match: Zoloft reinstatement didn’t work - hold or taper off?

[match]

Hi,

 

Nice to meet you all. I’ve been lurking on this site since earlier this year and am finally posting because I am in some serious need for advice. 
 

I started sertraline (zoloft) in March 2015 for panic and anxiety disorder. It worked wonders and basically cured my anxiety. I was initially on 50mg and had missed doses/failed attempts to quit but never had trouble going back on it (the longest I was off the meds was 2 weeks). From May 2021 to November 2022 I took 50mg every other day and was able to stabilize.

 

In November 2022 I decided to taper off Zoloft since I thought my anxiety was gone and my life had become pretty stable. I weaned off in three weeks, which was ridiculously fast in hindsight (I did 12.5mg for two weeks and 6.25mg for a week). I had all the classical withdrawal symptoms (flu like symptoms, insomnia, etc). However, some of them symptoms never went away to this day, such as fatigue and insomnia, although they did start getting better over time. From January 2023 to August I also tried a lot of supplements to help my sleep. I took ashwaghanda for two months, which helped slightly. I also tried 5-htp for a week. I thought it gave me more energy until it gave me a panic attack one day so I stopped. Magnesium glycinate and fish oil didn’t do anything to me, although I only took them on and off and max for a week.

 

The most bothersome symptom I’ve had is hard to describe. I can only describe it as sensory disturbances (sudden dropping sensation, random waves of pulling sensation in the body, especially in neck, almost dizzy feeling when I turn my eyes that last less than a second throughout the day). This symptom used to happen maybe once a day, but since July it became more and more frequent, and sometimes I feel like I’m almost floating/not grounded. I decided to reinstate on August 14 because my doctor thought it was my anxiety relapsing, which was partially true since I did feel my anxiety creeping back. However, I had never had such sensory disturbances/fatigue/insomnia before I got on Zoloft, even on my worst days.

 

After I reinstated 12.5mg Zoloft, I thought it helped with the dizziness/sensory disturbances in the first 2-3 weeks, but they slowly came back. It also started giving me bad insomnia after week 3 (worse than before reinstatement) and burning sensation in my back at random times of the day. Although my mood has been better and I feel like I have more energy, I also feel more anxious with a lot of mood swings. 
 

I apologize for the long post. I have a few questions that I was hoping you’d be able to answer: 

 

1. Should I hold my current dose (12.5mg) given that it didn’t help with my withdrawal symptoms and caused side effects that aren’t going away? If it’s safe to taper off, how fast can I get off?

 

2. Are the sensory disturbances withdrawal symptoms? Why do I feel like they only got worse as time went by? I also have a brain MRI scan scheduled soon just to rule things out.

 

Thanks in advance!

[LotusRising]

 

Hi @match and welcome to SA,

 

On 10/4/2023 at 1:17 PM, match said:

However, some of them symptoms never went away to this day, such as fatigue and insomnia, although they did start getting better over time.

 

It sounds like you may be experiencing The Windows and Waves Pattern of Stabilization 

 

On 10/4/2023 at 1:17 PM, match said:

Are the sensory disturbances withdrawal symptoms? Why do I feel like they only got worse as time went by? I also have a brain MRI scan scheduled soon just to rule things out.

Symptoms tend to ebb and flow and change over time, so they could certainly be WD symptoms, but it sounds like you're trying to rule out other causes, which isn't a bad thing. 

 

Unfortunately, reinstatement isn't always a guarantee and is best done soon after stopping your drug. Since you have been on and off zoloft for many years, you may have become sensitized to the drug, meaning a dose that once worked, may now be too much for your brain.

 

Please read About reinstating and stabilizing to reduce withdrawal symptoms

 

Overall, do you feel like your symptoms are better or worse?

