ohseedeed Obsessive-compulsive about everything if it's worth being worried about: Zoloft tapering due to side effects questions

[ohseedeed]

Hey folks! I'm a 37 year old male. I have OCD (both physical and pure-O) and have been medicated on and off since 2003.

I've had obsessions of so many different forms of OCD, and lately it's been quite some unusual ones.

 

I'm not sure if this is the right forum to ask about one specific side effect (emotional blunting), so please let me know if I should post this elsewhere.

 

For context: I have been navigating a very difficult period since June and so being careful taking my ativan as PRN.

I finally saw my psychiatrist in August and restarted sertraline (target 150mg capsules, start at 50mg upping by 50mg each 2 weeks) when he felt my issues were very much OCD.

I would say my primary fears of going back on sertraline were emotional blunting and sexual dysfunction. I think the former was the scarier thing to have to deal with so naturally I fixated a lot on it.

I was also prescribed quetiapine (Seroquel, atypical antipsychotic) 25mg 1-4 times per day as an adjunct to help with anxiety during the journey to the therapeutic dose. I also occasionally take ativan 1mg, about once or twice a week, once per day. Thankfully it seems to have had no side effects or harm from this "habit" this year, except a bit of drowsiness.

I hate to say it, but sometimes ativan would give me the best times in a week, because it shuts off 90% of the thought patterns that bother me and makes me enjoy the moment so much more. Yay for feel good drugs, but boo for risks of tolerance and withdrawals! 😅

 

Here's the drug history/increase schedule, experiences (it reads a bit like medical notes). My question(s) will come after regarding how I did a drop in dose due to the side effects. When I mention anything regarding how the dose is taken or feelings experienced, assume it lasted/happened during the period between dates.

 

August 3 2023 
Started 25mg quetiapine.

 

August 4 2023 
- Started 50mg sert morning

- Taking 1-3 quet daily

- Some sexual dysfunction (SD) started to happen, may be related to either meds, although I don't ever remember 50mg sert causing this in my lifetime of taking it (3-4 rounds).

 

August 15-18 2023
- Stopped quetiapine after feeling like emotional blunting (EB) was occurring (possibly from drowsiness). I was told it was safe to stop cold turkey since it's a very low dose and I was taking it as needed once to 3 times a day.
- Experiencing clenching sphincter, jaw clenching symptoms as well. Most likely sert, but wondered if stopping quetiapine was at all responsible for this. Still experiencing a little bit of clenching today.

- Switched at some point to evening sert dose

 

August 18 or 19 2023
- Upped to 100mg sert
- Daytime drowsiness in the late afternoon
- More SD
- No apparent signs of EB

 

Sept 5 2023
- Upped to 150mg
- Nearly full SD, but can still orgasm once a week with effort

 

Sept 13 or 14 2023
Sensed EB and was not willing to tolerate it while going through life issues and therapy. Dropped to 100mg after asking both psychiatrist and pharmacist about safety of dropping suddenly.

 

Sept 16 2023
Noticing SD reduction
Was out with friend, had some moments of strong emotional empathy looking at him, but still felt like I wasn't entirely enjoying things the way I think I do pre-medication.
Still missing anticipation feelings (those "oh, this is happening soon, i feel excited/can't wait!" feelings that to me drive me so much)

 

Sept 17 2023
Unsure if depression/life situation is responsible, some lack of sleep tiredness (impacts my ability to feel connected with people I find), or that EB still present. It seems to improve a little.

 

This has since been the dose and overall experience. On sept 30 I began taking maca powder and capsules with the aim to see if it could improve SD and potentially provide mood benefits (it raises dopamine supposedly).

 

 

Previous drug history

My first ever exposure to psychiatric drugs was in 2003 starting with ativan, then going on a mix of Citalopram (Celexa) (I forget the dosage but maybe 10mg?), Clonazepam and Risperidone for several months. I believe I stopped in 2004 and then started sertraline when I saw a new psychiatrist in 2005.

I have taken sertraline on and off for nearly 18 years now if I recall correctly. Sometimes for years, sometimes for a bit less, I've had 200mg at one point I believe, but more often than not sticking to non OCD therapeutic doses and then tapering to 0 from 25mg or 50mg usually after several months on them.

