hypnagogue: tapering sertraline after 10 years

[hypnagogue]

Hi, everyone. I just found this forum last night via links on Mad In The UK and Let's Talk Withdrawal. I've recently begun tapering sertraline after 10 years of use, and I hope that it will be mutually helpful for myself and others if I share my experiences here.

 

I'll try to summarize my personal mental health history with whatever information I think might be relevant. I've had depression, anxiety, and OCD-like symptoms beginning in childhood, possibly exacerbated by personal/family trauma. I saw my first therapist at age 7-8 when my parents divorced, and have been in and out of therapy for other reasons since about 14. Depression became severe around age 15, along with some disordered eating behaviors (I wasn't formally diagnosed with an ED until my 20s, but from the age of 16 onward was treated as though I had one--actually, I found my way here because this article resonated with some of my experiences in treatment and being pathologized). Many of the therapists I saw in my teens and twenties advised me to begin medication and would bring it up repeatedly against my wishes at the time. After my second year in college, my mental health became significantly worse and I had trust issues with my therapist at the time, who continued to insist that I needed medication and/or some form of institutional treatment. In 2008 I avoided being hospitalized for an eating disorder by cutting off contact with that therapist, but my GP diagnosed anorexia nervosa and prescribed sertraline because it was supposed to help with compulsive behaviors such as disordered eating and OCD. At the time, I did not get the prescription filled.

 

After I left college in 2009, my depression fluctuated but I had more severe anxiety than in the past. By 2012 I was having anxiety attacks almost every day that were interfering with my work and daily life. Doctor again prescribed sertraline, and I started taking it as a "last resort" because I felt suicidal and that I had nothing left to lose by trying it. I started at 50 mg and experienced some relief from the physical symptoms of anxiety, but I still worried constantly and had varying levels of depression. It also did absolutely nothing for OCD. :') After a few years on the sertraline, I felt that it wasn't working or wasn't necessary, and I also suspected that I might have some form of undiagnosed neurodivergence that was being covered up by the depression/anxiety/ED diagnoses. Around 2017 I began seeing a therapist at a practice that also required meeting with a psychiatrist every few months as a condition of continuing treatment. Said psychiatrist diagnosed ADHD and possible autism spectrum traits but did not prescribe anything for the ADHD; instead, he recommended increasing my dosage of sertraline from 50 to 75 and then to 100 mg a few months later. He also prescribed hydroxyzine PRN for anxiety attacks. Once again, any benefit of increasing the sertraline dosage was temporary or negligible/nonexistent. (The hydroxyzine seems to work by virtue of being a sedative, if nothing else.)

 

Starting around 2018-2019, I began having more acute depressive episodes that seemed to worsen with hormonal fluctuations; it was as though my SSRI "stopped working" for a few days/weeks every month and I experienced symptoms that were easily as bad as the withdrawal symptoms I got from skipping or missing a dose. For a while (2019-2020) I also had what I thought were moderate hypomanic episodes lasting a few weeks at a time, although this might have been how I interpreted having a more normative level of executive functioning/mood regulation as opposed to feeling fatigued and depressed as a baseline. ADHD and OCD-like symptoms also got progressively worse. In 2020 I asked my GP about ADHD treatment, and was prescribed Adderall (10 mg, increased to 15 mg later on). This was also around the time I decided to start tapering the sertraline. I went from 100 to 75 mg in 2021 without noticing much of a difference, but had severe depression/withdrawal effects at 50 mg and so remained at 75 for about a year. The hormonal exacerbation also got significantly worse--suicidal ideation, self harming behavior, increased anxiety, and paranoid/irrational/obsessive thoughts--to the point that I thought I might be having psychotic episodes. (I have a late maternal uncle who developed schizophrenia after recreational hallucinogen use, so there is some family history of being at risk.) In late August or early September of this year, I decided to resume tapering after missing a dose between refills; since I was already having withdrawal symptoms, I started taking 50 mg after my refill and just left it at that.

 

My current therapist referred me to another psychiatric practice to discuss medication management. During the appointment last week, they recommended tapering the sertraline from 50 to 25 for two weeks, and then to 12.5 before stopping entirely. However, they also prescribed a different SSRI (Luvox), which I do not want to take at all, as well as switching my ADHD medication from Adderall to Vyvanse. I'm not too concerned with the ADHD drugs right now; I think it might be easier to evaluate whether or not they're worth continuing after I get off the sertraline, but I don't know how to explain to my therapist and/or other health care providers that I don't want to start a different SSRI, without being seen as non-compliant.

 

tl;dr, as of this week I've gone from 50 to 25 mg on sertraline and I'm feeling pretty depressed/paranoid/anxious, but I think it's manageable if there's a possibility of it getting better after this. Sorry if any of the above is rambling or otherwise unclear. I'm still lurking on the rest of the forum while posting this, so please let me know if I've made any mistakes or left anything out. Thank you.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  I'm glad you found us.  I'll give you some basic information about these drugs and how to taper, then some suggestions at the end. 

