mtmalaka: Hello! Tapering from Zoloft 12mg to zero - need some advice

[mtmalaka]

Hello everyone. New here. Been on Zoloft for 10 years (100mg) - the medication worked wonders for my anxiety, however recently quit working which prompted me to come off the medication. I did a 3 month taper with my doctor going from 100mg - 75mg - 50mg - 25mg - 12mg - zero. I had very little withdrawal issues up until recently when I dropped from 12.5mg to zero. I have been at zero for about 5 days now and the withdrawal effects are creeping in. My question to the community is: Could I go back onto 12.5mg after being off for 5 days?  My new goal would be to then slow taper from 12.5mg to 6mg etc using this site for guidelines. Thanks in advance!

[Emonda]

Welcome @mtmalaka

 

So the moderators can best help you, please complete your drug signature by following these instructions. Adding a signature ensures your drug history appears at the bottom of every post, making it more efficient for those trying to assist. 

 

This link should go directly to your own signature: Account Settings – Create or Edit a signature

 

13 hours ago, mtmalaka said:

I did a 3 month taper with my doctor going from 100mg - 75mg - 50mg - 25mg - 12mg - zero. I had very little withdrawal issues up until recently when I dropped from 12.5mg to zero

 

A much slower taper is recommended here: Why taper by 10% of my dosage?

 

When you taper faster than this, WD symptoms are the likely outcome: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

These two links would be worth reading:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

Kindling

 

13 hours ago, mtmalaka said:

I have been at zero for about 5 days now

 

You say you're off for about 5 days. Exactly 5 days? 

 

13 hours ago, mtmalaka said:

My question to the community is: Could I go back onto 12.5mg after being off for 5 days? 

 

The guidance I've looked at suggests perhaps reinstating 50% of the original dose if you've stopped CT in the last 4 weeks. I'll ask someone offline for their input. Generally, it's best to start lower and work up from there....but the decision is yours.

 

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

[Dahlia50]

@mtmalaka Hi, I'm not a moderator/administrator and can't give advice but it sounds wise to go back, to what dose dont know. I didn't and regret it. Like you, I got WD after 5 days after zero (but also had it during previous taper). Everyone is different but for me it got worse and worse and crashed after 2-3 months.

Good luck and take care.

[Emonda]

How'd you go with that signature?

 

Chatting behind the scenes, if you stopped just five days ago and felt stable at 12.5mg, then it should be okay to restart at that dose.

 

Just monitor your symptoms.

[mtmalaka]

Thanks for the replies. Also thanks for the helpful information above, @Emonda PS I updated my signature! 

 

I have fairly mild physical withdrawal symptoms at the moment (dizziness, brain zaps etc.)... However some very notable malaise / depression. If going back onto 12.5 resolves this, I would consider going back onto 12.5mg and then tapering from there (using the SA recommended micro-tapering protocol) - I am hoping to wait this out in favor of being completely off the medication. However I do not want to miss my window for going back to 12.5mg for a longer taper. 

[Emonda]

5 hours ago, mtmalaka said:

PS I updated my signature!

 

Many thanks.

 

5 hours ago, mtmalaka said:

I am hoping to wait this out in favor of being completely off the medication

 

It can get very, very difficult. Reflect on the comments from Dahlia50.

 

5 hours ago, mtmalaka said:

However I do not want to miss my window for going back to 12.5mg for a longer taper. 

 

Reinstating is best sooner rather than later. You're only a few days at 0mg. The window is wide open for you...but 100% your choice.

 

Have a read of Josh and ThreeLittleBirds.

 

Emonda

[mtmalaka]

Hello! So I am about 5 weeks in at zero and I am certainly feeling the withdrawal symptoms. Anxiety is significantly worse than when I initially got on the medication. I am fearing this could get worse before it gets better. Is 5 weeks typically too late to reintroduce 12.5mg? 

 

Thanks

[Emonda]

Hi Mtmalaka,

I just saw you sent me a PM.

 

It's best to post questions here so everyone can read and respond. I get busy with work, so can't always respond in a timely manner.

 

12 hours ago, mtmalaka said:

So I am about 5 weeks in at zero and I am certainly feeling the withdrawal symptoms.

 

Ah, so you decided not to reinstate. Yep, I reckon you'd be feeling, well, not so good.

 

12 hours ago, mtmalaka said:

Anxiety is significantly worse than when I initially got on the medication.

 

A classic WD symptom.

 

12 hours ago, mtmalaka said:

I am fearing this could get worse before it gets better.