[match]

Hi, thanks for your reply! Overall I think it helped a little bit, but I think it might be too high of a dose for me since it’s been 8 weeks and I’m struggling to stabilize and still having side effects (insomnia and worsened anxiety). I’m wondering if I could reduce the dose and try stabilizing on a lower one to see if it works better. Do I still need to reduce 10% a month after being only on it for 8 weeks?

Edited October 12, 2023 by LotusRising

[Altostrata]

Hello, @match. If I were you, I might try 11.5mg Zoloft, using the liquid formulation. After stabilizing for a good while, you could taper off by tiny amounts.

 

Please let us know how you're doing. 

[match]

Hi @Altostrata thanks for your reply! If 11.5mg doesn’t work, how fast can I get off? My depression anxiety and insomnia has been worse than ever these past few days and I really think my body is just rejecting Zoloft this time around…

[Altostrata]

Are you taking 11.5mg? When did you start it?

[match]

@Altostrata thanks for your reply. I only started this past Sunday so I don’t think it has to do with the reduction in dose. The mood swings have honestly been pretty bad in the past few weeks. On good days I feel like the reinstatement is working but then on bad days I feel worse than ever (with crying and suicidal ideation). How long do you recommend waiting before deciding if reinstatement is working? If it doesn’t work and side effects persist, should I still do the 10% per month taper?

[Altostrata]

If you reduced to 11.5mg only 2 days ago, there hasn't been enough time for the decrease to fully register.

 

Insomnia and "mood swings" with waves and windows of other symptoms are classic withdrawal syndrome.

 

How do you feel now compared to how you felt in July, before you reinstated Zoloft?

 

 

[match]

@Altostrata my mood and energy levels are better on good days and worse on bad days. I also have worse insomnia and anxiety now with more headaches. I feel like I probably shouldn’t have reinstated and now im worried I’ll never be able to stabilize and holding will just do more damage to my brain…

[Altostrata]

If you hadn't reinstated, you'd probably be here with withdrawal syndrome worrying that maybe you should have reinstated.

 

If overall you're doing better, that would be the natural course of stabilization.

[match]

That’s such a good mindset @Altostrata and I’m trying to remind myself of that every time I feel bad, so thank you!

 

It’s been almost a month since I reduced the dose. I think the dizziness feeling has been a little better, but my anxiety is even worse now I feel. Insomnia is also sometimes better sometimes worse. I feel like I’m having a hard time stabilizing and I’m wondering if I should try a lower dose. How long do people typically take to stabilize on a reinstatement dose?

[Altostrata]

What times o'clock do you take your drugs, with their dosages? 

 

What times of day are these symptoms most intense?

[match]

I take 11.5mg Zoloft around 7:30 in the morning. The anxiety and burning sensation happens randomly throughout the day. I never had the burning sensation before I reinstated, but I would say it’s the most intense 3-6 hours after I take my medicine

[Altostrata]

Do you feel better on 11.5mg? Please update your signature.

 

It is the nature of withdrawal symptoms to come and go and change into other withdrawal symptoms in The Windows and Waves Pattern of Stabilization 

[match]

I’ve been battling with what I believe is protracted withdrawal from Sertraline for a year now. However, one symptom that I’m not sure if is withdrawal-related is unrefreshing sleep. I wake up tired almost every day, sometimes like I haven’t slept a minute. I read that unrefreshing sleep is a classic symptom of Chronic Fatigue Syndrome and I am really worried that I might have it. Some days I feel fatigued all day with pressure behind eyes that makes me dizzy. Has anyone else had similar experience? How long did it take for your sleep to return to normal?

[LotusRising]

Hi @match,

 

I moved your topic over here to your thread, as we already have several topics for sleep where you might find an answer to your question.

 

I can tell you that I've been dealing with this very same issue. Are you sleeping straight through the night?

