Elisabet

[Elisabet]

Hi, I was on sertraline for around 9 years, due to anxiety. I have had anxiety as long as I can remember, tend to ruminate, but have lived with it and it has mostly worked alright. Some periods I have not had it at all, but it is usually there. It has been in a way that I have been able to work and function though. I had just moved countries at the time I started sertraline, had two little ones and started a new job I wasn't comfortable in. I had tried cbt but think in hindsight that the therapist was just not right for me. I do believe in cbt and has had great help from that later on. I also have pmt. Starting sertraline helped me, after maybe ten days of anxiety and restlessness, worse than anything I had ever experienced in my life. I have since then tried to stop at least a couple of times. Once alone (stupidly) and also with help from a gp. I failed though. I have experienced head "zaps", a pinching feeling behind my ears that I have noticed in terms of withdrawal, restlessness in my limbs, tension and an anxiety so extreme it has really been hard to deal with. In hindsight, I probably was my best when I was on 25 mg sertraline, a lot more energetic and happier than when I was on 50 mg. I have also experienced my ruminating problems but in such an exaggerated and extreme way. Not like how I remember it before sertraline. This last time I tapered very slowly for two years, and had a great doctor who supported me. Then I moved countries and met a gp who suggested we could switch the last, at that stage 12,5 mg of sertraline to fluoxetine. This was done but the dosage I was asked to take meant I got down to the equivalent of 6 mg of sertraline, so for me who had tapered slowly, 1-2 mg, 6 mg seemed like a lot. I reacted with extreme anxiety, compulsive thinking and pure dread, I did not recognise myself at all.

 

The doctor suggested to take out the fluoxetine as well, after I had been on it maybe 6 weeks. This was in the beginning of July this year. The first bad period lasted about a month with anxiety and my sleep was just not working. Then it got quite a bit better in August (although not a 100%). Then three weeks ago I started experiencing the same difficulties I had in July. Extreme feelings of guilt and ruminating, an anxiety that feels so much more physical than how I remember that it used to be before sertraline. It feels extreme and long lasting, few breaks. I also feel sad and down, crying a lot, every day, which has never, not before sertraline either, been typical for me. I do not recognise myself. I have had my anxiety before but overall been quite happy. I am in contact with the same gp and whilst I don't feel entirely comfortable with him, he is very engaged and he thinks it is withdrawal as well, which is very much my interpretation too. I have some medications to help me get through this. Physical symptoms have been the pinching feeling behind my ears, tension and a restlessness in my limbs. An overall mental sickness feeling that is hard to describe, like I am totally out of balance. I really want to get through this but I am finding it hard to not know how long it is going to last? The obsessive thinking is making everything so hard at the moment. They did help but never did I think I would be on them for years, it was never my intention. I wonder if anyone else has experienced something similar? Any idea how long it can last and what can help? I understand that getting on ssri again probably would help but it has now been so long that I wish I could manage to push through (but obviously there are limits at the same time.) I exercise and try to do things that are good for me but it is tough at the moment.

[manymoretodays]

Hi there Elisabet,

Welcome aboard.

Sounds like WD(withdrawal).  Not fun.

 

I did get a chance to read through your narrative, and now could you put some of those details into a signature format for us please:

See:

How to Summarize Your Drug History in Your Signature(click on the underlined passage and you'll find instructions on how to do this, and how to lay it out)

It is different from your "profile information" you gave on registration, and that is confidential.  And it will appear below each of your posts, once done, and give us all a nice idea of where you are at, your timelines with WD, and drug history.

 

I don't know if you have perused the site much as yet so I will give you some general information about WD and protracted WD syndrome today.

 

We go with a harm reduction plan for tapering off psychoactive drugs, which is explained here:

Why taper by 10% of my dosage?

 

Some of what happens when we come off of our drugs and what exactly is WD?  What do the symptoms look like?

Brain Remodelling

What is withdrawal syndrome?

 

Dr.Glenmullen’s withdrawal symptom list.

Your symptoms described do sound like WD, see what you think, when you look at the PDF of symptoms in that topic.

 

The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur. And sleep is really important during withdrawal. 

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) 

 

We also don't recommend other drugs to treat WD.

Some do respond to a small reinstatement of their drug, to mitigate WD symptoms, best done immediately when symptoms first occur.  And I'll give you the link to that topic to look at.  It doesn't sound like the Prozac(fluoxetine) did much for you, or it may have made you feel worse.  So clarify on that, when you do respond again, and let's get some dates to look at via your signature around the sertraline too.

About reinstating and stabilizing to reduce withdrawal symptoms

 

Many of us have had to learn many non-drug coping skills and practices to cope with symptoms of WD, or even some of our pre-existing symptoms.  There is a wealth of information in that regard in our:

Symptoms and Self Care Forum

and we can further guide you to finding things on the site that are helpful, for now just perhaps look at some of the top pinned topics there.  You will also see how the site is laid out from the Home page.