 

It can get very unpleasant, which is why Dahlia50 also encouraged reinstatement after only five days off. But anyway, hindsight is wonderful. I've made the same mistake many times (before finding this site).

 

12 hours ago, mtmalaka said:

Is 5 weeks typically too late to reintroduce

 

It's not too late to reinstate, but the question is the dose. Please go back and read the reinstating and kindling links in my first post.

 

The further out you are, the lower the amount you'd try to reinstate. I've read a figure of 25% of the last dose around the period of time you've been off. 12.5mg * 25% = 3.125mg, but it's just a guess. I have no idea how you'll respond. You need to make this decision.

 

If you do reinstate, start small, monitor your response, and if things are ok with the amount reinstated, reassess the dose and your symptoms after say two weeks.

 

I hope this helps.

 

[mtmalaka]

Thanks Emonda for the reply! 

 

I reinstated at my last dose 12.5mg - per also my doctors recommendation. I don't have the means to split that 12.5 into smaller dosages accurately. (will need to get a scale and follow the taper schedule here in SA). My doc did recommend going back onto the therapeutic dose of 25mg in 2 weeks. I think that's too short of a window and I will monitor my symptoms in 12.5 for a while before making a decision. 

 

Thanks!

[mtmalaka]

Hello Emonda. 

 

6 days into 12.5g reinstatement. No noticeable adverse reactions, but last night I've noticed decent internal agitation and restlessness when trying to sleep. (need Ativan to sleep, currently bad insomnia.) 

 

I'm wondering if this is just reinstatement side effects that subside OR will it turn into Akatheisa? I dread the latter. Should I reduce my dose to 6.25? Or stop entirely? 

[Emonda]

19 hours ago, mtmalaka said:

need Ativan to sleep, currently bad insomnia.

 

Be very, very careful with this. You can become dependent very quickly. Insomnia impacts most of us tapering from ADs.

 

Perhaps look into this: Melatonin for sleep

 

19 hours ago, mtmalaka said:

No noticeable adverse reactions

 

That's good.

 

19 hours ago, mtmalaka said:

but last night I've noticed decent internal agitation and restlessness when trying to sleep.

 

At this stage it's a once-off.

 

19 hours ago, mtmalaka said:

Should I reduce my dose to 6.25?

 

I suggested a starting amount of ~3mg:

 

On 6/5/2024 at 4:17 PM, Emonda said:

The further out you are, the lower the amount you'd try to reinstate. I've read a figure of 25% of the last dose around the period of time you've been off. 12.5mg * 25% = 3.125mg, but it's just a guess. I have no idea how you'll respond. You need to make this decision.

 

If you do reinstate, start small, monitor your response, and if things are ok with the amount reinstated, reassess the dose and your symptoms after say two weeks.

 

 

Frequent changes in doses are unhelpful. Maybe monitor a little longer, and reassess...but it's your decision.

 

I hope you have a better night tonight.

 

 

[mtmalaka]

Thanks Emonda. 

 

I do feel a progressively a bit calmer after reinstating the Zoloft over these 7 days. The night-time restlessness might have been a one-off like you mentioned. (I do remember these side-effects when first starting the medication long ago) I am going to stay the course at 12.5mg 

 

I must say, I feel incredibly ignorant for not taking heed the advice here on the more gradual taper. I wouldn't be in the position. Yet, the taper leading up to the cessation was fairly easy, so I thought I had this in the bag and would finish the taper without problems.. My doc actually wanted me to stop at 25mg - and said I was being "prudent" by going down to 12.5mg for another 3 weeks. Eeesh

 

Re: the Ativan. I've only been taking between 1-2mg of Ativan per day for about 7 days now. Would this warrant a short-term taper? If so, is there any literature on the site that would provide a tapering plan? This has been an 'incase of emergency' medicine for me, and I am aware of the dependency risk but this past week has been an emergency indeed. Aside from the Ativan, I have Hydroxyzine, which is benign and seems to work when anxiety levels are lower. How do we feel about Hydroxyzine for sleep? I just ordered the melatonin, thanks! 

 

Last Question: If for some reason this Zoloft reintroduction doesn't work (It's feeling like it might, but just hypothetically speaking here), what would my options be at that stage? Cease the Zoloft and ride out the withdrawal without the help of Ativan or any other medication? That seems to be a devastating prospect. 

 

Again, thanks for all your help!

[mtmalaka]

Hi @Emonda - just checking back in to get your thoughts or the communities throughts on Hydroxyzine for sleep? I'd really like to transition from the Ativan to something less depenancy forming. 

