MommaJ: help with daughter's withdrawal from Sertraline and reinstatement

[MommaJ]

Hello,

I’ve been reading and trying to learn from you all for the last few months. With my daughter’s permission, I’d like to ask for help. She’s at college and I’ve been working to support her and to try to stay in front of what’s happening. She’s 21, but thankfully is allowing us to help her navigate this. I’m reaching out to you all for support.

 

She’s decided she'd like to try to reinstate Sertraline after being completely off since April 25, 2023. (She was on for 5 years.) She took 6.25 mg. this morning.

 

I understand this introductory post may take a few days to hit your community. I mainly wanted to open the line of communication/ support for reinstatement.

 

Sertraline Withdrawal:

We didn’t figure out that she was experiencing withdrawal until she was 2 months off of Sertraline. We assumed it was the stress of a summer internship that she needed to push through until we googled what sounded like odd symptoms. (Burning in her shoulders and a constant pit in her chest that seemed new/ odd.)

 

She’s done her own research and has questioned the timing of her intense symptoms emerging. The concept of doctors not fully understanding has been really tough for her to wrap her head around. (It does help her a bit to know that doctors in the UK are starting to taper differently.)

 

We were trying to avoid reinstatement and having to go through this again– but I’m worried we may be at the end of her time window to reinstate at 4 months. More than anything, she’s tired of feeling crummy and just wants to feel better. 

 

Sertraline Use and Taper:

 

She began taking Sertraline 25 mg in 2018 at age 17. When that was tolerated, went up to 50 mg. Dosage increased to 75 mg at some point a few years in. (Neither of us recall the specifics of why she went up.)

 

In March 2023, she decided she wanted to go off Sertraline. She felt happy, confident and wanted to know who she was without the meds. We supported this and didn’t think too much about the process– other than we knew she needed to taper.

 

Tapered under Nurse Practitioner in an established Dr. office in her college town: 

75 mg for 2 weeks; 50 mg for 2 weeks; 25 mg for 2 weeks; off April 25, 2023

**She reported a headache while tapering, but this resolved.

 

She seemed mildly not herself/ irritable when she came home for a few weeks in May/ early June. It occurred to us it could be going off Sertraline, but she said she thought she was experiencing more highs and lows– and this seemed reasonable. Then she left for an out of town internship.

 

June 12, 2023– she started working variable days/ nights in a high stress environment. On her 1st night shift, she said she was worried about staying awake and drank a ton of coffee. 

 

Huge influx of symptoms began: 

Round #1 Symptoms:

 

Nausea/ Vomiting a few times; Insomnia; Anxiety; Crying; Loss of appetite; Constant “pit” in her chest; “Burning,” uncomfortable feeling in shoulders; “Burning” in arms and legs.

**Mornings were the worst, but things sometimes let up by the evening.

 

June 27th, she messaged her Nurse Practitioner (from college) who prescribed Atarax as needed. She took it once, felt better briefly and then immediately worse as soon as it wore off. I started googling her symptoms and we started to realize this could be withdrawal. 

 

Around this time she started taking Benadryl at night (based on reading this helps with AD withdrawals) and this seemed to help.

 

July 7, she left the internship, came home and stabilized quite a bit. She wasn’t 100%, but her trajectory was promising and we thought the worst was over. 

 

August 8th, I took her to a Functional Doctor who suggested she take a supplement in our efforts to keep making her stronger:

 

Contents of CereVive and dose: (In addition to Vit C, Vit B 12, Vit B 6, Niacin, Folate, Magnesium and Zinc) 

Inositol: 1 g; L- Tyrosine USP: 400 mg; Mucuna Pruriens Extract (10% L Dopa): 400 mg; 5-HTP: 150 mg; L- Theanine: 100 mg; Gamma Aminobutyric Acid (PharmaGABA): 100 mg

 

Influx of symptoms came back within 3 days of beginning the supplement. We cut the CereVive in half one day, another ⅔ the next day and off. Unclear if it was the CereVive that caused the wave or maybe she wasn’t doing as well as we thought. It has felt like 2 distinct healing periods.

 

She stabilized a bit and hoped time would do the trick again. She went back to college and is functioning/ getting to where she needs to go. Overall not great though– and actively seeking a solution to feel better.

 

Round #2 Symptoms: same as before + new ones:

Tingling and/ or burning in arms; burning in neck with numbness in arms; lack of concentration, increased crying, decrease in appetite, feeling like she can’t breathe, a bit of despair that this is happening again.

 

This week, my daughter messaged her Nurse Practitioner about reinstatement and was prescribed 25 mg. of Sertraline. 

 

Dosage for reinstatement:

My daughter agreed to cut the pill into a ¼ (6.25 mg.) She’s using a pill cutter for consistent portions. 

 

I asked if she could split it into an ⅛  and she said the pills are too small and this seemed to overwhelm her a bit. I’m thinking that ¼ is the best we can do to also keep it manageable for her. (Open to input and ideas how to go smaller if that's better. Or is it too late and we need to stick with ¼ pill?) 

