ThisIsthestart: 5 months in: to reinstate or push through?

[ThisIsthestart]

Hi folks, 

TLDR: Too fast taper off 50mg Zoloft July/August 2023; withdrawal became intense in Nov 2023 and continues to today. Wedding is in early May so stress isn't stopping. Should I reinstate or keep going?

Ok so, I've been creeping on the site here for a couple weeks, and was very excited when February 1st rolled around so I could register myself. I'd love to hear any advice or input on my situation. I've summarized my med history in my signature but here's the full story of where I'm at: 

In 2010 I started having panic attacks during sophomore year of college. These panic attacks were coupled with anxiety and severe gastric distress so I ended up dropping about 10 pounds and going to a Gastroenterologist because I thought I had IBS. The doc informed me it was not IBS, but that I had anxiety, and he prescribed me 20mg of Celexa which I began taking in November 2010. I also did exposure therapy through the university, and was diagnosed with panic disorder. With the medicine, my symptoms got better and I finished college in 2013 thinking "if it ain't broke don't fix it". In 2014 I made a random med change from Celexa to Lexapro, I don't think I had a real reason other than maybe thought I had gained weight from the Celexa so I switched? I continued on with 20mg Lexapro from 2014 until February/March of 2020. At that time, I was in really wonderful and healthy relationship, had just received a new job offer and felt really stable and content in my life. I hadn't had a panic attack in years and had always wanted to stop taking the meds, so with the help of a NP at a psych office, I weaned (far too quickly), taking 10 mg for 2-3 weeks, and then 5 or so every other day till I was at 0mg in the end of April 2020. Withdrawal aside, there were a lot of reasons this was stupid and I was ill prepared but I didn't realize that at the time. From May-July 2020 I experienced flu like symptoms, a plethora of brain zaps, SI, and some of the worst anxiety and depression I've ever experienced, much worse than my original condition. With no end to the pandemic in sight, and thinking it was just me, and I couldn't handle life without an SSRI, I went back to my NP at the psych office and reinstated with 50mg of Zoloft. We chose Zoloft because the physical symptoms of withdrawal from the lexapro were so bad she thought I might react better to the Zoloft instead. 

Ok, so I took 50 mg of Zoloft from July 2020 to June of 2023. The entire time I was on it I knew I wanted to try weaning again but wanted to take steps to make sure I was in a better place. I began heavily limiting my alcohol, caffeine, and sugar intake (things that were very high during the first attempt), made a lot of progress in therapy, got off of hormonal birth control, and started seeing a functional medicine doctor (FMD) to test my hormones and make sure those were as stable as they could be since we suspected I deal with PMDD. I worked with both my FMD and my GP to get a taper schedule together, and I thought I was doing it much slower than the first time. I tapered to 25mg during July 2023, and immediately had so much more energy and emotion than I had had for the last 12+ years. I cried a lot and often out of no where, but that and energy seemed to be the only side effects I noticed. In August 2023 I took 12.5mg daily for ~ 2 weeks, and then 12.5mg every other day for ~2 weeks after that. During this time I was also in the thick of training for a marathon, so I was running around 30 miles a week, the sun was out, I wasn't really drinking and life felt pretty manageable! After talking to some folks I really trust, I also had begun micro dosing ~125mg Psilocybin for a few days a week (~July-January) to help bridge the gap of coming off the Zoloft. I had some possible mild akathisia during this time, but I thought it was just from the running, and I also would get really nervous and have gastric distress before I went out on runs, but again - I thought it seemed normal to have a little panic before running 15+ miles 🤷‍♀️. I completed the marathon in the first week of October and slowly started consuming a bit more alcohol here and there, I don't think I ever actually got drunk at any point, but maybe 3ish drinks in a night every couple of weekends max. End of October /beginning of November 2023 was around when the anxiety and insomnia started. Which then after a trip to Mexico for a wedding, and drinking ~1 drink a night for the week + more the wedding weekend, I felt like I completely regressed with my anxiety and depression symptoms. Everything "came back" like it had in 2020 with a vengeance, I was 10x more anxious, suddenly depressed, incredibly irritable and annoyed by my partner, living in a pit of comparison, going through awful waves of gastric distress and nausea, crying all the time (though that had been there since tapering started), could get 0 pleasure, excitement or hope out of life and waking up with panic out of nowhere at 4 and 5 in the morning. This continued in what I called a "roller coaster" (waves/windows) From Nov 2023 to now. 

