Marw: Tapering Zoloft and Lamotrigine

[Marw]

Hi everyone,

 

I'm a 52 years old male and I've been on Zoloft for 22 years, initially for Social Anxiety.  I have made three attempts to quit, the first one after 2 years, second after 5 years and the last one in 2019 - I did not know at that time that withdrawal effects could be so strong and long lasting so I was sure that my original symptoms had come back and reinstated the medicine. Over the years I have gradually increased the dose form 50 mg up to 150 mg to get the desired effect and in 2021 I was recommended to introduce Lamotrigine since I experienced periods of low mood and anxiety despite being on Zoloft. I am on 100 mg Lamotrigine (although my doctor would like me to increase it to 200 mg). Last fall I was experiencing a low period while on 100 mg Zoloft and after two months of increased dose 150 mg and still feeling bad I decided that I might as well quit the medicine and started to taper in January. Everything went well until beginning of August when I had been on 12,5 mg for a month and started to get anxiety and sleep problems which then also led to a severe depression, brain fog, cognitive impairment etc. I did the taper a bit quicker than 10% (the last ones where more 30%, ie from 25-18,75 and then to 12,5) Due to the symptoms and in an attempt to stabilize I increased to 25 mg end of August and have been on that dose since then but haven't found any relief yet. This Sunday I decided to increase the dose to 50 mg in order to stabilize on this level instead, now I'm reconsidering if that was a good choice or not? My fear is that I won't stabilize on that level and that I will need to increase the dosage even higher. What do you think would be the best way forward for me? I would be happy to get input on this and also whether I should start tapering Lamotrigin or Zoloft first or both at the same time.

[Catwoman73]

Hi @Marw, 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.  If you could add your recent updates to the signature, we would greatly appreciate it- having an up to date signature helps us see where you've been at a glance when we visit your thread.  I'm very sorry for your struggles.  As a long-term user of these drugs, safe tapering can take a very long time.  It seems your rapid tapers have thrown you into a destabilized state. 

 

My suspicion is that you are not getting any relief from updosing because you have been in a state of 'poop out,' or tolerance, for a very long time with your Zoloft.  These drugs are absolutely not meant to be used for such long periods.  Approval studies were only based on six weeks of data, and in recent years, we have discovered that these drugs do tend to reach that tolerance state very early on.  

 

Before giving you any advice specific to your situation, I need to know- do you think you feel exactly the same since your updose in August, or do you feel worse/more agitated and anxious?  Knowing this will help me to figure out exactly what the next best steps are.  

 

That being said, regarding updosing- it is best done in very small increments.  Doubling your dose can lead to a hypersensitivity reaction, which is why I am asking about the possibility of worsening symptoms.  And it can take quite some time to stabilize after updosing.  Here is a couple of important links on what to expect when updosing, how long it will take to stabilize, and what hypersensitivity reactions tend to look like. 

 

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

 Hypersensitivity and kindling

 

Regardless of what dose you end up on, given your rapid taper, you are likely going to need a very long hold to find some degree of stability again.  A couple of months often is not long enough to stabilize following a rapid taper- we have folks here who have help for many, many months, and some for a year or more.  These drugs cause all sorts of biochemical and genetic changes in our bodies, particularly within the central nervous system.  And the nervous system is a notoriously slow healer, so a long hold when you are destabilized is often very necessary.  

 

As for which drug to taper first, we do have guidance on that here.  We typically recommend tapering the most activating drug first.  Here's a link to our info on this, to help you decide:

 

Taking multiple psych drugs? Which drug to taper first?

 

It looks like you've already discovered our advice regarding tapering by no more than 10% of your current month's dose, no more often that every four weeks (so, an example- 10mg, 9mg, 8.1mg, 7.3mg and so on).  This is known as hyperbolic tapering, and it gives the nervous system the time it needs to slowly undo all those biochemical and genetic changes made due to the presence of the drug, and therefore, minimizes the severity of acute withdrawal symptoms.  It also reduces the risk of protracted withdrawal.  

 

Why taper by 10% of my dosage?

 

During a hold, this is a really good time to start working on taking good care of yourself, in order to provide your nervous system with the optimal environment for healing.  Eat a healthy, whole foods, balanced diet, stay well hydrated, engage in gentle exercise, and get adequate rest/sleep.  Avoid all neurologically active substances, including caffeine, nicotine, alcohol and recreational drugs. These things can be like pouring gasoline on a fire for your symptoms.  And avoid adding any further psychiatric medications to deal with the withdrawal effects of psych meds.  When the nervous system is destabilized, the effects of these meds are not predictable, and can make you worse rather than better.  We only recommend two supplements here to help with this journey- magnesium and omega-3 fatty acids.  Do be mindful though, it is very common for those in withdrawal to develop sensitivities to all sorts of things, like medications, supplements, or even foods!  So if you start any supplement, even those we recommend, start with a low dose, and see how you fare.  If you tolerate them, you can increase the dose slowly over time.  

