Nigel: Sertraline withdrawal

[Nigel]

Hello,

 

Currently trying to taper off my psych meds particularly Sertraline. I've been struggling so much with tiredness and lack of motivation since being on it. I recently tried to go from 50mg to 25mg and last about 6 days..I've reinstated 50mg today and I'm here for peer support/ advice on next steps. 

 

I am based in the UK and want to do the 10% method using Sertraline Oral Solution from the GP. They are very reluctant to prescribe it, can anyone provide me with advice on how best to approach this ? I really don't want to be messing around crushing up pills. 

 

Also how long should I sit at 50mg before thinking of starting my 10% taper? 

 

Thanks,

 

Nige

Edited January 2 by Emonda
Name to title

[Nigel]

I also want to add that these days my nervous system is very sensitised. I can definitely link this to AD use/ silly tapers. I find starting an AD, dose changes all very difficult and have had some quite rough reactions. Is this term called Kindling ? 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Yes, reducing by 50% is way too fast.  I'm glad you reinstated.  Let me give you some basic info, then some suggestions at the end.  

 

Have you been or are you on any other drugs or supplements?  If so, please specify.  

 

How to List Your Drug History in Your 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  

 

Brassmonkey Slide Method of Micro Tapering

 

Tips for Tapering Sertraline

 

Since you have shaken up your nervous system by attempting a large reduction, and doing many drug changes in the past, I suggest you wait at least 6-12 months before trying to reduce your dose again.  Your nervous system needs a chance to recover and stabilize again.  The more stable you are when you taper again, the more successful and easy your tapering will be.  You may also be a good candidate for micro tapering.  Please let us know how you feel over the next several weeks.  

Edited December 23, 2023 by getofflex

[getofflex]

9 hours ago, Nigel said:

Is this term called Kindling ? 

I don't know if you are kindled, but based on your history, you very well may be.  How do you feel in the hours after you take your dose of sertraline?  Do you feel worse, or about the same?  This link explains what kindling is.  

 

Post Withdrawal Nervous System Hypersensitivity - Kindling

 

 

Edited December 23, 2023 by getofflex

[getofflex]

13 hours ago, Nigel said:

They are very reluctant to prescribe it, can anyone provide me with advice on how best to approach this ?

This link will help you know how to talk to your doctor.  It has information you can print and take in to him/her to read.  

 

How to Talk to Your Doctor About Tapering and Withdrawal

[Nigel]

6 hours ago, getofflex said:

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Yes, reducing by 50% is way too fast.  I'm glad you reinstated.  Let me give you some basic info, then some suggestions at the end.  

 

Have you been or are you on any other drugs or supplements?  If so, please specify.  

 

How to List Your Drug History in Your 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  

 

Brassmonkey Slide Method of Micro Tapering

 

Tips for Tapering Sertraline

 

Since you have shaken up your nervous system by attempting a large reduction, and doing many drug changes in the past, I suggest you wait at least 6-12 months before trying to reduce your dose again.  Your nervous system needs a chance to recover and stabilize again.  The more stable you are when you taper again, the more successful and easy your tapering will be.  You may also be a good candidate for micro tapering.  Please let us know how you feel over the next several weeks.  

 

Thank you for this, I will look to wait atleast 6 months before trying again. When you refer to micro tapering, is that the 10% method ? 

 

One thing that surprised me with these drugs is how much Serotonin receptor occupancy they have at their "recommended" starting doses. 

 

I do take some other supplements these are Vit D3, Cod liver oil, Magnesium and Tumeric. No other medications that what is listed in my signature.

 

6 hours ago, getofflex said:

I don't know if you are kindled, but based on your history, you very well may be.  How do you feel in the hours after you take your dose of sertraline?  Do you feel worse, or about the same?  This link explains what kindling is.  