 

On 10/6/2022 at 11:22 AM, hypnagogue said:

as of this week I've gone from 50 to 25 mg on sertraline and I'm feeling pretty depressed/paranoid/anxious

It sounds as if you are experiencing withdrawal symptoms from doing too big of a reduction of your sertraline. 

 

Can you please give us more specifics in your drug history about when in September and October you reduced to 50 mg, then to 25 mg sertraline?  Thank you. 

 

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

 

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

 

My suggestion to you would be to hold for a while on your current 25 mg dose of sertraline. Please take this precise dose every day, don't miss a dose, and take it at the same time each day.  If you do this, your nervous system will gradually settle down, and these symptoms should reduce.  You may experience some windows and waves while your nervous system is stabilizing.  I would give it a few months.  When you feel stable for a couple of weeks, then do another reduction, but only do 10%.  The link above about tapering sertraline will explain exactly how to measure the nonstandard doses.  Your next reduction should be to 2.25 mg.  It is especially important to taper very slowly and carefully at the lower doses.  

 

Please let us know how you are doing.  

[hypnagogue]

Thank you so much for the welcome, and for the additional information! I'm really glad to have found this community when I did, as I've had a hard time obtaining specific guidance elsewhere.

  

1 hour ago, getofflex said:

It sounds as if you are experiencing withdrawal symptoms from doing too big of a reduction of your sertraline. 

 

Can you please give us more specifics in your drug history about when in September and October you reduced to 50 mg, then to 25 mg sertraline?  Thank you. 

 

I agree. I thought the drop from 50 to 25 as prescribed seemed very abrupt, and I'm not sure whether that's due to the psychiatrist wanting me to switch to Luvox (which I don't want to do) immediately after getting off sertraline. I do have both 50 mg and 25 mg pills and a pill cutter, so I can resume tapering by 10% in a few months if it seems safe to do so. I went from 75 to 50 about a month ago, on or around September 8, and to 25 this past Monday (October 3), which would be a little over 3 weeks between tapers?

 

So this week has been a little rough, and I'm going to try to take more detailed notes going forward, but I did notice something like a window towards the end of the week, where I was feeling better and more functional for most of the day. Other symptoms I've observed are more obsessive anxiety than usual, possibly more intense compulsions/BFRB (e.g. dermatillomania, which I've had pretty consistently since I was about 4 or 5 years old), and some disturbing dreams involving mutilation and torture. My home life is pretty stable, but I've been more volatile and irritable for a while and my spouse is worried. He has been pretty supportive of me getting off of the drugs and has encouraged me to do so, but I'm concerned that my behavior in the meantime is putting a strain on our relationship.

 

1 hour ago, getofflex said:

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

Re: GI symptoms, I've had IBS for some time, but recently (within the past two months or so) I've been experiencing something like early satiety or indigestion--feeling uncomfortably "full" after eating or drinking a normal amount. I'm not sure if that's a common side effect in withdrawal or if it's more likely to be due to something else.

 

I've started taking a fish oil supplement and will stick with the 25 mg of sertraline until I feel more stable and can reevaluate from there. Thank you again!

[getofflex]

4 hours ago, hypnagogue said:

psychiatrist wanting me to switch to Luvox (which I don't want to do)

Is your goal to get off of psych meds?  If so, you may have to start taking psychiatrists desires and prescriptions with a huge grain of salt, as they are trained and programmed to give people drugs.  To be honest, I've seen many people here switch drugs, and it often creates lots of problems for them in terms of hypersensitivity, adverse reactions to the drugs, nervous system destabilization, ect. equating to very uncomfortable withdrawal type symptoms.  

 

Please read the link about tapering sertraline I gave you above.  You will need to be able to measure non standard doses in order to reduce by 10%.  This link will explain ways to do this, which usually involve either grinding tablets into a powder and weighing this, or making or getting a liquid.  I think the liquid is the easiest route.  

 

Magnesium can help with anxiety, so consider giving that a try.  See the link on magnesium in my first post.  

[hypnagogue]

On 10/9/2022 at 7:14 PM, getofflex said:

Is your goal to get off of psych meds?  If so, you may have to start taking psychiatrists desires and prescriptions with a huge grain of salt, as they are trained and programmed to give people drugs.  To be honest, I've seen many people here switch drugs, and it often creates lots of problems for them in terms of hypersensitivity, adverse reactions to the drugs, nervous system destabilization, ect. equating to very uncomfortable withdrawal type symptoms.  

 

Yes, I'd like to stop using SSRIs altogether. During the psych eval I thought I was being relatively clear about that, but I'm bad at verbal communication and I'm somewhat used to having health care professionals talk over me, so I may not have been assertive enough or articulated it very well. I would rather not switch to Luvox for the reasons you've mentioned, and because it seems like the side effects could potentially be worse than the side effects I got from the sertraline, which have been pretty minor other than the withdrawal symptoms. (I also did some googling after the appointment and saw that Luvox was taken off the market for a while in the US. I don't know how reputable that source is, though.) All in all, I'd really just rather not open a new can of brain worms while I'm trying to crawl out of this one. 😐

 

Thank you for the tapering advice. Since I have a lot of pills left, I was thinking about getting a pill crusher and a milligram scale and starting with that, and if I'm still tapering after I run out of those I'll see if I can convince the powers that be to prescribe the liquid version, or try to make it from the pills. I'm reading the thread on magnesium supplementation now, too.

