Morgan: starting back on 25mg sertraline

[ChessieCat]

Reinstatement:  See Post #1 of this topic.  Note that SA recommends starting with a small dose and increasing by small amounts if needed.  The idea of reinstatement is to attempt to bring withdrawal symptoms to a bearable level.  It is generally better to aim for this and not try to find the "perfect dose" because you might end up taking too much and making things worse:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

"Therapeutic dose" is an arbitrary term which the pharmaceutical companies use and therefore doctors, which can be a much higher dose than SA would suggest for reinstatement.  SA prefers to think in terms of "lowest effective dose" which is what reinstatement aims for, the dose that works to bring the withdrawal to a tolerable level.

 

 

[Morgan]

It’s so hard finding how to change my signature each time I search for it. @Altostrata Sertraline: 2021: June 17, 50mg, 2022: February 14, 25mg, etc.

[Morgan]

@ChessieCatthank you for this explanation. 

[Morgan]

@ChessieCat @Altostrata in the post about reinstatement, it mentions sister drugs. Would Sertraline be considered a sister drug to Fluoxetine? If not, is there another? 

[Morgan]

@Altostrata re: adverse reaction. I reinstated the full 25mg per advise of a psychiatrist based in California. It exacerbated all of my symptoms and made my skin burn. Currently dealing what I believe is akathisia and acute insomnia. 

[ChessieCat]

15 minutes ago, Morgan said:

It’s so hard finding how to change my signature each time I search for it.

 

Account Settings – Create or Edit a signature

 

8 minutes ago, Morgan said:

in the post about reinstatement, it mentions sister drugs.

 

Citalopram is a gentler version of the drug escitalopram.  Lexapro / escitalopram can be very difficult to taper because it is very strong so if a person is reinstating after taking escitalopram they might change to citalopram.

 

Venlafaxine is another form of the drug desvenlafaxine.  Pristiq / desvenlafaxine is a difficult to taper because of the form that the drug comes in, only 25mg (not in Australia), 50mg and 100mg tablets which have a special matrix / glue to make them last 24 hours.  Instead of reinstating desvenlafaxine a person might reinstate venlafaxine which can be easier to get non standard doses and is also available in prescription liquid in some countries.

 

9 minutes ago, Morgan said:

Would Sertraline be considered a sister drug to Fluoxetine?

 

No, these are two completely different drugs.

 

Some people might decide to change to fluoxetine instead of restating the drug they had been taking.  And some people might try a Prozac bridge/switch if they are currently taking another drug.  However in both of these cases, there is no guarantee that it will work.  The person may get withdrawal symptoms from having stopped the first drug and/or they might get adverse/side effects from the new drugs and because there have been two changes at one it can be difficult to know what is causing any issues.

 

Please carefully and thoroughly read Post #1 of this topic which explains the risks involved with changing to fluoxetine, and much of the information is relevant to changing to any other psychiatric drug:

 

the-prozac-switch-or-bridging-with-fluoxetine

 

[Morgan]

@ChessieCatthank you for this info. My signature is updated. Does Sertraline have a sibling drug?

[Morgan]

@Altostrata@ChessieCat I’m going to try to reinstate a very very small does of Zoloft. After some research, it does not appear that Zoloft has a sibling drug. My original dose was 50mg. I was last on 25mg before things got very bad. I tried reinstating 25mg and it was not good. Do either of you have a suggestion for a very small dose to try again?

[Altostrata]

On 8/9/2022 at 6:26 PM, Morgan said:

No, hell broke loose it seemed when I tapered down on Zoloft. 

 

Did you feel well while you were taking 50mg sertraline from June 17, 2021 to February 13, 2022, before you started tapering it?

 

14 hours ago, Morgan said:

@Altostrata re: adverse reaction. I reinstated the full 25mg per advise of a psychiatrist based in California. It exacerbated all of my symptoms and made my skin burn. Currently dealing what I believe is akathisia and acute insomnia. 

 

As I understand it, you took 25mg Zoloft from July 31-August 5, then ??mg Celexa from August 10-14. Is that correct?

 

On 8/8/2022 at 7:05 AM, Morgan said:

....

I am now currently on Buspar and Klonipin. 

 

You're still taking Buspar and Klonopin? At what times o'clock do you take your drugs, with their dosages?

 

@Morgan what symptoms do you hope to address by adding Zoloft again?

[Morgan]

@Altostrata

 

I apologize for not replying to each individual question. I’m having some difficulties learning how to navigate this forum— it doesn’t help that I feel cognitively impaired much of the time. 
 

