Eera: sertraline - I need help

[Eera]

Hello!  I took sertraline for 5 months for panic attacks and insomnia caused by temazepam, which I have for sleep from very stupid doctors. Sertraline removed panic attacks and improved sleep, but caused constant tension and paranoia.I reduced the dose of 50 mg from May to the end of September, at the current dosage of 12.5, all this time I felt okay, small symptoms. At end of September I had to take the antibiotic clindamycin and diclofenac in suppositories, at the same time I reduced the dose (in grams from 0.047 to 0.037), after the completion of the antibiotic, anxiety increased, thoughts appeared  that I don’t want to live, but what’s the worst, terrible thoughts began to appear about how to harm the most beloved person in my life, just like that for no reason, I’m very afraid, I never thought that, I want to understand why these thoughts come  , I have no mental illnesses and never had, tell me, can a decrease in sertraline cause a desire to harm someone?  should I go back to 0.047 gr.  thanks everyone.

Please, can someone tell me if it’s ok? Will it gone? Did someone have had thinks like this.

 

 

10.2021 temazepam for 3 weeks KT

november all terrible symptoms 

12.2021 started sertraline ,from may 2022 until end of September decrease from 50 to 12,5(from 0,150 gr to 0,047)

6.09.2022 -13.09.2022 diclifenac

25.09-27.09 antibiotics clindamicin

28.09 decrease sertralin from 0,047 to 0,037.

 

Edited October 7, 2022 by Karma
Name update

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  You have come to the right place.  I will give you basic information, then address your concerns at the end.  

 

On 10/5/2022 at 2:41 AM, Eera said:

28.09 decrease sertralin from 0,047 to 0,037.

Can you please give us the dose in milligrams of active ingredient, instead of scale weight? This will be less confusing.  Thank you. 

 

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.  You did a 20% decrease, so this is probably why you are now having these dark and scary thoughts.  More on this later.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Sertraline

 

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

 

Are you having any other symptoms besides the dark thought of harming someone?  If it were me, I would wait a while before I did another dose reduction.  Wait until these symptoms reduce to a manageable level, and you feel reasonably stable.  I would wait until I was stable for 2-3 weeks before doing another reduction, and then I would not reduce by more than 10% of the current dose. 

 

Dark thoughts like this are a common part of withdrawal.  Please rest assured, these thoughts do not reflect who you are as a person. I totally understand, because I too have had lots of dark thoughts in my own withdrawal, and still have them from time to time.  The key to them, is to accept the thoughts as just a symptom of a brain that is struggling to adjust to getting off your psychiatric drugs.  Realize that you do not have to act on these thoughts.  It helps me to do a physical activity to distract myself from these thoughts, or to try to replace them with a different thought.  Here are some techniques that can really help you.  

 

Acknowledge Accept Float

 

 

APPLE Technique

 

I just came across a very nice technique that really helps me.  It's called APPLE. I have printed it and have it where I can see it every day and be reminded of it so I internalize this technique. 

 

A - Acknowledge Notice and acknowledge the thought or uncertainty as it comes to mind. 

 

P - Pause Don't react as you normally do.  Don't react at all.  Just pause and breathe.   

 

P - Pull Back Tell yourself this is just the thought or worry talking, and this apparent need for worry or analysis or certainty is not helpful and not necessary.  It is only a thought or feeling.  Don't believe everything you think.  Thoughts are not statements or facts.   

 

L - Let Go Let go of the thought or feeling.  It will pass.  You don't have to respond to it.  You might imagine the thought floating away in a bubble or cloud.   

 

E - Explore Explore the present moment, because right now, in this moment, you are OK.  Notice your breathing and the sensations of your breathing.  Notice the ground beneath you.  Look around and notice what you see, what you hear, what you can touch, what you can smell.  Right now.  Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the thought or worry, or do something else - mindfully - with your full attention.  

Edited October 7, 2022 by Karma
Name update

[Eera]

Hello! Thank you for answering, I will check all information, my symptoms, burning skin two hours after taking sertraline, excessive anxiety, crying, fear, they come in waves and go away, this didn’t happen before., more precisely, it was at the beginning of taking sertraline.  at the beginning of use, it caused a burning sensation in the skin of my neck and back, increased my panic, everything went away after a while and it started again after taking antibiotics.  Unfortunately, I don't know how to convert the scale to milligrams, my scales don't show this, 

[Eera]

I have very sensitive gaba system after benzo, and I know that this antibiotic decrease gaba, maybe that why I can not take Sertralin so easily as before 

[Eera]

I forgot to say that bad thoughts not so often anymore more

[Eera]

Maybe someone can explain to me how to calculate the weight 0,037 shown by the weights in mg

[Eera]

I also want to say that I noticed in morning I feel okay, I started to feel worse after taking Sertralin, sometimes after one hour or after two hours, it is always about same time .