I didn't realize this was still withdrawals or that it even could be until the middle of January when I found this group by way of another facebook group I'm in and felt like it was an answered prayer. Just even to have a name to put to what I was experiencing, and seeing so many other people share the same issues I was experiencing. The constant crying, the waves and windows of anxiety and depression etc. I couldn't believe we all had been given such short taper plans by doctors, and was kicking myself for not finding out about this hyperbolic taper concept earlier, but alas...

So! What I'm seeking is advice. My partner and I are getting married in early May 2024, and I am terrified of being in this depressed/agitated state (where often he is getting the brunt of my mood) on our wedding day. Stress isn't really able to be lowered at this time, with the wedding coming up, being understaffed at work, and us moving states this summer. My partner is incredibly understanding and supportive, and I've taken steps from what I've learned here to lower the stress on my CNS as much as possible: I'm not drinking or indulging in THC, I stopped the micro dosing mid January, I try to get 8-9 hrs of sleep every night, I exercise daily, take morning walks, eat a whole foods diet, go to therapy weekly, meditate and breathe daily, do cold exposure 4x a week, you name it I'm probably doing it. I track my waves and windows, but at this rate I don't see an end to them in the near future.

I'm around 5 months into 0mg, should I reinstate at .5mg Zoloft and see if that curbs my waves and windows or just continue to push through?

Thank you so much for reading, any advice is appreciated and valued! 

[LotusRising]

Hi @ThisIsthestart

 

We are a peer-run volunteer site dedicated to a harm reduction tapering approach in an effort to minimize withdrawal symptoms. As you may have already seen, we recommend tapering by no more than 10% of your most recent dose each month. See  Why taper by 10%.

 

Thanks so much for creating a signature.

 

16 hours ago, ThisIsthestart said:

Should I reinstate or keep going?

 

I can't answer this question, because of course everyone is different, but reinstatement of a very small dose of the original drug can sometimes help to alleviate withdrawal syndrome. The only other alternative is to wait out the symptoms and manage the best you can while your CNS returns to homeostasis. Unfortunately, no one can give you an exact timeline as to when you'll start to feel better, or if it will even help. While some notice immediate improvement, for others it can take many months or longer.

 

Reinstatement isn't a guarantee for everyone, but it's the best tactic available, aside from waiting it out. Since you are outside the 3 month timeframe where reinstatement reliably works, it might work and it might not. If you decide that reinstatement is an option for you, we would recommend a much smaller reinstatement dose than your last dose in an effort to avoid Hypersensitivity and Kindling. It seems you've already done a fair amount of reading on the site, and have come up with a reasonable dose to start at. 

 

Here's another link if you haven't already read about Reinstating and Stabilizing.

 

And this one for zoloft:

 

 

 

Please feel free to post any updates or questions related to your specific situation right here in your thread. It's helpful to keep everything related to your tapering journey in one spot. 

 

Once again, welcome to the site

 

LotusRising

[ThisIsthestart]

Thanks so much for your response @LotusRising! I so wish I had found SA or any information on the hyperbolic taper process prior to coming off my SSRI, it just was not on my radar or on the radar of the health professionals I was working with. But since I can't do anything about that, we must move on!

I'm looking at reinstating, I've bought the gemini20 and i've read through a lot of the information on the Zoloft taper thread and on the reinstating and stabilizing one. One thing I feel very intimidated about is how to actually do this with my 25 mg or 50 mg Sertraline tablets. 

