Daniel1269: Guidance Sertraline Taper 50mg for 3.5 Months

[Daniel1269]

Hello,

 

Please can you provide some advice, I am reluctant to follow advice received off of my GP to lower to 25mg for two weeks then stop upon carrying out a lot of research.

 

I have been looking at the hyperbolic taper and the 10% method, which is more effective and could you recommend an example tapering schedule based on being on sertraline 50mg for 3.5 months and best way to carry it out?

 

Will enquire about liquid solution availability at next appt next week to discuss again, currently only have access to 50mg tablets that can be split in 2 (two 25mg halves if split) 

 

Started due to an anxiety episode which was getting no better, now on sertraline have been at pre-anxiety levels for quite some time and looking to taper off as agreed with doc.

 

Also weening off omeprazole 20mg for another week, unsure if this will make a difference.

 

Many Thanks.

[Emonda]

Welcome @Daniel1269

 

6 hours ago, Daniel1269 said:

I am reluctant to follow advice received off of my GP to lower to 25mg for two weeks then stop upon carrying out a lot of research.

 

Have you seen this link: Why taper by 10% of my dosage?

 

If you follow the advice of your GP, you may well end up with very unpleasant WD symptoms: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

The hyperbolic / 10% taper works for so many here. It's working for me after taking an AD for a long time. Slow and steady is the way to go.

 

If you are currently taking 50mg (please add that to your drug signature), then once you feel stable, the next dose you take should be no lower than 45mg, then 40.5mg, etc. Just multiply the current dose by 90% to work out the next dose. You can go slower than this...and should go slower if the WD symptoms cause you grief. 

 

6 hours ago, Daniel1269 said:

Will enquire about liquid solution availability at next appt next week

 

If you transition from a pill to liquid, you should read the 4th post down by Gridley: Transitioning from pills to liquid

 

7 hours ago, Daniel1269 said:

Also weening off omeprazole 20mg for another week, unsure if this will make a difference.

 

Please add this to your signature. Only taper one drug at a time so you know what's causing you a problem if one arises: Keep It Simple, Slow, and Stable 

 

I am not familiar with the drug, but I suggest you read this:

 

 

A few helpful links:

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

 

Omega-3 fatty acids (fish oil)

 

Avoid alcohol. 

 

This is your own Introduction topic.  Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Once again, welcome to S.A.

 

Emonda

 

[Daniel1269]

Hi @Emonda,

 

Thank you very much for your timely reply and comprehensive information, I am so grateful that this information is readily available for free!

 

Please can you clarify if the hyperbolic method and the 10% method are the same thing or do they differ? I’ve been looking into Dr Horowitz’s work and just trying to ascertain if they are the same?

 

Is it even worth trying to switch to liquid solution or should I just keep going with the tablets and purchase a milligram scale?

 

I have also updated my signature, thank you.

 

As for magnesium and fish oil? Just checking there would be no interactions with the sertraline and omeprazole if I started supplementing with magnesium glycinate and fish oil?

 

Thank you so much again,

Daniel 

[Emonda]

19 hours ago, Daniel1269 said:

Please can you clarify if the hyperbolic method and the 10% method are the same thing or do they differ? I’ve been looking into Dr Horowitz’s work and just trying to ascertain if they are the same?

 

Same thing: This site talks about reducing your dose by 10% of the most recent dose, not your original starting dose. The reductions get smaller and smaller...same as Dr Horowitz talks about.

 

19 hours ago, Daniel1269 said:

Is it even worth trying to switch to liquid solution or should I just keep going with the tablets and purchase a milligram scale?

 

Your choice, just be consistent and accurate. If you do choose to switch to liquid, read the 4th post down by Gridley: Transitioning from pills to liquid

 

19 hours ago, Daniel1269 said:

ust checking there would be no interactions with the sertraline and omeprazole if I started supplementing with magnesium glycinate and fish oil?

 

This is a handy tool: https://www.webmd.com/interaction-checker/default.htm

 

As to supplements, best to start with one at a time and start small to monitor for any adverse reaction.

 

Hope this helps.