 

General observations starting my second week on 25 mg: mood has been low/volatile, possibly better in the morning since that's when I take most of my medications and supplements. Really bad wave (crying, obsessive paranoid thoughts, irritability) last night after an otherwise uneventful family visit. Feels like my "baseline" these days is depressed/low self worth + paranoid anxiety and mistrust of institutions + constant feeling of impending doom (none of this is new for me, just exacerbated by the combination of withdrawal and current events). I did get to talk to my spouse about it and he's still worried but wants to be supportive. (We don't have kids, btw, but we do have a pet. I haven't been able to work away from home for a few years, and I have a very part time remote job but my ability to focus is limited, so most of my responsibilities involve household stuff.)

 

Dietary/GI issues have been really distracting. I have no idea whether they're due to withdrawal or something else, but the indigestion/early satiety I mentioned previously did seem to get worse with tapering. I also have low blood sugar, but dread eating regularly because of sensory issues with food and possibly reduced appetite from the ADHD drugs, and feeling full/sick even on an empty stomach or after drinking a small amount of water or coffee is making that even worse. Sticking to a few "safe" foods and things with an inoffensive consistency (protein bars, etc) is probably not super healthy but it seems to help, for now.

 

I should also note that I switched to Vyvanse from Adderall over the weekend--not an ideal time to be messing with my ADHD prescription but I had very little of the Adderall left and it's always a circus trying to get it filled because it's a controlled substance. I don't notice much of a difference with the Vyvanse yet.

 

ETA, this is probably not news to anyone here but courtesy of google recommendations I found this article last night.

[getofflex]

4 hours ago, hypnagogue said:

I'm somewhat used to having health care professionals talk over me, so I may not have been assertive enough or articulated it very well.

Please try not to blame yourself.  Most of us have been manipulated and overpowered by the will of health care professionals, and there is a build in power imbalance in the relationship between a doctor and the patient.  Many doctors are arrogant, and do not care about their patients needs.  Many of us, myself included, believe that the mental health care system is inherently abusive and toxic.  Read Shep's story here; 

 

Shep's Success Leaving Plato's Cave

 

Here is one quote from the above: 

 

On 5/25/2020 at 9:48 AM, Shep said:

Psychiatry is about power and politics, not medicine.

 

4 hours ago, hypnagogue said:

I did get to talk to my spouse about it and he's still worried but wants to be supportive.

I'm glad to hear that you have support from your spouse.  This is very helpful.  It may help both of you to read some of the success stories on this forum: 

 

Success Stories

 

4 hours ago, hypnagogue said:

Dietary/GI issues have been really distracting. I have no idea whether they're due to withdrawal or something else

 

They may very well be from withdrawal.  This is a common withdrawal symptom.  Here is a link to search results about this symptom: 

 

Search Results for "Appetite"

 

4 hours ago, hypnagogue said:

I should also note that I switched to Vyvanse from Adderall over the weekend

 

I see.  Hopefully, this will not pose any major issues.  Let us know how this goes.  

 

[hypnagogue]

So, it's been about 6 months since my last post here and I've been struggling a bit. I'm currently off sertraline but I'm pretty sure I tapered too fast (two weeks at 25 mg, two weeks at 12.5 and then nothing) because my psychiatrist was pressuring me to switch to Luvox (I didn't) and I thought I could handle the withdrawal I was having in the short term. I also stopped taking Adderall and/or Vyvanse around the same time.

 

My last dose of sertraline was on October 31, 2022, and for the rest of the year my mood was pretty stable, about average levels of depression and anxiety for what I was used to. Then around the end of December I had a really bad anxiety attack, like the ones I used to have before I started taking the sertraline, and that seems to have destabilized something because I've been having pretty unbearable anxiety ever since. At first the anxiety was cyclical and I thought it was related to PMDD/PME, which I also had while I was still on the sertraline, so I tried going on hormonal birth control (ethinyl estradiol and norethindrone) in February. I had never been on birth control before and had to stop after two weeks because it gave me the worst depression and anxiety I think I've ever felt--I can only really describe it as a nervous breakdown. I finally stopped taking the birth control after I had an anxiety attack that lasted more than 6 hours. Since then, I've only been taking hydroxyzine to manage some of the anxiety (along with supplements, which I'll get to in a minute).

 

That was in the beginning of March, and for the last month and a half I've been trying to recover from whatever that breakdown/episode was. I've been able to control the depression with exercise (running about 5 km daily, among other things) and nutrition/supplements, but the anxiety has been very difficult. It keeps getting triggered by my OCD, which I also had the entire time I was on the sertraline but the obsessive thinking has been more intense since I stopped. I'll be starting CBT/ERP specifically for the OCD this week, but I'm concerned that I may not even be able to do the therapy work if my anxiety is too high to manage.

