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Theabominableslowman: My journey, adverse reactions and reinstatement


Theabominableslowman

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Hi all,

 

Finally making a post after soaking up all the knowledge on here 😀 Please see my history in my signature.

 

Today I started 0.5mg of sertraline in liquid form which I’m making myself using the guidance on this site. This is a reinstatement as I am currently 3 months into severe withdrawal from serotonergic medication. I chose to reinstate Sertraline as I’ve had adverse reactions ( suspected serotonin syndrome) to most other meds and this was the one I was on for the longest. I could not reinstate my last SNRI duloxetine as I was only in for a week and had adverse reaction.


Hopefully I’ve started on a low enough dose and do the mods think Sertraline is the sensible option for reinstatement in my case?

 

My adverse reactions have been called ‘serotonin syndrome’ by GPs. I have never been hospitalised but experience extreme panic, monophobia, insomnia and agitation. This subsides after five days of stopping the med with the help of low dose diazepam. Does this sound like serotonin syndrome or just a weird individual reaction potentially from when my drink was spiked in March 2023? I have never read of anyone having a similar reaction to me and I’m skeptics it’s serotonin syndrome as I do not get the muscle rigidity etc

 

Thank you in anticipation 🙂

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • KenA changed the title to Theabominableslowman: My journey, adverse reactions and reinstatement

Four days into reinstatement. Severe agitation, anxiety and SI is continuing from my wave prior to reinstatement. Day three of reinstatement had a calmer day but just in sofa watching the tennis and football as a distraction.

 

Currently just taking 0.5mg of sert. Worried that I’ve kindled so badly and it’s been over a year since last dose of sert with loads of other meds in between that this isn’t going to help. Wondering when to start 1mg? Perhaps after another three days so I’ve done 0.5 for a week if no improvement?

 

Just to note that after I reinstated sert after a week off from suspected serotonin syndrome in march 2023 it never worked very well again for anxiety. I just felt completely blunted emotionally but had no physical or other mental symptoms like I do now. Even if I can get back to that state would be amazing as I still could work and was going walking and cold water swimming which were great for my mind and body. 
 

Would really appreciate a mods help. 

 

Thank you.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Other option that mental health nurse discussed was starting 0.5mg of Prozac? Every AD I’ve taken at a ‘therapeutic dose’ has helped with anxiety and depression and then I’ll have an adverse reaction after a few days or weeks. 
 

Don’t want to add more fuel to the fire but worried about my safety and don’t want to be hospitalised as afraid they will make me a lot worse.

 

- Continue with 0.5mg sert (fourth dose today after a year off)?

 

- Increase sert to 1mg after one week and hold to see if any improvements? 
 

- Stop sert and try 0.5mg Prozac? 
 

Any help would be very much appreciated 🙂

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Hi, I'm glad you found the site and I'm sorry you're having such a rough time. Hopefully someone with more experience than I can offer you some advice and get you sorted out. But I imagine they'd say that trying new drugs that you've never used before (prozac, as far as I can tell) isn't likely to help, especially given you've had adverse reactions to the last number of drugs you've been switched to (take that with a grain of salt).

Olanzapine (5mg) started June 2023 - This is the only drug I'm currently taking, haven't used any other psych drugs.

After 4 weeks dropped to 2.5mg for 5 days then dropped to 1.25mg for 3 days, withdrawals commenced. I then took a single dose of 3.75mg. Then went to 2.5mg. since July 19

Hoping to hold at 2.5mg  and GODWILLING I will STABILIZE.

I can't tell WD symptoms from Long Covid symptoms. I think a bit of both, and I think my quick earlier taper has made the LC symptoms worse ... what to do.

Update: Sept 28 2023: -2.5%   Oct 5: -2.5%   Oct 12: -2.5%   Oct 19: -5%   Oct 29: -5%   Nov 10: -5%  2.0mg  Nov 20:  -5%  1.9mg  Nov 30:  -5%  1.8mg  Dec 12:  1.75mg   Dec 22: 1.70mg Dec 29: 1.65mg Jan 06/24: 1.60mg  Jan 14: 1.55mg Jan 25: 1.50mg   Feb 12: Updose to 1.55mg  Apr 25: 1.50mg  May 22: 1.45mg  Jun 5: 1.40mg  Jun 25: 1.35mg

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@N2deep thanks for your reply.  Yes Prozac would be new and from everything I’ve learnt on here it would be a bad idea to start it. Although starting all the other drugs previously has produced positive results in days following by an adverse reaction which leads to cold turkey.

 

Just hoping this Sertraline can alleviate the mental withdrawal symptoms. Physical ones have been debilitating but I can deal with those. The mental ones are just too overwhelming. Using all the resources on here to deal with them and do have a supportive family which I am so grateful for.

 

Hopefully a mod gets back to me soon. Best of luck with your journey too 🙂

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Unfortunately had a bad night last night with severe restlessness, agitation and SI thoughts on loop. Even with my 100mgXR quetiapine I found it hard to get to sleep. In the end I slept from about 3am and just woke up at 12:30pm as when I finally do get to sleep, the quetiapine knocks me out until midday the next day. Find this difficult as not really living much of a life but I know I need the sleep to heal so will take it.

 

It’s my 5th day of reinstating today and I took 0.75mg of Sertraline after taking 0.5mg the previous four days. I am going to hold this dose until Wednesday and then go to 1mg of sertraline. I then plan to hold this for a week and go up by .5 weekly to get some relief from withdrawal. Appointment to see mental health nurse next Friday to discuss progress.

 

Please could a mod advise if what I’m doing is ok? Slowly introducing the Sertraline back and will be at 1mg on Wednesday having started 0.5mg the previous Wednesday.

 

Thanks in anticipation. Could really use the support and guidance right now.

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • Moderator

Hi @Theabominableslowman, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes. 

 

Thank you so much for completing your drug signature, and I want to apologize that we didn't get to you sooner.  

 

Your poor nervous system has been on one heck of a ride over the last 1+ year!  I know I should be used to seeing this by now, but every time I see someone who has been on the drug merry-go-round like you have, I'm just so shocked that the psychiatric community at large has not clued in to the damage they are doing!

 

In any case, I'm very glad you found us.  By your first post, it looks like you've done some good research already, but I will point you to a few useful threads as I write my response, in case you haven't seen them.  First off, some info on how these drugs remodel your brain.  You were on the sertraline for long enough to have become physiologically dependent on it.  So your cold turkey likely thoroughly destabilized you, and the revolving door of drugs that followed certainly did nothing to help the situation. 

 

How Psychiatric Drugs Remodel Your Brain

What is happening in your brain?

