PBJallday337: Sertraline withdrawal after switching to liquid and dropping dose. Considering reinstating pill form. Looking for input

[PBJallday337]

Hey everyone.

 

I've gotten myself into withdrawal trouble trying to get off of sertraline. I've been at roughly 6 mg for the last couple of years and was operating well (been on sert for past 7ish years and was on fluvoxamine for 7 or 8 years prior), but decided to try to get off, which i'm now questioning if it was worth the hell.

 

In the past i'd been able to make big 50% cuts in medcation without issue, but any time i've come all the way off i've run into withdrawal trouble, which previously has been resolved rather quickly with reinstatements.

 

You can see my history in my signature, but the jist of where i'm at is that in May 2024 i decided to switch to the liquid form of sertraline. I went from 6mg of the pill to 5mg of the liquid, was fine for a couple of weeks and tapered much too quickly again to 4mg of the liquid, withdrawals followed shortly after and i held the dose. Awful w/d and then i reinstated back to 4.4 mg of the liquid june 23rd. there was maybe a small improvement and i held there for another month and a half, until August 31st i reinstated again to 4.8mg of liquid sert. had 1 amazing day and then crashed at day 3 and dropped back to 4.4 mg of the liquid, which is where i've been since september 2nd.

 

This last 5 or so months has been so so rough and i'm currently considering potentially reinstating back to the pill at roughly the same 4.4 or 4.5mg to see if that makes a difference.

 

I'm just curious to see if anyone has any input on that or has successfully seen people reinstate back to a pill from liquid sert after this long. any input would be welcome.

 

 

I also have a side question for the meantime: i've been taking my liquied sertraline at 11am without having eaten beforehand and i eat within a minute or two right after taking it. Does anyone know if this is the same as taking it with food? I've read that with food you get a 25% greater maximum amount of the dose than when taking the liquid on an empty stomach. so I guess i'm also wondering if the potential bit of variability within a few minutes after drinking the sertraline with water and then eating could cause variability in absorption and potentially impact my body's ability to stabilize? any input would be welcome.

[Jane318]

Greetings 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 signature. 

 

On 10/28/2024 at 4:15 PM, PBJallday337 said:

I'm just curious to see if anyone has any input on that or has successfully seen people reinstate back to a pill from liquid sert after this long. any input would be welcome.

Given your history of multiple changes in dose and manufacturer (pill to liquid), and that w/d symptoms are (slowly) improving, I would recommend that you  hold at your current dose of the liquid until you stabilize (preferred, given how much time has elapsed on this dose).  Alternately, you might do a slight up-dose of the liquid form. Every time we make a sudden change, including from pill to liquid, our bodies become increasingly sensitized.  It may take several more months for you to stabilize.  Suggest you also search the site to read case histories of people who have switched from pill to liquid form.

 

Recommend you read: 

About reinstating and stabilizing to reduce withdrawal symptoms. (Includes discussion of updosing).

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

 Hypersensitivity and kindling

 

After reading the posts above, if you decide to updose to try to ease w/d and want input on how to do that, let us know.

 

On 10/28/2024 at 4:15 PM, PBJallday337 said:

I also have a side question for the meantime: i've been taking my liquied sertraline at 11am without having eaten beforehand and i eat within a minute or two right after taking it. Does anyone know if this is the same as taking it with food? I've read that with food you get a 25% greater maximum amount of the dose than when taking the liquid on an empty stomach. so I guess i'm also wondering if the potential bit of variability within a few minutes after drinking the sertraline with water and then eating could cause variability in absorption and potentially impact my body's ability to stabilize? any input would be welcome.

Drug info indicates that the drug can be taken with or without food.  I would recommend that however you take it, you try to be as consistent as you can.  I suspect that it is consistent dose and time more than anything that you need to stabilize. 

 

Please read:  Tips for tapering Zoloft (sertraline)

 

MORE INFO

 

Like myself and many others here, it appears you attempted to get off sertraline too quickly in the past, more than once.   You've also made several dose changes up and down.   When working to get off an A/D is it important to give our bodies time to adjust to each change.  It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.  Withdrawal symptoms often lag the change by days or even weeks in some cases. 

 

Once you've stabilized on your dosage, which can take several months, you can begin a slow, controlled taper down to zero.  At SA, we recommend the hyperbolic taper method, which you can read about here:  Why taper by 10% of my dosage?  We have some great tools to help you with this at:  https://www.survivingantidepressants.org/forums/topic/9167-how-to-calculate-dosages-and-dilutions-spreadsheets-and-calculators/

 

Once you decide to taper and given that you are at a pretty low dose right now, you might consider choosing to taper even more slowly, with longer holds or smaller cuts.  Read about this here:  The Brassmonkey Slide Method of Microtapering.  The spreadsheet that you can download from here makes it easy to tailor to your needs.

 

It’s important to keep tabs on your symptoms and adjust your taper amount and schedule as needed.   This will help you identify your windows and waves and reveal your progress, which is encouragement we need!  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) 

 

You may choose to also track your foods and activities to identify things that trigger symptoms as well.  We do encourage people who are tapering to avoid caffeine, alcohol, and recreational drugs.  Many prescription and OTC drugs can cause problems too and should be avoided as much as possible. 

