kprime: Advice: too fast zoloft taper, 3 weeks of WD, and reinstating

[kprime]

Hello! First post here and let me first say I'm so grateful for the collective knowledge of this community. Up until this point I've been able to manage any WD symptoms I've had with tapering, but this time feels very, very different. I'd love perspectives on next steps and their benefits. I've been on sertraline (zoloft) since Oct 2022. It would work for a few months, then it would stop and I'd need to increase, etc. until I eventually reached a high enough dose that I became hypomanic.

From there, I managed to painstakingly and slowly decrease down to 50, at which point I had months-long depression from WD. That's when I saw a new psychiatrist who got me up to 200 lamictal in addition to the zoloft-- it was a MIRACLE once it started working. The lamictal lifted my WD depression lifted and suddenly it was so easy to quickly (too quickly!!) decrease zoloft. I was decreasing by 6.25 every week. It all went ok until I hit 12.5 and since then I've been experience severe withdrawals. It's been absolutely horrible. After a few days I went back to my previous dose, 18.5. Didn't help. Increased to 300 lamictal but it's not helping to stabilize my mood at all. It's been 3 weeks now and my symptoms are waves of extreme sadness-- uncontrollable crying-- brain fog, fatigue. For the first couple weeks I was experiencing nightmares and insomnia but those have thankfully passed.

I know my brain must be somewhat adapted to the decrease because the insomnia and nightmares are gone. But I can barely function and can't imagine feeling this way for however many months it would take for my brain to heal. My question is whether -- after 3 weeks on this dose, when I'm seeing at least some small changes-- it's too late to reinstate to a slightly higher dose, say 25mg, which would be exactly half of where I started.

 

I've of course heard horror stories about reinstatement's affects on our disregulated nervous systems. But I'd love to hear anyone's experience with something similar. Reinstating to in-between dose less than a month after a too-fast taper. Thank you so much.

Edited July 27 by Emonda
Name to title

[Catwoman73]

Hi @kprime, 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 for completing your drug signature.

 

I'm so very sorry for what you are going through.  You have learned the hard way why we do not recommend treating the withdrawal symptoms of one psych drug with another psych drug.  It can create a nasty cocktail that serves to only make things worse, rather than better.  Don't worry- most of us are here because we've learned lessons the hard way.  

 

It also looks like you have indeed tapered much too quickly, and it all caught up to you.  Here at SA, we recommend tapering at a rate of no more than 10% of your current dose (not your original dose) no more frequently than every four weeks.  This is known as hyperbolic tapering, and can do a wonderful job of minimizing withdrawal symptoms.  Read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

To understand more about how these medications affect your brain, and why this is so important, here are a couple more threads you may wish to review.

 

How Psychiatric Drugs Remodel Your Brain

 What is happening in your brain?

 

I suspect what has happened to you is that your nervous system has become destabilized because of the large, rapid changes to your Zoloft dosage, and the addition of the lamictal.  

 

Since you have seen some improvements on your current dosages of both drugs- namely, the loss of the nightmares and insomnia, I would strongly recommend making no further changes.  Hold here for a while- likely many months.  You will start to experience some better days as time passes, but you will continue to have rough times.  This is a normal part of the stabilization process, and is known as the windows and waves pattern of stabilization.  Read more here:

 

The Windows and Waves Pattern of Recovery

 

If you do wish to try updosing, it is an option, but a smaller increase would be best.  Think 0.5mg or 1.0mg at most.  This would prevent you from overshooting, and ending up with a hypersensitivity reaction.  If you make a small increase, and immediately get worse, go right back to your previous dose.  