[Daniel1269]

Please can you advise if the 10% per month reduction could be split into 5% every two weeks?

 

i.e from 50mg , first two weeks down to 47.5mg, then next two weeks to 45mg, stil aligning with the 10% schedule but just making it slightly smoother in terms of reductions and allowing any withdrawal symptoms to show themselves?

 

Thanks.

[Erimus]

That's fine @Daniel1269. Doesn't matter how you spread the reductions, as long as you're not doing more than 10% a month you should be okay. The 10%/month is just a guideline, some people can go faster, and others have to go slower. Best method is to make a small reduction and assess how your mind and body responds.

 

For example:

Day 0: 50mg

Day 1: 47.5mg (2.5mg)

Day 15: 45mg (2.5mg)

 

Day 30: 42.75mg (2.25mg)

Day 44: 40.5mg (2.25mg)

 

Day 60: 38.47mg (2.025mg)

Day 74: 36.45mg (2.025mg)

 

Etc.

[KaiLee]

Hi,

sorry I cannot give you any direct advice, but I wish you a good luck and hope you stay strong within this difficult time of enduring.

Good luck with your taper.

I also suffered from great anxiety, so I know how hard it can be.

Hope you have a nice day.

 

[Daniel1269]

Thank you both, much much appreciated, wish you all the best.

[Daniel1269]

Hello,

 

Is the duration of being on the SSRI (and tapering off) linked to the risk of developing PSSD?

 

 I.e is there a higher chance of developing PSSD if you have been on the SSRI for a long time as opposed to less than 6 months? 

 

I’m trying to weigh up potentially tapering faster if duration is a contributing risk factor of PSSD?

Obviously need to consider risk for withdrawals too as PSSD will be the least of my concerns if I get debilitating WDs. So difficult to weigh up.

 

Could tapering too fast cause PSSD too? Would a slow taper be best with reducing PSSD and WD risk?

 

Have no sexual side effects from the Sertraline at present. 50mg since 23rd October 2023, starting my taper next week. 18 yrs old.

Any advice/insights would be greatly appreciated.

 

Many  Thanks.

[Erimus]

Don’t read too much into PSSD if you don’t have any symptoms associated with it. Withdrawal is hard enough without terrifying yourself with the horror stories. 
 

Just focus on tapering. The rest is unnecessary background noise.

[Daniel1269]

Hello,

 

Please can someone advise me about exercise, I love to resistance train 3 days a week and go jogging once a week and it really keeps me going, am I going to have to stop this when I start my taper? 
 

Can I just see how my body reacts to exercise when I start? I really don’t want to give it up it and will be devastated if I have to.

 

I also have 20g 90% dark chocolate everyday, will I have to give that up too or is the caffeine content negligible, or can I just see how my body reacts too?

 

Obviously I will have to give it up if WD are bad, but can I at least try keeping them in before I start as opposed to just down right quitting both of them without assessing anything?

 

Many Thanks.

[Erimus]

As long as your taper is sensible and under control you should be fine continuing to exercise. This is one of the main reasons it's important to keep things slow and stable, so you can carry on living like you are now. I wouldn't worry about the chocolate either.

 

It sounds like you're predicting the worst-case scenario. For people that start the taper with the right knowledge like you have, it can almost be indiscernible to normal life. What I will say is steer well clear from alcohol, it's not worth the ramifications it can cause.

 

I also see you've recently stopped Omemprazole, you'll want to give it a good 2-3 weeks before changing anything else. The rebound acid can take a while to settle down.

[Daniel1269]

@Erimus,

 

Thank you so much.

[Daniel1269]

Hi,

 

Can anyone advise if I should let this cold I’ve caught pass before I start my taper?

 

Was meant to start today but been hit with a nasty cold.

 

Cheers.

[Emonda]

I'd be waiting until you recover from the cold. I've found that my WD symptoms are inflamed when I have a virus. Any reason to pause a taper is a good reason.

[Daniel1269]

Hi,

 

Can anyone advise if there would be any issues at an airport if I had the sertraline fragments in capsules along with the prescription label on the original packaging?