 

Post Withdrawal Nervous System Hypersensitivity - Kindling

 

 

 

I feel about the same. I tend to wake up feeling absolutely terrible and it's always more bearable to some degree by the evening. Since trying to reduce my dose I've been waking up at 4am filled with dread, it sucks. 

 

[getofflex]

6 hours ago, Nigel said:

When you refer to micro tapering, is that the 10% method ? 

No micro tapering is an alternative to the 10% method.  You reduce by 2.5% once a week for 4 weeks, then hold for 2 weeks.  It is a gentler method, and I think you would do well to use that method after your hold period. Read about it in link above - Brassmonkey Slide Method of Microtapering.  

 

6 hours ago, Nigel said:

I do take some other supplements these are Vit D3, Cod liver oil, Magnesium and Tumeric. No other medications that what is listed in my signature.

 

Please add this information to your signature. so it appears with each post - this help the staff, thank you.  Here is info about vitamin D.   

 

Vitamin D

 

6 hours ago, Nigel said:

I feel about the same. I tend to wake up feeling absolutely terrible and it's always more bearable to some degree by the evening. Since trying to reduce my dose I've been waking up at 4am filled with dread, it sucks. 

So it sounds like you are not having an adverse reaction to your updose in sertraline, which is good.  Please be sure not to miss any doses, be precise in your dosing, and take it at the same time each day.  Avoid alcohol. and other mind altering substances.  

 

What you are experiencing is an exaggerated reaction to the normal cortisol spike in the morning which everyone has.  This is extremely common in people who are sensitized by psych drug withdrawal.  

 

Managing the Cortisol Spike

 

Here is more info on withdrawal, and how to cope with symptoms.  

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

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, which you are already taking. Here are the links for info about those.  They will help you learn the best forms of these to take, and how much/when to take them to help your withdrawal symptoms.  

Magnesium

Omega 3 Fish Oil

Edited December 23, 2023 by getofflex

[getofflex]

The Brass Monkey Slide Method is one method of micro tapering.  Please see this topic for more info on micro-tapering: 

 

Micro-Taper Instead of 10 or 5 Percent Decreases

[Nigel]

Thank you @getofflex. I guess I just need to be a little patient now before I attempt stop again. 

 

Out of the Sertraline and Mirtazapine, what is advised to taper first ? 

[getofflex]

It is generally suggested to taper the activating drug first, which would be the sertraline.  Please read: 

 

Which Drug to Taper First

[Faure]

On 12/22/2023 at 12:11 PM, Nigel said:

am based in the UK and want to do the 10% method using Sertraline Oral Solution from the GP. They are very reluctant to prescribe it, can anyone provide me with advice on how best to approach this ? I really don't want to be messing around crushing up pills. 

I too did not want to “mess around crushing pills”. The result was I got extremely unwell. Please be assured it is actually pretty easy once you’ve done it a few times and much better to rely on yourself than anyone else. 
 

As you’re in the UK you will want to tell your GP about the Royal College of Psychiatrists guidelines re tapering. They consulted extensively with Alto (the founder of this site).  My GP was very interested in these and said he’d share them with his team. GPs don’t want to prescribe liquid because it’s way more expensive. It can also be tricky switching formulations and cause a bit of instability till you get used to the new format. 
 

I’ve had great success first of all grinding up and weighing pills (took about 15 minutes a week) and latterly making a liquid (takes less than 10 mins twice a week). I can share my instructions for this if you’d like. I am also doing the BrassMonkey slide which has resulted in minimal, short lived WD symptoms. I waited about 18 months from destabilisation before tapering again but I was very ill at the time. Since tapering I feel better and better every cycle ☺️

[Nigel]

Hey @Faure! Thank for your message. In the UK a pack of 28, 50mg Sertraline tablets is £1.01 haha the liquid is £40 - that's a big difference to a healthcare system on its knees so I agree with you on that point. It sucks though but I will reference the article you mention next time I go in. I'm going to hold for a little while before trying to drop again. This fatigue/ low mood is absolutely killing me but at least I'm not dealing with early morning cortisol spikes, that's by far one of the worst symptoms I face in withdrawal. 