[Emonda]

On 6/12/2024 at 2:49 AM, mtmalaka said:

I do feel a progressively a bit calmer after reinstating the Zoloft over these 7 days. The night-time restlessness might have been a one-off like you mentioned

 

Good to hear

 

On 6/12/2024 at 2:49 AM, mtmalaka said:

I must say, I feel incredibly ignorant for not taking heed the advice here on the more gradual taper. I wouldn't be in the position. Yet, the taper leading up to the cessation was fairly easy, so I thought I had this in the bag and would finish the taper without problems.. My doc actually wanted me to stop at 25mg - and said I was being "prudent" by going down to 12.5mg for another 3 weeks. Eeesh

 

Hindsight is wonderful

 

On 6/12/2024 at 2:49 AM, mtmalaka said:

Re: the Ativan. I've only been taking between 1-2mg of Ativan per day for about 7 days now

 

Can you add this to your signature, please.

 

On 6/12/2024 at 2:49 AM, mtmalaka said:

Would this warrant a short-term taper?

 

I have no personal experience with benzos.  I believe at 7 days, you may be ok to just stop. What do you think @LotusRising...7 days of 1-2mg of Ativan?

 

On 6/12/2024 at 2:49 AM, mtmalaka said:

How do we feel about Hydroxyzine for sleep?

 

I'd be sticking to the Melatonin.

 

On 6/12/2024 at 2:49 AM, mtmalaka said:

Last Question: If for some reason this Zoloft reintroduction doesn't work (It's feeling like it might, but just hypothetically speaking here), what would my options be at that stage? Cease the Zoloft and ride out the withdrawal without the help of Ativan or any other medication? That seems to be a devastating prospect.

 

Let's not cross a bridge we don't need to.  You said you were feeling progressively calmer...sounds like you're making progress.

[LotusRising]

On 6/11/2024 at 10:49 AM, mtmalaka said:

I've only been taking between 1-2mg of Ativan per day for about 7 days now.

@mtmalaka I would tend to agree with @Emonda, that at 7 days you would likely be safe to just stop it, assuming you have no prior history of taking a benzo?

 

Also, I want to point out a few things: 1-2mg might seem like 'only' a small dose, but it's not. A typical starting dose for ativan is usually not more than 0.5mg, so 1-2mg is actually pretty high. Secondly, it shouldn't be prescribed beyond 2-4 weeks and lastly, dependence can develop quickly even with intermittent use. It sounds like you're already on the right track with wanting to stop, but thought it worth noting. If you have other questions about it,  don't hesitate to tag me.

[mtmalaka]

 

Thanks you Emonda! Great insight LotusRising. 

 

I am able now to get the Ativan down to 1mg per day. I plan to keep at this rate for another week or so then move down to 0.5mg and so forth. I do not have a history of Benzo use, outside of intermittent uses for sleep a few times per year. The anxiety is still very high but 1mg in the morning coupled with plenty of rest and melatonin at night seems to make life bearable at the moment.

[LotusRising]

6 hours ago, mtmalaka said:

 

I am able now to get the Ativan down to 1mg per day. I plan to keep at this rate for another week or so then move down to 0.5mg and so forth.

I would caution against drawing it out too long. Your short-term use is in your favour and since your total usage is quite short, it may be beneficial to do a quicker taper. But definitely listen to your body.

[mtmalaka]

I hear you loud and clear. I'm really hoping I can restabilize with the Zoloft soon, thus cutting short the need for Ativan. 

[mtmalaka]

Is it possible for someone in my position to develope Akethesia from the resinstatment? I don't believe I am a candidate for kindling per my history, however the last few mornings, around 2am, I have hipnic jerks that awaken me, when then turn into mild akatheisa, which keeps me awake. Im really hoping this are just the transitory side effects from the Zoloft reintro and don't lead into anything long term. 

 

If Akatheisa does persists, would stopping the Zoloft be an option? I would imagine that would further damage my system and lead to even more sever WD effects. 

 

 

 

[itsalyssadood]

On 6/15/2024 at 10:30 AM, mtmalaka said:

however the last few mornings, around 2am, I have hipnic jerks that awaken me, when then turn into mild akatheisa

Hi @mtmalaka! 
 

Question for ya- what time do you take your dose? I noticed that when I reinstate a dose or am trying to stabilize again, that I will get feelings like this when the drug “peaked” in my system (for Lexapro it’s about 5 hours). 
 

 

[daffa]

On 6/16/2024 at 12:30 AM, mtmalaka said:

Is it possible for someone in my position to develope Akethesia from the resinstatment? I don't believe I am a candidate for kindling per my history, however the last few mornings, around 2am, I have hipnic jerks that awaken me, when then turn into mild akatheisa, which keeps me awake. Im really hoping this are just the transitory side effects from the Zoloft reintro and don't lead into anything long term. 

