AriesGirl: Sertraline Withdrawal and Reinstatement

[AriesGirl]

Hi there.  I am new to this site.    I have been on SSRI's for almost 30 years.  Have had to switch between a few different ones over the years because they would "stop working".  Currently I am on 50mg Sertraline.   I successfully came off Ambien and Bupropion a few years ago.  After coming off Ambien I started  taking 10mg Melatonin, and 300mg Magnesium Glycinate.  Recently I have been adding a Benadryl a few times a week just to get a descent night sleep because of anxiety and insomnia.

 

I have tried coming off SSRI's probably at least 4 or 5x without success.  All prior attempts (except this last one) were done the way the Dr told me to do it - you know, skipping doses, cutting in half and all that crap.   This last attempt started on 01/30/24 and I really thought I was going slow enough but apparently not.    On 05/02/24 I went down to 32mg and all of a sudden the withdrawal symptoms became super intense.  Crying, depression, severe anxiety, fear, dread, not wanting to be here, insomnia, no appetite, constant hot flashes, dizziness, and I completely passed out twice.   Symptoms would come in waves but mornings were pretty much always bad.   I also experienced lots of abdominal pain and other issues which I originally thought was caused by the liquid version of Sertraline.  Now I know those are also considered withdrawal symptoms.  So honestly it may have not been the liquid, I don't know.    Long story short the withdrawal symptoms became too unbearable and I couldn't take it anymore so I quit and went back up to my original dose of 50mg tablets on 07/17/24.   I put in over 5 months of this so I kept second guessing myself.   Wish I could have been stronger and just stuck it out.  However the new plan is to stabilize and RETRY but at a much slower rate and have longer holding periods to minimize the horrendous withdrawal symptoms.

 

I did try a Compound Pharmacy a couple of months later and had them crush the pills for me and put them in a liquid suspension.  However, there would be chunks of the coating all through out and also chunks of the powder in parts of the suspension (even after shaking very well).  So that kind of scared me thinking there is no way I am getting an accurate or consistent dose.   If I end up crushing my own pills and weighing them will I get a consistent weight even with the coating on them?  I was told the coating doesn't crush well.  Is Just not sure which route to go when I start this process all over again - the pills or liquid.  Also, has anybody mixed taking pills and doing partial liquid with success or does that screw things up since they get absorbed at different times?   Any advice is appreciated.  

 

I  just recently came across this website where you could get help with all this.  The wealth of information and support you provide is so wonderful.  Wish I would have known about you earlier.   So grateful and glad to have found you!

[Catwoman73]

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

 

I know Emonda has sent you a warning, but if you could kindly summarize your drug history in your drug signature, we would greatly appreciate it.  This helps us know your history at a glance when visiting your thread, making it easier to advise you appropriately.  To complete your signature, click the following link, fill in the box, and click save.  Do include any supplements or other medications you might be taking as well.  

 

Your drug signature

 

I'm so sorry you have tried so many times to come off your antidepressants without success.  This is a pretty common story around here.  Unfortunately, there are very few physicians on this planet who seem to understand the true impact these medications have on us, and how they impact our biochemistry, and even our gene expression.  This is why we get withdrawal symptoms- it takes a lot of time and patience to reverse the adaptations our bodies have made to taking these drugs, particularly when taken long term.  Read more here about how these medications change your brain:

 

How Psychiatric Drugs Remodel Your Brain

 What is happening in your brain?

 

Because of the adaptations our brains make while taking these drugs, here at SA, we recommend doing a hyperbolic taper when you are ready to taper again.  This means tapering no more than 10% of your current dose, no more frequently than every four weeks.  You may have to make smaller cuts, and/or go slower than this, however.  We do find that people who have had prior fast tapers or cold turkey stops tend to have worse withdrawal symptoms.  I am definitely in that camp, and I am currently micro tapering to ensure I can still function through the withdrawal.  Here are a couple of links on tapering methods that tend to work well:

 

Why taper by 10% of my dosage?

The Brassmonkey Slide Method of Microtapering

 

That being said, I would recommend you hold for a while before proceeding.  Your nervous system is in a destabilized state right now due to too fast tapering, and rapid updosing to the original dose.  You will need time to heal.  During this time, I would recommend you start keeping a symptom journal.  Track your symptoms, your activities, foods, etc.   This is a good habit to get into, as we tend to heal in fits and spurts- this is known as the windows and waves pattern of stabilization.  Read more about stabilizing with these links:

 

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

The Windows and Waves Pattern of Stabilization

 

Even very slow tapering does not eliminate all withdrawal symptoms.  While you are holding to stabilize, it would be a good time to work on developing some non-drug coping mechanisms.  This is VERY important.  The mental game is a tough one while tapering, and if you have a toolbox filled with tools to help you through, it's significantly easier.  Here are links to some of our recommended techniques, though you may find some of your own, too!

