FranOhio: New Here - Hello and Thank you!

[FranOhio]

Hello,

First of all thank you for accepting me to the site!

Here's my story:

62 year old female, extremely healthy and active prior to May 13, 2024. I had a traumatic tooth extraction that resulted in nerve damage. I had been previously stable on 50 mg sertraline for 30 years.  I asked the Dr. to increase the dose to 75 mg to deal with the anxiety.  I developed akathisia. I didn't know what it was , I thought I was just anxious and crazy.  Sleep stopped almost entirely.

June 26 - I was prescribed 1.5 mg clonazepam daily and 7.5 mg mirtazapine. Fortunately I didn't trust either and reduced each to .33 mg clonazapam and 5.2 mg mirtazapine within the next 3 weeks before I was too dependent. Cutting and weighing is so stressful. Both drugs make me sick, but I am sleeping. After reading online forums I realized what happened, that the Sertraline caused akathisia leading to a prescription cascade. This epiphany occurred around August 8. 

Trying to taper the sertraline first, but it's hard because the other drugs make me sick.  I'm currently at approximately 71 mg sertraline (from 75 mg, started taper as of 8/9/24. The physical withdrawal is lessening but psychologically I am struggling horribly. I am not "stable". How cruel to have both side affects and withdrawal at the same time!

Questions: I am getting liquid sertaline this week. Will the transition from solid be hard?

My hormone replacement implant has run out and I feel myself aging rapidly. Is it safe to resume HRT?

I will want to microtaper as much as possible. What is the best scale? The $35 gem scales aren't stable. Money is an issue, but my life depends on this.

 

 

Drug dosage_ffs_240902.xlsx

[Catwoman73]

Hi @FranOhio, 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've been through.  You certainly aren't alone- the vast majority of doctors do not recognize hypersensitivity reactions, and end up prescribing more medications, rather than cutting the original medication back to the previously tolerated dose, which likely would have solved the problem in short order.  

 

Just one question before I get into my whole welcome message- What do you mean when you say that mirtazapine and clonazepam are making you sick?  Can you describe exactly what symptoms those are causing specifically?

 

It looks like you have already discovered some good info on tapering, given that you made a small cut in your sertraline dose.  We recommend tapering by no more than 10% of your current month's dose, no more often than every four weeks.  This is called hyperbolic tapering, and is designed to release the receptors from the drug slowly, at a rate you can tolerate, allowing the brain to make adaptations to the progressively lower doses.  Tapering this way also means that you taper by smaller amounts at lower doses, where the drugs have the biggest impact.  It looks like you made about a 5% cut, which is perfectly safe, so great job on that!  You can read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

Cutting and shaving pills can be very time consuming.  But switching to liquid can be problematic for some.  I had very few issues- some increased dizziness for a few days.  Many here transition slowly, by taking 25% of their dose in liquid form and 75% in pill form for a few days, then 50/50, and so on.  That can ease the transition a little bit.  If you wanted to continue weighing instead, check out the following thread for some tips and tricks.  Do check out the links contained within this thread for videos, etc.  Most people here do use the Gemini 2 scale.

 

Using a Scale to Weigh and Measure Doses

 

Regarding your HRT, I would stay on it.  Estrogen should be tapered as well, so a sudden stop could make things much worse for you right now.  I'm on HRT, and can't fathom being without it.  I get night sweats from withdrawal, the last thing I need is hormonal hot flashes on top of that.  You're suffering enough- keep those hormones coming for now!

 

Female Hormone Replacement Therapy...

 

If interested in micro tapering, check out this method- I am currently using it, and I'm doing extremely well (despite also having long covid and dealing with perimenopause.... I'm a mess lol!):

 

The Brassmonkey Slide Method of Microtapering

 

I want to share some other important information that will help you understand what is happening to you, and how you can help yourself get through this.  First of all, it is absolutely normal and expected to go through periods where you don't feel so bad, and periods where you feel terrible as you taper.  This is known as the windows and waves pattern of stabilization.  You can read more about this in the following link.  