 

I would also recommend you start a symptom journal.  Keep a close record of your drug dosages, the symptoms you experience day to day, rating them on a scale of 1-10, the foods/supplements you eat, and your activities.  This can help you spot your windows, and can help you identify things that are triggers for your waves.  Here is a list of typical withdrawal symptoms that you can use as a template, if you wish:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Now, I know how terrible you are feeling right now- I've been there.  Emotional symptoms can be incredibly challenging to deal with.  It's important to start working on developing some non-drug coping mechanisms to deal with your symptoms.  As I previously said, we do not recommend adding any further drugs to the cocktail due to the unpredictable ways they will affect you, and the need for tapering those drugs down the road.  But we do have a bunch of threads on coping mechanisms- I'll link them below for you to review.  I can assure you that, while it takes work to really get the hang of many of these, they really do work well.  You may find some of your own coping mechanisms, too- I find getting in water to be very helpful with my symptoms- be it a bathtub (not too hot!) or a pool or the ocean. 

 

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

 

You can also facilitate healing by avoiding alcohol, caffeine, recreational drugs, and nicotine, and any other neurologically active substances.  We only recommend two supplements here, magnesium and omega-3 fatty acids (links below).  Do be advised, however, that it is very common for people in withdrawal to  become hypersensitive to all sorts of things- medications, supplements, and even foods!  If you choose to introduce anything, even our recommended supplements, start with a low dose, and go very slowly to see how you fare.  I would strongly recommend eating a healthy, whole foods diet, stay adequately hydrated, get lots of rest/sleep, gentle exercise, and avoid stress as much as humanly possible. 

 

I know this seems like a lot.  Just start small.  I like guided meditations on my worst days- there's lots of free ones on YouTube.  I also love walking meditation- such a simple thing to do.  Go for a short walk, and get out of your head.  Focus on the things you can see, hear, smell, and feel along the way.  Yes, your mind will wander, and start to ruminate.  Acknowledge the thoughts and bring your mind back to your immediate environment.  It's hard at first, but the more you do this, the more natural it will become.  I promise you, it works!

 

In summary, I would strongly recommend you hold your dosages of both drugs right now, since you have seen some mild improvements.  If you wish to updose again, keep it very small- 0.5mg or 1.0mg to ensure you don't overshoot your ideal dosage, and end up with hypersensitivity.  When you do find a dosage you feel you can ride this out on, you will need to hold for a while- likely many weeks to months- to get yourself stable again.  Track your symptoms in a journal, and take really, really good care of yourself right now.  This will help to facilitate healing.  

 

Most of all, know that you are NOT alone.  I know it can feel like you are at times, but everyone on this site has been there.  You can and will get through this, and you will be able to taper again, down the road, at a much slower rate.  If we provide our brain and body with the right environment, healing is happening all the time, even when it doesn't feel like it.  

 

This is your introduction topic- each member gets one intro topic.  Please post questions, concerns, updates here.  Feel free to tag myself and/or other moderators with questions by typing the @ symbol, followed by the moderator's username.  Feel free to explore the rest of the forum, and don't hesitate to engage with other members on the site.  Having a community of people who understand definitely makes this journey a little less painful.  

 

Hang in there... and I look forward to following your journey! ❤️‍🩹

 

 

 

[kprime]

Hi @Catwoman73 and thank you so much for your thoughtful and quick reply. This is all very helpful. I really feel pulled to go up a tiny bit in dose but will try to stick it out for a little bit and see if I can feel even a little better. I also realized how splitting my 25mg pills into quarters (to make 18.5mg total) might result in an inconsistent dose that is making things worse. I followed the directions here about making a liquid suspension and will be trying that to see if dose consistency can can take the edge off.
 

It’s scary to think of this as a months or years long journey. Previously my withdrawal experience had only been measured in weeks. But now that I’m in this position I’m so grateful for the support and community here. Thank you, thank you

 

Anyone’s advice or suggestions welcome at any time, especially re: updosing a little and the likelihood it will provide relief

 

PS

I also want to add, for what it’s worth and for future readers, that I don’t believe the lamictal has made any part of this worse per se. In fact it lifted me from a moderate to mild withdrawal I had previously been experiencing. It kept me steady and feeling good! The issue really came when I pushed way too fast with my taper and the lamictal is no longer able to keep the symptoms at bay. My psych said it helps because lamictal primarily decreases electrical activity in the brain and does not touch the receptors. Meaning that it helps regulate a disregulated nervous system.