 

(Departing from UK)

 

Many Thanks.

[Daniel1269]

Or should I bring my scale along with me?

[brassmonkey]

You should not have a problem. The only place you could have problems is going through the UAE, they have zero tolerance for any drugs. I carried mine through a dozen different countries and never was even questioned. Don't worry about it and enjoy your trip.

[Daniel1269]

Hi,

 

Is there any info on serotonin syndrome risk with tapering slowly?

 

I.e you’re in remission yet as you are still on the AD (tapering off slowly) you risk serotonin syndrome?

 

Or does the brain adapt to the AD and adjusts its serotonin secretion from there so serotonin syndrome doesn’t occur? (Dependance)

 

If the latter is true then obviously slow tapering necessarily to minimise WD.

 

Thanks

[Erimus]

2 minutes ago, Daniel1269 said:

Hi,

 

Is there any info on serotonin syndrome risk with tapering slowly?

 

I.e you’re in remission yet as you are still on the AD (tapering off slowly) you risk serotonin syndrome?

 

Or does the brain adapt to the AD and adjusts its serotonin secretion from there so serotonin syndrome doesn’t occur? (Dependance)

 

If the latter is true then obviously slow tapering necessarily to minimise WD.

 

Thanks

If you didn't experience serotonin syndrome from taking 50mg of sertraline, you aren't going to experience it as you reduce the dose. For most people, you'd have to be on upwards of 150mg and possibly other drugs before serotonin syndrome developed. It's a rare issue, and one that you need not worry about right now.

[Daniel1269]

Hi,

 

What are your thoughts on transitioning to the hyperbolic tapering method after reaching 6mgai (19mgpw rounded up) for sertraline as this is where several repeated doses (rounded to 0dp due to Gem Scale abilities) occur and can potentially unnecessarily prolong the taper and cause innaccuracies use due to fluctuations, essentially reversing the work done previously (to an extent) and this could be avoided by purely considering receptor occupancy reductions? I would follow the Maudsley Deprescribing handbook initially and adjust where necessary if too fast/slow

 

Obviously I will switch to liquid at this point, but I am investigating if it is still worth it to do so as after doing some calculations, switching to a hyperbolic method would save 20 reductions in total, so it essentially maximises time efficiency whilst simultaneously maximising safety due to the very specific calculations made by Horowitz and Taylor based on receptor occupancy.
 

Do you think this transition would be appropriate/ anyone have any thoughts?

 

Thank you very much.

[Erimus]

13 minutes ago, Daniel1269 said:

Hi,

 

What are your thoughts on transitioning to the hyperbolic tapering method after reaching 6mgai (19mgpw rounded up) for sertraline as this is where several repeated doses (rounded to 0dp due to Gem Scale abilities) occur and can potentially unnecessarily prolong the taper and cause innaccuracies use due to fluctuations, essentially reversing the work done previously (to an extent) and this could be avoided by purely considering receptor occupancy reductions? I would follow the Maudsley Deprescribing handbook initially and adjust where necessary if too fast/slow

 

Obviously I will switch to liquid at this point, but I am investigating if it is still worth it to do so as after doing some calculations, switching to a hyperbolic method would save 20 reductions in total, so it essentially maximises time efficiency whilst simultaneously maximising safety due to the very specific calculations made by Horowitz and Taylor based on receptor occupancy.
 

Do you think this transition would be appropriate/ anyone have any thoughts?

 

Thank you very much.

You can choose to follow whatever method you please when the time comes. It feels like you're over thinking the process a bit at the moment, Daniel. If you're following the 10%/month it will be quite some time before you need to worry about potential issues arising at the lower doses.

 

It is good to be organised, but tapering rarely follows a set plan, meaning you cannot plan your reductions much beyond a month or two down the road. Cross the bridge when you come to it. For now, forget about the future and try to focus on enjoying life right now.

Edited March 8 by Erimus

[Daniel1269]

@Erimus,

 

Yes I completely agree mate haha, just like to be prepared whilst I’m doing okay in case it’ll stress me out further down the line, but you’re completely right, cross bridge when I come to it.