Also, from what I'm understanding on kindling - is it correct that kindling only really happens when you reinstate at a higher dosage and the possibility of kindling is much less likely when reinstating at a lower dose? 

Lastly - I forgot to mention in my original post that when I was in a really intense wave the first week of the year (~4 months into 0mg), before I realized it was withdrawals, my therapist had recommended I start back on the SSRI to find some stability again since I was in so much distress. I took 25 mg of Zoloft on a Thursday, and then 25mg on a Sunday but then decided I wanted to push through and give it more time. Could those one off doses have cause kindling or does kindling only really happen when it's a repetitive dose?

Thank you for your time and support. This community has made this process feel hopeful ❤️ 

[LotusRising]

20 hours ago, ThisIsthestart said:

One thing I feel very intimidated about is how to actually do this with my 25 mg or 50 mg Sertraline tablets. 

Yes, the whole process can be intimidating, especially when it comes to weighing or making our own solutions, but rest assured, there are many that are doing it with success.  What specifically are you wondering about? I can try and help, but I didn't taper zoloft specifically. Alternatively, you could try reaching out to other members who are also tapering zoloft. 

 

20 hours ago, ThisIsthestart said:

Also, from what I'm understanding on kindling - is it correct that kindling only really happens when you reinstate at a higher dosage and the possibility of kindling is much less likely when reinstating at a lower dose? 

Yes, that's correct and by starting at a lower dose, one can hope to avoid this. For example, I knew within 1 or 2 doses that reinstatement didn't work for me. I had an almost immediate uptick in symptoms and they worsened again with my dose the following day. 

 

 

[Dahlia50]

@ThisIsthestart How are you?

[ThisIsthestart]

@Dahlia50 Thank you for asking! I'm doing ok - still experiencing waves and windows, but the waves feel smaller and the windows feel bigger. I am attempting reinstatement this week by dissolving a 25mg zoloft pill into 100 ml of water and taking a 1mg serving to see if that helps to curb the withdrawal symptoms of anxiety and depression I've been experiencing. Despite the better windows I'm seeing, I feel like I might need to protect myself against the upcoming stressors I'm going to have in getting married and moving states.

[ThisIsthestart]

Assuming I should just keep posting questions here directly to my intro topic so please let me know if this is not the case. 

On 2/22 I began reinstating with 1mg of Zoloft (dissolved a 25 mg tablet into water). The first day I got a bit nauseous and then had a migraine. The second day, a little nauseous and a headache that eventually went away. The third day only a little nauseous and no headache, had one of the best days I've had in months - felt almost fully normal! However by the 4th day I started to feel waves come over me just as bad as they were before, so no real change there - but the other thing I have noticed is I feel much more tired and exhausted over this last week than I ever did during the withdrawal months at 0mg. This feels much more like I did while on the SSRI. Today, I feel almost zombie like. I have 0 motivation and sort of just feel like I'm in a blank fog. 

Is 7 days of testing 1mg enough to just back right off or do I need to taper down? Do I need to hold at this 1mg dose for a few more weeks? I'm reading through the reinstatement thread and feel like my head is spinning. 

[ThisIsthestart]

Ok, so I'm just over 3 weeks into my reinstatement of 1mg of Sertraline (from being at 0 from a too-fast-taper for ~ 5 months prior). I dissolve my 25mg pill into 100 ml of water and take a (1mg) 4ml dose. 

I'm definitely still seeing windows and waves. The waves aren't as long as they were for the most part, and maybe every 10 days I have a serious emotional breakdown. The anxiety is pretty much always there like a ball of bad energy in my chest, and the depression comes in every so often through out the days. The morning waking has greatly improved from Late January/early February and I'm sleeping pretty well.

