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darkflame141: Quit multiple drugs CT before I knew. Now, chronic debilitating fatigue that I think is Zoloft/Lexapro WD, but possibly other WDs too. Please help!


darkflame141

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Hi all! Thank you in advance for any help/advice. 

 

Since July 2023 (8 months) I've dealt with debilitating daytime fatigue. It's not sleepiness, since I don't feel the need to nap—more like I'm pulled underwater. I can't process/experience anything. My eyes glaze over, almost like I go unconscious with my eyes open. It's devastated my life. Extensive blood work has come back mostly normal, with very slightly high cortisol & transferrin saturation which I doubt are clinically meaningful. I'm a 22-year-old male & when this started I was very stringent about exercise, sleep, & nutrition. Recently I've developed mild visual distortions: visual snow, trouble focusing my eyes, & distant objects sometimes seem to flow like oil, although I think these are due to Qelbree WD & not the SSRIs.

 

My drug history is in my signature. Here's my story with a focus on a few drugs: in Oct '23 (my senior year of college), I started Zoloft after an acute mental crisis. That Nov I went up to 100 mg & stayed on this for 6 months. Shortly after moving in June, I began to feel some daytime fatigue. It wasn't too bad, but I thought (& still think) the Zoloft was causing it, so I asked to switch to Lexapro. I should note that fatigue was much milder than the fatigue I'm experiencing now, so I don't think it suggests that my current fatigue started before any WDs.

 

After some time, things rapidly declined—I think I noticed in Aug. I felt strong fatigue even through Adderall (I have ADHD) & ~7 cups of coffee (I've cut back for periods & it didn't help the fatigue). I had known Adderall was bad for me in the long run, so I switched to Focalin in Sept. Focalin didn't mask the fatigue as strongly. My mood was fine, so I thought Lexapro was causing the continued fatigue. In Oct I started to wean off Lexapro. In Nov I stopped Lexapro & also replaced Focalin with Strattera (a non-stimulant drug for ADHD). Focalin had similar side effects to Adderall, but my fatigue became debilitating when I no longer had a stimulant masking it. I think it also worsened from quitting Lexapro. 

 

I spent the next few months trying a bunch of non-stimulants for ADHD. Because my fatigue had gotten worse & I didn't realize this could be entirely explained by quitting stimulants + Lexapro, I thought my fatigue was now because of these non-stimulants. I slogged through this repeated pattern of waiting weeks for the fatigue to go away each time I "adjusted" to a drug, & then switched to another non-stimulant when it didn't. 

 

After months of unbearable fatigue (& trying pretty much every drug for ADHD anyway), I got sick of it & got off everything except Wellbutrin & Armodafinil (both of which I was prescribed for the fatigue). Quitting these drugs didn't improve the fatigue. Two days ago I restarted guanfacine at my full dose since I realized I shouldn't have quit it CT & in the past I was pretty satisfied with it. I had quit it only to see if it was causing the fatigue.

 

Now I think my fatigue probably has little to do with the non-stimulants (although it did get worse when I went up to 80 mg Strattera). Looking back on the timing, this all started when I switched off Zoloft, & really got bad when I quit Lexapro. I think my fatigue is caused by WD from these two drugs. I've probably had Zoloft WD the whole time, initially softened by Lexapro since it functions similarly. When I quit Lexapro, the WD blew up. However, the mild visual distortions seem much more recent. I had severe visual distortions while I was quitting Qelbree, so they may be Qelbree WD. And considering that increasing Strattera did worsen my fatigue, I'm worried I may actually be juggling protracted WDs from multiple drugs.

 

I feel like I was pushed into climbing a cliff. Now that I'm there, there's no way down. I feel lost. My memory also seems to be impaired, so it's hard to even remember how I got here. Does anybody have any advice? Right now I'm getting my cortisol rechecked & also checking for sleep apnea, but I doubt either will lead anywhere. I know SSRI WD can last for years & the idea of feeling like this for years is terrifying. Does this get better?

 

A few other questions:

 

Most importantly, should I reinstate Zoloft? I was thinking of reinstating at either 50 mg or asking for a lower dose with a liquid formulation. But now that I'm back on the guanfacine that would put me on 4 drugs. And it's been 8 months since I was on Zoloft. 

