Ethylan: 6 year Zoloft journey (withdrawal vs. recurrence, reinstate or not, etc.)

[Ethylan]

Hi All,

 

I apologise in advance for the incoming essay. This website has been particularly helpful, and I was directed here after viewing a video by Dr. Mark Horowitz
(where he clearly insinuated that he had viewed the testimonials of people here). Everyone in this community is so thoughtful and giving in their responses, amd even having a space to type out my own journey has been extremely cathartic, so thank you!

 

My name is Xavier, I'm a 30-year old Australian. I have a partner/finacee of 5 years; she is wonderful and very supportive. We live in a southern state somewhat estranged from our support base in the north of the country, but both have supportive families and a decent network of friends (admittedly, these are also primarily interstate). I maintain a decent array of hobbies: I enjoy playing music, reading, and going to the gym. I have a spiritual dimension that has gone somewhat unfulfilled over the past few years, but that I am trying to reconnect with as a result of my experiences (which I will get into now).

 

I first interacted with psychiatric drugs after an acute MH episode in August of 2017 at the age of 22. I have always held a strong suspicion that the nexus of this episode was an illness (probably influenza) that I had suffered, combined with the return of a long-distance (now ex) partner to Australia around that time. I had what felt like a 'nervous breakdown', and experienced for the first time panic-attack symptoms (shakiness, inability to eat, sleeplessness, tightness in the chest). It culminated one morning with me breaking down fully. In a kind of crying, manic stream, I blurted out to my ex some tightly-held traumas I'd experienced as a child/youth, and my associated feelings of shame/guilt/self-hate. I had been repressing this for a long time, and this was the first person to whom I ever disclosed this.

 

We went to critical care, and at that time I was prescribed 0.25mg of Xanax and 20mg of Prozac. The Xanax worked immediate wonders, but I was still psychologically tortured when I wasn't taking the medication. I had recurrent intrusive thoughts, extreme feelings of shame and guilt, feelings of worthlessness, and disassociation. Additionally, I experienced IBS-D symptoms and started taking loperamide to manage them. I already had an inkling that the Xanax was kind of suppressing everything, rather than just my psychological distress, and I decided to stop taking it very shortly after (perhaps only ~2 weeks of use intermittently). Around the same time, I began therapy. This focused on basic CBT methods, but I mainly felt they were helpful in being another avenue for me to share what I saw as the skeletons in my closet, and nevertheless be affirmed. It was at this time that the psychologist 'diagnosed' me with OCD/Anxiety in relation to my past traumas. This was never really 'verified' - my medications were prescribed by a GP, and when I would fill my script I would simply state that 'diagnosis' as the reason. The onboarding for Prozac was terrible, and I felt there was a brief increase in the severity of my symptoms (almost resulting in another critical care presentation), before I seemingly stabalised, yet saw no improvement.

 

After persevering with Prozac for ~4 weeks with no discernible change in symptoms, I was prescribed Zoloft at 50mg. The onboarding was similarly hard for Zoloft, but after about ~4 weeks I noticed a reduction in my intrusive thoughts and feelings of worthlessness. Most of my physical symptoms (tightness in chest, difficulty sleeping, IBS-D) remained, but I concluded my subsidised course of therapy in late-Oct 2017 and chose to simply press on with my life with Zoloft at 50mg.

 

Maybe this is something other members of this forum can identify with, but after at time on Zoloft (by about January-February of 2018) I simply 'forgot', or was otherwise willfully ignorant of my experiences up until this point and my symptoms slowly subsided. This was particularly easy after my chest tightness ended in the first half of 2018. My ex broke up with me in May 2018 and I moved to a new city in November 2018 - by this time, most of my psychological and physical symptoms were gone. I wasn't feeling 'good', but I was easily able to maintain relationships and work, and dealt with the stressful move with relative ease. The only persistent symptom I had was IBS-D, which I had by now attributed entirely to the Zoloft (although my IBS-D symptoms pre-date its initiation). I went through another break-up in March 2019 with a short-lived romantic partner in a highly volatile fashion, and whilst not 18 months earlier this would have permanently rocked me, I managed to recover relatively quickly. By the end of 2019, the IBS-D, representing the last physical symptom, subsided.