 

If Akatheisa does persists, would stopping the Zoloft be an option? I would imagine that would further damage my system and lead to even more sever WD effects. 

 

 

 

 

I dont think its akathisia its probably anxiety

[mtmalaka]

On 6/16/2024 at 9:52 PM, itsalyssadood said:

Hi @mtmalaka! 
 

Question for ya- what time do you take your dose? I noticed that when I reinstate a dose or am trying to stabilize again, that I will get feelings like this when the drug “peaked” in my system (for Lexapro it’s about 5 hours). 
 

 

I take it at 12 - might switch to mornings and adjust within multiple days as your suggested. 

[mtmalaka]

Hello @Emonda 

 

I might be in a bit of a predicament here. I'm currently in 2 weeks on my zoloft reintroduction at 12.5mg - The withdrawal symptoms (mainly severe anxiety) has subsided some, good news. However,  over the past few days I've felt the Akathisia symptoms start to grow. I am afraid I am replacing one symptom with another, possibly worse symptom. Dodging a bullet, only to be hit with a grenade. 

 

I know not to make any drastic changes at the moment and let my body heal. I plan to hold the 12.5mg despite the Akathisias. However, if it does worsen, I maybe be at fork in the road. What would my options be here? I can't pull the Zoloft due to risking the initial withdrawal symptoms coming back, this time even worse. Then again, If Akathisia becomes unbearable, I might have to - but no guarantee it goes away with the cessation of the Zoloft. Is this a ride-it-out situation until I can stabilize more on the 12.5 then hope the Akathisia slowly goes away with the slow taper? 

 

Also, the only thing that helps with Akathisia at the moment is the 1mg Ativan which I still take each day. Perhaps I can substitute that with a beta blocker like Propranolol to ease Akathisia symptoms? Do beta blockers risk further kindling? 

 

Thanks for your help here. 

[LotusRising]

@mtmalaka

 

Yes, I hear what you're saying. Can you describe what you mean by 'akathisia'? How bearable is it?

 

It might make the most sense to play it by ear for now, assuming symptoms have improved since reinstatement?

 

5 hours ago, mtmalaka said:

Also, the only thing that helps with Akathisia at the moment is the 1mg Ativan which I still take each day. Perhaps I can substitute that with a beta blocker like Propranolol to ease Akathisia symptoms? Do beta blockers risk further kindling?

I'm concerned that you're still taking the ativan though. How long have you been on it now? And could you please add it to your signature?

 

Some people find the beta blocker helpful and some don't. It would be better than taking ativan, but depending on how many days you've been taking it, it may not be advisable to just stop it. 

[mtmalaka]

Akathisia: inner restlessness, urge to move, the sensation of tensing up of certain muscles. It comes it waves and starts as little jolts throughout the body then coalesces throughout as energy. It's bearable, but disturbing and interfere with sleep. 

 

I am in 2 weeks now, daily 1mg Ativan. Hard to live without at the moment. I am willing to taper if need be.

 

I will update my sig. 

[FindRest]

Mtmalaka, what non-drug coping skills have you implemented to deal with your symptoms? Relying on or seeking out drugs to try and mask our symptoms is what got us here in the first place. 
 

I see you asking a lot of “what if” questions regarding what might happen regarding different symptoms and scenarios. I think most of us can relate to feeling the same way when we first came here. The danger in thinking like this, however, is that it increases anxiety dramatically and also makes us on the lookout for the worse-case scenario. In withdrawal, almost every symptom is on a continuum. The “what if” thinking along with our hyper vigilance can easily take a mild symptom and cause it to flare into something more major. We have a lot of control over some of our symptoms just by the way we think about them. Granted, plenty of symptoms run their own course regardless of what we do. But, many times our anxiety alone escalates symptoms to a new level. 
 

What you are going through sucks, there’s no doubt about that. I encourage you to read the site and discover new ways to cope with the symptoms you are feeling. Your symptoms are an indication that your body is trying to heal itself. Once I started to think about my symptoms in this way, they became less scary.

 

Same with using the term “akathisia”. In my opinion, it was much better to address the individual symptoms I was experiencing that fall under that label rather than attaching the doom and gloom to them that the term normally conveys. It made me feel less anxious. For example, hypnic jerks were hypnic jerks. Inner agitation was inner agitation. Internal vibrations were internal vibrations, and so on and so forth. Tackling the individual symptoms took less of a toll on my mind and emotions. As moderators and mentors it also helps us if people tell us specific symptoms rather than labeling them with a term that can mean many different things to different people. It also helps other members when they read your thread. 