 

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

 

As for your specific questions- either purchasing a jeweller's scale and shaving small amounts off your pills with a razor blade or exacto knife, or liquid taper is perfectly fine.  If you decide to go with liquid, it is best to transition slowly to the liquid rather than all in one go.  Tablets are scored, so the easiest way would be to take 1/2 a tablet and create liquid with the other half.  Hold for at least a week to ensure you are tolerating that ok, then switch to all liquid.  If that's too fast, you can even do 1/4 liquid, 3/4 tablet for a while, then half and half, and so on.  Whatever you do, don't switch to liquid and taper your dose at the same time!

 

As for the little floaties in your suspension, this is just the coating AND the filler in the tablets.  I know it can be a bit alarming to look at, but it shouldn't affect your dosing, as long as you shake well before drawing up your dose.  

 

Personally, I prefer liquid.  I find it easier and less fussy.  But we all have to find what works best for us!

 

In summary, I would recommend holding for a while (weeks to months) due to the degree of nervous system instability you are likely experiencing after so many changes over the fist half of this year.  Use this time to start practicing some non-drug methods of coping with your symptoms, and start a symptom journal to keep track of your windows and waves.  When you do start tapering, taper by no more than 10% of your current dose, no more often that every four weeks, but do consider going even slower.  

 

Most importantly- don't lose hope!  It's going to take a while and the journey will be filled with ups and downs, but you can get yourself off of these meds in a slow and safe manner!  You're in good company here- we are all in it for the long haul lol... personally, I have at least 2 more years of tapering to go.  But every single day is a day closer to healing!!!

 

This is your introduction topic- each member gets one intro topic.  Please post questions, comments, updates here, but do explore the rest of the forum- there's a lot of great info here!  And don't hesitate to read the intro topics of other members, and engage with them- this journey is much easier when you have a village supporting you! ❤️‍🩹

[LostInCanada]

@AriesGirl hi and welcome to SA. 

20 hours ago, AriesGirl said:

did try a Compound Pharmacy a couple of months later and had them crush the pills for me and put them in a liquid suspension.

I have not had success with using a compound pharmacy. They are definitely not all good. Any pill ground up should be ground to an equal consistency if done correctly. There should not be chunks.

 

I also found not all pills are equal in weight. There is range of acceptability. I contacted my manufacturer to find the true weight of the pill and used this as my standard when weighing and shaving the pills. I have found it easier to just shave off what I don't need. I tried grinding and using capsules and found it alot of work. 

Many find making their own liquid very effective.

 

 

 

[AriesGirl]

On 7/23/2024 at 12:46 PM, LostInCanada said:

@AriesGirl hi and welcome to SA. 

I have not had success with using a compound pharmacy. They are definitely not all good. Any pill ground up should be ground to an equal consistency if done correctly. There should not be chunks.

 

I also found not all pills are equal in weight. There is range of acceptability. I contacted my manufacturer to find the true weight of the pill and used this as my standard when weighing and shaving the pills. I have found it easier to just shave off what I don't need. I tried grinding and using capsules and found it alot of work. 

Many find making their own liquid very effective.

 

 

 

Thanks so much for all the information!  I am almost in tears thinking about all this.  At times so overwhelming and seems almost impossible to do.... uggghhh

[Catwoman73]

53 minutes ago, AriesGirl said:

Thanks so much for all the information!  I am almost in tears thinking about all this.  At times so overwhelming and seems almost impossible to do.... uggghhh

 

It does seem like a lot, I know.  But the key to success here is preparation.  You are holding now to stabilize, so you have the advantage of time.  You can start working on those non-drug coping mechanisms.  It takes about three weeks of regular practice of ANYTHING to form a new habit.  Start that symptom journal.  While doing that, you could do some reading on this site, and decide how you want to proceed- liquid vs shaving small amounts off of your tablets.  

 

I really want to emphasize that there is NO RUSH!!!  Even once you feel like you have stabilized, you can keep holding until you feel like you have yourself in a good state of readiness to proceed with a taper.  From what I've seen around here, those who are in absolutely no hurry seem to fare the best on this journey.  Just take things one day at a time.  Planning is great, but it's important to step away from even thinking about tapering when you are feeling overwhelmed by it all!  Be very gentle with yourself.

 

I just noticed this phrase in your original post:

 

On 7/22/2024 at 7:13 PM, AriesGirl said:

  Wish I could have been stronger and just stuck it out.  

 

You are strong.  It takes courage to admit that what you were doing wasn't working, and choosing to backtrack.  It takes courage to work towards getting off of these medications, and learning to deal with our emotions in a healthy, non-drug fashion.  The people on this site are the strongest people I have ever encountered.  Don't sell yourself short- you're a warrior, and you WILL get through this!   And we will be here to support you along the way.  ❤️

[LostInCanada]

1 hour ago, AriesGirl said:

I am almost in tears thinking about all this.  At times so overwhelming and seems almost impossible to do.