 

The Windows and Waves Pattern of Stabilization

 

It might be a good idea for you to start a symptom journal.  Track each of your symptoms, and rate them each day on a scale of 1-10 for severity.  This can make it much easier to identify your windows and waves, along with things that could be triggering waves for you.  Not all waves have a specific trigger, but sometimes they do.  You can use the following list of typical withdrawal symptoms as a template for a journal, if you wish:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

 

There are a few things you can do to help with the healing process.  Most are pretty common sense, but I'll put them out there anyway.  Eat a balanced, whole foods diet, stay adequately hydrated, prioritize rest/sleep, engage in gentle exercise, and avoid neurologically active substances, like caffeine, nicotine, alcohol and recreational drugs.  Avoid adding any other psychiatric medications into the mix- the results are unpredictable on an unstable nervous system, and you will also create a situation where you have something else to taper from in the future.  We only recommend two supplements here at SA- magnesium and omega-3 fatty acids.  Do be mindful though, it is very common for those in withdrawal to become hypersensitive to all sorts of things, such as medications, supplements and even foods.  This is where your journal comes in- if you are tracking these things, it is easier to identify triggers, making the journey much more smooth.  If you decide to try any supplements, including those we recommend, start at a low dose, and see how you fare.  You can increase slowly over time if you tolerate them well. 

 

As for the emotional symptoms, I know these can be incredibly difficult to manage.  It's really important to start developing some solid non-drug coping mechanisms early in your journey.  We have lots of threads on this stuff here at SA- I will link some of them below.  Speaking from a personal standpoint, I have found practicing mindfulness every minute of every day, and listening to calming music/meditations/yoga Nidra at night to be some of the most effective practices in management of anxiety and depression.  I have also discovered that I am incredibly calm when I'm in the water, so I swim every day.  And distractions are wonderful- I love watching horror moves and true crime (I know, not very calming lol), and working on art projects.  These things get me through my days with relative ease... though nothing is ever easy on this journey!

 

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

 

Given that you are on three drugs, and have been on them long enough to have made physiological adaptations to their presence, I'm going to include the following link, discussing what order to taper the drugs in.  Spoiler alert- you have absolutely chosen correctly in your case.  We recommend tapering your most activating drug first.  If a high dose of sertraline gave you akathisia, you made the right choice.  The others may help to mitigate some of your withdrawal symptoms as you taper the sertraline.  That being said, I would definitely like to know more about what the other drugs are doing to you- the plan may have to change if they are putting your health in danger in other ways.  

 

Taking multiple psych drugs? Which drug to taper first?

 

In summary, you've done a great job choosing the right drug to taper first, and have made a very safe cut to start.  You can continue making 5-10% cuts every four or more weeks, or you could try the Brassmonkey slide that I linked you to above.  It works very well for me!  I would recommend starting that symptom journal, and starting to work on some non-drug coping mechanisms.  The journey is a long one, and anything you can do to make it easier on yourself will be appreciated!

 

Most of all, don't lose hope.  We all heal, given time, patience and stability.  Even when it doesn't feel like we're healing, we are.  You are in very good company here.  I look forward to following your journey, and answering any further questions you have along the way!

 

This is your introduction topic- each member gets one intro topic.  Please post questions, concerns and updates here, on this thread.  But don't hesitate to explore the rest of the forum- there's so much good information here!  And if you feel up to it, feel free to read the intro threads of other members, and drop a comment of support.  This journey can be a lonely one, but here, you can create a community who will understand everything you are going through, and will provide you with some much-needed support.  

 

Sending healing vibes your way!❤️‍🩹

[FranOhio]

@Catwoman73 Thanks for the welcome and all of the good information! To answer your questions, Mirtazapine causes daytime sedation including brain fog and headache.  Clonazapam makes me feel excessively sedated and detached. My estrodiol/testosterone pellet implant has run out and I'm afraid to re-introduce it since I'm already so unstable.  I'm 1 month out from my first 5% cut and still having bad symptoms. Going to hold for a while. ~Fran

[Catwoman73]

Can you try a different form of HRT?  Something that is easily stopped, should you have a bad reaction to it?  I'm on Estrogel and it's very easy to stop if I need to- certainly easier than an implant!  I can't take estrogen or progesterone orally, as I have clotting issues, but topical is fine.  Maybe it would be a good option for you.  