[getofflex]

18 hours ago, Eera said:

Maybe someone can explain to me how to calculate the weight 0,037 shown by the weights in mg

Weight 7 of your whole pills.  Divide this number by 7, which gives you the average weight of one pill.  Let us know what this number is.  We'll take it from there.  

 

19 hours ago, Eera said:

my symptoms, burning skin two hours after taking sertraline, excessive anxiety, crying, fear, they come in waves and go away, this didn’t happen before., more precisely, it was at the beginning of taking sertraline.  at the beginning of use, it caused a burning sensation in the skin of my neck and back, increased my panic, everything went away after a while and it started again after taking antibiotics.

It sounds as though you may be having an adverse reaction to sertraline.  However, I still suggest you taper according to the 10% per month guideline, because withdrawal from too fast tapering is likely to be worse than this.  Here is some information on adverse reactions.  

 

Adverse Reaction

 

We need to try and figure out if this is withdrawal, or if it is an adverse reaction or possibly a combination of both. To see if there is an adverse reaction going on, please do a daily drug and symptoms journal.  Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

Antibiotics can often upset the nervous system, and aggravate withdrawal.  This is a thread where other members discuss their experiences of how antibiotics have affected their withdrawal.  

 

Antibiotics

 

I'll go ahead and put your drug history into your signature box for you, so it appears with each post, and the staff can help you.  

 

 

 

[Eera]

Hello! Thank you so much, for help, I made the measurements as you asked, so I have on 0,038.   I feel much better now, all bad symptoms are almost gone. But I still need some help and advice from you, Sertralin increase my prolactin and estrogen levels, I have a lot of gynaecology problems because of it, they are quite serious . I need to stop Sertralin soon it’s possible. How fast I can go? Is it 10% each two weeks are to fast? Thank you.

[getofflex]

On 10/11/2022 at 10:29 PM, Eera said:

I made the measurements as you asked, so I have on 0,038.

 

This still doesn't give us the average pill weight, this is just your current dose, I'm assuming.  It would be best if you would take an average of the pill weight, as they may not all be exactly the same, as I explained above. We need you to please express your dosage in milligrams of active ingredient, not pill weight.  Here is how to do that: 

 

1) Multiply the average weight of a whole pill in grams by 1000 to get the milligram weight.  We call this mgpw (milligrams pill weight) It's the physical weight of your pill, which includes the drug, plus fillers, coating, etc.

0,150 x 1000 = 150 mgpw 

 

2) Divide the drug strength of the whole pill by the weight of the pill in milligrams. 

50 divided by 150 = 0.333. This is the active ingredient concentration, or AIC.  

 

So the AIC for your drug sertraline is 0.333.  We will use this number to convert your pill weight to your drug dosage in milligrams. 

 

OK, lets do the math on your current dose now. 

 

First, convert your pill weight to milligrams.  

0,038 x 1000 = 38 mgpw. 

 

38 x .333 = 12.654 mgai. 

 

Round this number up to 12.7.  That is how much of the drug you are getting in your current dose. 

 

 

On 10/11/2022 at 10:29 PM, Eera said:

Sertralin increase my prolactin and estrogen levels, I have a lot of gynaecology problems because of it, they are quite serious . I need to stop Sertralin soon it’s possible. How fast I can go? Is it 10% each two weeks are to fast? Thank you.

What I would suggest is that you choose the lesser of two evils.  People who taper too fast run a significant risk of having severe withdrawal, to the point they cannot eat, cannot sleep, cannot work/go to school/care for their family.  Withdrawal can cause severe distress for a long time, and there is no cure for it but time,  and this can last for many months to years.  If solving your gynecological problems in worth this, you could go faster, but if it were me, I would choose to still taper at the 10% per month rule.  Ultimately, it is your decision to make.  

 

Edited October 13, 2022 by getofflex

[Eera]

Well today I woke up, and fill much worse, maybe it was to early, to think that I am okay, so I will make some notes during this day about how I feel and will post it tomorrow.Hope that everyone has a good day today!

