NewEnglandSun: I was doing so well...

[NewEnglandSun]

I'm in my mid-40s and have been on an SSRI for most of my adult life. These past few months, I have been doing a lot of healing work and was able to drop from 100 to 50mg of Zoloft with almost no withdrawal effects aside from a few days of annoying brain zaps. I actually felt better emotionally than I did at a higher dose. Then, in mid-September, I was feeling amazing after a weekend of ceremonial healing and thought I maybe didn't need the Zoloft any more at all. I'll put the rest into a list so it's easier to follow:

 

Sept 12th: Stopped Zoloft completely (had been at 50 for two months and doing great)

Sept 17th or so: quick deterioration into deep sadness and fear

Sept 19th: Reinstated 25mg Zoloft

Sept 22nd: Reinstated 50mg Zoloft out of concern that the 25 wasn't helping

Sept 24th-30th or so: Felt more stable, if slightly "medicated"

Oct 1-6th: Decided to try a taper again, this time with the 10% method. 45mg Zoloft using the sertraline oral concentrate. Today, October 6th, I'm feeling awful again, and not sure what to do. I welcome suggestions or interpretations about what you think happened here.

 

Thanks for reading.

 

[Catwoman73]

Hi @NewEnglandSun, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes.  

 

If you could kindly put the above information in a drug signature for us, we would greatly appreciate it.  This helps us see your progress at a glance when visiting your thread, rather than having to comb through many posts to figure out where you've been and where you're going.  You can have a look at mine at the bottom of this page to see what the general format is.  To create a signature, click the following link, fill in the box, and click save.  That's it!  Your signature should be updated as you make changes to your dosage.

 

Your Drug Signature

 

I'm so sorry for what you're going through.  It looks like you tapered from your Zoloft far too quickly, and stopped from what would typically be considered a cold turkey dose, which lead you to having serious withdrawal symptoms.  Here at SA, as you've discovered, we recommend tapering by no more than 10%, no more often than every four weeks.  So I'm very glad to see you are switching to that method.  That being said, after reinstating, and updosing so quickly, I would recommend you hold for a LONG time- think many months.  All the rapid changes that you've made has destabilized your nervous system, and has left you feeling like garbage.  Reinstating should be done at very low doses to start- like, a few milligrams- and very slowly increased over time.  Rapid changes can lead to hypersensitivity and a phenomenon known as kindling.  You can read more about reinstatement here:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

 Hypersensitivity and kindling

 

So I think you need to do a nice long hold on your current dose to give your nervous system a chance to play catch up to all the changes you've made.   I think you probably got lucky that you didn't develop kindling after such a rapid increase after reinstating, but do keep your eye out for kindling-like symptoms, as described in the link above.  Kindling is one of the only times we would recommend going ahead with a taper, even when you aren't stable.  

 

While holding, I would recommend you start a symptom journal.  Keep track of each of the symptoms you experience each day, rating them on a scale of 1-10 for severity.  You can use the following list of typical withdrawal symptoms as a template for your journal, if you wish:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

As you hold and your brain is working towards stabilization, it is normal to have periods where you feel better, and periods of time where you feel worse.  This is known as the windows and waves pattern of stabilization, and it is actually a good sign that your nervous system is healing.  Keeping a journal can help you identify your windows and waves.  Read more here:

 

Windows and waves pattern of stabilization

 

There are a few things you can do to help your nervous system heal.  Most are intuitive.  Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise, and get adequate rest/sleep.  Avoid all neurologically active substances, like caffeine, alcohol, nicotine and recreational drugs- these are like pouring gasoline on a fire for your symptoms.  Avoid adding any further psychiatric medications to deal with your withdrawal from psych meds- the effects of these meds on a destabilized nervous system is unpredictable, and taking something else could make you worse.  Here at SA, we only recommend two supplements- magnesium and omega-3 fatty acids.  Be mindful though- it is very common for those experiencing withdrawal to become hypersensitive to all sorts of things, including medications, supplements, and even foods!  So if you start taking a supplement, even those we recommend here, start with a very low dose, and see how you fare.  You can increase slowly over time if you tolerate it well. 