 

From 2020-2023 I was able to deal with myriad stresses (multiple moves, new jobs, starting the relationship with my current partner, housemate tensions, death of a family member, COVID-19 pandemic restrictions etc.). My life had radically changed from 2017 - I had completed uni, I was gainfully employed, I maintained a wonderful relationship, I had a good network of friends. Simply put: it was good, and I was something approximating happy! As a result of this, I started having thoughts of getting off Zoloft in early 2023. Keep in mind: I had always remained relatively ignorant of the literature on these drugs. It was only when I read an article in the ABC about new horror stories with desistance from SSRI usage that I was reminded of the time I had been on mine, and that was probably what sparked my desire to get off them. So, in Sept 2023 I had a single-consultation with a Dr. who supported my decision to try and taper off the drugs. He recommended a 2-4 week taper, only cutting the dosage once (from 50mg-25mg) and then cold turkey.

 

I essentially followed his advice, with a slight extension. During Oct 2023 I alternated from 50mg to 25mg to 50mg. I don't recall experiencing any significant symptoms during this period except light-headedness. Then for the first two weeks in Nov 2023, I went down to 25mg. Again, I don't recall experiencing any significant symptoms. For a brief period in the last weeks of Nov 2023, I took 12.5mg, but I didn't persevere with this course and stopped taking Zoloft altogether in Dec 2023. 

 

From Jan-Mar 2024 I experienced brain zaps, increased libido, and some very strange taste sensations (food seemed to be far richer/sweeter). I noticed an increase range in my emotions - I began to cry at media for the first time since I started taking the medications. My mood/emotions didn't seem to be affected, and I thought that my taper was a success.

 

From Mar-June 2024, I started feeling a little bit more depressed, but I chalked this up to the stressful nature of my work. I proposed to my partner in Mar 2024 - it was the best moment of my life. Life seemed to be continuing on fine. In May 2024, I got a winter-seasonal illness, but I sustained multiple in succession and this absolutely impacted my mood. Still, I wasn't perceptive to any other physical/psychological issues that I put down to my desistance from the Zoloft.

 

In July 2024, after another round of illness, I went to another Dr. When I explained my recent desistance from Zoloft and my tapering regime, he looked at me and stated rather dryly 'I bet that would've been difficult'. He then suggested I might in fact be experiencing a recurrence of my underlying OCD/Anxiety, which I brushed away. About 4 days after this consult, I was triggered by a friend request via social media from someone who I would've rather have forgotten. Usually, on Zoloft, I would've given this no further thought, but it ate away at me and after a weekend of rumination I had a breakdown similar to 2017 but smaller in magnitude to my fiancee, where I basically rehashed the traumas I'd recounted to my ex in 2017. Almost immediately after this I had a recurrence in the psychological symptoms that initially got me on Zoloft in the first place.

 

All of this brings us to now. From late July-Sept I've seen incremental progress in my psychological and physical symptoms, but it has been slow and non-linear. I feel quite lost and at very emotional. It is hard to tease out what I think of as the psychological vs. physical causes of what I am feeling. I try and employ basic CBT techniques, and they are helpful (particularly square breathing), but there is a general feeling of despondency that is deeply unsettling. I'll try and order some of the questions/guidance I'm looking for, and maybe some additional context:

 

Reinstatement: Frankly, I am TERRIFIED of reinstating on Zoloft. My partner and the GP I am seeing have been very kind in that they said they will support whatever I want to do - I'm also lucky in that I have medical practitioners in my extended family and they've said the same. I know this is a hang-up, but I took a lot of pride in being able to desist 'without incident' (even though this obviously not so). I also remember how horrible it was to start on Zoloft in the first-place, and so the idea of having to spend weeks re-stabilising is just so scary. Furthermore, there seems to be a little bit of conflicting advice about the level to which I should reinstate after such a long time cold turkey. This also plays into a second problem...