 

I've also cut out caffeine and alcohol almost completely (I'll have one cup of decaffeinated coffee every few days and that's about it) because I found that they were making the anxiety and mood swings worse. After rereading this article, I'm wondering if it has something to do with hyper-reactivity or neurological kindling and if I've permanently destroyed my tolerance for any kind of psychoactive substance. (Supplements and hydroxyzine don't seem to produce the same reaction, though, so maybe it's just certain substances that I can't tolerate right now.)

 

The tl;dr of all this is that in retrospect I'm pretty sure I tapered too fast and broke something. A friend of mine went through a similar fast taper of sertraline a few years ago with almost exactly the same timeline of withdrawal symptoms, so she went back on the sertraline and is now tapering more slowly. I'm terrified of going back on the medication and getting stuck or dependent on it, or going back to the depression, emotional numbness, and complete lack of executive function/motivation I had while I was taking it. I feel like I've already wasted 10 years of my life on this medication and damaged my nervous system to the point that I'll never be able to function again without it.

 

So at the moment, my options are:

1. Go back on the sertraline at a lower dose (my GP recommended starting back up at 50 mg) and taper again, more slowly.

2. Start a different SSRI (e.g., Luvox) or some other medication like trazodone or buspirone, stay on it while doing CBT/ERP until the anxiety and OCD symptoms improve, and then try to taper off that.

3. Continue as I have been, without SSRIs, using the hydroxyzine or similar medication as needed along with the therapy and lifestyle changes mentioned above, and hope that the long term withdrawal symptoms resolve.

 

I'm curious as to what others would recommend in this situation or if anyone else has had a similar experience.

 

I'll update my signature with my current medication and supplements after I post this.

[hypnagogue]

Another question: has anyone experienced withdrawal symptoms and/or other issues with hydroxyzine? I'm currently taking 15 mg of hydroxyzine HCL (Atarax) in 5 mg doses throughout the day, and 25 mg of hydroxyzine pamoate (Vistaril) before bed, but I've been using it consistently for about a month and it's not indicated for long-term use, so I'd like to taper off it at some point. Some days it helps and other times I feel like a zombie and can't concentrate. I assume it has to be tapered (despite medical literature saying it has "no withdrawal symptoms" ... sure ) because it has some SSRI-like and anticholinergic effects, and as I mentioned in the previous post, I seem to be having some reactivity/hypersensitivity to substances as a result of the sertraline withdrawal.

 

I have an appointment with a psychiatrist next month where I'm going to discuss all of this, but I'd like to hear from anyone with firsthand experience as my willingness to trust medical professionals with this sort of thing has been a bit damaged at this point. Basically, how fast/slowly do I have to taper to do it safely, what symptoms should I look for, and do I have to taper the HCL vs. PAM separately (I read that the pamoate version can cross the blood-brain barrier while the HCL can't)?

[hypnagogue]

Sorry for the multiple posts. I've been experiencing a lot of anxiety over my withdrawal symptoms and I'm concerned that anything I do to remedy it could potentially make it much worse. I'm almost certain that I've had some kindling as a result of stopping sertraline too quickly, and while the overall anxiety has become somewhat more manageable, I'm afraid of tapering the 40 mg hydroxyzine in case it causes my nervous system to destabilize even more. However, I really want to start getting off the hydroxyzine as I'm pretty sure it's causing or exacerbating some cognitive difficulties and I'm worried about long-term side effects.

 

I should also mention that I've had one appointment with a CBT/ERP therapist for OCD and I was told that I would have to be on an SSRI in order for the treatment to work. I got the feeling (though it wasn't stated outright) that my being allowed to receive therapy will be conditioned on my willingness to take an SSRI and/or that I may be threatened with hospitalization for noncompliance. I have received a similar ultimatum from therapists in the past (a few years prior to starting SSRIs) and it has always made me very uncomfortable. Currently, I have about a month to research my current condition and advocate for myself before my psychiatrist appointment, and I'm terrified that I'm going to be pressured into doing something that damages my health even more and makes it even harder to recover. If anyone has any sort of advice for this, I'd be so infinitely grateful. I can't trust health care professionals anymore and I'm not sure I can trust myself either.

[LostInCanada]

@hypnagogue welcome back after 6 months. Sorry you are having to deal with this. ❤️If a person tells you you have to be on a drug for their treatment to work then they must be pretty bad at their job. Basically they want to give you a chemical lobotomy so you are compliant and make them look successful? Sorry but you and I are both in this mess because of these same “professionals “.  Huge red flag if you are being intimidated or threatened. I personally would never go back to be put in a position of having my rights taken away. There are CBT links for free on many mental health sites. There are also books on Amazon you can order that are effective and do not require medication. I have taken group courses and used workbooks on my own. I like the workbooks but that is personal preference. As for your 3 choices…the moderators will advise. They have the knowledge and experience to really help you. They don’t get paid and there is no big pharma giving them kickbacks like the doctors get. Be patient and kind to yourself.

[LostInCanada]

@Carmie I see no one has responded to hypnagogue here. The original moderator is taking a break. I don't know if this appropriate protocol so my apologies in advance if it isn't. 

