Ethan1: Withdrawal and reinstating

[Ethan1]

Hello,

I have just read a bit but i would like to ask for advice on what to do i am quite scared and overwhelmed at the moment

 

Took 150mg sertraline for 5 years,

 

foolishly went off over the course of two weeks, 6 months ago

Now i think i am feeling withdrawal effects my experience has been extremely intense i think my nervous system is super dysregulated. Today felt unbearable. Ive had a mold exposure which plays into this leveling up of intensity

 

So 150mg for 5 years

2 week taper off completely 

been 6 months

Nervous system is in bad shape

 

Just tonight tried taking 25mg, was thinking of trying it for two weeks

 

I came to read here and i am scared and overwhelmed this.

 

Please give me guidance through the spot that i am in. Dosage to reinstate? What to watch for? 

 

Nervous system is so damn shot and this is rough god bless the people who have had it worse

 

 

 

 

Edited September 22 by Emonda
Name to title

[Ethan1]

In the 2 hr after taking 25mg (first time in 6 months) seems to be positive change, though after rising feeling of stability there was a crash of depression and fear ~ 1 - 1.5 hr after. And after reading a bit i think perhaps reinstating a lower dose is wiser. 

Feels like i have been playing with things that could seriously mess with me and it is terrifying

Cheers to anyone who will throw me some advice

 

[Ethan1]

Currently finishing the third day of reinstating Sertraline after 6 months (3 week taper off after 5 years)(much too quick I realize)

felt withdrawal effects through heightened nervous system up to a few days ago feeling unbearable

symptoms were not extreme but worsened alongside exposure of mold/environmental toxin 

 

The last 3 days I have taken 25mg - 6mg - 6mg - 

My experience so intense I went out on a limb despite my uncertainty and took the 25mg dose, within the hour the main symptom plaguing me (being my nervous system activation) dissipated to quite a degree, though after a rise upwards There was a wave of despair and emotional volatility. 

I learned that I had been in withdrawal, and that having these drugs in my system scare the hell out of me

The next 2 days there have been swings of energy and mood and the sense of destabilization. It is scary and part of me does not like it at all. Though the stabilization of my nervous system seems to have continued, There has been far more anxious energy and swings; unsure exactly what it is but that underlying lock that my nervous system had seems to have let up.

 

Reinstating seems to be the right thing for me to do but I really am swirling in fear and doubt

 

There is much information on this site but if someone can hold my hand and write to me with what they observe from my situation - what should i be considering .. point me in the right direction in this process -  - to a specific point - what dosage to reinstate / how to find it ?

 

Any guidance, advise, or something to ground me in this situation is much appreciated.

god bless

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Ethan1]

Ignore first two posts thought i was restarting it .. 

4 days now, I am deciding whether to go to 0mg and stay there for good before its too late or to continue on this path of reinstatment... welcoming any opinions , i am having trouble being certain on my descision

[Catwoman73]

Hi @Ethan1, 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.  And I apologize for the slow reply- we are all volunteers here, many of us in withdrawal ourselves, all while trying to live our lives, take care of families, etc.  Sometimes it takes us a while to respond as a result. 

 

I'm so sorry for what you've been experiencing.  As you've already figured out, a 2 weeks taper is way too fast, and this explains why you are experiencing symptoms.  Here at SA, we recommend tapering by no more than 10% of your current dose, no more often than every four weeks (so as an example- 10mg, 9mg, 8.1mg. 7.3mg and so on).  This is known as hyperbolic tapering, and is effective in keeping withdrawal symptoms to a minimum because it allows the receptors in the brain to be released from the drug in a slow and steady manner.  You can read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

Since you are struggling with symptoms, and have already seen that there is some benefit in reinstating, then I think you should go ahead and continue with reinstatement.  Typically, you would want to reinstate the lowest possible dose that keeps your symptoms at a tolerable level.  How did you feel on the 25mg?  And on the 6mg?  It's quite possible that your ideal dose lies somewhere in the middle.  Overshooting can be quite dangerous, causing a hypersensitivity or kindling reaction, so it is best to start on the lower end, and increase very slowly until you feel your symptoms are at a tolerable level.  Then you would need to hold for weeks to months in order to fully stabilize, before proceeding with a hyperbolic taper.  Read these links to fully inform yourself about reinstatement:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 Hypersensitivity and kindling

 

Even if you choose to discontinue your reinstatement, you will eventually heal.  We all heal.  No one can guarantee the timeline, but it will happen!  Restatement may make the journey a bit more tolerable though. 