 

I have had the brain zaps and drowsiness that comes, but I don't think I've had worsened symptoms of anything else. Sexual dysfunction goes away entirely each time, and emotions seem to be all there (no idea if some have ever been permanently impacted over the years, or I'm just who I am), I can confirm last year breakup grief made me feel intense sadness and crying for months, which to me, even though it might be excessive, was a good sign of being alive. I also had joyous moments and had great days during the year.

I know I do obsess at times over how I am feeling about situations though.

I guess my question is, can this sudden taper after about 10 days of a higher dose cause or potentially permanently impact EB?

Can it change from each round on the same AD or is it the AD specifically that can cause something more permanent if not well matched to someone?

I am currently on 100mg and feel like I am not all there emotionally. It's like, partially depending on the emotions?

 

I would say that I am not as deeply emotional, but I did cry last week over something difficult, and my grandma passed away and I had a lot of moments of sadness and grief denial. I didn't cry there but I teared up a little. I think it might just be acceptance over something I felt was coming and grieving in advance for it.

What I am mainly feeling (or not feeling) that gets me wondering whether it's EB or hyperawareness causing it (which can be quite common with OCD, especially ROCD, like a form of semantic satiation where checking constantly numbs you more to the emotion you are seeking to feel) is the lack of anticipation arousal (hence why I mentioned partially depending on the emotions, if that's even part of the clinical profile of EB). 

I've had moments where I am with people and family and felt a sense of joy in the moment. I would often then take notice and start questioning how deep or how intense that joy was however, which then causes ruminating over whether I am emotionally blunted, or have caused something far more permanent for choosing to be on sertraline again, and temporarily quetiapine. Then I would inevitably look back at my life, trying to find moments where events could prove otherwise, or find events that trouble me about my response or lack of to the moments. Classic hypervigilance I would think.

 

I did attempt at times to just stop responding to doubts in my mind about how I am feeling, in an effort to get out of causing myself an obsession over my emotions (yay OCD, latches on anything you value!). 

So I guess I am just wondering whether you folks feel like my rapid tapering from 150 to 100mg is at all a risk for any permanent EB, or whether 100mg is also a level that can cause it and it's just my brain accumulating more serotonin from reuptake inhibition, and arriving at similar effects as 150mg would. I was starting to think of asking my psychiatrist to lower to 75mg in 2 weeks when I see him, and see how it goes, because I want to focus on CBT and other treaments with the psychologist and need to be able to feel all of the emotional distress possible to cope better.

 

I know it seems a little silly but to me it's just so important to feel physical anticipation when I think of something coming up that usually is worth feeling looking forward to. It gives me a sense of purpose, life. 

And again I can't say I haven't felt some good moments (including sadness) and empathy in the last few weeks. It's just hard to tell if the obsessing over emotions is what's causing the dullness of certain emotions, whether it's medication dosage, OR the situation I am going through that could also be impacting my ability to enjoy myself more. What I am going through is definitely difficult, it's life altering in a way, and it isn't going to change overnight.  It's even caused me a sort of perma-nausea (started pre medication), without the usual anxiety symptoms I feel (burning sensation in legs, heart rate increase, sweaty palms). So I wonder if some of that also isn't from feeling the situation impacting me.

 

Sorry for the long post, hopefully this wasn't too difficult to read through.

Thank you so much in advance!

[Onmyway]

Hi @ohseedeed

welcome to SA. I am sorry you have been suffering with OCD. It is a brutal thing to deal with and underappreciated how hard it makes life for people. 

 

I just want to clarify, however, that here at Surviving Antidepressants we do not really engage in helping people deal with side effects of drugs and finding a right dose or cocktail. So unless you are interested in coming off all of these drugs, we are not in a position to help you. We are peer volunteers who are not trained in side effect management and many of us think that these drugs are no better than placebo - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/. It is also widely recognized in psychiatry now that there is no such thing as a chemical imbalance so your desire to somehow fine-tune your brain chemistry is not something we support (the macha tea etc.) or can help with. 

 

Having said that, I can give you a few pointers based on our experience with these drugs: 

1) these drugs do cause emotional blunting in many members, that is how they really have an effect, if any 

 

2) coming on and off of these drugs can change the body's reaction to them - i.e. you may be able to come off of them once or twice without issue but may not be so lucky subsequently. To avoid more prominent withdrawal effects, we advise that you take your drugs on a consistent schedule so that you can keep a constant level of the drug in the blood so as to avoid sensitizing your nervous system. 