 

While it's a classic symptom of CFS, it's very common in WD as well. There's no way to know for sure, however, if you did not have CFS prior to psych drugs and/or tapering, you can assume this is something that will go away in time when your sleep cycle normalizes. I had that same sense of pressure behind my eyes, where I felt forced to lie down and close my eyes, even if I'd had a decent night's sleep. I've noticed just recently that my fatigue is starting to improve, but it has taken much longer than I ever would have thought. I try to help myself along by staying consistent with daily light movement, strict sleep hygiene (most of the time), eating well and drinking lots of water. 

 

I hope some of this info in these topics will help:

 

 

 

 

[match]

@LotusRising thanks for your reply! I’ve rarely been able to sleep through the night since I got off Zoloft, maybe 5 nights in the past year. I never used to have fatigue or sleep problems before & while I was on Zoloft. Reinstatement has definitely made my sleep even worse because it tends to make me feel wired, even though I take it in the morning. I’ve had good days where I felt almost normal and bad days with crushing fatigue (lately more after busy days). How long did it take for your sleep to return to normal?

[LotusRising]

My sleep has followed the windows and waves pattern, so it's still pretty irregular. I've had weeks at a time where I slept straight through, but am currently in a pattern where I wake 2-3 times/night. I track my sleep with a fitbit, so I can see a general trend of more deep, restorative sleep, even with waking, but it's still below what is considered optimal. I suspect there is a hormonal component to my sleep pattern, so I can't say for sure my issues are completely WD-related. Are you practicing good sleep hygiene? Do you get early morning light? Daily movement? These things seem trivial, but together, they can really make a difference in resetting a good circadian rhythm. 

[match]

Yes I have been trying to be better with sleep hygiene, and I want to start using light box soon. I was exercising pretty intensely for a few months (30 minutes cardio or 1 hour weight lifting 6 times a week) and I’m wondering if it’s too taxing on my body and contributing to the bad fatigue and slow healing. What are your thoughts?

[LotusRising]

@match

 

Do you feel good and energized after you exercise? Or do you feel worse, and tired? Really intense exercise also raises cortisol, so it could potentially contribute to sleep issues. 

 

I hit a point post-taper where I thought I was okay to start lifting weights again, so I went "all in" with weights and walking. I found out the hard way it was too much for me. I think I set myself back by doing too much too soon so I've since backed off and am only doing yoga now.

 

If I could suggest anything, it would be to listen to your body - if it's telling you to slow down, heed the advice. Our bodies are going through a lot right now and it takes a tremendous amount of energy to reverse everything the drug has done. Just try to keep that in perspective.

 

[match]

Thanks for the advice! I do feel better after exercise, but it doesn’t last long (usually a few hours) and I get more tired the night of.

 

By the way, I have been taking magnesium glycinate before bed for the past week (200mg, with 30mg magnesium), and I noticed that I still wake up a bunch at night, but it’s harder for me to wake up in the morning, and I feel groggy and tired the entire next day with pressure behind eyes. Could it be the magnesium? 

[LotusRising]

Personally, I haven’t heard of this happening and it hasn’t been my experience, but what I’ve seen here is that we’re all affected differently. You could certainly try stopping it for a few days to see if it makes a difference. 

[match]

Thank you for your reply! I recently developed some new symptoms and I’m not sure if they are withdrawal related:

 

1. Muscles get easily sore from exercise

2. knee and calf muscle pain

3. Limbs easily go numb at night when I’m sleeping

 

Are these common withdrawal symptoms? They tend to come and go and I haven’t noticed a pattern (for example some days I could be more fatigued but muscles are less sore). Could some of but not all the WD symptoms worsen during a wave?

[LotusRising]

@match

4 hours ago, match said:

1. Muscles get easily sore from exercise

2. knee and calf muscle pain

3. Limbs easily go numb at night when I’m sleeping

 

Yes, these can all be withdrawal related. I've had them all.

 

I found there wasn't really a pattern to my symptoms. One day I could be just fine, and the next hit with a symptom I'd had a number of months ago. But yes, all the symptoms you listed here, are very common. 

 

 

Any time you have a new symptom, you could have a quick look on the site. You're likely to find someone who can relate. 