 

I think you have done exactly the right thing, reintroducing your sertraline at a very low dose.  It is likely going to take quite a bit of time for you to stabilize, so you're going to have to be very patient with the process.  I see in your signature that you don't feel like you've improved since reinstatement- that's ok!  As long as you don't feel worse, you are not reacting adversely.  The general rule of thumb with reinstatement is that if you feel worse, stop immediately.  If you feel no better or slightly better, hold for at least a week, and slowly updose until you find some relief.  So you are on the right track.  Here is some more info on reinstatement, though I suspect you may have read this stuff already.

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 Hypersensitivity and kindling

 

I see you had a terrible night last night- I'm so sorry to hear that.  It will happen- you will go through periods where you feel better and periods where you feel worse.  This is known as the windows and waves pattern of stabilization.  Read more here:

 

Windows and waves pattern of stabilization

 

Yes, it's awful when those waves hit, and learning to ride them out with a sense of calm takes work and practice, but we do have a few techniques we recommend to assist with coping.  You may find some of your own as well- I enjoy swimming- I have severe body aches, headaches and chest pain, and these all disappear in the water!  Here are some threads on coping:

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

Like I said, none of this is easy, but with lots and lots of practice, you will eventually learn to respond calmly to these symptom waves, and your journey will become a bit smoother.  

 

In terms of what you are doing drug wise (outside of the sert)- do not stop the quetiapine right now.  You will need to taper this down the road, but continuing with that, even on nights like last night, where you don't feel it's helping much, will help to mitigate some of your withdrawal symptoms.  I can't recommend taking the diazepam though, as we all know how habit forming benzos are, and you could be creating yet another dependence that will require tapering and withdrawal down the road.  Practicing those non-drug coping skills is your best bet... just keep trying and trying them.  I promise that they will start to make a difference.  Mindfulness and mediation has become the cornerstone of ability to cope, but it took a while to really figure it out. 

 

In summary, you are doing just fine!!!  Do keep posting.  If you aren't already, do keep a symptom journal- rate all your symptoms on a scale of 1-10 each day.  This will help you see your windows and waves more clearly (I know they can be hard to see when you're in the thick of it- this really helps!).  Weekly increases are fine- if you hit a week where you start to see a bit of relief, you can always hold for a bit longer to see if that ends up being your ideal dose.  More is not always better, so take your time.  Keep it simple, slow and stable.  You'll be ok!!!  Down the road, when you want to taper, we can certainly help you come up with a plan for that, but for now, you likely have many months of stabilizing ahead of you.  So just take things one day at a time... one minute at time!  And we're here with you every step of the way! ❤️‍🩹

 

This is your introduction topic- every member gets one intro topic.  Please post updates and questions here.  I look forward to following your journey, and helping in any way that I can!

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Hello @Catwoman73 🙂 Thank you so much for getting back to me and please don’t apologise.

 

Yes I can’t quite believe the rollercoaster of the last year and where it’s left me. The poly drugging and merry go round has been really traumatising and that was prior to withdrawal even started. Now I’m just a shell of who I was with debilitating mental and physical systems. Just like most people on here, worse symptoms than anything I had before being put on medication. I am glad that I now know what I am going through as when I first started withdrawal I thought I had lost my mind which led to ridiculous additional diagnosis’ by psychs and additional meds that just worsened my condition.

 

I have been thoroughly checking all the helpful links on this site and will try my hardest to put them into practice. I can handle the physical no matter how bad it is (although obviously very difficult at times over the past month where I have not been able to walk far due to pain and dizziness etc), it’s the mental that I find so scary when I’ve never had these thoughts or urges prior to withdrawal. I do think I have inner akathisia at times which returned last weekend. I find the agitation so hard to deal with and that flares all my other symptoms as it’s stressful.
 

Prior to last weekend I had a two day window where I was struggling physically but mentally felt a lot better and went out for walks and in nature. That was two and a half months off the cymbalta so I’m hopeful that’s a sign of healing.

 

Today I took 0.75mg of sertraline, an increase of 0.25mg. I have been out for a small walk in nature and cleaned my car (very slowly and with great difficulty) but glad that i achieved those two things when I had such a bad night last night.

 

Do you think it’s possible to stabilise on the Sertraline after a year off it and having an adverse reaction at 150mg? It never worked properly for anxiety when I took it again however I did seem to stabilise on it which was good. From my research it seems that adverse reactions seem to be dosage related so hopefully such a low dose in on will prevent this from happening.

 

Please could i kindly ask if the following plan sounds good and safe to you?

 

- Continue with 0.75mg of sertraline until Wednesday. I would have been on 0.5mg for four days and 0.75mg for three days.

 

- On Wednesday increase to 1mg and hold for a week.

 

- If I see no improvement in that week, increase to 1.5mg. If I do see improvements, to hold there for a while to see if I stabilise or perhaps need to increase slightly if no improvement.

 

- I will continue with the quetiapine until I am stabilised and tapered the Sertraline. It’s horrible but I’m grateful for sleep.
 

- I am doing everything to not take the diazepam and will use it as a last last last resort as I have always done. My friend was a heavy benzo user and I have seen the damage it did to him so I only use these if I feel like I could potentially be in some danger and in crisis. I will try the non drug coping techniques going forward and limit this benzo use to nothing if I can.

 

Really appreciate you getting back to me and for all the amazing work you and your colleagues do on here for people. 

 

Thanks! 🙂

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Health background:

 

- I have not drank alcohol since January 2024 after being quite a binge drinker when on medication.


- I stopped fizzy caffeinated drinks in June 2024 and don’t even drink decaf tea anymore.


- From June 2024 I have decreased my sugar intake massively and trying to eat a healthy diet with plenty of greens. Majority of sugar will come from fruit.

 

- No supplements apart from magnesium Epsom salt baths that seems to relax leg muscles at night.

 

- No plans to try oral magnesium or fish oil whilst still so unstable in July 2024

 

- Exercise is just light walking when I am up to it as any more intense exercise flares physical withdrawal aches and pains.

 

- Thankfully sleeping 8-10 hours a night from quetiapine although struggle to wake to before midday.

 

- Diagnosed prediabetic in June 2024. 
 

- Elevated ALT liver enzymes June 2024 suspected due to long term med use.

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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2 hours ago, Theabominableslowman said:

Do you think it’s possible to stabilise on the Sertraline after a year off it and having an adverse reaction at 150mg?

I'll link the Reinstatement thread down below, if you haven't seen it already.

 

So it's been about 16 months since the problems and switching doses began, and about 10 months since the last time you took sertraline.

 

 

Olanzapine (5mg) started June 2023 - This is the only drug I'm currently taking, haven't used any other psych drugs.

After 4 weeks dropped to 2.5mg for 5 days then dropped to 1.25mg for 3 days, withdrawals commenced. I then took a single dose of 3.75mg. Then went to 2.5mg. since July 19

Hoping to hold at 2.5mg  and GODWILLING I will STABILIZE.