 

Thank you!

[Erimus]

2 hours ago, Daniel1269 said:

@Erimus,

 

Yes I completely agree mate haha, just like to be prepared whilst I’m doing okay in case it’ll stress me out further down the line, but you’re completely right, cross bridge when I come to it.

 

Thank you!

The ideal scenario is that tapering takes a back seat during your life, and just becomes another mundane task that you have to do. Try to engross yourself in other things and don't spend too much time reading here, especially now you know what you're doing.

[Daniel1269]

@Erimus

 

Yeah you’re absolutely right, the only thing is with my situation is that I believe the sertraline is causing a level of insomnia for me (fragmented sleep, vivid dreams, less overall duration, but its better than it was during my mental health crises), so I just like putting myself in the best position possible for how to mitigate this issue.

(Sleep hygiene /CBTi techniques already perfect so I’m sure it’s not related to that, administer sertraline first thing in the morning too)

 

The fragmented sleep doesn’t impact my daytime functioning hence why I’m okay going slow and dealing with it for a little longer, as the potential WD is not worth risking just to try to mitigate the sleep issue by going faster, and I’m unsure if it’ll even improve as I reduce the dose, just hoping it might given that sertraline can exacerbate insomnia.

 

Apologies I was digressing there, and yes, whilst I sympathise deeply for everyone on here, it shouldn’t become a habit to delve deeper and deeper into the horror stories as it will get me nowhere.

 

Thank you so much for your continued support.

 

 

[Erimus]

3 hours ago, Daniel1269 said:

the only thing is with my situation is that I believe the sertraline is causing a level of insomnia for me (fragmented sleep, vivid dreams, less overall duration

These are unfortunately common side effects of SSRIs. They should reduce as you get way below the “effective” doses. 

[Daniel1269]

1 hour ago, Erimus said:

They should reduce as you get way below the “effective” doses. 

 
@Erimus,

 

What would you class as the lowest “effective dose” for Sertraline?

 

Cheers

[Erimus]

3 hours ago, Daniel1269 said:

 
@Erimus,

 

What would you class as the lowest “effective dose” for Sertraline?

 

Cheers

When I say effective dose, what I mean is what the drug manufacturers and governing bodies list as "effective". For example in the UK the lowest they will prescribe is 50mg tablets, this is what they (doctors and psychiatrists) would deem "the lowest effective dose". The experience of those on this site is that these drugs still have a significant impact at much lower doses, for example 25mg and 12.5mg.

 

You'll be alright through this process, Daniel. You seem to have a very sensible head on you, and I wish I was as meticulous as you were before starting my ill-advised taper 3 years ago.

[Daniel1269]

1 hour ago, Erimus said:

The experience of those on this site is that these drugs still have a significant impact at much lower doses, for example 25mg and 12.5mg.

This is also conveyed via the RO graphs so makes perfect sense, will just deal with the sleep for the time being.

 

1 hour ago, Erimus said:

You'll be alright through this process, Daniel. You seem to have a very sensible head on you, and I wish I was as meticulous as you were before starting my ill-advised taper 3 years ago.

I can’t tell you how much those words mean to me, so many uncertainties throughout this process so it’s nice to hear some words of encouragement, and I’m so sorry to hear about your hardship, the fact that you still support people despite your own struggles and failed past tapers is commendable, I have the utmost respect for people like yourself, much, much appreciated, and I wish you the best of luck yourself.

[Daniel1269]

Hi,

 

Does anybody have any insights on whether the duration of being on an SSRI ( and the time taken tapering off it) is linked to risk of WD?

 

I.e if the duration you spent tapering is a factor in determining WD risk, this means you are on the drug longer than a faster taper, and as a result of this there’s a higher chance of WD as per a group of studies indicating long term use has higher chance of WD?

 

Should this be considered with regards to tapering speed if you have only been on the drug say 4 months in my case, or should the 10% rule still firmly remain despite any duration that is over a month.

 

Also I obviously realise that too fast tapering can cause WD, I’m trying to determine if there’s a perfect balance that could be made in my case.

