AugustC: Recently switched SSRIs, not sure which one to taper

[AugustC]

Hi all! I had been taking Celexa 20mg for 7 years since I was 17, but had experienced chronic fatigue the entire time. About 4 months ago my doctor suggested trying a different antidepressant to see if I felt better, so I cross tapered to Zoloft 75 mg. However, I did not feel any less tired, so I spent the last 2 months tapering down to 0 mg of Zoloft.

 

Obviously this was way too fast, and I've been having daily "rage attacks" since I hit zero, as well as suicidal thoughts, random bouts of crying, dizziness, brain zaps, and digestive issues. I reinstated with 10 mg of Zoloft a few hours ago, but I'm not sure if I should be on Zoloft (my most recent medication) or Celexa (my most long term medication) for when I start doing a proper taper. Alternatively, I'm also considering switching to Prozac because that is the only SSRI I can get in liquid form where I live, and I would have to create a homemade liquid for the other 2. 

 

Does anyone have suggestions for what I should do in this situation? I have a doctor's appointment on Thursday, but I expect her to be no help so I want to come prepared to ask for what I need.

 

Thanks in advance!

Edited September 16 by Emonda
Name to title

[Emonda]

Hi @AugustC

So the moderators can best help you, please complete your drug signature by following these instructions. Adding a signature ensures your drug history appears at the bottom of every post, making it more efficient for those trying to assist. This link should go directly to your own signature: Account Settings – Create or Edit a signature

 

5 hours ago, AugustC said:

I cross tapered to Zoloft 75 mg

On three occasions, I switched to another AD. I'd never do it again!

It's been 4 months since you took Celexa? Going back to it would be yet another change. Others may have a different view.

Keep It Simple, Slow, and Stable

 

5 hours ago, AugustC said:

Alternatively, I'm also considering switching to Prozac because that is the only SSRI I can get in liquid form where I live, and I would have to create a homemade liquid for the other 2. 

 

I heard Dr Mark Horowitz recently discuss the "prozac bridge'. Some choose to switch to Prozac as they believe it is 'easier' to taper off. Dr Horowitz cautions against this as it can be a bridge to nowhere. ADs can work on different receptors, and you can end up dependent on both.

 

When it comes to tapering, slow is the way to go: 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.

5 hours ago, AugustC said:

I've been having daily "rage attacks" since I hit zero, as well as suicidal thoughts, random bouts of crying, dizziness, brain zaps, and digestive issues.

These sounds like WD symptoms from stopping Zoloft.

Once you add your signature, someone will try to assist.

Emonda

[AugustC]

6 hours ago, Emonda said:

Hi @AugustC

So the moderators can best help you, please complete your drug signature by following these instructions. Adding a signature ensures your drug history appears at the bottom of every post, making it more efficient for those trying to assist. This link should go directly to your own signature: Account Settings – Create or Edit a signature

Hi Emonda! Thank you very much, I have updated my signature.

 

I guess my main question now is, now that I have reinstated at 10 mg, should I continue taking 10 mg, take a lower dose, or go back to not taking anything at all?

[Emonda]

Thanks for adding your signature.

 

I'd start by reading these two links:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

Kindling

 

It's best to start low and see how you go when reinstating to try and minimise kindling risks. If you had asked before restarting, I'd have suggested lower...but it's just a best guess.

 

How do you feel since restarting 10mg? Anything adverse?

 

[AugustC]

11 minutes ago, Emonda said:

 

How do you feel since restarting 10mg? Anything adverse?

 

I do have some weird symptoms, last night I had insomnia and feeling of dread, and today I have back pain, muscle aches, headache, and heart palpitations. 
 

What would be a reasonable dose for me to take today?

[Emonda]

Have you read the two links? You should have a good read, as it's your decision what to do. Consistency of dose is important. Same dose each and every day.

 

As to the amount, it's just an informed guess. When someone has stopped within one month, I've seen 50% of the last dose suggested...perhaps half what you tried, assess and make a decision from there.

 

From personal experience, when I reinstated at too high a dose, I knew within 24 -48 hours that I was reacting badly, and stopped.

 

13 hours ago, AugustC said:

insomnia and feeling of dread, and today I have back pain, muscle aches, headache, and heart palpitations. 

 

Are these new symptoms following the reinstatement at 10mg, or more of what you have already been experiencing?

[AugustC]

On 9/17/2024 at 7:07 AM, Emonda said:

Are these new symptoms following the reinstatement at 10mg, or more of what you have already been experiencing?

 

Definitely new symptoms, I've been taking my dose at night and I wake up with fever and back pain but it goes away later in the day. It does seem like the symptoms are as a result of going back on the antidepressant.

 

I only took 6.25 mg the past few days, do I go even lower than that? I did read the articles you sent but I'm still a bit confused by the whole situation. I'm a bit nervous to go much lower in case I start having rage episodes again. 