I can't tell WD symptoms from Long Covid symptoms. I think a bit of both, and I think my quick earlier taper has made the LC symptoms worse ... what to do.

Update: Sept 28 2023: -2.5%   Oct 5: -2.5%   Oct 12: -2.5%   Oct 19: -5%   Oct 29: -5%   Nov 10: -5%  2.0mg  Nov 20:  -5%  1.9mg  Nov 30:  -5%  1.8mg  Dec 12:  1.75mg   Dec 22: 1.70mg Dec 29: 1.65mg Jan 06/24: 1.60mg  Jan 14: 1.55mg Jan 25: 1.50mg   Feb 12: Updose to 1.55mg  Apr 25: 1.50mg  May 22: 1.45mg  Jun 5: 1.40mg  Jun 25: 1.35mg

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Thank you @N2deep. Yes I think I’ve read it about 30 times by now trying to plot my next steps 😆 Appreciate you sharing it nonetheless, it has great information. 

 

18 minutes ago, N2deep said:

So it's been about 16 months since the problems and switching doses began, and about 10 months since the last time you took sertraline.


Yes this is correct. First dose of reinstatement was last Wednesday. I’ve read it takes sert 7 days to reach steady state in the blood so still early days of course.
 

Struggling a little tonight with low mood and inner akathisia like agitation after having a day out with reduced mental symptoms. Agitation has been there the whole day though. This really scares me and intensifies the dark thoughts. Physically feeling bit better this evening, just have aching legs from walking. 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Continued with 0.75mg of sertraline today. Hour after taking it feeling very jittery, headache, and increased anxiety. Not sure if just activation reaction from reintroducing the drug or just me worrying about reinstatement? Feeling very tired also but wired at the same time.

 

Inner restlessness (akathisia?) was very bad last night. Hard to work out if withdrawal symptom as had this after cold turkey or has increased since starting Sertraline.

 

Currently six days into reinstatement. Think I will give it a week to see where I’m at and increase to 1mg on Wednesday. Really difficult to tell whether withdrawal is getting worse or whether reinstatement of Sertraline is causing this. I think giving the reinstatement more time is really the only option at this point unless things get a lot worse.

 

Do people agree?

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • Moderator

I think your plan sounds just fine, as long as you are not feeling worse with reinstatement.  Keep that symptom journal- it is really helpful to see your windows and waves, and it can help you make decisions about whether or not to hold vs. updose, vs. (someday) start tapering again vs abandoning reinstatement.  Without a journal, the days can really start to blend together, and it can be very difficult to remember what has happened to you over the long term.  Move slowly and very consciously as you proceed, and you'll do just fine.  I know it doesn't feel like it right now, but you will.  

 

Restlessness/akathisia is most definitely one of the most brutal symptoms one can deal with.  Here is a thread on these topics that I found very helpful.  I have suffered from both restlessness and akathisia, so I can sympathize.  This thread is useful is making distinctions about what is actually going on with you, and there are some suggestions about things that can help (weighted blankets, etc), but sadly, the best thing you can do is hold, and wait it out.  

 

Akathisia vs Restlessness/Anxiety/Agitation

 

Give yourself some credit- you are a strong person!  You have to be to deal with this stuff. Do try some guided meditations as well when you are struggling at night.  It may take quite a bit of practice, and you may have to keep pulling your mind back, but they are very helpful.

 

The fact that you've had even a small window is an excellent sign of healing.  It's a slow process, but it's happening!  This is something to celebrate!  As is finding that epsom salt baths help... finding something that gives you some relief is so important.  The swimming does that for me.  You're doing everything right- just be patient now, and wait to see what happens.  

 

Oh- by the way- my liver enzymes are elevated from long term use as well.  Not dangerously elevated, and my doctor kind of blew it off, but knowing what I know about these drugs, it provided me with extra motivation to get this taper underway.  I still find it hard to believe how little our prescribing docs actually know about these drugs.  It's quite shocking!

 

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Thanks @Catwoman73
 

I can’t work out whether the akathisia/restlessness is from the Sertraline or just withdrawal getting worse. I’ve felt like this in the first month of my last cold turkey. It’s so difficult to tell what symptoms are from withdrawal/reinstatement as they constantly chop and change. Since last Sunday I’ve had the akathisia again though which was before reinstatement so believe it’s not the Sertraline. But then can’t work out if Sertraline making it worse; very confused right now but will keep documenting symptoms to try and work this all out.

 

I’m sure the answer will probably be no but do you recommend taking anything for the akathisia? I have used propanolol previous although 10mg made me depressed and would probably only take 2.5mg. I’ve also read that benzos can help but don’t want to go down that avenue and have held off taking any today. I did have 2.5mg of diazepam yesterday as agitation was so bad and I just felt so overwhelmed.

 

i think I’m going to try 1mg of sert tomorrow and then hold for a week. I’ll then go up in 0.5 increments after that. Petrified that I’m not going to ever stabilise after all these drugs changes over the past year. 
 

if reinstatement doesn’t work, would starting a low dose of Prozac be an option? 0.5mg of Prozac I’m talking. I’m concerned as I know that’s the most activating SSRI but I don’t think I can handle the cold turkey from everything and need something to taper properly.

 

fingers crossed I can stabilise on the sert so I don’t ever have to consider that as an option.

 

thanks so much. It really means a lot with these supportive messages at such a difficult time.

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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08/07/2024: continued with 0.75mg sertraline. Felt very jittery and wired but also tired an hour after taking it. Akathisia then flared and felt very agitated sat on sofa watching the tennis. Felt very overwhelmed and like I had to run but feel too weak to do any exercise and legs were spasming and contracting. Feels like legs plugged into electric socket.

 

19:00pm: feeling a little less agitated and legs calmed down a bit. Always on edge that akathisia could flare up again which scares me more than anything. Have been feeling teary and hopeless just wishing I could be away with my friends on holiday which is very upsetting. Trying to think positive and imagine me on holiday in a few years when I am recovered. Holding out hope but severely struggling with agitation. Would take all the physical aches and pains over agitation and depression.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Hi @Theabominableslowman

 

I think I'd slow down the updose by a lot if it was me...

 

You had a lot of meds change in the past few months. This, I believe, can cause instability and hypersensitivity to meds.

Supplements: Vit D3, Fish oil, Magnesium bisglycenate 200mg (when needed), Melatonin 1.25mg (when needed), Camomile tea (1 cup before bed), THC oil (0.03ml once a week, don't do this to yourself), Vit C 500mg a day
Started effexor in 2011.

Stopped effexor in 2012 (fast tamper).

Got back on effexor in 2012.

Tried stopping effexor again in 2014 (I'm not sure?), fast tamper again.

Started effexor again in 2014.

Switched to Escitalopram in 2016 I believe

Stopped Escitalopram 10mg cold turkey on January 3 2024.