 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your WD or tapering, give updates, and just keep a record of your journey.  Communicate with us right here for now, on your Introduction page, while you get familiar with the site.  Just one Introduction per member please.

 

Welcome again.

Love, peace, healing, and growth,

manymoretodays(mmt)

Edited November 8, 2022 by manymoretodays
double link removed

[Elisabet]

Thank you for your reply, Manymoretodays,

I have looked at the links and am really thankful for the support. I am hoping it won't take too long to recover from this. I feel too like it is WD since it is so much more extreme than my original condition. It also started with an extreme tiredness, which in hindsight, I think was the beginning of it. Just before what I believe was the start of the second wave, I got a sore throat, nothing else at all, no cold, but I had that for a couple of days and then got a sudden and severe anxiety, like an actual illness but psychological. Hard to put it into words. Of course it is hard to know if the throat and the rest were connected. I don't have very many physical symtoms. It is the pinching  feeling behind the ears and still some restlessness/shakiness, mainly. Although the anxiety is very physical, more than I remember it being before ssri. It is almost like a nausea but psychological. I had a big outbreak of acne on my forehead, that lasted for a long time but that has calmed down. I had never had anything like that, it just went on and on for so long. I wish there was a way of knowing how long the psychological symtoms will continue, since they are quite hard to accept. It is hard to know if it is worth persevering rather than reinstating a small amount, when it has already been a few months. Also, the tricky thing is not knowing how long this will go on. I get a bit terrified when I read how people here describe severe withdrawal symptoms for very long periods of time. Last night I decided to try and not use any promethazin or betablockers for sleep. I will try and not use those so much and see how I go. Slept really well and did not even notice the difference! Luckily I have just started psychotherapy, which is already helpful. I will keep looking at the links and am thankful for any ideas anyone has on what could be helpful.

[manymoretodays]

Hi again Elisabet,

Good to hear that you ARE seeing Waves and Windows(I assume), as that's a good sign healing is happening.

It could also be that you did have a virus or something, and then that triggered a new Wave.  We see that happen with our now sensitive nervous systems.

And yes, you understand how sometimes some of the WD symptoms ARE so much more than what you had ever experienced in the way of fears/anxiety or despair/depression.  It's so crazy.

 

It sounds like you are really off to a good start, with a good prognosis for healing now.  We expect that you'd have variable symptoms in the months following the CT, and there really is a nice slow progression to your healing going on now as evidenced by windows and waves.

 

I love this:

And as long as you can function a bit during the healing process, it doesn't have to be a horrible experience.  Oftentimes......I know I did.......we get a chance to learn more about ourselves and our own innate capacity to heal, or bounce back(resilency), as well as all other types of things.  I mean maybe you'll get answers to your own existential questions eventually. 

 

On 11/9/2022 at 2:56 PM, Elisabet said:

Last night I decided to try and not use any promethazin or betablockers for sleep. I will try and not use those so much and see how I go. Slept really well and did not even notice the difference! Luckily I have just started psychotherapy, which is already helpful. I will keep looking at the links and am thankful for any ideas anyone has on what could be helpful.

I am glad that psychotherapy is helpful for you now.  They don't always "get" why you are going through what you are now......but may be helpful in helping you cope now.  As well as finding practices to practice and learn so you can cope without drugs going forward.  So that is good.

 

So many great non-drug coping skills can be found in Symptoms and Self Care too.  Our forum.  Once in that forum, you can use the search box at the top right and plug in a topic, e.g. anxiety and then see what comes up and look at all the coping ideas there, and try some.

 

I'll include what we have on betablockers.  AND be aware that if you had been on them regularly, then you should taper.  This should help you avoid rebound symptoms from just a CT, alot like the psych drugs.

 

Beta Blockers: Propranolol, Metopropol, Atenolol, etc.

 

Tapering BetaBlockers or Alpha Blockers

 

I would recommend the same, some kind of taper with the promethazine as well, if you had been using that regularly.

And we have a topic:

Tips for tapering promethiazine

^ this is worth a complete read if you had been on the promethiazine regularly

 

And then even more helps for tapering can also be found:

Important topics in the Tapering forum and FAQ's

 

Also best to just taper one or the other first, rather than both at the same time.  I'd go with tapering the less sedating one first, if it was me.

 

So mainly ideas around your promethazine and beta blocker today.  I've put you on auto pilot for searching for non-drug coping.

Keep us updated, and do let us know what symptoms in particular you might need help with finding good coping for.