What I'm not sure about is - do I just hold at this 1mg of Zoloft for the foreseeable future? We're getting married in May and moving states in July, so I don't plan to try and taper down until well after we're settled. I don't feel like I've got a good grasp of whether or not I should continue up in my dose for reinstatement, or just continue to hold here at 1mg for the next few months? Out of the last 3 weeks, I've had 3 really awful wave days, but other than that I'd say I'm cruising at a solid 4 on a scale of 1-6, with 1 being most awful wave, and 6 being feeling really good. Is this withdrawal normal? 

 

Edited to add: I was on a **** ton of supplements from my functional med doc for the last year. I have stopped all of my supplements for the time being except mgnesium and glycine before bed, and my probiotics (Neuralli Mood) in the morning. Slowly testing adding various ones back in to see how I react to them over the next couple months. 

Any input/perspective/good juju is appreciated ❤️

Edited March 15 by ThisIsthestart
Forgot to include supplements

[Dahlia50]

@ThisIsthestart Hi, Great if it works and helps you. Thinking about reinstatement 1mg zoloft myself 5,5 months off. Just a question, did you have any side effects when you started?

[ThisIsthestart]

@Dahlia50 The only side effects I have noticed so far have been 1-2 days of depersonalization about a week into reinstatement, it wasn't all day and it improved and I haven't had it since; headaches a bit more often (not debilitating, but annoying), and I've been more tired. The tired feeling was a huge complaint for me the last ~13 years of being on the SSRI. I had never connected the 2 but after stopping the SSRI and reinstating, I definitely see that it's connected. 

Those are the only side effects I seem to have noticed since reinstating ~3 weeks ago. My waves have gotten smaller, so I'll chalk it up to a win I guess. 

[LotusRising]

1 hour ago, ThisIsthestart said:

What I'm not sure about is - do I just hold at this 1mg of Zoloft for the foreseeable future?

Hi @ThisIsthestart,

 

If you feel like symptoms have improved, you could hold at your current dose for now. It sounds like you have a lot coming up, so as you mentioned, best to hold until you're in a place where there is less stress. 

 

 

[ThisIsthestart]

Thanks for the input @LotusRising! I definitely plan to at least hold here for the next fewmonths, but just to clarify - you don't think it's necessary to taper up? I guess I wasn't sure what success with reinstatement would look like.

If success =  not crying every day in a ball on the floor questioning my entire life, then I'm (mostly) good lol

If success with reinstatement = not having any anxiety or depressive symptoms daily then I don't think i've quite hit it yet. 

 

[LotusRising]

You could definitely try tapering up!

 

It's really hard for me to say either way, but if you've had improvements in some symptoms and not others, it might be worth it to try. 

[ThisIsthestart]

Still considering tapering up, especially when I have "bad" days - I had initially reinstated thinking I could live a little bit of a normal life for the wedding festivities but joke was on me for that. On the bright side, I can say that I haven't needed alcohol to have fun - which is a god send. Sometimes I do feel othered when out with friends and everyone else is drinking, but 90% of the time, I'm really fine in those situations. 

Leaving a note for myself mostly as I did try a few sips of people's beverages on Friday night of my bachelorette party, just to taste them, etc. I just sipped on a mocktail, and truly just tasted the other drinks, didn't take a large sip or anything. That night i felt SO ACTIVATED. I'd heard people describe this and honestly just thought they were much more sensitive or something, but after not having a drink since December 31st, a night that sent me into awful waves for a few weeks, I recognized the feeling right away. It was like my body and eyes were tired, and it was well past my normal bedtime, but my brain felt so alert and like it kept waking me up all night when I had fallen asleep. Truly a wild experience, and while it was uncomfortable, I'm also glad I had it because it reminded me I'm much too sensitive for anything like that for the time being, and also that I don't need it to have fun. 

I never thought i'd be living a sober life. I wouldn't say I was a lush or anything, especially not over the last 3 years, and I realllllly cut back my drinking once my partner went to grad school, but I still thought we'd enjoy wine together or a cocktail out occasionally - my father owns a liquor store! But after this experience with WD, it's just not worth it at all, and being sober is actually not as boring as I'd imagined it would be.