I am paralyzed with fear of doing the right or wrong thing; I am sure many folks stumbling upon this site in desperation can relate. 
 

I was advised by Dr. S to fully reinstate Sertraline at 25mg. I felt this exacerbated my symptoms and I stopped after about a week. I then checked myself into a psychiatric hospital where, of course, it was implied once again that I was having a “relapse”. One nurse went as far as saying that I fell into such a depression off of my antidepressant that I was beginning to have delusions. 
 

At this psychiatric hospital, I was prescribed new medications, one of which, the 1.5 mg of Klonipin, I have consistently taken since (understanding I will have to carefully, gradually taper later on). I take .5 around 9am and 1mg around 8pm. I am a parent of two small children trying very hard to function for them. 
 

It is hard to say if I felt completely well on the Zoloft as I was teaching at the time; it is an inherently stressful job. I’m not sure I ever felt completely well on any of these drugs. In hindsight, with Zoloft, I don’t believe I had any symptoms that impaired me. At the time, even having bought into the belief that these drugs help some people, I also subscribed to the belief that conventional medicine tends to medicalize our humanness and personalities and I would typically refuse up-dosing recommendations from doctors. 
 

To answer your question about what it is I’m trying to resolve: My most disabling symptoms are the inability to sleep and either chemical terror or akathisia (I am unsure which because both descriptions resonate with me although I have only had one short episode of feeling like I needed to constantly move— the unbearable terror is typically occurring at night). Because of this, I have recently taken a leave from my job. 

 

I will need to update my signature, again. Apologies for the frequent signature updates. I will also update my username for identity purposes. 
 

Thank you for your help and patience. 
 

 

[Morgan]

Question about the differences in SSRIs

 

I am just trying to understand: why does reinstatement need to be the same SSRI? Is it because of the chemical makeup? @ChessieCat

 

Edited August 17, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[ChessieCat]

Please do not create a new Introduction topic to ask a question.

[ChessieCat]

6 minutes ago, Morgan said:

I am just trying to understand: why does reinstatement need to be the same SSRI? Is it because of the chemical makeup?

 

I have already answered this question here:

 

On 8/16/2022 at 6:04 PM, ChessieCat said:

The person may get withdrawal symptoms from having stopped the first drug and/or they might get adverse/side effects from the new drugs and because there have been two changes at one it can be difficult to know what is causing any issues.

 

[Morgan]

@ChessieCatthis makes sense and thank you.

 

In theory, if someone was only on one SSRI and experiencing withdrawal, could they reinstate with another SSRI?

[ChessieCat]

You seem to asking the same questions.

 

  

On 10/9/2012 at 10:17 AM, Altostrata said:

You may be able to reinstate an equivalent drug. Some drugs are siblings, such as citalopram and escilatopram or venlafaxine and deslavenfaxine. Fluoxetine, which is arguably easier to taper than other SSRIs, may be substituted for SSRIs such as paroxetine or sertraline. (If you have had a prior adverse reaction to a drug, it may not be advisable as a substitute.)

 

[Morgan]

Forgive my brain fog @ChessieCat I’ve found my comprehension is quite impaired during withdrawal. 

 

So, one can reinstate, not just bridge, with fluoxetine when withdrawing from Sertraline. Is this correct? 

[ChessieCat]

I suggest that you read back through your topic and also the links you have been given.

[Altostrata]

@Morgan I'm sorry you are getting confused. The reason I'm asking about your drug history is because I'm trying to figure out what you should do for reinstatement, if reinstatement is indicated.

 

I've asked this question several times:

On 8/16/2022 at 3:04 PM, Altostrata said:

Did you feel well while you were taking 50mg sertraline from June 17, 2021 to February 13, 2022, before you started tapering it?

 

This would be your FIRST round of sertraline, not the 25mg reinstatement you attempted in July 2022.

 

On 8/8/2022 at 10:08 AM, Morgan said:

Klonipin 1mg/day, but really as needed. I know it is terrible but it has been the only way I can sleep and stay sane so far. 
 

Buspar 5mg. I have been taking this since Saturday (although I have taken this briefly in the past indicated in my med signature).

....

2 hours ago, Morgan said:

At this psychiatric hospital, I was prescribed new medications, one of which, the 1.5 mg of Klonipin, I have consistently taken since (understanding I will have to carefully, gradually taper later on). I take .5 around 9am and 1mg around 8pm.

 

At one point, the Klonopin helped you sleep, is that correct? When was that?

 

Why did you say you were taking 1mg Klonopin as needed per day on August 8, but you say you have been taking 1.5mg per day consistently since August 5? 