I hope this doesn’t come across as minimizing what you are going through. I’m not. This is not a fun ride. I wish you the best.

 

BTW, it took me about 6 months after reinstating to stabilize, with each month getting better than the month before. Some people are able to stabilize sooner, others take longer. Keep holding on to the improvements you are making week after week. Keep a daily list of symptoms and rate them. Refer back to that list to remind yourself how far you’ve come.

Edited June 19 by FindRest

[mtmalaka]

Thanks @FindRest - this is a quite profound in many ways. Everything you've mentioned is spot on, in particular the advice about trying not to bulk symptoms into one scary category. What I'm experiencing that I am calling "akatheisa" is in fact an array of various symptoms that actually roam and change over the days. 

 

I am ALL 'what-ifs' at the moment, and yes, it's doing nothing but perpetuating the horror. I do understand this and I'm working on it. Incredibly hard to see objectively when my mind is on fire. It's practice I guess. 

 

I use Ativan as a crutch, and you're right, it's the same behavior that landed me in this hole to begin with. That said, if I didn't have the Ativan when I first crashed, I wouldnt know where I'd be right now. It was a life saver. That said, I'm incredibly concerned about depenancy and it's looking like I need to toss that crutch to the side very soon. I don't feel too confident, but I know I'm in a better spot than 2 weeks ago, and will need to rip the bandaid off and deal with it. I have many ways to cope and discovering more every day. 

 

Anyhow, I'm going to take a screen cap of your post and pull it up when I'm in a bad spot. It'll be my mantra going forward. 

 

Very much appreciate your insight here. This site and it's members have been God-sent and I hope to return the favor to others in need once I have gained the wisdom and experience of recovery. 

 

Appreciate you. 

 

 

 

 

 

 

[FindRest]

Your great attitude will help you immensely during this process. Hope today is a good day.

[mtmalaka]

@LotusRising

 

My plan is to come off the Ativan after tomorrow (need to go out of town for a few days and need the crutch).. 

 

It'll be 16 days at that juncture. Any tips for a tapering plan? 

[Backnforth]

Hope you are doing okay today! 

[LotusRising]

8 hours ago, mtmalaka said:

It'll be 16 days at that juncture. Any tips for a tapering plan? 

If it were me, I would still lean toward a quick taper, perhaps cutting the dose in half every 5 days. However, if you find symptoms to become intolerable, you could wait a week or more before reducing again. Just ensure you're listening to your body. 

[mtmalaka]

On 6/19/2024 at 5:49 PM, Backnforth said:

Hope you are doing okay today! 

 

 

Thanks, likewise. Ups and downs. 

[mtmalaka]

On 6/19/2024 at 6:05 PM, LotusRising said:

If it were me, I would still lean toward a quick taper, perhaps cutting the dose in half every 5 days. However, if you find symptoms to become intolerable, you could wait a week or more before reducing again. Just ensure you're listening to your body. 

 

Thanks!! I will impliment this and report back.

[mtmalaka]

@Emonda @LotusRising

 

Hey there! Sorry to tag you again but I have a question: since I've been tapering the Ativan, I've noticed a startling increase in anxiety. To me, this concludes that the Ativan has been propping me up, maybe more so than the reintro of Zoloft at 12.5mg

 

I read on the reintroduction topics that if I don't experience a cessation of my withdrawals symptoms (extreme anxiety) within 4 weeks, it may be worthwhile to increase the dosage, or even increase back to my original dosage at 100mg. 

 

The panic is so severe at times that I cannot seem to cope with it without a crutch such as Ativan, or some help from zoloft (which is questionable at this dosage) 

 

Getting off the meds completely is still a priority for me... However, I'm willing to kick that can down the road in favor of easing the crushing panic by going up in dosage now. 

 

I know I may be falling victim to the 'need to do something' trap due to the seveeirty of my symptoms, but the idea of increasing the dosage, atleast to a comfortable level, is appealing at this stage. 

 

 

[LotusRising]

On 6/22/2024 at 11:51 AM, mtmalaka said:

since I've been tapering the Ativan,

Where are you at with the ativan?

 

On 6/22/2024 at 11:51 AM, mtmalaka said:

even increase back to my original dosage at 100mg. 

I would not go directly back to 100mg. This will likely be too much. 

[mtmalaka]

7 minutes ago, LotusRising said:

Where are you at with the ativan? 

 

3rd day at 0.5mg - then to 0.25mg... seem to be holding up despite my concerns