Reinstated Escitalopram 5mg on april 2 2024.

Down to 1mg on april 3 2024, 1.25mg on april 11 2024

 

 

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51 minutes ago, Theabominableslowman said:

I can’t work out whether the akathisia/restlessness is from the Sertraline or just withdrawal getting worse. I’ve felt like this in the first month of my last cold turkey. It’s so difficult to tell what symptoms are from withdrawal/reinstatement as they constantly chop and change. Since last Sunday I’ve had the akathisia again though which was before reinstatement so believe it’s not the Sertraline. But then can’t work out if Sertraline making it worse; very confused right now but will keep documenting symptoms to try and work this all out.

 

I’m sure the answer will probably be no but do you recommend taking anything for the akathisia? I have used propanolol previous although 10mg made me depressed and would probably only take 2.5mg. I’ve also read that benzos can help but don’t want to go down that avenue and have held off taking any today. I did have 2.5mg of diazepam yesterday as agitation was so bad and I just felt so overwhelmed.

 

 

It is very hard to know what is causing what.  I get it- I have long covid, withdrawal, and perimenopause going on lol!  You're doing the right thing by thoroughly documenting.  Sometimes you can't really see what's going on until some time has passed.  If you're able to look back at your days in detail, it can really help you sort it all out.  So I suspect you will have more clarity as time passes. 

 

There are meds that are used to treat akathisia, but the concern is always creating other problems, or using a drug that might create withdrawal issues down the road.  Benzos are obviously an issue, but you already know that!  The data on beta blockers for akathisia isn't exactly abundant, and there is always a risk of low blood pressure and heart rate.  Vitamin B6 has been shown to be useful- if you want to try it, start VERY low with dosing and see how it goes.  B vitamins can be very activating for some.  Low dose mirtazepine has been used, but again- you are creating an issue with yet another drug you will have to taper and will cause it's own withdrawal symptoms.... and there is a chance it can make akathisia worse if you don't get the dosing right.  All in all, the non-drug coping mechanisms are best, but there is no immediate relief with those.  They take consistency and practice. 

 

I don't love the Prozac bridge option- it is introducing yet another agent into your already unstable nervous system.  And it also requires tapering, and could have its own withdrawal symptoms.  It is your body though, and if you want to try that instead of the sert reinstatement, you certainly can, with the assistance of your provider.  If you do, just STOP if you have any adverse reactions to it, and absolutely don't let them increase your dose quickly.  Slow, slow, slow is the way!!!

1 hour ago, Theabominableslowman said:

19:00pm: feeling a little less agitated and legs calmed down a bit. Always on edge that akathisia could flare up again which scares me more than anything. Have been feeling teary and hopeless just wishing I could be away with my friends on holiday which is very upsetting. Trying to think positive and imagine me on holiday in a few years when I am recovered. Holding out hope but severely struggling with agitation. Would take all the physical aches and pains over agitation and depression.

 

This is a window.  That's a good sign- try to focus on the fact that your body is showing you signs of healing instead of the stuff you can't do.  You've got the right idea with the visualization... just keep going.  You're doing well!

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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16 minutes ago, Tweed9674 said:

think I'd slow down the updose by a lot if it was me...

 

You had a lot of meds change in the past few months. This, I believe, can cause instability and hypersensitivity to meds.


Thanks @Tweed9674

 

Im definitely hypersensitive from all the med changes I believe. I was going to increase to 1mg tomorrow and then just hold. Do you think that’s acceptable? Or just continue with the 0.75mg for now?

 

appreciate your help and advice 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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I think I agree with Tweed. It has been a very long time since you were on sertraline. We can't know which/how much of your symptoms are caused by going off sertraline too fast, and which/how much of the symptoms are caused by the drug merry-go-round your doctors put you through in the past year. We know reinstatements generally work better the sooner they are implemented, and since your brain has made a lot of changes in the 10 months since you last touched sertraline, one might want to exercise caution. I know it's hard in the moment and we just want to change something to make the problems better, but if it were me, I'd be cautious. At least you are sleeping ok.

Since this whole situation started, how have your symptoms changed? Have some gone away, others started? ... has the akathisia been there since the start?

You mentioned you had a couple days of a window a bit back, that's really good.

 

When I had aka last year, and was just absolutely demolished by agitation, I just laid outside on a lounger all day and did breathing exercises, and looked at birds, and chipped a golf ball around the yard. I really believe keeping the nervous system calm can do wonders for us in withdrawal (and the opposite is also true). Since then, I just started using the internet all day, not doing breathing exercises and not keeping my nervous system calm, and I can tell you, my inner experience is night and day different (worse) now. So I'm gonna put in huge effort to get back to the calm inner state ... watching tennis (or golf for me) is really good too ... calm stuff.

Olanzapine (5mg) started June 2023 - This is the only drug I'm currently taking, haven't used any other psych drugs.

After 4 weeks dropped to 2.5mg for 5 days then dropped to 1.25mg for 3 days, withdrawals commenced. I then took a single dose of 3.75mg. Then went to 2.5mg. since July 19

Hoping to hold at 2.5mg  and GODWILLING I will STABILIZE.

I can't tell WD symptoms from Long Covid symptoms. I think a bit of both, and I think my quick earlier taper has made the LC symptoms worse ... what to do.

Update: Sept 28 2023: -2.5%   Oct 5: -2.5%   Oct 12: -2.5%   Oct 19: -5%   Oct 29: -5%   Nov 10: -5%  2.0mg  Nov 20:  -5%  1.9mg  Nov 30:  -5%  1.8mg  Dec 12:  1.75mg   Dec 22: 1.70mg Dec 29: 1.65mg Jan 06/24: 1.60mg  Jan 14: 1.55mg Jan 25: 1.50mg   Feb 12: Updose to 1.55mg  Apr 25: 1.50mg  May 22: 1.45mg  Jun 5: 1.40mg  Jun 25: 1.35mg

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37 minutes ago, Catwoman73 said:

There are meds that are used to treat akathisia


Thank you for the advice. Think I will hold off these for as long as I can in the hope that reinstatement starts to work and I stabilise.

 

37 minutes ago, Catwoman73 said:

don't love the Prozac bridge option- it is introducing yet another agent into your already unstable nervous system


Completely agree. Will be using this as a last last last resort. I will update my progress tomorrow and see how I’m doing. Fingers crossed for less agitation and some positives 🤞 Your support is helping so much so thank you again.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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6 minutes ago, N2deep said:

I know it's hard in the moment and we just want to change something to make the problems better, but if it were me, I'd be cautious. At least you are sleeping ok.


Yes the agitation is just completely overwhelming me and wants me to make that quick fix but I know that’s not going to happen in this case after being off for so long. Will hold at 0.75mg tomorrow again and see how I go. 