 

What effect do you feel from Buspar?

 

2 hours ago, Morgan said:

To answer your question about what it is I’m trying to resolve: My most disabling symptoms are the inability to sleep and either chemical terror or akathisia (I am unsure which because both descriptions resonate with me although I have only had one short episode of feeling like I needed to constantly move— the unbearable terror is typically occurring at night). Because of this, I have recently taken a leave from my job. 

 

I think the benzo might be the key to what's going on here, and reinstatement of an antidepressant is not needed.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Morgan]

On 50mg of Sertraline, I felt severe depersonalization/derealization, unfocused, unmotivated and, overall, fairly discontented in life relative to my 7 years on fluoxetine.

I was originally prescribed 1 mg of Klonipin in the psychiatric hospital, intending on taking it as a PRN, and my psychiatrist upped my dose to 1.5 mg at our first out patient appointment about a week afterwards, at which point, I’ve taken it consistently. For the first few days at the psychiatric hospital, taking 5 mg Buspar and 1 mg of Klonipin, I slept better with the concoction, but still not well (relatively speaking). After being released, I switched from Buspar to 5mg then 2.5 mg of Celexa and my sleep worsened (3-5.5 hours, broken, presumably some REM). I discontinued Celexa after about 4 or 5 days of using and my sleep worsened again (2-4, broken, presumably non-REM, with terror increasing between waking up). 

Prior to all of this, acute insomnia with days of not sleeping at all coupled with the hours-long of chemical terror/akathesia(?) is what led me to the psych ward and the Klonipin. I am no longer sleeping better with the Klonipin relative to when I took it at the hospital. I have (somewhat) educated myself on your literature @Altostrata and I am trying to become more disciplined in documenting my daily routine and stop med hopping out of this extreme discomfort. Documentation is challenging with small children and the overall terrible sleep/terror/anxiety withdrawals, but I have documented 4-5 days so far that are not nearly as precise as they need to be. I've reviewed your page on how to document and intend on buying an appointments diary to help with this. I've had a family member (retired nurse well-versed in conventional medicine) review your literature and she is not only convinced this is SSRI withdrawal, and believes all medical practitioners and patients should read it prior to taking psychotropics, but found your use of lamotrigine of particular interest-- is that ever suggested on here? I have printed your literature, with key points highlighted, to present to my sympathetic, patient-led psychiatrist tomorrow. Having acted hastily in desperation, I now dread being on a benzo as it doesn't feel as though it does much (perhaps that is an indicator of either tolerance or how uncomfortable this would be without depressing my CNS) and the need to taper this now (going on week 3 of use). I intend on discussing bridging Klonipin to Diazepam tomorrow using the Ashton model and possibly requesting a Fluoxetine script per your initial suggestion (starting 1 mg of Fluoxetine) with my psychiatrist. 
 

Quick question: how do I change my name on this site?

 

My diary so far: 

Fell asleep 11pm
4am Woke up anxious (broken sleep, jolted awake 2-3 times)

9am .5 Klonipin, .25 mg Celexa

8pm 1 mg Klonipin

Fell asleep 10:30

2am Woke up with overwhelming terror, dread, could not fall back asleep

9am .5 Kl

Terrible afternoon anxiety

8pm 1mg

Fell asleep 10pm

Jolted awake throughout the night, terror, anxiety, dread

Got out of bed at 4:30

9am .5 kl

Felt irritable

Felt better in afternoon

9:30pm 1mg kl

Fell asleep 10:30pm

Jolted awake throughout the night, terror, anxiety, dread

Got out of bed 4am

10am .5 kl

10:30pm 1 kl

Very restless throughout the day

Feel asleep 11:30pm

Jolted awake throughout the night, terror, anxiety, dread

Got out of bed at 3am

10am .5 kl

Terrible dread, cried, depression, suicidal ideation

Got better after talking with friend

9pm Buspar

10:30 1 kl

Feel asleep 11pm

Woke up 3-4 times feeling restless, but was able to fall back asleep

Got out of bed 4am

11:30am .5 kl, 5mg buspar

Somewhat restless throughout day, better than most days, became more anxious later afternoon

 

 

 

 

 

 

[Altostrata]

20 hours ago, Morgan said:

My diary so far: 

Fell asleep 11pm
4am Woke up anxious (broken sleep, jolted awake 2-3 times)

9am .5 Klonipin, .25 mg Celexa

 

Why did you take 0.25mg Celexa this once?

 

Please indicate the date of your notes. We cannot tell what day the events occurred.