 

As time passes, in either situation, you will notice that you have days/weeks where you feel better, and days/weeks where you feel worse.  This is an absolutely normal part of the healing process that we refer to as the windows and waves pattern of stabilization.   This is a great sign that your nervous system is healing!  Read more about windows and waves here:

 

Windows and waves pattern of stabilization

 

Finding stability and healing can be helped along by following a handful of rather intuitive guidelines. Eat a balanced, whole foods diet, stay well hydrated, get adequate rest/sleep and engage in gentle exercise.  Avoid neurologically active substances like caffeine, alcohol, nicotine and recreational drugs- these things are like pouring gasoline on your symptoms.  And avoid adding any other psychiatric mediations to cope with your withdrawal symptoms.  The effects of these drugs while in withdrawal are not predictable, and often make people feel worse rather than better. Not to mention, more psych drugs just create a situation where you have to taper off of something else in the future, thereby prolonging your withdrawal journey. 

 

We only recommend two supplements here at SA- magnesium and omega-3 fatty acids.  Do be mindful though- it is quite common for those in withdrawal to become hypersensitive to all sorts of things- medications, supplements and even foods!  So if you start taking anything new, even the supplements we recommend, start at a very low dose, and see how you fare.  You can increase slowly over time if you find you are tolerating them ok.  I am a prime example of hypersensitivity in action.  Magnesium is supposed to have a calming effect, but it gives me brain zaps and insomnia.  So caution is always warranted!

 

You may benefit from starting a symptom journal at this time.  Keep track of the symptoms you are experiencing, rating them on a scale of 1-10 each day for severity.  This will help you see your windows and waves more clearly, and see your progress over time.  If you also track your activities, foods and supplements, you may be able to identify some things that trigger symptoms in you as well.  So far, I have identified that magnesium is a no go for me, as I said above.  Plus, I no longer tolerate coffee (even decaf), chamomile, refined sugar, loud social gatherings, and intense exercise.  Knowing your triggers makes the journey much easier.  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) 

 

Dealing with emotional and cognitive symptoms is very challenging!  I completely feel you pain.  It is so, so important to start working hard on developing some non-drug coping mechanisms while on this journey.  We have many threads on this subject here at SA- I will link some below.  Personally, I have found that developing a mindfulness practice to be the most helpful thing I've done.  I also use guided meditations/yoga Nidra/ nature sound recordings to help calm my nervous system.  I use CBT techniques like box breathing and challenging/replacing negative thoughts to help with emotional and cognitive symptoms.  And my favourite coping mechanism is simple distraction!  Engage in activities you love, whether you feel like it or not.  I love to swim (I feel normal in the water), take dance classes, cook, and work on artistic projects.  Experimenting and finding out what helps you keep your nervous system in a calm state will help you tremendously!

 

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

Symptoms and self-care

Mindfulness- getting started

 

In summary, you can choose to continue your reinstatement (we can chat further on selecting a dose, how long to hold, etc), or not!  It's entirely up to you.  You will heal either way, though we can't make any guarantees on timeline.  I have made a whole bunch of suggestions here on managing your symptoms, and how to take care of yourself- I can attest from personal experience that they all do help, though it does take some time to develop these habits and start seeing a real difference.  One way or another, you're stronger than you think, and you will get through this!  So don't lose hope!  You're in very good company here! ❤️‍🩹

 

This is your introduction topic- each member gets one intro topic.  Please post any updates or questions here, on this thread.  But do explore the rest of the forum- there's lots of good info here!  Developing a community of like-minded people experiencing the same issues as you can be very helpful in making this journey less lonely, so don't hesitate to read and comment on the intro threads of others in the community.  The peer support here is wonderful!

[LotusRising]

Hi @Ethan1

 

Welcome to SA,

 

Sorry it's taken a while to respond. The site can get quite busy.

 

To recap, can you tell me what dosages you've taken the last 4 days. Can you also tell me, in general, if you feel there has been improvement?

 

On 9/24/2024 at 2:44 AM, Ethan1 said:

Reinstating seems to be the right thing for me to do but I really am swirling in fear and doubt

I get the fear and doubt. Many of us have been where you are, but I can assure you that we all get through it, YOU will get through it. 

 

It sounds as though you've already read the topic on reinstatement?

 

Reinstatement of a very small dose of the original drug can sometimes help to alleviate withdrawal syndrome. The only other alternative is to wait out the symptoms and manage the best you can while your CNS returns to homeostasis. Unfortunately, no one can give you an exact timeline as to when you'll start to feel better, or if you even will. While some will notice immediate improvement, for others it can take many months or longer. Since you are outside the 3 month timeframe where reinstatement reliably works, it might work and it might not. 