 

8 minutes ago, N2deep said:

Since this whole situation started, how have your symptoms changed? Have some gone away, others started? ... has the akathisia been there since the start?


It’s been 3 months now since I last took SNRI duloxetine (prior to my reinstatement and addition of quetiapine plus cold turkey off lamotrogine). The first symptoms I had were severe suicidal ideation and depression which I had never experienced before prior and on medication. This is when I took myself to Accident & emergency and was out on quetiapine and then lamotrogine by psychiatrist as I was only seeing my GP prior to all of this. SI and depression were bad for two months, went away for a week and then have come back with a vengeance starting last Sunday when the akathisia started again. The akathisia came right after my last cold turkey and stopped for a small period and then reinstated again last Sunday too.

 

My first physical symptoms were severe abdominal cramping and urinary retention issues. These became worse on high doses of quetiapine which was why I was proscribed procyclidine a my dose reduced to 50mg XR quetiapine. Since starting the Sertraline I have had no bladder problems and only an hour of abdominal pain which is a positive.

 

A symptom that began a month into withdrawal was restless and severely aching legs from the thighs to the ankles felt like I’d walked up Everest with a low electrical current flowing through the muscles constantly. This symptom is back in full force after the akathisia has returned.

 

I also experience random aches and pains all over, dizziness, twitching, flu like symptoms but these come and go at random. Sometimes here for a few hours, sometimes just minutes at a time.

 

Finally chemical anxiety is constant and not much I can do to alleviate it. I am well versed in anxiety coping techniques as I was out on meds for panic disorder after traumatic event however there techniques really don’t touch this anxiety. I understand this is common in withdrawal and I just have to ride it out. It was a relief that this alleviated a fair bit in my window but has returned with the akathisia 

 

I was pleased I had a window at 2 and a half months. I haven’t been able to listen to music (my biggest passion in my life) in withdrawal and last Sunday i put on a record and had a great time listening to the music (even with a little dancing at times.) I perhaps over did it a bit and then crashed hard and that’s when the akathisia, chemical anxiety, SI retuned. Think I over stimulated myself like you said.

 

ive currently spent the day on the sofa watching the tennis and feeling a little calmer this evening so hopefully this continues. Things seem to get worse late at night tho but we will see.

 

”Low and slow is the way to go” is my motto with meds and any stimulating activities which could compromise my CNS stability further after this horrible year and a half.

 

Thanks for the advice once again.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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09/07/2024: Had probably the worst night of my life last night. Agitation and SI was so intense that I felt compelled to act on it which was so scary.  Managed to get to sleep once the quetiapine kicked in but even whilst I was asleep I dreamed of the trauma I’m going through which was horrible so had no let up. 
 

I took 0.5mg of sertraline this morning, instead of the 0.75mg I’ve taken for the last two days. I know I shouldn’t chop and change but worried the intense SI is due to the Sertraline. Going to hold this dose now and increase until these mental symptoms ease up. 
 

If the mental symptoms get worse, should I abandon the reinstatement by just stopping the Sertraline? I would be on 0.5mg.

 

Also feeling very restless this morning and worried about having to go to hospital to keep myself safe which is making me feel worse.

 

Would appreciate some advice on abandoning the reinstatement if I get worse. Thank you.

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Just had to take 2.5mg diazepam as agitation so bad and feeling overwhelmed. Not sure if Sertraline causing increased agitation or this is just continuation of wave I was in.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Also taken 2.5mg of propanolol as agitation was unbearable. Was worried about my safety so took the diazepam and propanolol as a last resort. I know this is not ideal but unfortunately I was struggling the worst I’ve been in withdrawal and reinstatement. 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • Moderator

Are you finding that your symptoms ramp up after taking the sertraline?  Is this happening every day?  How are you feeling now compared to how you felt before starting the sertraline?  Would you say you are worse?  It certainly could be that you are reacting adversely to it, particularly in light of the fact that it looks like you have adversely reacted to a lot of other meds over the last year.  If you feel you are adversely reacting, the best thing to do is abandon the reinstatement.  

 

Whether you do choose to go that route or not, you're really going to need to kick it into high gear with the non-drug coping mechanisms.  N2Deep wrote a comment above about spending large amounts of time lying on a lawn chair, listening to nature sounds, rather than starting at a TV- this is sound advice.  Time in nature is very calming.  Do try getting in a pool and swimming gently as well... that has been my go-to for restlessness and pain for a while now.  Slow gentle walks, focusing on the sounds and sights around you too... if your mind wanders, pull it back.  Have a read of the non-drug coping mechanisms that I linked you to above.  Like I said, they all take practice, but once you get the hang of it, they really do help.  As you know, we don't recommend taking psych meds to deal with the withdrawal effects of psych meds, so it's my job here to remind you that you really need to work hard to avoid the diazepam.

 

I understand your desperation, and my heart breaks for you.  I wish there was a magical cure for all of this.  If you do want to watch some really great stuff on surviving withdrawal, I would strongly recommend you go to Youtube and look for Angie Peacock.  She herself is a polydrugging survivor, at one time on 18 medications.  She is now a drug tapering coach and social worker.  She interviews people who have survived horrendous withdrawal situations.  She always ends her videos with messages of hope.  Those messages have helped me through my toughest days.  

 

Wishing you peace, @Theabominableslowman.  I'll be thinking of you.  Just an FYI- I'll be away from tomorrow until Saturday for a wedding.  If you need support, please tag another moderator in your messages during that period of time so that they are alerted to your message- you can tag Erimus, Emonda, LotusRising, FireflyFyte, Onmyway.  They're all pretty active, and most likely to see your messages.  I'm here today though. ❤️‍🩹

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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22 hours ago, Catwoman73 said:

Are you finding that your symptoms ramp up after taking the sertraline?  Is this happening every day?  How are you feeling now compared to how you felt before starting the sertraline?  Would you say you are worse?  It certainly could be that you are reacting adversely to it, particularly in light of the fact that it looks like you have adversely reacted to a lot of other meds over the last year.  If you feel you are adversely reacting, the best thing to do is abandon the reinstatement.  


Unfortunately the agitation was so bad last night that I went into crisis. Just been to see mental health nurse this morning and she has stopped the Sertraline so I’m no longer reinstating with that. Waiting to be referred to the primary care team so I see a consultant psychiatrist . Not that they’re going to be able to help at all but perhaps be able to stay safe.

 

does anyone think a low dose of Prozac could be an option or am I too sensitive and too far gone for anything like that? I really can’t deal with this agitation/akathisia much longer.

 

thank you

 

@Erimus @Emonda @LotusRising @FireflyFyte

 

 

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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I'm really sorry. The risk/reward of adding a new drug (or any drugs) here doesn't sound good to me, whatsoever. I was in the same place last year, like I mentioned, and just doing calm stuff and riding it out it went away in a couple months. Agitation and akathisia isn't forever. Just try to find a healthy/calm way to pass the time. I know it's rough.