 

Was getting back on the guanfacine the right idea? I do feel somewhat better. 

 

Does this even sound like WD? My understanding is most people end up feeling "activated" rather than fatigued.

 

Has anybody experienced the combo of fatigue/visual distortions/impaired memory as part of SSRI withdrawal? 

 

Are there any lifestyle changes/supplements/etc. that people with WD-related fatigue have found helpful? I know there's a few posts about lifestyle/supplements generally but for most people fatigue doesn't seem the primary symptom.

Green = started drug, Red = stopped drug, -> = replaced drug with another

July '21: started Ritalin 15 mg daily (10 mg LA + evening 5 mg IR, later ↓ to 5 mg daily)
Oct '22: started 50 mg Zoloft
Jan '23: ↑ to 100 mg Zoloft; Ritalin (CT switch) -> 2.5 mg Adderall 2x daily
July '23: Zoloft (CT switch) -> Lexapro 10 mg due to mild-moderate fatigue (after ~6 months on 100 mg Zoloft)

July - Oct '23: Fatigue considerably worsened. From here on I think I was already in a state of severe fatigue (initially masked by stimulants).

Sep '23: Adderall (CT switch) -> Focalin 1.25 mg 2x daily
early Oct '23: started Wellbutrin XL 150 mg (for the fatigue)
late Oct - Nov '23: stopped Lexapro (1 month taper off); started Strattera 40 mg (1 month taper up); stopped Focalin (CT in Nov)
Jan '24: started Guanfacine XR 2 mg 
Feb '24: tried ↑ to 80 mg Strattera for fatigue, then Strattera (1 week taper) -> Qelbree 200 mg; started Modafinil 100 mg 2x daily
Mar '24: Stopped Qelbree (1.5 week taper); Stopped Guanfacine (CT); Modafinil (CT switch) -> Armodafinil 250 mg

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  • Moderator

Hello, and welcome to Surviving Antidepressants. We are a peer support forum to assist in tapering off psychiatric drugs safely, or recovering from psychiatric drug withdrawal.

 

Could you post a list of the current drugs you are taking, their doses, and the time of day you take them? This will make it easier for me to digest what is happening.

 

Regards

Erimus

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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Hi Erimus, and thank you. I know it's a lot, I can definitely do that. 

 

Right now, I'm taking Guanfacine 2 mg ER (for ADHD), Wellbutrin XL 150 mg (initially for the fatigue), & Armodafinil 250 mg (for the fatigue). I take the Guanfacine right before I go to sleep (time varies but ~11-11:30 PM lately), the Wellbutrin right when I wake up (usually 7:15 or 9:15 AM), & the Armodafinil I split in two, so 125 mg when I wake up & another 125 mg between noon & 1 PM. I don't think any of these are causing the fatigue because it didn't seem to get worse when I started them, although it was worse when I temporarily tried to CT the Guanfacine. 

 

I can add this to my original post if that would be helpful. 

 

Green = started drug, Red = stopped drug, -> = replaced drug with another

July '21: started Ritalin 15 mg daily (10 mg LA + evening 5 mg IR, later ↓ to 5 mg daily)
Oct '22: started 50 mg Zoloft
Jan '23: ↑ to 100 mg Zoloft; Ritalin (CT switch) -> 2.5 mg Adderall 2x daily
July '23: Zoloft (CT switch) -> Lexapro 10 mg due to mild-moderate fatigue (after ~6 months on 100 mg Zoloft)

July - Oct '23: Fatigue considerably worsened. From here on I think I was already in a state of severe fatigue (initially masked by stimulants).