[Carmie]

Hi @hypnagogue

 

I’m sorry that you’re struggling so much. Yes, it certainly looks like you tapered too quickly. My CFS brain fog is really severe at the moment. I was just over on another thread, but I’m barely able to read now. I can only skim through briefly, but wanted to touch base. 
 

Yes, it certainly sounds like you’re going through withdrawals with the anxiety levels you have. If you did decide to reinstate the sertraline to try and help with withdrawals just start on a small dose, like 1mg or so. There’s no guarantee it will work, sometimes reinstatement can make things worse, but a lot of people on here have really benefited from it. You would have to make that choice yourself. The further away from when you went off the medication the less likely it is to work. 
 

I’ll come back over when my brain will allow me to think again, I can’t think to save my life at the moment. In the meantime please go over to the Symptoms and Self-Care section and have a look at the thread entitled: “About reinstating and stabilising to reduce withdrawal symptoms.” 
 

Sending hugs🤗

[hypnagogue]

Thank you both so much for the support. @Carmie, I'm so sorry you've been struggling with brain fog. I hope it improves for you soon, and I really appreciate your taking the time to advise. 🤗

 

4 hours ago, Carmie said:

The further away from when you went off the medication the less likely it is to work. 

 

That definitely comports with what I've read about reinstatement. At this point it's been almost 6 months since my last dose of sertraline, and my appointment with the psychiatrist isn't until next month, so I assume that trying to reinstate it even at a low dose could potentially do more harm than good. Currently the symptoms I'm experiencing are somewhat less severe than they were a few weeks ago and/or I'm more used to them--the only really distressing thing is the anxiety/OCD exacerbation and it's somewhat manageable with the hydroxyzine and supplements. As long as it stays manageable, I don't want to risk making it worse by introducing another substance.

 

I have some concerns about staying on the hydroxyzine long-term and that it might be harder to taper the longer I'm on it, but I've also read that it's a bad idea to start tapering anything while you're already destabilized/in withdrawal from something else, so I will probably have to wait until the sertraline withdrawal stabilizes before I do anything about the hydroxyzine. I'll ask the psychiatrist about that but it sounds like I'd have to taper that very slowly too, by no more than 5% of the previous dose monthly. I've used hydroxyzine sporadically in the past, but this is the first time I've been on a regular dose for more than a few weeks.

[manymoretodays]

hypnagogue,

We've got a new one in Success Stories who used Vistaril(hydroxyzine) a lot.

So here is a link to their story.  https://www.survivingantidepressants.org/topic/28787-cristal27-success-from-almost-10-years-of-psych-drugs/#comment-641111

 

It's not one of the usual things we would recommend ever.  And I don't know that your psychiatrist will say anything other than "you can just go off of it" .  I'll link you up to related topics on the antihistamines.

https://www.survivingantidepressants.org/topic/2352-antihistamines-for-withdrawal-insomnia-diphenhydramine-doxylamine-hydroxyzine/

https://www.survivingantidepressants.org/topic/505-allergies-sneezing-stuffed-up-nose-sinus-antihistamines-and-what-to-use-for-allergy-relief/

 

You'll have to read through each topic to find comments regarding Vistaril.  I know there are some regarding tapering of antihistamines, as well as mentioning that they can go paradoxical sometimes.......and wind up doing the opposite of what they are intended to do.  For now it helps calm you a bit?  And that's good but proceed carefully.

 

You are also on a stimulant?  Can you get your present stimulant drug dose clearer in your signature.......like is it Vyvanse or Adderall right now and the dose please?  I thought I read something in your narratives about switching stimulants from short acting to long acting or the opposite.  But then it reads like you came off them altogether in you signature.

Link to your signature for edits/updates

 

That is important information. 

 

Your Vyvanse or Adderall is a psychoactive drug too!

Please check interactions with your other additions.  Drugs.com

and then post a link to them or copy and share here in your Introduction......thank you

You might want to run one with sertraline too, just so you begin to get educated.  You don't want to risk any degree of serotonin syndrome.

If you have options I sure would not do therapy somewhere where they force you to be on an AD.  Lot's of online options and lot's of therapists out there.

 

Have you also considered asking your shrink to lower your stimulant dose if your symptoms are insomnia or over activation?  That's something they might understand.  Unlikely they'll be on board with WD.

 

And also:

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.  

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

Have a focused on what is going well day and make it good enough.

 

Best.  L, P, H, and G,

mmt

Edited April 20, 2023 by manymoretodays

[hypnagogue]

Thank you for the additional information on antihistamines! I remember briefly trying to self-medicate with Benadryl for a short time before I started sertraline, about 11 years ago. I had no idea what I was doing at the time but I was desperate for anything that would mitigate the anxiety attacks I was having at work. I haven't touched Benadryl since then, just hydroxyzine. Currently it doesn't seem to be disrupting my sleep but I do feel somewhat tired during the day. I started taking the 25 mg of hydroxyzine pamoate before bed specifically because I was waking up with intense cortisol surges (often with nightmares) almost every morning a few hours before my alarm would go off, but that seems to have lessened. I also take 15 mg of HCL for daytime anxiety in three 5 mg doses a few hours apart. I'm wondering which of those would be the best place to start tapering when I'm ready to do that.

