning which in turn helped my akathisia a bit. I moved my doses two hours apart and no change to report. I feel exactly the same. 

 

Drug Interaction Report - sertraline, propranolol, and ativan

 

I wouldn't drop from 112.5 mg down to 100 mg because that's an 11.12% decrease, higher than the 10% per month reduction (based on the prior month's dose) that we recommend. And how much of your symptoms are due to the sertraline updose and how much are due to adding in other drugs is unknown. 

I only started to feel better when I added Ativan back, added propranolol, and decreased Sertraline. 

 

You may want to separate your drugs out so you're not taking them at the same time of the day, which increases the likely of drug interactions. You would do this by moving them at least 2 hours apart. The best way to do this is to only move them one hour per day, so it will take two days to get them 2 hours apart. 

 

I would try that first before making any reductions. 
 

Noted, Shep! I did indeed do this and no noticeable change to report. My akathisia is not yet back to what I considered my “baseline” that I felt at 100mg, which was horrible but livable, so after a month of holding at 112.5 (from 125), I have reduced to 106.25mg. I did this 3 days ago. No significant issues yet, but that was never the case with me anyways. All of my major issues with DECREASING doses came many months after. 
 

I am now 16 months into my akathisia journey and if I could just get this symptom to go away I could function better. Withdrawal akathisia makes no sense to me. I mean, it does to an extent but when reinstatement doesn’t work, that’s what’s so confusing. Well, my reinstatement to 100mg from 50mg stopped my last crisis, but my next updose to 125mg was horrific. I am wondering if, even though larger doses of Ativan seem to help in the moment, by still being on this small dose, tapering it, if it is keeping the akathisia alive. Either way, my plan is, and let me know if you agree, to get to 100mg Sertraline in the next month/month and a half. After I am back at 100mg Sertraline, if I’m not feeling any additional symptoms, I will then jump from Ativan. After that I will slowly reduce propranolol. Goal is to have one drug, sertraline, in my system and hold for a few months to see if I improve. (I held steady at 50mg sertraline only last year for 9 months but I was also drinking moderate amounts of alcohol and taking benzos as PRN.)

 

[Shep]

13 hours ago, Lauren90 said:

Either way, my plan is, and let me know if you agree, to get to 100mg Sertraline in the next month/month and a half. After I am back at 100mg Sertraline, if I’m not feeling any additional symptoms, I will then jump from Ativan. After that I will slowly reduce propranolol. Goal is to have one drug, sertraline, in my system and hold for a few months to see if I improve. (I held steady at 50mg sertraline only last year for 9 months but I was also drinking moderate amounts of alcohol and taking benzos as PRN.)

 

I would not go off Ativan while you are still on Sertraline. Please see:

 

Taking multiple psych drugs? Which drug to taper first?

 

Scroll down in the first post of that thread until you get to this part: "Benzos are addicting! Why not quit the benzo first?"

 

I would come all the way off the sertraline before you reduce the propranolol and the Ativan. You are especially in danger of kindling due to the off and on use of Ativan, as well as drinking alcohol. Please see:

 

Hypersensitivity and Kindling