 

Glad to hear you are sleeping.  @Elisabet

 

Okay, and best,

L, P, H, and G,

mmt

 

 

 

[Elisabet]

Hi Manymoretodays,

Thank you so much for your encouragement and support. It is very helpful. I experienced an evening two days ago when the symtoms just went away for some hours. It was rather sudden and definitely felt like a window. I am now back to experiencing quite strong anxiety and ruminating though and it really is an all body experience, which makes it so intense. I have started with magnesium and omega 3. I am waiting to hear back from a psychiatrist who is very good and who I trust. She has only helped me with tapering, that was the reason I found her, that I felt I needed someone who understood tapering. She really has been such a rock but now I am in another country. It also helped that she really thought I can do this and that it was a good idea.

 

I am really now starting to feel I need to try to reinstate the sertraline, and that I can not cope with this they way I had hoped. It has been two weeks that have just been so awful, as well as the other month that was really bad a while ago. I am overseas and going back to my job in not too long. I really can't see myself functioning at this capacity. I have not been unable to work before and I really want to be able to get back into my routine. Not waking up in feelings of dread nearly every morning. It is the way it persists as well and the physical tension. Do you know much about reinstating? I just need to become stabile again, get back to my normal life, functioning and then do it more gradually with the competent psychiatrist. Do you have any idea what a reasonable amount to reinstate on, could be? I am thinking if I start low and then maybe get up to something where I can feel like myself. Like I wrote before. I was at my best at 25 mg and before everything went wrong with the new doctor's miscalculation and the (in hindsight, in my case, very stupid) change to fluoxetine, I was at 12,5 mg, or was it 12mg sertraline.  I regret so badly that I didn't not just keep doing the very slow taper I was doing. The doctor here later indicated he does not quite believe in slow tapering, which made me so frustrated. Also, I wish I had reinstated at an earlier stage when I experienced the first wave. But no point thinking about that now. I want to not just get rid of the worst withdrawal symtoms, I feel like I need to feel normal again. The cost of this just feels way too high at the moment. What are your thoughts? I do have some liquid sertraline left but will try to wait until I have discussed it with the specialist. I haven't been using other medications before this whole tapering and withdrawal process. Trying to avoid it but it is hard with the symptoms I am having.

[manymoretodays]

Hi again Elisabet,

We recommend small reinstatements here, as do many in the deprescribing/WD community.

 

And here is the reinstatement link again for you, and if you think your doctor will be open to your suggests, do share with them as well:

About reinstating and stabilizing to reduce withdrawal symptoms

 

How were you doing in June 2022, on 12 mg of sertraline?

 

And me, if it were me, I wouldn't reinstate any higher than 1 mg of sertraline.  This is harm reduction after all, and possibly might help mitigate the worst of your WD symptom severity now.  If you are sensitive now to sertraline, which we have no way of knowing, this would be your best option.  Reinstate low, observe carefully for 4-7 days, and if no adverse effects, and even a bit of improvement, then that may be all you need.  Then.....after some WD stability, same symptoms every day, not changing, tolerable, .........in a few months time, you would attempt to taper from the 1 mg of sertraline, using the 10% or less of each previous dosage......until you were at perhaps .025 mg, before eliminating or jumping off of it completely.

 

You've had a few, or many years on SSRI's, and this can take some time, to rebalance, or reach pre-drug homeostasis of things......and so.  I hope that makes sense to you.

Because you can work with a doctor, any doctor really and take a lot of this into your own power and control too.  Or empower yourself basically.

 

Tips for tapering Zoloft(sertraline)

this will come in handy ^, to find ways to get that small reinstatement dose.  sertraline does come in a liquid formula, which might be easiest to use.

 

Even though, at one time, you did well on 25 mg sertraline, that likely isn't necessary now, not would it be needed, or really help with WD symptoms.  If you get even just enough relief of symptoms at 1 mg, wouldn't that be great?  If not, but if no adverse effects.......then you could updose a bit more in very small increments again. 

This isn't a complete cure for WD, but might help, even at 5 months out.

2 hours ago, Elisabet said:

I do have some liquid sertraline left but will try to wait until I have discussed it with the specialist.

 

Man, I hate to sound pessimistic, but don't get your hopes up that the specialist is well versed in tapering, and WD, or what is called deprescribing.  So few are still.

And many don't take kindly to patients telling them what to do, or showing them articles.........although one can always hope.

 

Okay.  More questions?  Just ask Elisabet.  We're here.  I hope I answered most of your questions.  Sounds like you are being pro-active.  Might this be a Wave?  How long in tough symptoms now?

 

Non-drug coping for anxiety, ruminating, and thoughts that might be unwelcome now:

Neuroemotions

 

Ways to cope with daily anxiety

 

The Dr. Claire Weekes Method of Recovering from a Sensitized Nervous System

 

Withdrawal causing repetative or intrusive thoughts, rumination, and increased panic?

 

 

Sleep is on your side anyway.  And what did you think around the betablockers and promethiazine?  Could some of this, if recent, be due to a too rapid reduction in those, if they had been taken regularly?