 

And I apologize for wording it vaguely in my signature--I'm not currently on any stimulants, prescription or otherwise. (I can only tolerate a small amount of decaffeinated coffee a few times a week and I suspect even that might be making the anxiety worse.) I had been taking 10-15 mg of Adderall for a few years, and in 2022 a psychiatrist told me to switch to Vyvanse, which I tried very briefly and it didn't work at all. I think I went back to the Adderall for a few weeks and then stopped cold turkey around November 2022 because it didn't seem to be having any significant effect, other than maybe covering up some of the immediate withdrawal symptoms from the sertraline. Didn't notice any withdrawal from the Adderall but it may very well have contributed to the destabilization I experienced a few months afterward.

 

I have been taking fish oil and magnesium glycinate along with the other supplements listed in my signature. Lemon balm also seems to help a lot with the anxiety, although like the hydroxyzine it's also kind of sedating.

[manymoretodays]

Okay.  Thank you so much for clarifying that.

You've been rocking and rolling with stops and starts then too.

Do commune with cristal27 in Success Stories.

I think you both have the youth in common, as well as the Vistaril/atarax/hydroxyzine.

 

Good good on trying the magnesium and fish oil(omega 3's) too!!!

When the time comes you may be able to do and tolerate a faster taper down or even off the hydroxyzine's that you are on now.

I certainly would not increase the dose now.

 

Again thank you.  You ARE getting it.  Yes, you are.

 

And sending massive healing yesterday for you......it should be hitting right about now today!  🙂

[hypnagogue]

Thank you so much! I'm following/reading through cristal27's thread now.

 

As far as tapering the hydroxyzine, I found this re: tapering by about 10%-25% weekly(?): 

 Is that because it has a shorter half-life than the SSRIs? I would be inclined to start tapering by 10% of the previous dosage in that case. I'm afraid to rush it because I've read that stopping hydroxyzine CT can lead to psychosis, but staying on it for too long (>7.5 months) could cause tardive dyskinesia, so I guess when I'm ready to get off it I'd like to do that both as soon as possible and as safely as possible, which might be kind of a catch-22.

 

Would something like this be a reasonable taper? The math isn't exact and I don't have a lot of experience measuring precise doses (though I do have a milligram scale), so I'm not sure how precise it has to be in terms of tenths or hundredths of a milligram, but if I didn't mess this up it looks like I could get to 0.5 mg from 40 in about 10 months:

 

Maybe I should do the first week at 37.5 (or a 6.25% reduction) instead of jumping from 40 to 35? And I'm guessing I'd have to keep tapering for a while after the 40th week to get it closer to 0.0, but at what point do I stop altogether? I really messed it up with the sertraline, so I'm anxious not to make that mistake again.

[hypnagogue]

ETA: I'm looking through the tapering forum now and I realize that the answers to a lot of the above questions are probably already there, so I apologize for asking about stuff that's already been covered. Looks like there are better spreadsheets available than my attempt, so I'll have a look at those as well.

[LostInCanada]

@hypnagogue there is alot of info on here but it isn't easy to always find it when you need it. Glad you are getting the needed support. 

[Carmie]

How are you doing? @hypnagogue I was glad to hear that some of your symptoms aren’t as bad now. I see you’ve made a decision about not reinstating, yes, it’s more than likely that half a year out it probably wouldn’t work anyway. 
 

Keep us updated as to how you’re doing💛

[hypnagogue]

Thank you ❤️ I realize it's been a few months since I last posted here, and I apologize for the absence. I had what felt like a pretty good window between the end of April and early June, but in the last 2-3 weeks I seem to have relapsed very badly to the point where the depression and anxiety are as severe as they were when I first started having protracted withdrawal symptoms in February/March, if not even worse at this point. I was doing okay tapering off the hydroxyzine by about 2.5 mg a week, but I'm down to 15 mg now and I'm concerned that I may need to slow down or increase the dosage as the anxiety has returned.

 

I also had a menstrual cycle last week for the first time in about 3.5 months since I stopped taking birth control, and that (i.e. the PMS and aftermath) seems to have affected my mood and anxiety pretty disastrously. I noticed some worsening depression for a week or two during PMS, and about a day before the period, I started having anxiety and panic attacks that have been pretty much unrelenting for about a week now.

 

I've been seeing a therapist for OCD but have not been able to make much progress as the anxiety has been overwhelming at times. My therapist is now recommending an intensive outpatient program as well as starting a different SSRI. I saw a psychiatrist last month who recommended Prozac. Neither the therapist nor the psychiatrist is forcing me to take medication at this time, but I've begun to feel as though I have no other options. After a brief window of improvement, I feel as though I'm no longer able to function. The constant dread and hopelessness are hard to describe, but I'm sure others here will understand what I mean. I feel as if something is fundamentally broken in my mind; the world feels wrong. I'm afraid that trying another SSRI could potentially cause an adverse reaction and make these feelings worse, but I'm at a loss for what else to do. It's been about 8 or 9 months since I stopped the sertraline. Has anyone else here experienced any relief or improvement from starting another SSRI in this kind of time frame or is this something you would advise against?