[getofflex]

Windows and Waves Pattern of Stabilization

[Eera]

Thank you for link. I think, that I messed with my pils from yesterday, I took yesterday 0,034 g and today 0,037, I already ordered a new scales from amazon. Can it’s be a reason? 

[Eera]

Hey!Thank you so much for help and support! I completely forgot to add that together with Sertralin I have had  quetiapine for two months 25 mg, for sleeping. I have some notes from tomorrow 

6 am small anxiety, but manageable 

9 am Sertralin 

10:30 anxiety, jumping through, sadness, irritation all this symptoms increase and only 13.00 they go down.

13-16 almost ok, but some jumping through and small anxiety 

16 pm-19pm red face, burning skin, burning chest, fear, crying., paranoia 

19pm no symptoms, all gone .

 

7 pils are together 1063

1 pil is 151,85

My scales are so bad, I will receive new for Amazon at Tuesday.

 I really don’t know which dose should I take today? I definitely can not go fast, thank you for advice. I am thinking is it better for me 5% per two weeks or 10 % per month ? Maybe you have some advice? 

I would like to ask you, why during all this time, since I started to use Sertralin I have some paranoia, I never have this before. Is this something about dopamine? I really want to find some explanation, I am afraid that it will never gone.

[getofflex]

On 10/13/2022 at 10:05 AM, Eera said:

I think, that I messed with my pils from yesterday, I took yesterday 0,034 g and today 0,037, I already ordered a new scales from amazon. Can it’s be a reason? 

Yes, varying your dose can definitely cause worsened symptoms.  It's important to be as consistent with your dose as you can, and stick to the same exact dose each day. 

 

I'm not feeling well, and I'm traveling tomorrow, so I will notify the other staff of your concerns.  

[getofflex]

15 hours ago, Eera said:

I completely forgot to add that together with Sertralin I have had  quetiapine for two months 25 mg, for sleeping.

I need you to add this information to your signature box - it's important for the staff to know all your medications to advise your properly.  Please give the dates your started it, and if you are still taking this.  

 

15 hours ago, Eera said:

 I really don’t know which dose should I take today?

 

I would take the 0,037 dose, as this is what you have been taking since September 28.  Stick with this for a few weeks or longer, until you get stabilized for a couple of weeks before reducing again. 

[Eera]

Thank you so much! I hope you get better soon!!!!!!! I have been using quetiapin from begin of December 2021 until end of January 2022, 25 mg. Since then no more. Can anyone give me some advice how to weigh small doses, to get exact dose( I have right now 11.8 mg) my scale’s always jump. I think that why I have some problems. 

[Altostrata]

I'm confused. What times o'clock do you take your drugs, with their dosages in milligrams of active ingredient?

[Eera]

Hey! Thank you for answering, I take a drug’s always 9 am, now my dose is 11,8 mg. 

[Eera]

I take same dose since 28.09 , I really try to cut and take same dose but my scales jump all the time. Sometimes it’s take 1 hour to weigh 1 pill. I  notice some symptoms after 1,5-2 hours when I take drugs. It start to be like this after antibiotics, same problems I have in the beginning, when I started to take Sertralin. Some notes from yesterday 

6.am small anxiety

9 am sertraline

11:00 apathy, depression, anger, jumping through, paranoia, fear.

13-16 feel better

16-19:00 apathy, fear, jumping through 

after 19:00 feel much better

I also started to have reactions on food, after taking antibiotics, so now I’m on antihistamin diet. I don’t drink coffee and alcohol more than 1 year. During all this year since I started to take drugs I have two sides effects from Sertralin jumping through and some paranoia, I never had this before. It is really scares me, that why I start to decrease drugs in may, I knew , that I can’t stop it KT. I hope I was not wrong, because this poison now so long in my system. And I need about 1 year more to stop it. And all this time drugs continue to affect on my brain. I hope that it will go away. I hope it won't be like this all my life.

  

 

 

[Eera]

I also trying to find some information about how many %of receptors block my current dose 11,8 mg, but I can’t find anything, maybe someone can help me with this.Thank you.

[Altostrata]

Why don't you use a liquid form of sertraline to taper? You'd be able to measure it more precisely. See Tips for tapering off sertraline (Zoloft)

[Eera]

Hey! thank you for the advice, but unfortunately there is no liquid Sertraline in the pharmacy at all, I have a new scale, they are much better, but of course in the future I will have to prepare liquid sertraline, but before that there is still a long time, I decided to keep for at least 1months my 11,8 mg, and then reduce by 1.5% per week and so for 4 weeks it is 6 %, then hold for another week, I hope I can handle it.  Do you think this is the right decision? 