 

See this post for how to do a site search:

 

 

[match]

Hi @LotusRising hope you are doing well. I have a question about my experience with Zoloft. Ever since I reinstated, I feel like every day I can feel the meds kick in. For example, about an hour after I take my dose in the morning I start feeling more energetic, and then I usually feel the best early afternoon. Although the side effects I get also worsen as the day go by, such as back burning feeling. After dinner is when I start feeling worse (dizzy, worsened orthostatic hypotension, and weird tingly/warm feeling in the brain). Is this common? What do you think might be the cause?

[LotusRising]

Hi @match

 

20 hours ago, match said:

I feel like every day I can feel the meds kick in.

I had this too. Very odd sensation, but I don't think anything to worry about. 

 

20 hours ago, match said:

After dinner is when I start feeling worse (dizzy, worsened orthostatic hypotension, and weird tingly/warm feeling in the brain). Is this common?

Is this new? What has been your tapering rate? - it looks like you last reduced in Sept 23?

 

Although zoloft has a decently long half-life, I wonder if you would feel better dividing the dose to twice daily? 

[match]

Hi @LotusRising 

 

On 3/10/2024 at 11:32 AM, LotusRising said:

Is this new? What has been your tapering rate? - it looks like you last reduced in Sept 23?

No the hot/swollen brain sensation and worsened dizziness at night started after I reinstated, but recently got worse.

 

I just updated my signatures. As you can see I probably made some mistakes by tapering too fast when I was not stabilized. I decided to reduce to 10mg because the insomnia wasn’t going away and had no problem. Although I don’t think I stabilized because I still had days (2-3 days a week) when I had worse symptoms. However, the jump to 7.5mg was when everything went downhill. All of my previous symptoms got worse and some new symptoms showed up. I held for 2.5 months, some symptoms got slightly better but never went away (like fatigue and insomnia, baseline was still worse than at 10mg), but I just thought it’s because lower dose was less stimulating. I started the 10% taper every 3 weeks because I didn’t get immediate withdrawal reactions. However I think I might be getting delayed withdrawal that starts a week or so after I reduced the dose. Please see my symptoms summary below. They are all on and off and seem to have windows and waves:

 

1. head pressure/fatigue: reinstatement improved it until I reduced to 7.5mg. Now it’s worse than before reinstatement

 

2. headache: reinstatement made it more frequent, but tapering made it even worse

 

3. Insomnia: reinstatement made it worse but manageable. Has become worse since reduction to 7.5mg

4. Tired, dizzy, worsened orthostatic hypotension, and tingling brain sensation: started after reinstatement, used to be only at night, but now start around 4pm. I think the shift happened around reduction to 5.4mg, but not entirely sure. When this happens I feel like I’m going crazy, almost like nothing is real and I live in slow motion

 

5. vague pain and aches: started after 7.5mg reduction

 

6. Brain zaps: always gets worse as the day goes on. Some days better than others

 

7. chemical sensitivity: started before I reinstated but it’s worse now. 2mg melatonin can give me panic attacks

 

8. burning sensation: started after reinstatement. Went away when I was holding at 7.5mg, but recently came back

 

9. anxiety: reinstatement made me anxious possibly because it’s stimulating. But tapering made it even worse, especially since two months ago

 

 

I have some questions that I hope you can help with:

1. Should I updose given my worsened symptoms? If so, by how much?

 

2. Do you think I might have been kindled? I never used to find Zoloft stimulating, but this time it makes me feel energetic and happy and when it happens my other symptoms are better too, except insomnia (only on “good days” though. Good days were more frequent at higher dose but I don’t get them quite as often now)

 

3. What does stabilization mean in my case given that reinstatement didn’t fully help? I tried holding at 7.5mg but I don’t think I ever stabilized. 