 

Olanzapine (5mg) started June 2023 - This is the only drug I'm currently taking, haven't used any other psych drugs.

After 4 weeks dropped to 2.5mg for 5 days then dropped to 1.25mg for 3 days, withdrawals commenced. I then took a single dose of 3.75mg. Then went to 2.5mg. since July 19

Hoping to hold at 2.5mg  and GODWILLING I will STABILIZE.

I can't tell WD symptoms from Long Covid symptoms. I think a bit of both, and I think my quick earlier taper has made the LC symptoms worse ... what to do.

Update: Sept 28 2023: -2.5%   Oct 5: -2.5%   Oct 12: -2.5%   Oct 19: -5%   Oct 29: -5%   Nov 10: -5%  2.0mg  Nov 20:  -5%  1.9mg  Nov 30:  -5%  1.8mg  Dec 12:  1.75mg   Dec 22: 1.70mg Dec 29: 1.65mg Jan 06/24: 1.60mg  Jan 14: 1.55mg Jan 25: 1.50mg   Feb 12: Updose to 1.55mg  Apr 25: 1.50mg  May 22: 1.45mg  Jun 5: 1.40mg  Jun 25: 1.35mg

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1 hour ago, N2deep said:

I'm really sorry. The risk/reward of adding a new drug (or any drugs) here doesn't sound good to me, whatsoever. I was in the same place last year, like I mentioned, and just doing calm stuff and riding it out it went away in a couple months. Agitation and akathisia isn't forever. Just try to find a healthy/calm way to pass the time. I know it's rough.


You’re completely right and I’m really sorry for constantly asking. It’s just out of desperation really. Would another category like TCA which I’ve never tried be a possibility or is that just as bad? 
 

I’ve been taking 10 mg of propanolol split into four throughout the day and it does seem to calm the agitation slightly. I know I shouldn’t be taking it but desperate for relief. I’ve tried the non drug coping techniques and whilst they help, it’s still at an unbearable level that’s driving SI and compulsiveness which terrifies me. Sorry to be all doom and gloom but this agitation just started two and a half months into withdrawal after stopping in the first month. Is that something normal?

 

Thanks

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Hi all.

 

just an update: I’ve restarted 0.5mg of sertraline today after speaking to mental health nurse. The agitation started before I started the sertraline however in a panic I believed it was the sertraline so stopped it. Going to stick to this dose now for a while and see what happens.

 

i am also taking diazepam 2mg tablets once or twice a day depending on how bad agitation is and also 10mg of propanolol. Unfortunately the propanolol makes me feel depressed but it does take the edge of the agitation. I’m aware that using both of these is not ideal which is why I’m trying to use as sparingly as possible.

 

im hoping the sertraline will reduce the agitation. I last took it on Tuesday and it’s Friday today so I’ve had a three day break. I know this is even more instability for my nervous system so I’m just going to stick with it now and see what happens. 
 

unfortunately I have been in a bit of a crisis with the agitation fueling SI and impulses so had to make sure it wasn’t the Sertraline causing this. Now we’ve ruled that out, I feel more confident in continuing with the reinstatement unless I notice agitation getting worse.

 

if this doesn’t work, could I look to reinstate 0.5mg dose of citalopram which was one of the drugs I was on this year but had adverse reaction to after using it with Sudafed nasal spray (doctor said there would be no bad interactions but this was terribly wrong)?

 

I have also reduced quetiapine to 25IR from 50mg XR. There is no way to reduce it slower than this as 50 is the lowest XR they do and I react badly to IR with extrapyramidial symptoms. I have noticed I am still sleeping well but don’t feel like a zombie the next day which is a positive and can get up at 9am and not midday or later like I was doing on the 50. I am going to hold this 25mgIR dose now until I stabilise on the Sertraline and not make anymore changes.

 

Apologies for the changes I have made which were slightly against your guidance but I had to make sure the Sertraline wasn’t causing the agitation which was my biggest issue. I’m hoping I see steady improvements now using the Sertraline for a while but now this could take months for stabilisation.

 

Thanks all.

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Took 0.5mg this morning of sertraline. Felt slightly restless legs and crawling feeling like I do after taking quetiapine but nothing debilitating. Can cope with this if it makes mental symptoms better. Will keep an eye on this and hope it doesn’t improve.

 

No other physical issues apart from slight chest tightness (I believe anxiety from taking the drug again) and a headache but nothing I couldn’t cope with.

 

Agitation and SI has been slightly less today but I think that may be because I have some hope that I can continue with reinstatement. Not to say that I’m holding out all good on reinstatement as I’m realistic that it may not work the way I’m hoping. If it can just stabilise some of my mental symptoms then I’m happy to take things as slow as possible.

 

Seeing a consultant psychiatrist next week who worked on the Maudsley deprescribing guidelines so hopefully he will have a good insight on reinstatement. He was happy for me to stick at 0.5mg for a bit until I see him an then we’ll go from there; perhaps up dose very very slightly or hold that dose.

 

if this reinstatement fails, would low dose citalopram be an option as I was taking that for ten weeks this year with success until bad reaction following Sudafed nasal spray? I was switched to escitalopram after this and had  another bad reaction so cold turkeyd that. Just thinking that it did work for me after I got over the initial startup period and would only take a low dose.

 

of course, hoping low dose Sertraline is the one that stabilises me first though 🙂🙂🙂

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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Back last year I started Olanzapine at 5mg per day. After only 4 WEEKS on the drug, I dropped my dose to 2.5mg (50% cut), then to 1.25mg per day for a few days, and the symptoms were so unbelievable that I thought I was going insane, and had to be put in a psych ward for my safety, I went back to 2.5mg and stayed there and it took a couple months of akathisia, and crying and pacing around my driveway, until  it eventually got better ... now I'm having trouble dropping little bits, as can be seen in my signature.

 

I mention all this, just to show that just that one change of one drug had me on my knees, and to compare it to all the changes you've made, and continue to make. Just consider one of your drugs, Seroquel. You were on a bunch of different doses, from 125mg to 200, down to 100, down to 50, now down to 25 ... all in a short period of time. This is just one of the drugs, and all in the last few months. How do we know your symptoms aren't caused just by that? ... no one here would advise you to make a 50% cut of any drug, especially when one is fully destabilized. I don't know about tapering seroquel, or the issues of XR vs IR or whatever, but I'm sure an answer to how to avoid making a 50% cut could be found.

 

Also, if you had come here, and instead of your first post saying "I've just reinstated sertraline" it had said "I haven't been on sertraline in 10 months, and really more like 16 months since it was working for me, should I reinstate?" ... I'm not sure anyone would have encouraged you to do so, as it had been so long.