 

I also wonder about people's experiences with tapering off Prozac--needless to say, I don't want to be stuck on it for 10 years like I was with the sertraline. But I wonder if using it "as prescribed" (i.e., for a year or two at most) would make tapering less of an ordeal or if I'd just be setting myself up for more suffering and prolonging the withdrawal even more.

[LostInCanada]

@hypnagogueyou are in protracted withdrawal from the sertaline. Another SSRI may mask some symptoms or make things worse. I tried to bridge with Prozac for the purpose of tapering. Not recommended and definitely not recommended trying another SSRI. 

[hypnagogue]

Thank you. I will address that with the psychiatrist, as my main concern is definitely that the Prozac could make my current withdrawal symptoms worse. They are already pretty unbearable as it is. Any recommendations on how to deal with extremely bad days/waves? I feel like I've been in nonstop fight or flight for >24 hours. Is there any climbing out of the black hole or do I just habituate to feeling awful until it passes (assuming it does, at some point)? I'm taking supplements, exercising, and trying to keep a consistent sleep schedule but it doesn't seem to have much bearing on how I feel. Not sure if messing with the current dosage of hydroxyzine would help either.

[LostInCanada]

@hypnagoguepsychiatrist believe what the drug companies tell them. They are not chemists. Their profession is based on prescribing these drugs. They get a cut for prescriptions. Withdrawal is not easy. Please read previous links given as well as supplements under self care and coping techniques. So sorry you are struggling.

[hypnagogue]

Thanks again.  I decided not to mess with trying Prozac or introducing any other new medication.  My psychiatrist never replied to my last inquiry so I didn't bother following up, which is probably for the better.  My therapist seems to be okay with me continuing without SSRIs for now, although she brings it up occasionally and thinks it would make my treatment "easier," but I think we've agreed to disagree.

 

The flare I was experiencing last time I posted seems to have been a pretty bad wave that lasted a couple of weeks, but overall symptoms have been tolerable since then.  Still pretty frequent anxiety spikes and AM cortisol a few times a week, but not as bad as it was a few months ago.  Some fatigue, but most days functional.

 

I've continued tapering the hydroxyzine by about 1.25-2.5 mg weekly, sometimes pausing the taper for a week or two if I notice a lot more anxiety after reducing the dosage. I'm at 10 mg now and considering switching from cutting the tablets to making a liquid solution since I'll presumably have to measure smaller amounts more precisely.  I'm wondering if anyone else has tapered hydroxyzine in a similar fashion (I searched the forums a while back but didn't see anything specific) and if I should stick to a hyperbolic 10% taper as is recommended with SSRIs or if it's safe to keep reducing by 1 or 2 mg for now.  I'd rather err on the side of caution but I also don't want side effects from long-term use of the hydroxyzine.

[modelarz71]

 How are your  stomach problems, is the feeling of fullness still after eating small meals? That's what I have and functional digestive disorders. All recently since WD . Will it get better or is it permanent?
 

[hypnagogue]

37 minutes ago, modelarz71 said:

 How are your  stomach problems, is the feeling of fullness still after eating small meals? That's what I have and functional digestive disorders. All recently since WD . Will it get better or is it permanent?
 

 

I didn't have that particular issue (feeling full after eating a small amount) for very long, although I get it occasionally when I'm having other GI issues.  I have had chronic IBS for 15+ years (starting from before I was on sertraline but it seemed to get worse over time and especially during withdrawal) so that may be part of it as well.  I believe I've read somewhere that SSRIs can kill off or otherwise disrupt the GI microbiome; you can find studies on this by doing a web search for "ssri effect on microbiome" if you're interested.  I've tried probiotics and various dietary changes but haven't really been able to stick to a low-FODMAP diet long enough to know if it helps (probiotics didn't have much of an effect for me, either on GI stuff or mood, unfortunately).  Anxiety can also make digestive problems worse, and to some extent vice versa.

[LostInCanada]

@hypnagogueglad you posted an update and that things are improving. I think 10% is probably a good rate since even then you sometimes feel an increase in anxiety. Better to err on the safe side. Happy for you. Just keep being kind to yourself.❤️

[hypnagogue]

I think I'm in a bad wave at the moment, unless it's something unrelated to withdrawal.  I had some (possibly seasonal) depression between late October of last year and January, the first few months of this year were pretty good/stable, but as of March/April I've been having some absolutely hideous mood swings with some of the worst depression I've ever had. At first I thought it was hormonal, like a PMDD/PME thing, as I've had those kinds of mood fluctuations in the past and the episodes in March and early April seemed to coincide with that. (Also because I briefly tried hormonal birth control for mood issues in Febuary 2023, which was a horrible mistake--I had what felt like a nervous breakdown and had to quit after two weeks--but that felt comparable to what I'm going through now, despite not having taken birth control since then. I think the BC may have actually triggered the other withdrawal symptoms I started experiencing around that time.)  But in April it was much worse, just endless crying for a week straight and then some random days afterward. It's very frustrating as I had been feeling better and noticing some pretty significant improvement, but these bad days/episodes just come out of nowhere and knock down whatever progress I feel like I was making.