Sep '23: Adderall (CT switch) -> Focalin 1.25 mg 2x daily
early Oct '23: started Wellbutrin XL 150 mg (for the fatigue)
late Oct - Nov '23: stopped Lexapro (1 month taper off); started Strattera 40 mg (1 month taper up); stopped Focalin (CT in Nov)
Jan '24: started Guanfacine XR 2 mg 
Feb '24: tried ↑ to 80 mg Strattera for fatigue, then Strattera (1 week taper) -> Qelbree 200 mg; started Modafinil 100 mg 2x daily
Mar '24: Stopped Qelbree (1.5 week taper); Stopped Guanfacine (CT); Modafinil (CT switch) -> Armodafinil 250 mg

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  • Moderator
1 hour ago, ericmi11er said:

Hi Erimus, and thank you. I know it's a lot, I can definitely do that. 

 

Right now, I'm taking Guanfacine 2 mg ER (for ADHD), Wellbutrin XL 150 mg (initially for the fatigue), & Armodafinil 250 mg (for the fatigue). I take the Guanfacine right before I go to sleep (time varies but ~11-11:30 PM lately), the Wellbutrin right when I wake up (usually 7:15 or 9:15 AM), & the Armodafinil I split in two, so 125 mg when I wake up & another 125 mg between noon & 1 PM. I don't think any of these are causing the fatigue because it didn't seem to get worse when I started them, although it was worse when I temporarily tried to CT the Guanfacine. 

 

I can add this to my original post if that would be helpful. 

 

Thanks. Could you also choose a pseudonym for the forum? I am assuming you have used your real name here.

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment
  • Moderator

Regarding the fatigue and other withdrawal symptoms: It is difficult to tell due to the number of different drugs you have tried, tested, and stopped over the last 12 months or so.

 

I don't think reinstating zoloft, particularly at such a high dose of 50mg, will be a good idea. If I was you, I would be considering reducing my drug burden very gradually. I don't think you will find another drug to "cure" the fatigue if it is being caused or compounded by the medication you already take. Sometimes we have to take a step back and allow our mind and body to reset in the absence of medication. This doesn't mean we can immediately remove them, however, it takes careful and cautious tapering so we don't shock our brain.

 

Drugs can initially be activating but as the nervous system adapts they can go the other way, causing fatigue. I'm not versed on guanfacine and armodafinil, but we do provide information on Tips for tapering off buproprion (Wellbutrin, SR, XR, XL) .

 

We suggest tapering by no more than 10% of your current dose each month. To taper Wellbutrin XL it is first recommended you transition to the SR version first. Read more in the link just above.

 

 

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

Link to comment
19 hours ago, Erimus said:

Thanks. Could you also choose a pseudonym for the forum? I am assuming you have used your real name here.

Ah, I didn't even think about the name. I could change it to darkflame141 (used to go by that on xbox... lol). I need to message an admin to change my screen name, right? I also can't find where to edit my post title so if you're able to change my name there I would appreciate it. 

 

19 hours ago, Erimus said:

Regarding the fatigue and other withdrawal symptoms: It is difficult to tell due to the number of different drugs you have tried, tested, and stopped over the last 12 months or so.

 

I don't think reinstating zoloft, particularly at such a high dose of 50mg, will be a good idea. If I was you, I would be considering reducing my drug burden very gradually. I don't think you will find another drug to "cure" the fatigue if it is being caused or compounded by the medication you already take. Sometimes we have to take a step back and allow our mind and body to reset in the absence of medication. This doesn't mean we can immediately remove them, however, it takes careful and cautious tapering so we don't shock our brain.

 

Drugs can initially be activating but as the nervous system adapts they can go the other way, causing fatigue. I'm not versed on guanfacine and armodafinil, but we do provide information on Tips for tapering off buproprion (Wellbutrin, SR, XR, XL) .

 

We suggest tapering by no more than 10% of your current dose each month. To taper Wellbutrin XL it is first recommended you transition to the SR version first. Read more in the link just above.

 

 

Thanks for the reply. I read what you linked. Do you still recommend against reinstating Zoloft at very low dose (~10 mg)? I absolutely agree that these drugs won't cure my fatigue. I don't trust them anymore. Some part of me still clings to the idea that the right combo will make my life a lot better, but my experience says otherwise & I do think I should get off them in the long run (except possibly guanfacine).