 

 

 

 

[match]

By the way, I didn’t really feel the adverse effects of Zoloft until about 3 weeks into reinstatement. I’ve also been thinking about splitting the dose into 2, but not sure how to best do it, especially when I’m not at home

[LotusRising]

 

 

22 hours ago, match said:

Do you think I might have been kindled? I never used to find Zoloft stimulating, but this time it makes me feel energetic and happy and when it happens my other symptoms are better too, except insomnia (only on “good days” though. Good days were more frequent at higher dose but I don’t get them quite as often now)

No, I don't think you've kindled. Many people find SSRIs stimulating. It's possible that you're responding differently to it because you've been on and off it multiple times. 

 

22 hours ago, match said:

3. What does stabilization mean in my case given that reinstatement didn’t fully help? I tried holding at 7.5mg but I don’t think I ever stabilized. 

I'm wondering if you didn't hold long enough? Do you recall when you first noticed an increase in symptoms between Nov 28 and now? I'm just wondering why you kept making reductions?

 

This a good description Stability. Based on this, you might decide that you need to updose. If it's been almost a month since your last reduction, you could hold here for a while to see if you stabilize at your current dose, or you could try raising your dose, but personally, I wouldn't go up by much more than 2%. 

[match]

Hi @LotusRising

23 hours ago, LotusRising said:

I'm wondering if you didn't hold long enough? Do you recall when you first noticed an increase in symptoms between Nov 28 and now? I'm just wondering why you kept making reductions?

I noticed an increase in symptoms about a week or two after I dropped down to 7.5mg, mostly fatigue and body aches, but they slowly got a little better. I thought that was just how I was going to be until I can stabilize without the drugs. I noticed another uptick in symptoms early March after reduction to 6.0mg, but I was also very stressed at work during that time so I thought it was because of that. 
 

I guess in my case, does stability mean no more windows and waves, even though Zoloft might be causing side effects?

[Emonda]

Hi @match

I saw the message you sent me.

 

It's best to post all questions here so others have the chance to read and respond. I work full-time, so I often can't respond immediately.

 

I'd re-read these two links:

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) Many of the things you mention are on this list.

 

Why taper by 10% of my dosage? The reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc. Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward.

 

You look to have gone faster than this = WD symptoms. I've seen others wait many months to find stability. Stability doesn't mean no symptoms. Windows and waves are part of the journey. 

 

Regards, Emonda

[match]

@LotusRising @Emonda I think I’ve been kindled and I am really scared and need some help. I was in a really bad place early September because I thought I got long covid and my spouse encouraged me to try a different AD because my mental health was at its worst. I got overly optimistic and thought a different SSRI would potentially work for me (in hindsight this was so stupid). Please see my drug and symptom summary below. I could really need some help. 
 

5/12-8/10: Zoloft 5mg

8/10-9/8: Zoloft 4.8mg

9/8: stopped Zoloft 

9/9-9/12: 2.5 mg Viibryd. No major symptoms except some dizziness

9/13-9/19: 5mg Viibryd. The first 3 days felt really good (almost euphoric) but then on 9/15 I got hit with insomnia. The next few days I was also a lot more anxious. Psychiatrist thought it was caused by Viibryd and told me to stop.

9/20-9/23: 2.5mg Viibryd. Did not feel much difference except feeling depressed about the situation. Still have insomnia 

9/24-9/30: nothing. Psychiatrist decided to switch me to Lexapro. I had alternating good and bad days where on good days I felt optimistic and less anxious and bad days where I had panic attacks out of nowhere and had to take Xanax to calm down

10/1-10/4: 1.25mg lexapro. Felt very good these four days, not anxious, even had the best sleep I had in a while (8 hours of sleep and woke up only once)

10/5-now: 2.5mg lexapro. Started getting worse insomnia on 10/7, only slept 4 hours for two days, but then it got better and I had some decent sleep 10/9 and 10/10. Then the bad insomnia started again. Had 4 nights of only sleeping 3-4 hours from 10/11 to 10/14. I’ve also been a lot more anxious since 10/12, probably because of the bad sleep. Lately I noticed the alternating good day/bad day pattern is back, where on good days I feel energetic and optimistic, and bad days are filled with bad anxiety. I’m also more anxious now because I think I’ve been kindled and I feel like I’ll never go back to my normal self.