 

As you stabilize, you will notice that you have periods where you are feeling better, interspersed with periods where you feel worse.  This is an absolutely normal part of the process that we refer to as the windows and waves pattern of stabilization.  Experiencing windows and waves is a sign that the nervous system is doing the work it needs to in order to find homeostasis again.  Read more here:

 

Windows and waves pattern of stabilization

 

You may wish to keep a symptom journal during your journey.  Track each symptom every day, rating them on a scale of 1-10 for severity.  This will help you identify your windows and waves, and if you choose to track your foods, supplements and activities as well, you may be able to identify some things that trigger symptoms for you.  If you can avoid your triggers, the journey definitely goes a bit more smoothly.  You can use this list of typical withdrawal symptoms as a template for a journal, if you wish:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

As for the emotional and cognitive symptoms, it's really important to start developing some non-drug coping mechanisms as early as possible in this journey.  We have lots of threads on this stuff- I'll link some below.  Personally, I have found practicing mindfulness every day to be a critical coping strategy.  Guided meditation/yoga Nidra is also very helpful for calming the nervous system.  Lots of deep breathing too!  CBT techniques are very useful for reprogramming your mind, and helping to recognize and transform those negative thought patterns that lead to emotional spirals.  And sometimes, good old fashioned distraction is what we need- I've come to love working on various art projects to keep my mind focussed elsewhere, and keep my nervous system calm.  

 

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

 

In any case, you will heal.  It just takes time, patience, and making the choice to do everything you can to support your body, in particular your nervous system, by implementing the above changes, and incorporating them into your daily life.  Just keep believing!  I can help you figure out what dose to try to stabilize on, once I know the specifics of how you've been feeling before updosing to 25 then 50mg vs how you are feeling now.  

 

This is your introduction topic.  Each member gets one intro topic, so please post updates or questions here, on this thread.  Do explore the rest of the forum though- there's lost of good info here.  And I always recommend reading and commenting on the intro threads of other active members.  This can be a very lonely and difficult journey, and it really does help to built a community of people who are in the same boat as you, and fully understand the challenges that withdrawal can present.  We can be that community for you!

 

Stay strong, keep the faith!  I look forward to following your journey and helping out in any way I can!

[Marw]

Hi @Catwoman73!

First of all thank you for your elaborate and warm response to my introduction. I have now added the recent updates to my signature. I don’t feel any significant difference compared to what I did in August. My nervous system is still highly activated and I have similar levels of anxiety and low mood. My intention with going up to 25 mg was to stabilise at a higher dose but maybe it was to high increase, and since i did not notice any effect after 6 weeks I increased again to 50 mg. Anyhow, now I’m in the current situation and I have to do the best I can from here. 

 

Thank you for all the links and information as well - very helpful

 

Ps At least I know that it is Zoloft that I should taper before Lamotrigine - (thank you for the link.) 

 

 

 

[Catwoman73]

20 hours ago, Marw said:

 

First of all thank you for your elaborate and warm response to my introduction. I have now added the recent updates to my signature. I don’t feel any significant difference compared to what I did in August. My nervous system is still highly activated and I have similar levels of anxiety and low mood. My intention with going up to 25 mg was to stabilise at a higher dose but maybe it was to high increase, and since i did not notice any effect after 6 weeks I increased again to 50 mg. Anyhow, now I’m in the current situation and I have to do the best I can from here. 

 

 

 

 

I'm happy to say that if you have seen no difference, at least you did not have a hypersensitivity reaction, which was my biggest concern.  It totally sounds to me like you are simply in poop out/tolerance with your Zoloft.  These drugs do stop working with prolonged use.  

 

If I were in your shoes, I would immediately drop back to the 25mg and hold there to stabilize.  You haven't been on the 50mg for a long enough period for your body to have adapted to the presence of that dose.  Going back to 25mg now means you will not have to taper as far when you are ready to resume tapering.  You may have to hold at 25mg for a while- many months... take that opportunity to start your symptom journal, watch for those windows and waves, and figure out if anything you do/eat/drink is triggering symptom waves.  Once you feel your waves are tolerable, and you can function relatively well through them, that's a good time to resume your taper.  There's no rush- the tortoise always wins when tapering!  Slow and steady is best!

[Marw]

Thank you for your advice. I will try to go back to 25 mg and stay there until I stabilize. 🐢