 

I sent her a scale to try to get smaller portions, but I sent the wrong one at first. Another is on its way but again-- we're balancing her being overwhelmed.

 

She did not ask the Nurse Practitioner for liquid– and given how she managed the initial taper, I’m not sure she’s the one to ask. I honestly don’t think it’s realistic for my daughter to make her own liquid at this point.

 

Symptoms since starting 6.25 mg today: dry mouth (resolved), headache (resolved with Tylenol). Some negative symptoms that caused her to reinstate may be getting somewhat better. Still a bit of burning in her arms and she's exhausted but can't nap.

**My daughter said the headache feels the same as when she went off. Kind of in the back of her head. (I don’t know what significance this holds.) 

 

Supplements/ Medicines she’s still using: 

 

Benadryl when physical symptoms are bad at night; Probiotic; Allegra; Midnite (Extended release melatonin); Magnesium Glycinate ;Vitamin D3 with K2; Fish Oil: Omega MonoPureA 1300 EC.

 

I know this is a lot and I appreciate any help and feedback. My biggest concern is that I feel like she’s the wrong doctor and a crummy day away from starting a new medicine. She’s very strong minded and was really thriving before all of this. She was really excited about being off the Sertraline. 

 

Crossing all fingers and toes that the reinstatement (followed by a gradual taper) will work. In addition to practical help, I’d welcome any prayers or good thoughts anyone would like to send her way.

 

MommaJ

 

[Emonda]

Welcome to the community, @MommaJ

Your daughter is very fortunate to have you by her side, encouraging her at this time. It’s great that the lines of communication are open between you.

 

Many years ago, when I was 21 and at college, I was prescribed Sertraline, too. I took it for some time and felt great, so I stopped. I don’t recall how quickly I cut down the pills….but with the benefit of hindsight, I know it was too fast, and I experienced what I now know were withdrawal symptoms, as you described in your post.

 

It does look like your daughter’s taper was too fast. As you would have read on this site, the recommendation is a maximum reduction of 10% per month of the most recent dose. The amount you reduce gets smaller and smaller every month.

 

As to reinstating, I’ll let one of the Moderators well experienced with reinstating jump in. I know they say reinstatement generally works best in the first three months. I also know they advise reinstating a very small amount. I believe a liquid form of Sertraline is available in the USA, and she could be far more accurate with liquid versus cutting pills. Accuracy of dose and consistency of time taking the dose is important. 

 

As to supplements, on this site, they recommend magnesium and omega 3 only. The recommendation is to start small and see how you respond in case of an adverse response, like your daughter seems to have experienced.

 

You mentioned you were concerned about perhaps having the wrong doctor. If your daughter is not comfortable, I’d be looking for another doctor.

 

Make sure you use the search function in the top right corner of your computer on this site. I often search for people that have used my AD. You can learn a lot from the experiences of others.

 

I’m sure another moderator will be along soon with some reinstatement advice.

 

Once again, welcome to the community. Feel free to jump on other introductions and interact with others.

[Altostrata]

Welcome, @MommaJ

 

On 8/24/2023 at 4:53 PM, MommaJ said:

Symptoms since starting 6.25 mg today: dry mouth (resolved), headache (resolved with Tylenol). Some negative symptoms that caused her to reinstate may be getting somewhat better. Still a bit of burning in her arms and she's exhausted but can't nap.

**My daughter said the headache feels the same as when she went off. Kind of in the back of her head. (I don’t know what significance this holds.) 

 

These are good signs for reinstatement. It may take some weeks for the full effect of 6.25mg to emerge. It may not take away all the withdrawal symptoms at first, but enable gradual stabilization.

 

We need to know how your daughter's symptoms change over time, to verify that 6.25mg is not too much or too little. It's hard for us to counsel a third party. Is your daughter able to register here?

[MommaJ]

To the SD Community @Altostrata, @Emonda

Thank you so much for your replies Altostrata and Emonda. My daughter and I are both grateful to have found this site. Hearing that she has good signs of reinstatement gave us both a good deal of hope.

 

Altostrata, I passed on your request to have my daughter register, and she said she'll do that– I hope within the next few days. I’m with her at college now, as it was too hard to text and call about all of this. 

 

She just got diagnosed with a UTI and started antibiotics-- but is feeling pretty cruddy and low on energy overall. In the short term, could I ask a few more questions to make sure we stay on track with reinstatement? (She just texted me from her class and asked if I could ask about the dosage.)

 

I'm wondering if you can give us more information on it taking weeks to feel the full effect. While I would prefer for her to go as slow and steady and possible, she really, really wants to feel better. It looks like something happens at 4 days as far as stabilizing levels in the body-- so wondering if we have enough information on this dosage to possibly make a small tweak? 