 

If you track the things you eat, the supplements you take, and your activities in your symptom journal as well, you may find that you identify a few things that trigger symptoms for you.  This makes the journey a bit easier, as it allows you to avoid substances and activities that are activating for you.  For me- I can no longer tolerate coffee (even decaf), chamomile, refined sugar, intense exercise, loud and crowded places, and magnesium (yes, it's supposed to help, but for me, it causes brain zaps and insomnia). 

 

Dealing with symptoms as you stabilize, and subsequently taper, can be a big challenge.  The above recommendations are helpful, but it's really important to start developing some solid non-drug coping mechanisms as well to deal with emotional and cognitive symptoms.  We have lots of threads on this topic- I link some below.  For me, I have found mindfulness to be extremely helpful, guided meditations and yoga Nidra are great for calming the nervous system and sleep.  Deep breathing, mantras, and identifying and transforming negative thought patterns are important skills as well.  Staying busy and distracted is also important- engage in things you love to keep your mind off of the symptoms you experience.  I love to swim (I feel so good in the water!), cook, write, and do all sorts of artistic projects.  

 

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 

The importance of recognizing you're feeling good

 

In summary, I think you're going to need a good long hold at your current dose in order to allow your nervous system some time to find some equilibrium again.  You can use this time to develop some good physical, emotional and cognitive habits that will help you stabilize, and help you through your taper to come.  When you start tapering again, you already have the right idea- no more than 10%, no more often than every four weeks.  Given the length of time you have been on Zoloft, you may wish to move even slower.  I am currently doing a microtaper, dropping 5% every six weeks.  I can provide more info on micro tapering as well, if you are interested. 

 

Most of all, don't lose hope.  Withdrawal stinks, and interrupts our lives, but you will heal!  Give your brain and body what it needs to facilitate healing and recovery, and the journey can be a bit less unpleasant.  We're here to help!

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, on this thread.  But do explore the rest of the forum- there's lots of good info here!  And I recommend this to everyone- do read and comment on the intro threads of others in order to really take advantage of the peer support model offered here.  This can be a long and lonely journey, and it really does help to have people who truly understand in your corner. ❤️‍🩹

 

Wishing you well- I look forward to following your journey, and assisting in any way I can!

 

[NewEnglandSun]

Thank you so much for your thorough response. Last Sunday, I decided to go back up to 50mg sertraline from the 45 that I had been taking for a week. I felt fairly "okay" during the week, but this weekend has not been good. I'm having intense fear/panic, tightness in my chest, and also feelings of sadness and loneliness. It feels just as bad now as when I was in full withdrawal after cold turkey. I'm concerned that I may be experiencing kindling; there is so much fear that I am also afraid to try reducing the medication again. I take the sertraline in the morning, and there was a wave of symptoms in the early afternoon which abated somewhat, and now I'm having another one in the evening. I feel frightened. Using kava has helped some, probably because it acts on GABA receptors. Any additional advice is welcomed.

[Catwoman73]

If you had kindled, you would likely have felt significantly worse after updosing, rather than having an okay week.  I think you are just very destabilized and experiencing windows and waves.  Holding is almost certainly your best option at this time.  Unfortunately, there are no magic cures- the only way out is through.  Work on those non-drug coping mechanisms- they really do help, though it takes time to create these new habits, and to start seeing any difference.  I wish there was an easier way.  Sending love and hugs- I know how difficult it is. ❤️‍🩹

[NewEnglandSun]

Thank you so much. That is comforting to hear that it does not seem like I kindled. I did feel somewhat better for the first few days after reinstating my dose, but then have been struggling for most of the past couple of weeks. I agree that it seems like a windows and waves situation. Positive update: Last night I began taking magnesium glycinate again (I've taken it before for other purposes) and this morning when I woke up, I felt noticeably better. It's so hard to put it into words but I know that people here understand. It's like I just feel more...the way I'm used to feeling. I knew that my emotions were being caused by a destabilized brain/nervous system, but the pain is just as real. I'm just so grateful to have had a better day. I will definitely stick with my 50mg dose for a good long time - probably until next spring, since I also get a little bit of SAD symptoms when the days get shorter.