 

I'm happy that you have access to possibly, one of the rare good psychiatrists and that you get to see this person shortly. I would encourage you to stop making big changes that further destabilize you. Again I'm not a mod, just trying to do my best. Me personally, after what happened to me, the last thing I wanted to do is try more or different drugs.

Olanzapine (5mg) started June 2023 - This is the only drug I'm currently taking, haven't used any other psych drugs.

After 4 weeks dropped to 2.5mg for 5 days then dropped to 1.25mg for 3 days, withdrawals commenced. I then took a single dose of 3.75mg. Then went to 2.5mg. since July 19

Hoping to hold at 2.5mg  and GODWILLING I will STABILIZE.

I can't tell WD symptoms from Long Covid symptoms. I think a bit of both, and I think my quick earlier taper has made the LC symptoms worse ... what to do.

Update: Sept 28 2023: -2.5%   Oct 5: -2.5%   Oct 12: -2.5%   Oct 19: -5%   Oct 29: -5%   Nov 10: -5%  2.0mg  Nov 20:  -5%  1.9mg  Nov 30:  -5%  1.8mg  Dec 12:  1.75mg   Dec 22: 1.70mg Dec 29: 1.65mg Jan 06/24: 1.60mg  Jan 14: 1.55mg Jan 25: 1.50mg   Feb 12: Updose to 1.55mg  Apr 25: 1.50mg  May 22: 1.45mg  Jun 5: 1.40mg  Jun 25: 1.35mg

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Hi @N2deep. Thanks for your comment and really sorry to hear of all the difficulties you’ve been through. I can relate to a lot of it so know how tough it is.

 

I completely agree with all the comments about the drug changes I’ve made (99% advised by a doctor and unbeknownst to be how bad this was until I started to research further.) My CNS is a wreck and I need to completely stabilise now before I make any changes. 
 

In regards to the seroquel, there was no other way for me to begin to taper off it and psych was worried this was causing the akathisia (my most distressing symptom). Prior to starting quetiapine I had SI, chemical anxiety and depression and physical symptoms but no akathisia. 50mg XR is the lowest extended release they do and you cannot cut or crush the tablet as then you will just release it into your system straight away. I could also not tolerate any higher than 25mg of the instant release as had Parkinson’s like symptoms and had to be prescribed procyclidine to counter this. What most people do is take X2 25mg IR but for me this was just not feasible due to the horrific side effects. Even at 25mg I’m still getting involuntary movements in my hands and severe restless legs. The psychiatrist I spoke to believes it may be causing the akathisia symptoms (it’s the first antipsychotic I’ve ever taken and should never have been prescribed it as a mood stabiliser and for sleep as I was just going through AD withdrawal.) Now I’m at 25mg I can wake up at 9am and actually have a full day doing things to distract me and help heal (walks in nature etc). At 50mg I would go to bed at 10pm and struggle to wake up earlier than 2pm the following day. I was a completely zombie and this made me severely depressed as I barely saw any sunlight. Completely agree that a 50% cut is extreme and shouldn’t be done but in my case it was a necessity to be able to heal from AD withdrawal. Not that this isn’t serious but I was only on 200mg for one day and 100 for less than a week due to the severe side effects. Completely understand that this still has the potential to effect someone significantly in such a short space of time. 
 

In regards to the reinstatement, I should have definitely worded it how you have stated. Unfortunately I haven’t really been in the mind frame to convey my words properly and every time I’ve written on here has been when I’ve been very distressed looking for any help possible. Unfortunately for me I believe reinstatement was kind of a life or death decision and I sat down with my family to discuss this. I was close to the edge in withdrawal so the risk of reinstatement outweighed the alternative which I can’t believe was even in my mind. Prior to withdrawal ive never had any such thoughts and they literally came on like a light switch. 
 

I am now determined (a lot of it to do with yours and @Catwoman73inspiring comments) to stick with the 0.5mg sertraline reinstatement and hold the 25mg quetiapine until I have stabilised and tapered off the sert. Now I can actually function as a human being rather than a zombie I feel like I can actually make some progress. My family can’t believe the difference in me just from reducing the quetiapine. I’m hoping this also reduced the akathisia but know it could go the other way. Ive also prepared my family to admit me to hospital should I get any worse so I have a good safety plan.

 

Again, I was failed by the medical system and then made some decisions recently that weren’t ideal but I believe they were needed to save my life. I’ll live with the consequences going forward and hold these two doses until I stabilise. Only potential movement would be increasing the Sertraline after a while if no improvement in withdrawal symptoms. I just need the mental symptoms to alleviate slightly as I can cope with the worse physical.

 

Appreciate your honesty and for sharing your experience with me. 

 

 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • Moderator

Hi @Theabominableslowman- I'm just back from my vacation and trying to slowly catch up.  I'm so glad to hear you're in a better place, and so glad that @N2deep was able to provide you with some much needed support. And to have access to one of the very few good psychiatrists out there to help you along... this all sounds great!  I'm so very happy for you!  Keep us posted on how you're doing- we're here for you 100% of the way! ❤️

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Hi @Catwoman73 hope you had a well deserved break and a good holiday 🙂  Yes a big thanks to @N2deep for keeping me going and motivating me with good advice.

 

i increased my reinstatement to 1mg today and going to hold this now for a while. I felt very stimulated an hour after taking it but that has now settled down and I feel the calmest I have in months. I have no physical body pain apart from some aching legs and my mental symptoms seemed to have lessened in intensity.

 

i don’t want to speak to soon but I believe reinstatement may be helping alleviate withdrawal slightly. I know this could change from day to day as had an awful day on Saturday but today has been positive and I would go as far as saying this is a window.

 

i believe it will take a few weeks/ months for my body to steady itself with the increase to 1mg so holding here now and seeing what happens 🙂

 

I have not had to take any diazepam or propanolol today and the agitation has reduced significantly. Perhaps my body was just in complete meltdown with the absence of the drug and is feeling a little better with it back in my system for two weeks? Hopefully this continues.

 

Have also continued with the 25mg quetiapine dose and will not start to taper that at all until I have stabilised on the sert which could be months or years yet.
 

which would be advisable to taper first once stable? The quetiapine or sert? I think I’d rather taper the quetiapine first as it can cause lots of health problems and it does make me fatigued (although much improved on 25mg IR compared to the 50mg XR I was on).

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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  • Moderator
1 hour ago, Theabominableslowman said:

Hi @Catwoman73 hope you had a well deserved break and a good holiday 🙂  Yes a big thanks to @N2deep for keeping me going and motivating me with good advice.

 

i increased my reinstatement to 1mg today and going to hold this now for a while. I felt very stimulated an hour after taking it but that has now settled down and I feel the calmest I have in months. I have no physical body pain apart from some aching legs and my mental symptoms seemed to have lessened in intensity.