I’m SURE there are people here who are really suffering as a result of lamictal and of COURSE your mileage may vary. I don’t want to minimize anyone’s suffering in any way. Just to say, lamictal did help me with tapering. It just helped so much that I got complacent and pushed it. And now it seems? not to be helping/hurting at all.

 

 

[Catwoman73]

Glad I could help a little bit!  

 

I want to caution you about the transition to a suspension- many people react with severe symptoms when making this transition.  For some, it is best done in stages- 1/4 liquid, 3/4 tablet for a few days, then half and half, and so on.  Personally, when I transitioned to a suspension, I did it all at once, and only had some moderate dizziness.  This was done purely out of ignorance lol... knowing what I know now, I absolutely would have gone slower.  

 

As for your experience with lamictal- I'm glad it gave you short term relief.  It may be helpful in the moment, but we need to be very cautious on this site about endorsing any drug for the relief of withdrawal symptoms.   Specifically with lamictal, it is best started at extremely low doses if used for withdrawal syndrome (like, as low as 0.5mg). Most doctors, even psychiatrists, do not know this, and end up prescribing doses that are far too high to accomplish what we need it for- to  bring withdrawal effects down to a tolerable level.  Too high a dose can be very activating, and make things significantly worse rather than better. Worst case scenario, improper high dosing, or rapid upward titration can lead to stevens-johnson syndrome, which is very serious.  I think we see these negative effects so often around here because, sadly,  there are only a small handful of doctors on this planet who know how to use this drug properly for withdrawal.  I don't know how you titrated upwards, but given your current dose, I think you have been quite lucky not to experience anything negative from the lamictal.  Someone else, particularly those with much longer drug histories than yourself, might not be so lucky.   This is precisely why we do not endorse taking psych meds to deal with withdrawal symptoms of other psych meds. 

 

This is a great thread on all of this, particularly the comments by Altostrata- have a read!

 

https://www.survivingantidepressants.org/forums/topic/3769-lamictal-lamotrigine-to-calm-post-acute-withdrawal-symptoms-paws/#comment-11570

 

Also keep in mind that you will have to titrate your lamictal very slowly, using the 10% (at most) rule, as described in my first post.  And it is best to only titrate one drug at a time, so there is no confusion about what drug is causing what withdrawal symptoms.  Most people here have a goal of becoming completely drug free, so adding lamictal can add a significant amount of time to someone's tapering/withdrawal journey.  This needs to be carefully weighed against potential short term benefits. 

 

Please don't take any of this as a personal criticism- it is absolutely not meant that way!  As a moderator here, I feel it's very important to make sure our members have ALL of this information in order to make informed choices.  Unfortunately, we can't count on the medical community to provide this info- otherwise, sites like this wouldn't exist!  

 

In any case, I'm very glad you're going to hold for a while.  Start that symptom journal, and start working on some of those non-drug coping mechanisms.  I'm very glad you're here, and please don't hesitate to reach out with questions.  We're here to help!

[kprime]

Yes absolutely, so sorry if I seemed to endorse lamictal. I think I AM very lucky that it didn't cause any issues for me. I titrated up extremely, extremely slowly under my dr's supervision to avoid SJS. I definitely don't endorse it as a way of easing withdrawal. Again, I think I just got very lucky with its effect in my single case. Thanks for making this clear for me and for anyone reading this thread later.

[Catwoman73]

No worries at all!

 

Keep us posted on how you're doing!  I hope you start to see more and more windows! ❤️

[kprime]

I will keep you posted, thank you! I actually took your being in water tip today and went to the beach for the afternoon to cool off and float. Here’s hoping for more windows

[kprime]

Today was a really hard day. The wave of depression and fatigue is just really bad, can’t seem to exercise, meditate, stay hydrated, the things that help. Feeling like I ruined my life with this taper. Any encouragement would be really helpful 

[Catwoman73]

Just seeing this @kprime- I've been struggling lately too!  