 

Current progress: the past week I think my sleep has been maybe a little better. I can get 7 hours of broken sleep (wake up every 1.5-2 hours) with melatonin or Benadryl. However, my anxiety and insomnia is still worse than when I was on Zoloft. I also just feel very destabilized. On bad days I would have moments of calm just to get hit by horrible panicky feelings. I also developed fear towards random things and possible DPDR symptoms where my vision feels weird and the environment doesn’t seem real.
 

At this point, what do you think is the best path forward? Sticking out on the lexapro for a few more weeks? Dropping the dose of lexapro? Going back to Zoloft? The thing is the dose of Lexapro (2.5mg) I’m on now is higher than equivalent Zoloft that I was on before I stopped (4.8mg). My psychiatrist wanted to try Seroquel for my sleep since I think the poor sleep is really impacting my anxiety level - should I do it? Maybe start with 1mg? Any help is appreciated. I’m at my wits end. I don’t have anyone to talk to because my therapist/psychiatrist/spouse don’t believe in kindling or protracted withdrawal. On bad days my anxiety is so bad closing my eyes give me a sense of dread and I wonder if I should just take benzos for the rest of my life…
 

 

[Emonda]

On 10/28/2024 at 5:42 AM, match said:

got overly optimistic and thought a different SSRI would potentially work for me (in hindsight this was so stupid).

 

When changing ADs, you can end up with WD from the one you stop as your body tries to adjust to the new one. It's very difficult.

 

On 10/28/2024 at 5:42 AM, match said:

At this point, what do you think is the best path forward?

 

So many changes are so unhelpful. Stability is key.

 

I've changed AD 3 times in close to 30 years. It is something I will never, ever do again. It was brutal.

 

On 10/28/2024 at 5:42 AM, match said:

My psychiatrist wanted to try Seroquel for my sleep since I think the poor sleep is really impacting my anxiety level - should I do it?

 

My understanding is that more drugs are not the solution to WD. It's just another drug you have to try and taper off.

 

On 10/28/2024 at 5:42 AM, match said:

I can get 7 hours of broken sleep (wake up every 1.5-2 hours) with melatonin

 

Sounds like me, although I don't make it to 7 hours.

 

On 10/28/2024 at 5:42 AM, match said:

On bad days my anxiety is so bad closing my eyes give me a sense of dread and I wonder if I should just take benzos for the rest of my life…

 

Better days are ahead. How you feel today is not how you will feel in the future. Time + Patience.

 

Can you please update your signature.

 

[match]

@Emonda thanks for your reply. I’ve updated my signature. Would you say I should keep holding at 2.5mg Lexapro until I stabilize? 

[match]

Hi @Emonda @LotusRising I just wanted to follow up on this. I had a good week where I was less anxious and had better sleep, but since last Wednesday they are getting worse again. Do you think I should hold at 2.5mg Lexapro? I’m wondering if I should switch back to Zoloft but it’s been 2 months since I got off…

[LotusRising]

3 hours ago, match said:

I’m wondering if I should switch back to Zoloft but it’s been 2 months since I got off

@match I think your nervous system has been through lot of changes in a relatively short period of time. You've received some very good advice from @Emonda. Did you read the response from October 29?

 

3 hours ago, match said:

I had a good week where I was less anxious and had better sleep, but since last Wednesday they are getting worse again

Your nervous system is trying to regain some traction, which it sounds like it may be succeeding at since you had a week with less anxiety and better sleep. One would expect that there will be some ups and downs while trying to stabilize. 

 

3 hours ago, match said:

they are getting worse again.

What is getting worse again? What has been the general trend in how you feel since starting lexapro on October 1?