 

While the side effects you are experiencing from the clonazepam and the mirtazapine sound unpleasant, it does sound like tapering the sertraline first is the best option for you.  Being on the mirtazapine and clonazepam will likely help mitigate the severity of your withdrawal symptoms from your sertraline taper.  

 

Taking Multiple Psych Drugs?  Which drug to taper first?

 

If a 5% cut is causing you severe issues even a month out, I agree, hold for a while longer.  You may wish to consider a micro-tapering method rather than making 5-10% jumps.  I am currently dropping 1.25% each week for four weeks, and then holding for an additional two weeks.  My symptoms are perfectly tolerable, even in the context of also having long covid and perimenopause.  Here's the link again to the method I am using- this may be an excellent option for you:

 

The Brassmonkey Slide Method of Micro-tapering

[LostInCanada]

@FranOhio hi and welcome to SA.

I just want to weigh in on the hormone replacement drugs. There is a new member named ProgesteroneWD. I think you may benefit from having a read of her thread. Investigating it a little further may be helpful as well.

I put your drugs in the drug checker and found this:

3 Interactions Found

Don’t use together

Serious

Monitor closely

Minor

Monitor Closely

Significant interaction possible (monitoring by your doctor required).

 

clonazepam + mirtazapine

clonazepam and mirtazapine both increase sedation and drowsiness.

 

sertraline + mirtazapine

sertraline and mirtazapine both increase affecting serotonin levels in the blood. Too much serotonin is a potentially life-threatening situation. Severe signs and symptoms include high blood pressure and increased heart rate that lead to shock.

 

sertraline and mirtazapine both increase causing a dangerous abnormal heart rhythm.

 

 

No wonder you feel awful. 

On 9/3/2024 at 6:50 AM, FranOhio said:

I am getting liquid sertaline this week. Will the transition from solid be hard?

This can be difficult. It will also be a manufacturer change which can be a problem. 

When transitioning this is the schedule:

Hold each change 4-7 days 

1/4 dose liquid/ 3/4 dose pill 

1/2 liquid/1/2 pill

3/4 liquid/1/4 pill

Full liquid 

Also check the amount of drug per ml carefully 

[LostInCanada]

 

 

[LostInCanada]

 

 

[LostInCanada]

This is the scale I use:

https://www.amazon.com/EJ-54D2-Portable-Balance-0-0002-0-001mg/dp/B08S3WQTBG

 

[FranOhio]

@LostInCanada  Thanks so much for the good information. I am on 200 mg progesterone. I know now not to mess with that thanks to you!

 

Every revelation is a new shock to my system. I am still not stabilized from dropping 5% of the sertraline a month ago and am getting extremely discouraged.  I am just starting out and starting to feel hopeless. Im glad I found this site. 

[LostInCanada]

These doctors hand out all these drugs and have no clue how intricate our bodies are. My understanding is progesterone needs tapering as well. Some of us are unfortunately very sensitive to coming off anything.

I am 64 and not on any hormonal anything and thankful for that. To me, doctors and big pharma just want to make money from it all. I just went to the gyno and she wanted to put me on estrogen cream and vaginal diazepam even knowing I am in WD. I have got along fine without it so far so why would I. Frustrating. 

29 minutes ago, FranOhio said:

getting extremely discouraged

It is definitely a marathon. Time, patience, acceptance and kindness towards yourself will go a long way. ♥️

[FranOhio]

@LostInCanada Looks like it actually measures to .0001 gram, nice! Hard to get for under $500.  

 

That is so outrageous that your gyno suggested more drugs. 

[LostInCanada]

8 minutes ago, FranOhio said:

it actually measures to .0001

It measures to .0002 g. Because I am so sensitive it sure helps. Eventually I will make liquid but at the moment I appreciate it. 

It definitely isn't cheap but for me it was worth it. 

[LostInCanada]

I got mine here

https://cambridgeenviro.com/products/a-d-ej-54d2-dual-range-22g-x-0-0002g-54g-x-0-001g-compact-balance?srsltid=AfmBOoo3Nc5n0DLhrtqysGvjkFsOfX4HFGbcrkie1sWCT__nt45BB80p

They gave us a good deal on the phone about $600 Cdn.Maybe they would ship to you if you wanted to go that route.