 

3) reinstating after multiple stoppings may make the body hypersensitive and cause more prominent drug reactions. Here is more info on it. https://www.survivingantidepressants.org/topic/27800-hypersensitivity-and-kindling/

 

4) If and when you do decide to come off of your drugs we recommend that you lower your dose by no more than 10% of your previous dose every 4 weeks one drug at a time. This allows for your nervous system to adjust to the changes and makes withdrawal effects less likely and less prominent. We find that ALL psychiatric drugs cause withdrawal effects similar to benzos - that is how most of us ended up here, so this is a harm reduction technique to get off of these drugs. 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

https://www.survivingantidepressants.org/topic/300-important-topics-in-the-tapering-forum-and-faq/

 

5) I like this guy's view of OCD and rumination https://drmichaeljgreenberg.com/malans-model-of-ocd/, maybe you will find it helpful as well. Also this on rumination: https://drmichaeljgreenberg.com/anatomical-models-of-rumination/

IFS can also be helpful for OCD but not sure how it compares to ERP (the above model with some modifications).

 

I hope you find help for your OCD. I will not address the rest of your questions on whether this could be emotional blunting or not because your post is mostly reassurance seeking and I will be harming you if I engaged in it with you. 

 

Sending you warn wishes

OMW

Edited October 3, 2023 by Onmyway

[ohseedeed]

Hey Onmyway!

 

First thank you for the thorough response and for understanding how insidious OCD is, especially with your last sentence, which I think non-OCD folks wouldn't always understand why you'd say it hah!

Your articles shared from Dr Greenberg were super insightful and I even shared them with my psychologist. Thank you! I'm intrigued to do more of that for my current therapy.

 

In terms of the reduction I opted to make with the ok from the psychiatrist, 150 to 100, after 10 days on 150mg, is there much that can be said about the potential of damage there? I don't know that I felt anything bad per se, but it's worth asking since it's still a tapering question.

 

I read through a bunch of your tapering posts linked. The only thing that I am left wondering about is doing this with the Zoloft capsules we have in Canada. I have never seen tablets of sertraline in Canada.

Unless I can find by asking my doctor if it's possible to get the liquid version, I don't know how easy it could be to open up the capsules and work with those. I noticed some posts about it in the FAQ post, but is there a specific one that discusses capsules and how to work with them? I anticipate having to deal with the 25, 50 and 100mg forms.

 

I think more or less I don't want to remain on sertraline long term again. If I can help it through dedicated therapy and practice, and only keeping emergency backups of ativan. So next week I'll discuss with my psychiatrist what is on my mind and how I plan to take care of myself. 

 

Thanks again!

[Onmyway]

Hi @ohseedeed

 

I am glad you found Dr. Greenberg's site helpful. I got to it from someone else here. I like his view of rumination as compulsion - i.e. there is no pure-O OCD and ERP therapy with so-called pure O OCD is achieved by preventing rumination. I hope you can find some relief using it. OCD is truly awful. 

 

I also like this book: 

https://www.amazon.co.uk/Needing-Know-Sure-Overcoming-Reassurance-ebook/dp/B07MMQ7HRK

The authors have a variety of articles as well on the topic. 

 

If you are interested in tapering we would ask you to please create your drug signature using the instructions below. It would give us a way to have a glance at your history and advise you quickly. Going from 150mg to 100mg of sertraline was OK but we wouldn't advise going from 100 to 50. Instead we would advise 100 to 90 and then to 81 then to 73 every 4 weeks (10% reduction of previous dose no faster than every 4 weeks). 

 

 

Here is the info for tapering sertraline:

 

I haven't heard of capsules for sertraline but checked and see that in Canada that's what you get. I am not sure if that means that these are delayed release or just normal release. Usually if the capsules are delayed release they have little beads inside that people count but if not delayed or extended release then it should be OK to just pour out some and measure using a scale or make a liquid. 

 

 

Let us know if we can help with more. 

Hope you feel better as you lower your dose. 

OMW

Edited October 8, 2023 by Onmyway