 

The thing is, the fatigue was already severe before I started any of these 3 drugs. Possibly they're now making the fatigue worse but the bulk of it must be something else. I'm pretty confident it's WD from Zoloft/Lexapro. Admittedly, I've been confident before about what's causing my fatigue & been totally wrong, but the timing lines up with Zoloft/Lexapro WD. When I thought my fatigue was caused by ADHD drugs, the timing never made much sense since my fatigue preceded all of these drugs except possibly Strattera.

 

So, I guess what worries me about tapering Wellbutrin (besides not being sure it would help, but I don't know anything) is that it wouldn't be a clean single-drug taper. I'd be tapering Wellbutrin on top of severe cold-turkey WD from another drug. Should I taper another drug when I'm not stable right now? Admittedly it's also kind of scary because I've been depressed lately from the fatigue, although the Wellbutrin was never prescribed for depression & I have no idea how it affects my mood. 

 

I think my options are to 1) taper Wellbutrin, 2) keep everything the same for now (wait), or 3) reinstate very low dose Zoloft. The more I read here I'm wondering if waiting is the smartest idea, since I'm not stable right now. But patience is hard after 8 miserable months. 

 

Thanks again for your advice. 

Green = started drug, Red = stopped drug, -> = replaced drug with another

July '21: started Ritalin 15 mg daily (10 mg LA + evening 5 mg IR, later ↓ to 5 mg daily)
Oct '22: started 50 mg Zoloft
Jan '23: ↑ to 100 mg Zoloft; Ritalin (CT switch) -> 2.5 mg Adderall 2x daily
July '23: Zoloft (CT switch) -> Lexapro 10 mg due to mild-moderate fatigue (after ~6 months on 100 mg Zoloft)

July - Oct '23: Fatigue considerably worsened. From here on I think I was already in a state of severe fatigue (initially masked by stimulants).

Sep '23: Adderall (CT switch) -> Focalin 1.25 mg 2x daily
early Oct '23: started Wellbutrin XL 150 mg (for the fatigue)
late Oct - Nov '23: stopped Lexapro (1 month taper off); started Strattera 40 mg (1 month taper up); stopped Focalin (CT in Nov)
Jan '24: started Guanfacine XR 2 mg 
Feb '24: tried ↑ to 80 mg Strattera for fatigue, then Strattera (1 week taper) -> Qelbree 200 mg; started Modafinil 100 mg 2x daily
Mar '24: Stopped Qelbree (1.5 week taper); Stopped Guanfacine (CT); Modafinil (CT switch) -> Armodafinil 250 mg

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  • Erimus changed the title to darkflame141: Quit multiple drugs CT before I knew. Now, chronic debilitating fatigue that I think is Zoloft/Lexapro WD, but possibly other WDs too. Please help!
  • Moderator
2 hours ago, ericmi11er said:

Ah, I didn't even think about the name. I could change it to darkflame141 (used to go by that on xbox... lol). I need to message an admin to change my screen name, right? I also can't find where to edit my post title so if you're able to change my name there I would appreciate it.

I'll take care of that.

 

2 hours ago, ericmi11er said:

Thanks for the reply. I read what you linked. Do you still recommend against reinstating Zoloft at very low dose (~10 mg)? I absolutely agree that these drugs won't cure my fatigue. I don't trust them anymore. Some part of me still clings to the idea that the right combo will make my life a lot better, but my experience says otherwise & I do think I should get off them in the long run (except possibly guanfacine).

I just feel that at 8 months off, and in adding another drug to a concotion of 3, you would be taking an unecessary risk. It's very difficult to tell what is happening when you're taking stimulants and other durgs which are associated with activation (wellbutrin).

 

Holding will probably be beneficial, but if the fatigue doesn't improve then I would seriously be looking at reducing the drug burden.

Active Monday-Friday UK time

 

MEDICATION:

1) Sertraline:

50mg - Oct 2020, 100mg - Dec 2020, 50mg - April 2021, 75mg - May 2021, 50mg - Sep 2021; 55mg - 23 Feb 2024; 60mg - 20 March 2024; Start tapering - 24 April 2024

Current dose: 57.93mg  (15 May 2024)

2) Mirtazapine:

15mg - Nov 2020

SUPPLEMENTS:

Cod liver oil, Magnesium, Vitamin C

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