 

Any insights greatly appreciated, many thanks!

[Daniel1269]

Hi,

 

Following on from my last question,

 

Anyone have any thoughts on Dr Josef Witt Doering who specialises in tapering psyhciatric drugs stating that “ if you you have been on a SSRI for less than 6 months you can probably do a faster taper at 20% initially and adjust the rate depending on withdrawals and severity of symptoms etc. and the reasoning for this is due to the brain having less adaptations to accommodate the drug, so they can typically tolerate faster reductions” ?

 

This roughly equates to about a 10% reduction of the RO of SERT for Sertraline initially when you hit 12 weeks, then the tapering rate (and subsequent RO reductions) will get slower as the dosage is getting lower where the more pronounced withdrawals are seen to happen. Can this be influenced by tolerability of WD, i.e if no symptoms are above 4/10 intensity the 20% reduction can continue (of previous dose)? Is it just wise to stick with no more than 10% reductions and to do them more frequently if tolerable?

 

Just trying to ascertain if this could be viable given my 4 month usage.

 

Many thanks again.

[Erimus]

3 minutes ago, Daniel1269 said:

Hi,

 

Following on from my last question,

 

 

Anyone have any thoughts on Dr Josef Witt Doering who specialises in tapering psyhciatric drugs stating that “ if you you have been on a SSRI for less than 6 months you can probably do a faster taper at 20% initially and adjust the rate depending on withdrawals and severity of symptoms etc. and the reasoning for this is due to the brain having less adaptations to accommodate the drug, so they can typically tolerate faster reductions” ?

 

This roughly equates to about a 10% reduction of the RO of SERT for Sertraline initially when you hit 12 weeks, then the tapering rate (and subsequent RO reductions) will get slower as the dosage is getting lower where the more pronounced withdrawals are seen to happen. Can this be influenced by tolerability of WD, i.e if no symptoms are above 4/10 intensity the 20% reduction can continue (of previous dose)? Is it just wise to stick with no more than 10% reductions and to do them more frequently if tolerable?

 

Just trying to ascertain if this could be viable given my 4 month usage.

 

Many thanks again.

We don't recommend anything faster than the 10%/month rate, except in extenuating circumstances, such as an adverse reaction. Some people will taper quicker with no issues, whereas some will have big problems despite only using the drug for 3-4 months. The best thing you can do is listen to how your body reacts to the dose changes. There is no one size fits all approach, and the taper guidelines are the best way to encompass 95% of patients taking antidepressants.

[Daniel1269]

Thank you once again @Erimus

 

What are your thoughts on my question above this post about duration and WD risk?

 

(see post posted Sunday 09:23pm above)

 

Also out of interest, where did you get the “95% of patients” figure from?

 

Many Thanks.

[Erimus]

3 minutes ago, Daniel1269 said:

What are your thoughts on my question above this post about duration and WD risk?

I can't stop you from tapering quicker, all I can do is advise you. If you follow the 10%/month withdrawal will be very manageable, and you will be able to continue your life with minimal disruption.

 

4 minutes ago, Daniel1269 said:

Also out of interest, where did you get the “95% of patients” figure from?

I just made it up. As in, the majority of people on antidepressants would be able to manage the 10%/month taper.

[Daniel1269]

@Erimus,

 

 Ahh okay I get you, understood, and thanks for the info RE WD, helps a lot, will continue at 10%, so annoying how dr Josef says one thing, Horowitz something similar but not quite the same, and Surviving AD another thing!

 

I guess 10% method is most conservative and as you say,it decreases the risk the most to allow for normal life to continue.

 

Thanks once again mate.

[Daniel1269]

Hi,

 

If chemical imbalance is a myth, and SSRIs inhibit the reputake of serotonin, what is the actual mechanism of action of these drugs if serotonin deficiency is ruled out, anyone know? How do they improve mental state if there was never any deficiency to begin with?
 

And why have I felt a massive benefit from it, is it due to the drug, therapy, change in life circumstances/ stressors, or all of the above?

 

Many Thanks.