 

It sounds to me like you are just in a bad wave.  Go back and have a look at the following link.  The good news is that waves always end.  Just keep giving your brain and body the stability that it requires, and you'll get there! 

 

The Windows and Waves Pattern of Stabilization

 

You most certainly haven't ruined your life.  Try your best to pull out of these catastrophic thinking patterns.  Cognitive Behavioural Therapy techniques are helpful with this- always ask yourself the question 'is this true?' when you start having these blanket, horrible thoughts.  I suspect it is not true- I suspect you have people who care for you in your life, a place to sleep at night, food to eat, and so on.  There are good things, even on the worst possible days.  

 

I also find mantras to be super helpful on the bad days.  Try lying down with your eyes closed, repeating the following, over and over (and over): This is NOT me.  This is only the drugs.

 

Finally, rituals are extremely comforting.  Think back to when your nervous system was stable- what would you do to give yourself comfort on crappy days.  Cuddle with a pet?  Watch TV under a nice, warm blanket?  Eat banana bread with a hot cup of tea?  All of those things can still trigger your happy hormones.  The effect may not be as strong right now, but anything you can do to help yourself will make a small difference.  

 

You've been through quite a lot- give yourself some credit.  You are a strong person, and I have zero doubt that you can make it to the other side of this journey.  Take things one minute at a time.  Stay in the present moment.  Each moment that passes is a moment closer to healing.  

 

Thinking of you! ❤️‍🩹

 

 

[kprime]

I really can’t thank you enough for the support @Catwoman73. I did reach the other end of the wave. I’m still early in this journey and it is still shocking to me how intense a wave can be, and how swiftly it can come and go. The pattern is completely new to me.

 

I really like your techniques, especially “This is not me, this is the drugs” mantra which I will absolutely use. It’s my instinct to apologize for dropping something so dramatic here but I realize that this support is (partly) what this forum is here for. So instead I’ll just say thank you. Relieved to see that even such a BAD wave will recede at some point ❤️

 

also, I’m very sorry you’ve been struggling lately too. Wishing you healing. Can you get into any water soon? 🌊

[Catwoman73]

31 minutes ago, kprime said:

I really can’t thank you enough for the support @Catwoman73. I did reach the other end of the wave. I’m still early in this journey and it is still shocking to me how intense a wave can be, and how swiftly it can come and go. The pattern is completely new to me.

 

I really like your techniques, especially “This is not me, this is the drugs” mantra which I will absolutely use. It’s my instinct to apologize for dropping something so dramatic here but I realize that this support is (partly) what this forum is here for. So instead I’ll just say thank you. Relieved to see that even such a BAD wave will recede at some point ❤️

 

also, I’m very sorry you’ve been struggling lately too. Wishing you healing. Can you get into any water soon? 🌊

 

Thanks @kprime- I believe I am at the end of a month long wave... this is day 2 of feeling ok-ish lol.  Hoping I can resume tapering in a couple of weeks.  It often feels like two steps forward, and anywhere from 1 to 100 steps back, doesn't it?  

 

I swim every day, no matter how I'm feeling.  That's the beauty of having a pool lol- I don't even have to leave home!  When I'm in a wave, I have zero heat tolerance, so sometimes, I have to just slip out to the pool, and get right back inside after a swim.  I'm dreading the day when we close the pool for the season- looks like I'll be purchasing a membership to our community indoor pool!  And of course, that will come with challenges.. having to leave the house, deal with other people, etc.  I'm still deciding if it's the right move for me. 

 

I'm so very glad you got through your wave.  I am mostly very accepting of my situation, but I, too, sometimes feel completely shocked and blindsided by just how bad I can feel.  I'm very thankful for this community, the success stories here, and for the likes of people like Angie Peacock on YouTube.  Watching her recovery interviews reminds me on the bad days that healing absolutely WILL happen. ❤️