[Emonda]

Ok. I'd sit where you are at the 6.25mg dose you are taking and make no further changes.

 

Record your symptoms. If anything adverse happens, you can reconsider.

 

As I mentioned, it's best to start low and slowly increase over time (if you must) to relieve symptoms...rather than starting too high and experiencing kindling.

[AugustC]

22 hours ago, Emonda said:

Ok. I'd sit where you are at the 6.25mg dose you are taking and make no further changes.

 

Record your symptoms. If anything adverse happens, you can reconsider.

 

As I mentioned, it's best to start low and slowly increase over time (if you must) to relieve symptoms...rather than starting too high and experiencing kindling.

I am still having severe back pain, fever, muscle pain and headache. I am assuming this is kindling. I cannot work or do anything.

 

I went to the doctor today and she was zero help. She said that PWS doesn't exist.

 

I have no idea what I am supposed to do and there is no one who can help me. The wait time for a psychiatrist is 6 months. Do I keep taking the same dose of 6.25 mg? Do I try a smaller dose? Do I try going off the antidepressants entirely again? Do I try a different antidepressant to see if the kindling is less severe?

 

Please help! 

[Emonda]

13 hours ago, AugustC said:

am still having severe back pain, fever, muscle pain and headache.

 

Sounds like WD symptoms to me. This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.

 

Can you relate to the list?

 

13 hours ago, AugustC said:

went to the doctor today and she was zero help. She said that PWS doesn't exist.

Not surprising, sadly.

 

13 hours ago, AugustC said:

Do I keep taking the same dose of 6.25 mg?

 

Stability is important. What you describe sounds like WD symptoms.

 

Have you read the kindling link? This is an extract from that link: Generally, kindling is an activation reaction -- a sense of overstimulation, which may be an inner electrical feeling, anxiety, nervousness, panic, or at the extreme, akathisia, which includes an urge to move to relieve intense inner agitation.

 

I haven't read you describe the above.

 

13 hours ago, AugustC said:

The wait time for a psychiatrist is 6 months.

 

They'll just give you more / different drugs. That's not the solution to WD symptoms.

 

13 hours ago, AugustC said:

Do I try going off the antidepressants entirely again?

 

Cold turkey is almost always not recommended.

 

13 hours ago, AugustC said:

Do I try a different antidepressant to see if the kindling is less severe?

 

Stability is key. I've changed three times...never again. They often work on different receptors. So you'll have WD from one, whilst hoping the other does something.

 

 

[AugustC]

6 hours ago, Emonda said:

Sounds like WD symptoms to me. This Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) is a helpful summary of what many experience.

 

Can you relate to the list?

I'm not entirely convinced that what I'm experiencing currently (fever and back pain) is withdrawal. I never had these symptoms while I was tapering or when I stopped completely, they only showed up when I went back on sertraline.

 

That's good to know that what I'm experiencing doesn't sound characteristic of kindling. Maybe it could be an adverse reaction to sertraline though? It seems like fever is on the list of possible side effects for sertraline but it is considered rare. I didn't have any of these side effects the first time I took sertraline.

 

I'm also wondering if it's possible that I just have some kind of illness or infection that is unrelated to the drug. My doctor thought my symptoms are infection related because I have swollen lymph nodes.

 

I do feel a bit better today. Last night I reduced my sertraline dose again, to around 3.5 mg. I had also recently started a new birth control pill to control my endometriosis, so I stopped taking that until I get things figured out. So I'm not really sure which thing is the cause of my symptoms here. I guess I will keep monitoring and see if I can find a pattern.

[AugustC]

Just an update on my case if anyone’s interested. I ended up going to the ER because my fever, back pain, and headache kept getting worse. They ran some tests and determined that I have a kidney infection. I started taking antibiotics and I already feel much better. 
 

I guess this experience serves as a reminder that not every symptom we experience during antidepressant withdrawal is actually caused by the withdrawal. It’s possible to have multiple things going on at the same time. Now that I’m back on a low dose of Sertraline, my actual WD symptoms are minimal and I feel much more confident about tapering it properly this time. 

[Patient2022]

2 hours ago, AugustC said:

Just an update on my case if anyone’s interested. I ended up going to the ER because my fever, back pain, and headache kept getting worse. They ran some tests and determined that I have a kidney infection. I started taking antibiotics and I already feel much better. 
 

I guess this experience serves as a reminder that not every symptom we experience during antidepressant withdrawal is actually caused by the withdrawal. It’s possible to have multiple things going on at the same time. Now that I’m back on a low dose of Sertraline, my actual WD symptoms are minimal and I feel much more confident about tapering it properly this time. 

Just read through your posts. Definitely not everything is related to AD withdrawal but it does play a part in many areas as the nervous system tries to adjust.  I’m so glad you’re feeling much better & got to the bottom of the fever. I hope WD continues to be a smooth ride for you 🤗