 

Withdrawal vs. recurrence: I am unsure whether what I am experiencing is withdrawal or the legitimate recurrence of my underlying psychological condition. I do feel that the Zoloft was very effective in being a 'bandaid solution', which is a sentiment that is seemingly shared by a lot of people in the forums. I really did simply 'forget' that I ever was in such a bad mental state! I was also fortunate in that I never really experienced the severe side-effects that others on SSRIs experience, which played into this selective amnesia. It's quite tricky to tease out what this recurrence of symptoms represents.

 

Psychological factors: I find the interaction of psychology with the actual medications used to address our 'conditions' really quite obfuscating. I admittedly did not engage with self-care as much as I should have during the period I was on medication, and I am realising that I have a very long way to go in self-compassion, self-forgiveness, etc. But the logical inference I keep making is that this new 'relapse' is largely related to a psychological 'trigger' which involved a person from a time of my life I'd rather not think about, as I hold feelings of shame/embarrassment, and this then opens a further door to traumas I've suffered. I'm not sure whether this makes much sense, but what I'm getting at is that in some ways it almost feels like I'm unfairly scapegoating Zoloft in a weird way? Not sure if others might relate...

 

Environmental factors: The final thing is a very strong suspicion I have that this is somehow related to physical/non-psychological illness. It seems very coincidental that right before my 'breakdowns' in both 2017 and 2024 I was quite ill with some respiratory illness. Has anyone else experienced this? My GP checked my bloods and nothing came back untoward. There are also some other obvious environmental factors that may have influenced my stress - last month I moved to another city within my state, I'm planning a wedding, and my job, though I'm well-supported, is very stressful (dealing with heavy subject matter that plays into my trauma somewhat). Has anyone else found a connection between illness and their mental health, and how do you mitigate risks?

 

Thank you very much for taking the time to read this far if you have. I wish you nothing but the best in your own journey.

 

Xavier

 

 

Edited September 8 by Emonda
Name to title

[Emonda]

Welcome @Ethylan

 

22 hours ago, Ethylan said:

I apologise in advance for the incoming essay.

 

Sometimes it is helpful for yourself to write this down.

 

Could you please update your signature so I can see drug/dose/date at a glance.

 

23 hours ago, Ethylan said:

So, in Sept 2023 I had a single-consultation with a Dr. who supported my decision to try and taper off the drugs. He recommended a 2-4 week taper, only cutting the dosage once (from 50mg-25mg) and then cold turkey.

 

23 hours ago, Ethylan said:

During Oct 2023 I alternated from 50mg to 25mg to 50mg

 

Not good advice to alternate doses/skip doses, nor taper so rapidly. 

 

Why taper by 10% of my dosage? The reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc. This process involves a degree of trial and error, as there is no way of predicting how an individual will respond. Importantly, if you develop unpleasant side effects from tapering, halt the taper, give yourself time to settle, and once stable, taper more slowly and by smaller amounts moving forward. The experience of others suggests that the lower you go in dose, the slower you need to go with tapering.

Those that taper too quickly often develop very unpleasant withdrawal symptoms. This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.

Many of the symptoms you describe sound like WD symptoms to me.

23 hours ago, Ethylan said:

All of this brings us to now. From late July-Sept I've seen incremental progress in my psychological and physical symptoms, but it has been slow and non-linear. I feel quite lost and at very emotional.

The fact that you can identify progress is very good. Recovery from ADs and tapering / CT is not linear. There are good days and not-so-good days/weeks/months. This is referred to as the Windows and waves pattern of stabilization.

23 hours ago, Ethylan said:

Reinstatement: Frankly, I am TERRIFIED of reinstating on Zoloft.

Reinstating works best within the 1st three months. You are way past that.

23 hours ago, Ethylan said:

Withdrawal vs. recurrence:

Sounds like withdrawl, and it is exactly as would be expected from stopping the AD as you were advised.

I'd be exploring counselling to help with your recovery / deal with the emotional thoughts/triggers that have bothered you.

 

The following general links are worth reading:

 

Emotional Spirals

 

Non-drug coping strategies

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

Omega-3 fatty acids (fish oil)

Avoid alcohol.

Once again, welcome to S.A.

Emonda

 

[Ethylan]

Thanks for responding, I've found these links very helpful