Trust me when I say I understand by my own experience. Just take it one step at a time. Like Catwoman73 said, you are just stabilizing and don't have to do anything till you are ready. 

We are here for you to help along the way. 

You have been through alot. Just breathe. You will be okay and get through this. 👍♥️

Feel free to ask whatever you need to know. 

[AriesGirl]

Thanks so much for the support 💗  I am going to keep going through this site and learn all I can so hopefully I will be much more prepared to start the tapering process again.  

[LostInCanada]

11 minutes ago, AriesGirl said:

I will be much more prepared to start the tapering process again.  

Good for you. I have a notebook handy so I can write down points that resonate for quick access. 👍💯♥️

[AriesGirl]

Great idea!  I think I am going to try the shaving method.   Do you find that to be pretty easy and accurate?  

[AriesGirl]

12 minutes ago, LostInCanada said:

Good for you. I have a notebook handy so I can write down points that resonate for quick access. 👍💯♥️

Is there a particular brand of scale to buy that you could recommend?  

[ShantyO7]

Sorry, don't know what happened there!

[LostInCanada]

24 minutes ago, AriesGirl said:

A&D EJ-54D2 Dual Range - 22g x 0.0002g / 52g x 0.001g Compact Balance

[LostInCanada]

This scale weighs to .0002g and is about 10x more expensive than the Gem 20 jewelry scale found on Amazon which weighs to .001g.

I was sure I was going to use it for my full taper so I wanted it to be able to get me there. I am not sure if I will eventually go to homemade liquid or not. 

28 minutes ago, AriesGirl said:

try the shaving method.   Do you find that to be pretty easy and accurate?  

I find it good. Takes a bit of practice. I cut my 20 mg pill in 4 pieces with a pill cutter and then use a one sided razor blade to careful shave off powder to the desired weight. My 20 mg pills weigh 236.4 mg or .2364 g on the scale. I weigh each quarter and shave to the desired weight. For me 4.32 mg is .0512g on my scale.

[AriesGirl]

1 minute ago, LostInCanada said:

This scale weighs to .0002g and is about 10x more expensive than the Gem 20 jewelry scale found on Amazon which weighs to .001g.

I was sure I was going to use it for my full taper so I wanted it to be able to get me there. I am not sure if I will eventually go to homemade liquid or not. 

I find it good. Takes a bit of practice. I cut my 20 mg pill in 4 pieces with a pill cutter and then use a one sided razor blade to careful shave off powder to the desired weight. My 20 mg pills weigh 236.4 mg or .2364 g on the scale. I weigh each quarter and shave to the desired weight. For me 4.32 mg is .0512g on my scale.

I appreciate the information.  

[AriesGirl]

I am all over the place.  I went back up to 50mg Sertraline on 07/17/24 after an unsuccessful taper attempt.  I felt weird and had prickly sensations on my skin, and lots of dizziness so I figured that was just too high a dose to go back up too after tapering down somewhat.  So I went down to 48mg on 07/30/24 combining halving 1-1/2 of the 25mg pills and taking the difference in the liquid form (commercial grade from Pharmacy which seems to affect my stomach).  But then I got concerned because I was doing both liquid and pills and they were getting in my system at "different times".  So I started second guessing myself again.  So then I went to the compound pharmacy and had them make 48mg capsules (they did the crushing and weighing of pills) and I started taking the capsules 08/03/24 but I am still not stabilizing.  Although there are some good periods I feel like I am starting to have more waves.  So now I am freaking out that maybe the pharmacy capsules aren't accurate.    Can you get an accurate dose when you also have fillers and a coating from crushing tablets?  Some capsules might be filled with more coating and fillers than others right?  Also, during the last taper episode I had the Compound Pharmacy make the liquid form for me which they did by crushing tablets and they mixed it with Unispend (a suspension).   Later I found out that the Sertraline was actually not completely dissolving in the Unispend it was mixed with, it was actually clumping up (I sent the pharmacy a picture of the residue in the medicine cup and they confirmed it) so while I was on that liquid they made me I have no clue what dose I was actually getting during the time I took it.   I would not of even known about it except I poured the liquid in a medicine cup instead of syringing directly out of the bottle one morning and that's when I saw the clumping.  I am using a PCAB accredited Compound Pharmacy which I was told had stricter guidelines.  Because of that maybe I am just paranoid about the dosing being accurate with the capsules too.   Right now I just want to stabilize and don't know if I should just stick it out on the 48mg capsules or go back to commercial grade combo of liquid and tablets.  Do I go back up to 50mg or wait it out?   I guess I am just looking for reassurance and want to know what others have done and had the most success with when tapering off Sertraline and what form or combination, if any, seems to work best and is the most accurate?   Anyone have stomach issues from liquid Sertraline (commercial grade) or is that just withdrawal symptoms?  I was gonna do the weighing and shaving method myself but that started stressing me out thinking about it being accurate.   I just feel a bit overwhelmed and can't seem to think straight.  Any advice would be so greatly appreciated.