Otter22: Reinstatement advice - Sertraline

[Otter22]

Hello. Wondering if someone might be able to help. I tapered myself off sertraline 50mg too quickly back in March. I'd been on it for 7 years for GAD and did the taper recommended by doctors over a couple of weeks. I did ok without it for a couple of months and then things got really rough (anxiety, constant nausea, agitation, depression etc). I spoke to my doctor, and he put me on agomelatine 25mg because it's a newer drug with supposedly fewer side effects. I've been on that for a couple of months now, but haven't really noticed any improvement. I'm really struggling. The nausea seems to be getting worse, and i'm extremely foggy and anxious all the time. I feel like my nervous system is extremely dysregulated. I exercise regularly, eat well, practice mindfulness, see a psychologist, take magnesium and fish oil supplements, and yet, I just can't seem to find the stability I had when I was on sertraline. I have no idea if this is PAWS or a reoccurrence of my original symptoms, but either way, I know something needs to change. I'm thinking about reinstating sertraline at 12.5mg and stopping the agomelatine, but I'm very worried this is going to make things much worse as it's been over 4 months since my last dose. Is this a bad idea? Does anyone have recommendations? Unfortunately I can't get liquid sertraline because I'm in Australia. Thanks so much in advance.

Edited August 7 by Emonda
Name to title

[Erimus]

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

 

This topic is for anything relating to you, and any questions you have. Please do not start another topic.

 

What date in June did you start the agomelatine? How frequently are you using benzodiazapines, when did you last take one? I would suggest you refrain from intensive exercise for the time been as it further stresses an already sensitive nervous system. Walking, and anything that does not significantly raise your heart rate, is fine.

[Otter22]

Hi Erimus. Thank you for your reply.

 

The timeline is as follows. Probably worth mentioning that I also took a few doses of sertraline in May/June because my plan was to reinstate before my doctor recommended agomelatine. I ended up doing a bit of a cross taper.

 

March 23: stopped sertraline after a few weeks of taper.

May 28: took 25mg sertraline

May 29: took 12.5mg sertraline

May 30: took 12.5mg sertraline

May 31: took 25mg sertraline

              started agomelatine 25mg each night from here

June 1: took 12.5mg sertraline

June 2: took 6.25mg sertraline

June 3: took 3.125mg sertraline

June 4: stopped sertraline

 

Regarding the lorazepam, it's fairly infrequent. Once or twice a month on average, although, last week I had to have a colonoscopy and gastroscopy. I took .5mg for four nights leading up to it, then 1mg the morning of. Haven't used it since (as much as I have wanted to). I have a feeling that the rebound from this plus the propofol they used for the procedure has thrown my nervous system into further disarray. I'm feeling a little better today after some light exercise last night. Now I'm wondering leaving things as is to see if my NS will settle.

 

The joys of windows and waves, eh? I'm keeping a symptom journal to try and work out a pattern.

[Erimus]

14 hours ago, Otter22 said:

Regarding the lorazepam, it's fairly infrequent. Once or twice a month on average, although, last week I had to have a colonoscopy and gastroscopy. I took .5mg for four nights leading up to it, then 1mg the morning of. Haven't used it since (as much as I have wanted to).

I would suggest you don't ever take it again. It is unlikely you are dependent on it, so you are fortunate that you can escape benzo withdrawal.

 

14 hours ago, Otter22 said:

I'm feeling a little better today after some light exercise last night. Now I'm wondering leaving things as is to see if my NS will settle.

I think the most sensible solution would be to keep things as they are for the next 3-6 months, and perhaps beyond. Your nervous system is now sensitised to a number of different things you previously could use. Any psychoactive drugs, recreational drugs, alcohol and antibiotics can cause issues, so you must be careful about every pharmaceutical you ingest moving forward.

[Otter22]

Hello again, and thanks for the response.

 

I think you're right about the lorazepam. It's nice to know it's there, but I'll definitely refrain from using it and just have it as a last resort. I don't need a benzo dependence on top of everything else.