 

i don’t want to speak to soon but I believe reinstatement may be helping alleviate withdrawal slightly. I know this could change from day to day as had an awful day on Saturday but today has been positive and I would go as far as saying this is a window.

 

i believe it will take a few weeks/ months for my body to steady itself with the increase to 1mg so holding here now and seeing what happens 🙂

 

I have not had to take any diazepam or propanolol today and the agitation has reduced significantly. Perhaps my body was just in complete meltdown with the absence of the drug and is feeling a little better with it back in my system for two weeks? Hopefully this continues.

 

Have also continued with the 25mg quetiapine dose and will not start to taper that at all until I have stabilised on the sert which could be months or years yet.
 

which would be advisable to taper first once stable? The quetiapine or sert? I think I’d rather taper the quetiapine first as it can cause lots of health problems and it does make me fatigued (although much improved on 25mg IR compared to the 50mg XR I was on).

It sounds like you're doing great!  Windows and waves are absolutely normal, even when reinstatement is successful- your body will still need to reverse all the adaptations it made when you were on higher doses of these drugs.  It is most definitely going to take time, so flex those patience muscles lol!  

 

If you haven't read these links on how these drugs affect your brain, now would be a good time to do so.  It will help you understand why it takes so long to recover. 

 

How Psychiatric Drugs Remodel Your Brain

 What is happening in your brain?

 

In terms of which med to taper first, we do have a thread on this as well!  I will link it below.  Typically, we recommend tapering the more stimulating drug first, as the less stimulating drug can help offset some of the withdrawal symptoms.  In your case, that would be the Sertraline.  However, I do understand your concerns regarding quetiapine... are you experiencing any serious adverse effects from it (outside of the fatigue)?  There is a suggestion at the bottom of the opening post in this thread that suggests alternating- tapering a bit of one for a while, then a bit of the other.  That might work for you as well.  Have a read, and see what you think:

 

Taking multiple psych drugs? Which drug to taper first?

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN

 

Supplements/other meds: Vitamin D, B12, Claritin

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Hi all, just to update:

 

I was still struggling with the agitation slightly although that has lessened. My physical symptoms such as pain and aching had almost completely resolved apart from the odd random times. 
 

unfortunately my mental symptoms with the chemical anxiety and depression were still pretty severe. Spoke to my psych who wanted me to increase to 10mg and to up 10mg every two weeks but I categorically refused that. I am sticking with 2mg for two weeks like I did with 1mg and will increase to 2.5mg if needs be to try and alleviate some of these mental symptoms. Don’t want to go much higher so I don’t have as much to taper off from eventually.

 

i have completely stopped the propanolol (took for four days when agitation was severe) and have taken 1.25mg of diazepam sparingly (every three days or so) but only as a last resort.

 

Does staying at 2mg for two weeks and then increasing by .5 or 1mg sound feasible to try and alleviate some of these mental symptoms? The fact that some of my physical ones have gone has been amazing. 

2014 - 2023: Medicated successfully with 150mg of sertraline for panic and generalised anxiety disorder. No adverse reaction or issues with sleep throughout. March 2023: Had adverse reaction to sertraline after a night out. Doctor diagnosed suspected serotonin syndrome and believe drink may have been spiked. Taken off cold turkey for 7 days for wash out. March 2023: Prescribed 2mg of diazepam x3 PRN per day due to serotonin syndrome reaction.March 2023: Reinstated Sertraline at 50mg. Returned to 150mg over six weeks and stayed at this dose until September 2023. Unfortunately never worked the same so tapered down over to weeks to 25mg.

September 2023: Cross tapered from 25mg Sertraline straight over to 37.5mg venlafaxine. October 2023: Increased venlafaxine to 75 XR. Couldn’t tolerate side effects so switched.December 2023: Switched to propanolol 10mg only and using diazepam sparingly (X2 a month for anxiety). Propanolol made me depressed and tired so stopped this after five doses.December 2023: Switched to 10mg Citalopram. Titrated up to 20mg. Had adverse ‘serotonin syndrome’ like reaction again after using Sudafed nasal spray. Came off cold turkey and 7 day wash out period.

February 2024: Started Pregablin 75mg X2 per day. Couldn’t cope with side effects so stopped cold turkey after five days. Taking 5mg diazepam until side effects went off after a few days.February 2024: Started 5mg of Escitalopram. Had adverse ‘serotonin syndrome’ like reaction after ten days use so came off cold turkey.March 2024: Taking diazepam 5mg to help with serotonin syndrome like reaction to escitalopram for five days.March 2024: Started 7.5mg mirtazapine and titrated up to 15mg. Made me have panic attacks and hypnic jerks so couldn’t sleep after a week of use. Reduced down to 7.5mg over the course of a week and came off cold turkey. No adverse reaction. March 2024: Took one 7.5mg zopiclone to sleep as was worried about reliance on diazepam. Didn’t help sleep.April 2024: Started 30mg duloxetine. Was on for one week and then had serotonin syndrome like reaction and came off cold turkey.April 2024: Went into crisis after last cold turkey triggered SI (never experienced before) and extreme anxiety/panic. Placed under care of NHS Crisis team and Consultant Psych. Taking 10mg diazepam for five days to get over adverse reaction. April 2024: Consultant believed I developed mood disorder (not serotonergic med withdrawal) and prescribed 100mg XR and 25mg IR quetiapine to use three times per day. Side effects were horrible but continued and upped to 200mg XR. Experienced extrapyramidal symptoms (twitching, involuntary movements) so was reduced back to 100mg XR and prescribed 5mg of procyclidine to use twice daily. 25mg made me feel too drowsy so stopped taking and dropped down to 50XR quetiapine.

April 2024: Consultant prescribed 25mg lamotrogine. Took for two weeks but had same reaction that I did to pregablin to came off cold turkey.May 2024: Continued with 50mg XR quetiapine and taking 2mg diazepam sparingly. Researched and found Maudsley Deprescribing book and SA. Told new consultant that I was suffering from withdrawal to serotonergic meds and wasn’t believed. July 2024: In severe withdrawal for 11 weeks with mental and physical symptoms. Unbearable so went to mental health nurse. Have started 0.5mg sertraline making the liquid solution myself. 
July 2024: Four days into reinstatement of Sertraline at 0.5mg.10th July: Stopped Sertraline reinstatement due to agitation. Having to take diazepam 5mg to cope 

12th July: Restarted Sertraline reinstatement at 0.5mg as worked out agitation started before this. Having to use up to 5mg of diazepam daily along with 10mg of propanolol split across the day to deal with agitation. Have split quetiapine from 50mgXR to 25mgIR as worried this causing the agitation. Will hold this now until I stabilise.

 

 

 

 

 

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