 

I also realized I've had anehedonia pretty much throughout the entire withdrawal so far, and that isn't getting any better despite my overall mood and anxiety levels improving.  I used to draw and write and have various other interests but I just haven't been able to get excited about any of them or focus on one thing for very long since early 2023 when the withdrawal started. Writing is the most distressing for me now, as I've been making an effort at it but it feels like I lost the capacity to express complex ideas in words, like those parts of my brain just got vaporized or something. I have some works in progress I've been trying to get back to, but everything feels so heavy and forced. I'm a bit worried that I was only ever able to write coherently while I was on the SSRIs and that it was a state-dependent skill that's just gone now and I'll never get it back. I'm pretty despondent about it honestly. Even when I was on the medication(s), I was never really able to keep jobs for very long and never had a professional career because of my mental health, so my creative interests were where I derived a lot of my self-worth, and now those are inaccessible to me as well. I'm fortunate that my spouse and family have been very supportive, but the depression and uncontrollable mood swings make me feel as though I'm ungrateful to them and that my unhappiness is hurting them. There's a disconnect between my home life, which has been very good overall, and the fact that I just feel broken and empty inside.  I have two part-time remote jobs but they only amount to a few hours a week and I haven't been able to find any other work, so I'm kind of just stuck at home with no interests and very few activities and not a whole lot to keep me occupied and out of my head.

 

I've been having some insomnia on and off as well, since about last fall. It's not every night, and I keep a pretty consistent routine re: going to bed and getting up at the same time, but some nights I just can't turn my thoughts off and I'm sure the lack of sleep has influenced my mood to some extent. I suspect it may be due in part to tapering the hydroxyzine, which I've now stopped. My last dose was about 0.15 mg sometime in March. I don't know if stopping at that dose (instead of tapering for longer) had anything to do with the mood swings starting. I've tried lactium and a few other things for the insomnia--5-HTP, theanine, GABA supplements, magnesium, lemon balm, and valerian among others. None of them really seems to work consistently. Oddly enough I don't think I'm particularly sensitive or reactive to anything--I might as well be swallowing empty capsules for all the difference I notice. I wonder if there's something wrong with me that I'm just not able to metabolize or process anything.

 

Apologies if this was kind of a ramble.  I'd love any advice for dealing with the anhedonia and/or the mood fluctuations, if anyone has had experience with those.

 

 

[LostInCanada]

@hypnagogue could you please update your drug signature. Remove any supplements that you are not using. Are you drug free now? 

This is a good video on waves and windows.

https://youtu.be/KQtO6HXJfjw

 

[hypnagogue]

@LostInCanada Thank you for the video! That does help to put it in perspective. I liked the Rubik's Cube analogy, as I've definitely had experiences with changing symptoms over the past year or so.  For a while the anxiety/OCD-like symptoms were much worse, whereas now it's depression.

 

I just updated my signature to reflect when I stopped the hydroxyzine. I'm not currently taking any drugs other than 10 mg loratadine (Claritin) for allergies.

[LostInCanada]

The vitamin B's, D, NAC, theanine and 5 HTP can cause some issues. Does blood work show deficiency or inefficiency in B's or D? I know 5 HTP caused issues for me. It is a supplement that needs tapering if taken consistently for a couple months. 

[hypnagogue]

@LostInCanada Ah, thank you, I hadn't known that about the 5 HTP. I had some blood work done on Saturday but haven't received the lab results yet. I can update if/when I find out.

[hypnagogue]

I got my labs back a few weeks ago and they were (story of my life) pretty unremarkable, with one or two exceptions. B12 was actually really high (1958 pg/mL with a reference range of 200-1100 pg/mL), I assume because of supplementation, so I've cut back on that somewhat. The only other surprise was that I'm *checks notes* "compound heterozygous for the variants C677T and A1298C in the MTHFR gene," which supposedly affects folate metabolism and can be associated with mood disorders and ADHD, among other things. I doubt it's the root cause of all my problems but I guess it could be another piece of it.

 

Other than that, I've been thinking a lot about what I've gone through in the past year or so. It has now been a little over 18 months since I went off sertraline and Adderall and I do feel that I've improved overall from where I was last year. I wouldn't say I've recovered completely, because I don't even know what that would look like. I don't particularly have any desire to go back to the way I was before medication, because that person was kind of miserable (and also a 20-something who made a lot of bad life choices repeatedly) and I'd like to think I've matured since then (no thanks to the meds, but maybe in spite of them). I've had to do a lot more to take charge of my life in the past year than I did in the 10 or so years when I was medicated, so I feel like my overall circumstances are better than they were at any point previously, and certainly better than the last few years on meds when it felt like I was just coasting between being emotionally blank and having inexplicable, uncontrollable episodes of feeling awful. The waves and mood swings still suck but I feel like I have more insight into why they happen and I'm trying to take more responsibility for my moods and behavior even when they feel out of control.

 

Withdrawal has sucked and continues to suck and there's (almost) no one I'd wish this on, but I am learning a lot from it, and ironically I think it did what my past therapists told me medication would do (and didn't)--motivated me to be more proactive about improving myself.