 

I also feel like leaving things to stabilise without reinstating is the right move. I needed someone else to reinforce this though, because it's easy to start second guessing when you're having a bad day. So thank you for that. It's amazing how having one coffee or one beer has such a drastic effect now, when previously I wouldn't notice anything at all. 

 

My gastroenterologist recommended either mirtazapine or nortriptyline for the chronic nausea and I said no thank you. Might try gut directed hypnotherapy further down the line.

 

Thanks for your support.

 

 

[Ariel]

@Otter22

24 minutes ago, Otter22 said:

chronic nausea

 

Common WD symptom.

 

Some members report relief from gentle herbal remedies such as ginger, peppermint, licorice root -- teas, infusions, chews and drops, essential oils to sniff, etc.

There's a help topic about it (in your situation I'd recommend staying away from the motion sickness drugs, but you might give the herbal remedies a go):

What to do for dizziness, queasiness, nausea

 

 

On 9/5/2013 at 9:05 AM, mtnbkr said:

Ugh! I'm certainly familiar with the nausea. There's been lots of it in my life - motion sickness, the flu, pregnancy, and now withdrawal - and I've tried everything.

 

I concur with the posts above re GINGER and LICORICE. I find ginger beer (it's not an alcoholic beverage) is the most helpful. I also use ginger gum. Ginger tea is nice because it's also soothing. If you don't care for the taste of ginger, then you can take a ginger pill or chew on licorice root or licorice candy.

 

There's also an ACCUPRESSURE POINT on the inside of your wrist which you can press and hold to help with nausea. Here's a youtube video with a good demonstration of how to find the correct point and apply pressure: http://www.youtube.com/watch?v=KcZs6BYFyTo. In my experience, you'll know you've found the spot because within 15-30 seconds you can feel the nausea diminishing. This is a partucilarly good remedy if your nausea comes in waves because you can catch it quickly and get immediate and profound relief. Unfortunately, if your nausea is continuous, you'll find you have to continue to hold the pressure point.

 

The quote above is from another help topic.

 

It gets better ❤️

 

 

[Otter22]

Thanks for the tips, Ariel. My nausea is always worst in the morning. Actually mornings are always horrible. Once I wake up, I can actually feel the (what I assume is) cortisol/adrenaline flooding my body 20-30 seconds later. I go from calm to extremely anxious and nauseous within 1 min, and this feeling doesn't start to subside until I've been up and active for about 3 hours. Evenings are the only time I get any respite. My bloodwork is all fine (including thyroid), and they didn't find any issues r.e. colonoscopy/gastroscopy. Plus I exercise and eat healthily. I'm going to try acupuncture for the first time in a few days.

 

Is the heightened cortisol awakening response common in w/d? Any tips for reducing and managing it?

 

Thanks.

[Erimus]

13 hours ago, Otter22 said:

Thanks for the tips, Ariel. My nausea is always worst in the morning. Actually mornings are always horrible. Once I wake up, I can actually feel the (what I assume is) cortisol/adrenaline flooding my body 20-30 seconds later. I go from calm to extremely anxious and nauseous within 1 min, and this feeling doesn't start to subside until I've been up and active for about 3 hours. Evenings are the only time I get any respite. My bloodwork is all fine (including thyroid), and they didn't find any issues r.e. colonoscopy/gastroscopy. Plus I exercise and eat healthily. I'm going to try acupuncture for the first time in a few days.

 

Is the heightened cortisol awakening response common in w/d? Any tips for reducing and managing it?

 

Thanks.

It's just down to our natural hormone levels throughout the day. Cortisol is highest in the early morning and slowly decreases throughout the day. Melatonin increases as it gets dark, which promotes sleep.

 

Some people find high doses of vitamin c helps with early morning cortisol rushes. You have to introduce it gradually and increase slowly, otherwise your digestive system will suffer.

 

https://www.survivingantidepressants.org/forums/topic/40-vitamin-c-ascorbic-acid-or-ascorbate/?do=findComment&comment=180282