[Eera]

I also kept a diary for two days

7am - anxiety,

8am better,

9am sertraline,

10:30am anxiety, racing thoughts, aggressive thoughts, fear,

11:30am symptoms subside.

 12-15 almost normal, quite a bit of anxiety and obsessive thoughts,

15:30 anxiety, racing thoughts, apathy, sadness cry,

17 better., but some apathy.

 

the second day is almost the same

 

  Since I have been used antibiotics I have sometimes aggressive thoughts in the morning, but they go away on their own, maybe it’s because I reduced the dose of medication on 20% in September . I'm trying to figure out if I'm having Sertralin side effects or withdrawal symptoms. What do you think?

[Eera]

I am very upset by my aggressive thoughts about relatives, they come and go during this 3 weeks, I understand that this is partly my fault, the dose reduction was significant plus antibiotics, but can you please give me some advice , is it better in this situation to wait on a stable dose 11,8 mg, that these thoughts  will go away or may return to the previous dose of 15.4 mg.  ?

[Altostrata]

When have you taken antibiotics recently? Please do not change your sertraline dose while you may have adverse effects of antibiotics.

 

If you read Tips for tapering off sertraline (Zoloft) you will see ways to make your own liquid.

[Eera]

Hey! I have take them 26.09.2022-28.09.2022, three days. clindamycin.

I also use diclofenac from 12.09 until 18.09, after diclofenac I started to have more anger and and tension and more racing thoughts. But the worst start after clindamycin.

Thank you for advice . I will keep my dose 11,8. What in your opinion will be the sign, that I can start tapering again?

[Eera]

I have notes that I put wrong date  when i last time reduced sertraline from 15,4mg to 11,8 mg, correct date is 20.09, not 28.09. 

[Altostrata]

Suggest you taper again when odd feelings have gone away and you're getting good, regular sleep.

[Eera]

By odd feelings you mean aggressive thoughts? Or all bad symptoms?

[Altostrata]

By odd feelings, I mean those feelings that you don't ordinarily have and that started when you decreased sertraline.

[Eera]

Thank you for the clarification, I'm following your advice and will keep the dose until significant improvements.  At the moment, aggressive thoughts began to come very often, began to cause mini panic attacks, the thought that I was experiencing such feelings and the fear that sertraline did this to my brain triggers these attacks.  I would like to ask your opinion, why exactly such thoughts about harming others  come up, has this caused last 20%dose reduction. I am very afraid that they will not gone and my brain will get stuck in this, I cry because of this all the time.  could sertraline damage brain chemistry so much? maybe someone had a similar experience?  although it’s probably difficult to write about it, it would help me a lot if I understood that it happens, but it will go away. thank you, have a nice day!!!!  I apologize for my English, I write through a translator.

[Eera]

I just want to know that it’s happens with this drugs, but it will gone .

[Altostrata]

Very often, those types of exaggerated feelings are from your nervous system being upset by withdrawal. They tend to come in waves. Be like a surfer, surf the waves, ride them and let them pass. See

 

 

The Windows and Waves Pattern of Stabilization

 

Neuro-emotions

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Ways to cope with daily anxiety

 

Dealing With Emotional Spirals 

 

Deep emotional pain and crying spells, spontaneous weeping

 

Sudden fear, terror, panic, or anxiety from withdrawal

 

Coping with irritation, anger and rage

 

 

You should gradually feel better as your body gets used to the lower sertraline dosage. Please let us know how you're doing.

[Eera]

Thank you for your reply , it really help me. these thoughts are really like waves, sometimes they go away and I feel normal. I try to remember time when I feel like normal.

From the last one, unfortunately, I had evening waves of anxiety and crying , this has not happened for a long time, the last time this was in January, when I just started taking sertraline.  I still don’t change anything with the dosage, my new scale is much better, but sometimes when I weigh a pill there is a fluctuation between 0.037g (12ml) and 0.036 (11.7ml) I ask myself if it’s a big problem if the scales are wrong  and I take instead 12 mg, 11.7, is such a dose fluctuation 2,5% acceptable, or can it cause problems? 

[Altostrata]

Using a liquid enables more precise measurement. Otherwise, your best is all you can do.