 

 

Yes I'd be very interested in your instructions for both. Thank you! 

[Faure]

Glad the cortisol spikes are passing, that’s good news. Here’s my instructions for making up pills:

 

I make up 7 tablets at a time, so when you start you’ll need to pulverise 7 and then weigh out 7 identical amounts. Much better this way as it’s all done in about 15 mins (when you get the hang of it) just once a week, rather than daily. I also like to believe doing it all in one go gives the best chance of getting identical weights with the calibration etc.  Here is how I do it: 

 

Step 1, only necessary the very first time: weigh three whole pills and divide the total weight by 3 to get the average weight per pill. Put this into a tapering spreadsheet to get the reduction schedule. Print reduction schedule and if you’re at all bad with numbers change the decimal points so the schedule looks the same as the scale readout.  The pill weighs more than the dose of meds you are taking because of filler. 

 

Step 2 calibrate the scales (every time use them) following the instructions that come with the Gemini scales. Always weigh in the same place and leave the scales on for a minute for them to warm up before calibrating. 

 

Step 3 grind 7 pills, I put the powder into an egg cup and stir it with a toothpick, including the outer layer of the pills (my outer layer is yellow and the powder is white). 

 

Step 4, Using a teaspoon scoop up some powder and using a toothpick knock it into the measuring tray till you get the right weight. I take off excess powder with the tweezers that come with the scale. When I get near the target weight I lift up the weighing tray and tap it to get the powder into the middle. I do this a few times till the scales settle on the target weight. Once you have the target weight do not re weigh. Accept you got it right and move onto the next tablet. 

 

Step 5 tip the powder into a folded small piece of paper and use this to transfer the powder into the capsule. Don’t worry about microscopic bits not making it into the capsule. 

 

Step 6 repeat till 7 pills are complete and store spare powder in a separate capsule for next time.  I then use this powder first in my next session. Be sure to keep pills in the dark. 
 

I use size zero capsules, the Gemini scale and bought a nice pill grinder as I knew I’d be doing it a while!

[Faure]

You might prefer to go straight to making a liquid as it is very easy. Alto (founder of this site) always recommends using liquid. It’s also better for the lower doses as the scales are not accurate below a certain level. Below is a link to a method I use for making a liquid created by a very mathematical friend! Happy new year! 
 

 

[Nigel]

Thank you, this is very helpful.

 

Does anyone have any good advice on how to deal with fatigue ? I'm sooo tired all the time. 

[LotusRising]

49 minutes ago, Nigel said:

Does anyone have any good advice on how to deal with fatigue ? I'm sooo tired all the time. 

 

Listen to your body. Don't overdo it. I've had ongoing fatigue for a while now and I made it worse by doing too much. I decided I was feeling so great that I'd get back into my weight routine and start doing all the things again. BIG mistake. Your body is going through a lot right now, so if you're feeling fatigued, stick with exercise that doesn't raise cortisol too high eg. yoga and walking. If you feel worse, back off. I'm slowly seeing positive changes, but even with the holidays, I can feel that I've done a little too much so I know I need to dial it back.

[Faure]

20 hours ago, Nigel said:

Does anyone have any good advice on how to deal with fatigue ? I'm sooo tired all the time. 

You need to accept it and just rest. I know it’s frustrating. I rested for about 3 years, working very part time. I am lucky in that I’m self employed and could just take on a small amount of work. It’s much harder if you don’t have control over your work life. 
 

As I’ve gone through this taper I have, every 6 months or so, been able to add an extra extra hour here and there (very small amounts). 
 

As Lotus says, our bodies are dealing with an awful lot and we need to rest. I know it’s frustrating ☹️

[Nigel]

Thanks guys, it is what it is I guess.