 

Best, L, P, H, and G,

mmt

Edited November 12, 2022 by manymoretodays

[Elisabet]

Hi again Manymoretodays,

Thanks so much for your information and words of encouragement. I was doing ok in June, I believe, although, in hindsight I can see that I was possibly not a 100%. I probably could have stayed on that level a bit longer, possibly. It is hard to know, but I believe I was mostly ok. The first chaos period "wave" came when I took out the sertraline completely, first extreme tiredness and then extreme anxiety, dread and rumination. This is the reason I have failed in the past (apart from tapering too fast, or as a result of that): I have developed an extreme version of the ruminating problems I already have and I end up quite quickly feeling that I just can not accept them since they take over everything. But it is really nothing like the original problem, this is much, much more extreme. And the sadness and crying as well.  I do also keep having that feeling in the back of my head/behind my ears a bit, that I relate to withdrawing, and always have, but hard to know.

 

I will absolutely share what I have been told here with the psychiatrist. She is very open and has also printed articles about hyperbolic tapering to show me in the past. She is excellent. Only problem is I am now temporarily living overseas, where I met a doctor who does not seem to believe in hyperbolic tapering (as it turned out).

 

It is great with the idea of 1 mg. I will discuss that with the psychiatrist since we will have contact remotely now. I do want to get off the sertraline long term but not to what ever cost. It makes sense that my brain wouldn't need much of it but I really do not have the knowledge.

 

It is hard to know about the beta-blockers and the promethazine. I am not used to taking so many medications. I will discuss it with her as well. It has always primarily been sertraline when it has been anything, in the past. I don't know what to do with the other ones/or rather how to think around it. I feel like I am just trying to function at the moment. I definitely believe I am in a wave. It is at a level that I just want it to go away, can't stand not knowing how long it will last and just being stuck in my own thoughts. Like a total overload of scary and guilt obsessive thoughts that take over everything. Really like I am totally out of function psychologically. I really like this forum and get so much out of it but it is also stressful to read about people who have had it like this for a long period of time. I have always had my anxiety (with some shorter periods where it has been close to non existent) but have worked and been up to lots of things. Quite a happy person. There is no way I could even work in this state.

 

What would you suggest I do with the promethazine and beta-blockers?

 

Thanks for pointing out that sleep is on my side:-) So encouraging! Yes, strangely, with everything going on! It has always been a strength. It went crazy for a period of the first wave but that part went quite quickly.

 

I will read all the links, so, so thankful for your support. I know it will work out alright, I just need to be wise about it and this site is a great resource as well as the psychiatrist.

[Elisabet]

Also-You asked if this might be a wave. I really feel so. I believe I have had two weeks of these very difficult, symptoms where every day is a rollercoaster without the highs, all low. (I have good support though.)

[Elisabet]

Have reinstated on 2mg zoloft a week ago with some lessened anxiety, definitely some effect, but still having a very tough time. I have at this stage accepted that my attempt to stop zoloft did not work out and it now feels more important to be back functioning at normal capacity than being medicine free. I still have a long term goal of stopping but will do it in a more controlled way next time.

 

I am thinking of increasing to 4 mg zoloft. How can I go about this if I need to up it more after this? At what pace? I do not want to overdo it but also do not want to drag out the process of getting more stabile.  I doubt I will need as much as I used to take but my aim now is to get back to feeling ok. Before things went really bad for me, I was, like mentioned on 12 mg zoloft although I can in hindsight see that I may have had some withdrawal experiences then too but not realising. It is hard to know since anxiety is a problem I had before starting zoloft (although withdrawal definitely enhanced it, made it extra intensive and unbearable). I also got depression after stopping with zoloft, which is not something I have had problems with in the past. I think withdrawal plays a big role in all of this, that it sparked things for me, but that there are also other factors that may have contributed.

 

I have mixed feelings about reading about people on this site who suffer extremely and the goal seems to often be to endure it. It makes me question what is reasonable to endure in order to not be on medication and when it actually can become dangerous for people. I think it is really wrong that ssri can be so hard to quit and that patients have not been fully informed but I am in no way against medicine in general. I do believe it can play an important role (and also think therapy should be offered a lot more than currently). I just want to say that I really appreciate the support on this site and I also think it is important to not be black or white about medicine/not medicine. This is not a response to anything anyone has written to me, I have only felt supported. More a bigger reflection on this topic as a whole, recognising it is complex and the need to have contact with knowledgeable health professionals.

[Altostrata]

Hello, @Elisabet

 

You might go to 2.5mg for a week and see the effect. This can indicate if a higher dose is warranted.

 

You haven't failed, you're taking a lower dose of Zoloft now, and you can taper again eventually.

[Elisabet]

Thanks for your encouragement, Altostrata!