 

Please let us know what other questions you have.

 

 

[Catwoman73]

@LotusRising- it looks like we responded at the same time lol!

[LotusRising]

@Catwoman73 yes, I just noticed that! It sounds like we're on the same page  

[Ethan1]

Thank you both very much for the replies

I have reflected and am now confident in reinstating. 

 

16 hours ago, LotusRising said:

To recap, can you tell me what dosages you've taken the last 4 days. Can you also tell me, in general, if you feel there has been improvement?

 

Day 1-2-3-4 25mg-6mg-6mg-6mg-6mg

 

Day 1 - (first hour) - Felt instant relief of worst symptom followed by a wave of anxiousness and despair. (24 hours) Brought big swings in energy and mood, waves of anxiousness, . multiple times throughout the day found moments of more peace and positive emotion than I have had for months. 

 

So, It seems there was a big stabilization effect at one level, and at another level a destabilization.

I assume that it did and can really help stabilize me from withdrawal, but that at too high a dose and with a hypersensitive brain i reacted quite intensely maybe had a kindling effect. is this likely what happened? is it likely for those negative effects to stabilize over time?

The negative emotion and destabilization scared me a lot and after reading here i figured that i should have started with a lower dose. 

 

Day 2-4 - some stabilization i would say, same swings in energy and mood. 

 

My feeling is that a higher dose will be better (once i settle on a dose i will stay there for months)

How should i go about this process of finding the best dose to reinstate?

 

thank you

 

 

 

 

 

[LotusRising]

@Ethan1

 

15 hours ago, Ethan1 said:

had a kindling effect. is this likely what happened? is it likely for those negative effects to stabilize over time?

I'm not certain it was a kindling effect; many people have an activated feeling when they first start an antidepressant. Do you recall feeling this way when you started sertraline in 2018?

 

15 hours ago, Ethan1 said:

My feeling is that a higher dose will be better (once i settle on a dose i will stay there for months)

How should i go about this process of finding the best dose to reinstate?

Yes, you might be right about that. If it were me, I would increase in very small increments (1mg) until you hit your sweet spot. If you've been at 6mg for 4 days now, you might give it a full week at that dose before making any changes.

 

Does that make sense?

[Ethan1]

 

@LotusRising @Catwoman73 tagging for attention and help

 

8 days of reinstatement .  scary reactions . don't know what is best to do

 

I've been continuing on 6mg, just taken my 9th reinstatement dose. having very concerning reactions, Feel i may be trapping myself into needing to continue while it does more harm than good. I am again asking for an opinion. These last days i have been far more destabilized and felt more intense anxiousness than ever and its clouded my vision completely I am just floating right now.

 

On 9/26/2024 at 4:50 PM, LotusRising said:

Do you recall feeling this way when you started sertraline in 2018?

 

I started sertraline in 2018 and it had little to no noticeable side effects. Neither much positive effect.

I am dealing with a condition where my body cant filter out environmental toxins but the immune system keeps reacting and makes me more and more sensitive. The system ends up in chronic stress, i'm sure i am reacting more intensely to the sertraline because of that.

 

I have been more sensitive since reinstatement and had 2 bad exposures. started reacting to new things. Tried eating off heavily restricted diet and had a very intense reaction. This heightened sensitivity, the heavy sense of being off / destabilized, the fogginess, the anxiousness, really does make me scared of this drug .. on the other hand i feel that something was unlocked or unstuck, that it could be good for me and that this negative has just been the initial hypersensitive reaction to reinstating. 

 

Is what has happened to me concerning or within reason?

Why did I have such highs that first day? is this an activation effect or maybe correlated with that high dose?

How safe would quitting the reinstatement be? 

 

On 9/26/2024 at 4:50 PM, LotusRising said:

If it were me, I would increase in very small increments (1mg) until you hit your sweet spot.

How often would you think safe, and how do you think i will know?

 

I am just at a loss with trying to figure out what is best for me to do i cant see a clear answer and i feel my judgement is clouded, i have a doctor off that list that I might be able to see. I appreciate greatly opinions to help me navigate this 

 

Thank you for the help here, it is important to me in this time

 

 

[Ethan1]

12 hours ago, Ethan1 said:

tagging for attention and help

Ok this is less urgent now .. I am confident again in sticking to what i am doing

 

I got lucky and managed to book time to speak with Monic Mina https://www.mindfulmedicinebymonica.ca/ who i found on the list of doctors. She was great and it was important for me to have that talk. I will rest now

[LotusRising]

@Ethan1

 

Perfect, I was just going to recommend her  

 

Were you able to weigh out the pros and cons of the reinstatement?