 

She’s questioning whether 6.25 is enough and would like to try more. (She normally has pretty good instincts.) While I’m with her, I can help more with dosage and help her advocate to get the liquid if possible. Cutting pills and weighing them is proving difficult-- but we're also getting better at it.

 

She’s on day 5 of reinstating 6.25. 

 

Significant symptoms: 

-Day 2 of reinstatment (8/25): She had a few hours where she felt dizzy and unsteady, unable to eat, low emotionally and said she felt a bit detached from her body--which I can't recall her ever saying. She took a magnesium and felt somewhat better. (She'd forgotten that part of her routine so was a bit late to take it.) 

 

–Evening of day 3 (8/26), pretty severe heartburn, then pressure in chest-- which she describes as both burning and just pressure, like someone is sitting on her. This is different from the “pit” in her chest she felt at the worst of the initial withdrawal symptoms. She had it all day yesterday (8/27) and it let up a bit around 3 am last night-- but she said it is back today.

 

This is the worst symptom right now. It’s not just the physical sensation, but the sense of dread to feel it coming back. This is why she's asking if increasing the dose would help.

 

Other intermittent symptoms since reinstatement:

-At night and intermittently in the day, she feels tingling in the middle of her forehead. 

 

–Burning in shoulders and arms seems better. Numbness in arms and hands seems better. 

 

–The burning seemed to get better, was replaced with more of a “weak” feeling all over and now that is better too.

 

-Insomnia was improving but last night was not good. (Pressure in chest seemed to be a factor.)

 

--Still nauseous at times, lack of appetite continues, especially in the morning-- but seems to be improving at other times.

 

-Note, Day 4 (yesterday, 8/27) we went to Urgent Care where she was diagnosed with a UTI and was given antibiotics. She gets these frequently and felt it coming on the last few days. (She's never had chest pressure with a UTI.) 

 

She told them about the pressure in her chest, pain in throat/ neck and they advised her to go to the ER for an EKG. The Nurse Practitioner at Urgent Care said when you say you have pressure in your chest they said they have to rule out things. She also acknowledged that coming back to college is a high-germ time and stuff is going around.

 

My daughter has a virtual call with her regular Nurse Practitioner scheduled today (to discuss Sertraline reinstatement), so she asked to wait and discuss whether the EKG is necessary. If so, we'll get this done today. 

 

Other details that are nagging at me:

The more I read and learn, the more I'm wondering if she maybe she has always had a low-grade reaction/ sensitivity to Sertraline? Possibly to other meds? If so could this be impacting her as she tries to reinstate/ stabilize Sertraline prior to a slow taper.

 

The main reason I'm saying this is she had to be hospitalized for Acute Kidney Injury (AKI) in 2020 at age 19-- 2 days after routine oral surgery. Along with drugs in the "twilight sedation" which lost effect during surgery and she had to be given more-- she was given Tramadol for pain. When she threw up/ was nauseous, she was given a nausea medicine (Zofran?) While the cause of the AKI remains undiagnosed after about every test possible, they wrote on her chart: possible dehydration and NSAID reaction. (Advil.) 

 

She's had some other "odd" immune reactions during this time she's been on Sertraline. We never connected the dots back to Sertraline-- but the reactions were out of contrast with her overall health. She's always bounced back quickly and doctors could not explain them. We just took them to be one-offs.

 

Hope that wasn't too much detail. I'm hoping that someone out there may be able connect dots for us if any of this is important.

 

And we'll get her registered asap. I appreciate your patience with this.

 

With hope and gratitude,

MommaJ

 

 

[Emonda]

Hi @MommaJ

It's great news that your daughter will open her own S.A account over the next few days. It will be easier for the moderators to work directly with her.

 

Sorry to hear she has a UTI. In my experience, when you have an illness such as a UTI, Flu etc., it can exacerbate your mental health struggles. I'm sure the antibiotics will sort out the UTI soon enough.

 

2 hours ago, MommaJ said:

can give us more information on it taking weeks to feel the full effect. While I would prefer for her to go as slow and steady and possible, she really, really wants to feel better

 

This is certainly the case in my personal experience. With the ADs I've taken, I'd say it's been ~4 weeks before I noticed a change. Slow and steady is the way to go. I know it is hard to be patient when you feel rotten, but going slow gives you time to monitor for any adverse reactions to the reinstatement.

 

2 hours ago, MommaJ said:

Hope that wasn't too much detail. I'm hoping that someone out there may be able connect dots for us if any of this is important.

 

That's very helpful information, MommaJ. I'll let Altostrata chime in with her comments on tweaking the dose and a possible low-grade reaction.

 

Your daughter will bounce back with time. It took me many months to stabilise following a reinstatement/up-dose. Once stable, I found this site, adopted their tapering advice, and 18 months later, I've made real progress...your daughter will, too.

 

 

 

[Altostrata]

If she's being treated for a UTI, we'll have to sort out the reinstatement question after she finishes the treatment.