 

We recommend only two supplements here at SA, magnesium and omega-3 fatty acids.  So if you decide to try a supplement, even those we recommend here, start with a very low dose.  If you tolerate it well, you can increase the dosage slowly over time.  

 

As you hold and then resume your taper, and even in protracted withdrawal, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:  Windows and waves pattern of stabilization

 

We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Do explore the rest of the forum – there is a lot of great information here.  Be sure to read “About SurvivingAntidepressants.org,” which has good information about how to use / search the site: https://www.survivingantidepressants.org/forums/topic/54-about-survivingantidepressantsorg  

 

Also, feel free to read and comment on the intro threads of other members.  This is how you build a community of people who understand what you are dealing with.   It is so helpful to connect with others who are experiencing the same things.

 

I look forward to following your journey, and helping out in any way I can.  Best wishes.

 

Edited November 2, 2024 by Jane318
editorial

[PBJallday337]

@Jane318

 

Thank you for the kind response.

 

I've read up on the links and I would like a little more info on the updosing idea. From where I'm at and with what i've read on my end, i'd be considering either 2.5% or a 5% updose to see what happens.

 

I wonder what you would recommend? Also how long to hold the updose before reevaluating?

 

Thanks again!

[Jane318]

4 hours ago, PBJallday337 said:

I've read up on the links and I would like a little more info on the updosing idea. From where I'm at and with what i've read on my end, i'd be considering either 2.5% or a 5% updose to see what happens.  I wonder what you would recommend? Also how long to hold the updose before reevaluating?

@PBJallday337 - From How long does it take to stabilize after reinstating or updosing? - "If you are tapering and develop withdrawal symptoms, you might updose (increase the dose slightly, part of or all the way back to the prior dose in your taper) and after stabilizing, taper again at a slower rate when the withdrawal symptoms have resolved."  In your case, if you choose to updose, you would want to increase a small amount from 4.4 mg but no more than 4.8 mg.  So if you decide to updose, you might try 4.5 mg.   As for How long to update before reevaulating - the comments here about reinstatement also apply to updosing:   Reinstatement: About reinstating and stabilizing to reduce withdrawal symptoms

 

That said, I would stay at 4.4 mg if I were you.  Because:  (1) you have been at 4.4 since June 24, except for a couple days when you updosed to 4.8 mg/day and (2) your symptoms have improved, albeit slightly.  It may take several more months for you to stabilize, but that may end up being the quickest path to stabilization.  You've made so many changes since May of this year, I would be concerned that another change might do more harm than good.   

 

Hope this helps.  Keep us posted.

[PBJallday337]

@Jane318

@RachelSusan

 

Hey team,

 

Rachel, I'm tagging you since I found that you had also used the liquid version of sertraline to taper. I hope you can help me out with a question. 

 

I'm currently holding at around 5.6 mg of liquid sertraline. (Withdrawals started quickly after switching to liquid and dropping down back in May/June). As a side note for Jane, I noticed an uptick in withdrawal symptoms around month 6, including neurological symptoms like twitching muscles, electrical pins and needles sensations that move around, some involuntary movement stuff, as well as increased insomnia, and that got me a bit worried. Is it normal to have an uptick in symptoms around 6 months?

 

Unfortunately I've also noticed that there may be some variability in the way I've been taking the medication, which may be inhibiting my healing process. the first thing i noticed is that before this last week i was pumping the remainder of the syringe after measuring into my dose (which after measuring this amount is about .06 ml or roughly 1.1 or 1.2 mg of additional medication, which i've now updated my signature with) but how much would actually come out of that last little bit of the syringe I think was inconsistent. I've fixed that by just adding .06 to my dose and then refraining from pumping the end of the syringe into the dose. (This may have created a slight updose for me and i've noticed a difference in symptoms this last week with some symptoms lessening).

 

Now I've also noticed that the syringe tick marks for measurement on the plastic syringes i bought are also slightly inconsistent to more of a degree than i'm comfortable with from syringe to syringe, (the 0 mark is in different spots on the different syringes sometimes by as much as .01 or maybe even .02 of a ml, ultimately affecting the entire scale on the syringe) so when one gets worn out and i've switched to another, i think i've been altering my dose.

 

I'm using the manufacturer liquid which is 20mg per ml along with a 1 ml syringe (where i measure .28 ml to get my 5.6mg—which actually might be closer to 5.7 due to the tick mark variability), and i'm wondering especially for @RachelSusan, how did you get an accurate and consistent measure of liquid sertraline in the range between 4 and 7 mg? I would love any insight into your process of measuring and taking it to get accuracy and consistency. Are there specific syringes you used?

 

Thanks so much for all you do

[Jane318]

@PBJallday337 - here is good information on using a syringe to measure dosages:  https://www.survivingantidepressants.org/forums/topic/235-using-an-oral-syringe-and-other-tapering-techniques/#comment-2284

 

[Jane318]

@PBJallday337

6 hours ago, PBJallday337 said:

As a side note for Jane, I noticed an uptick in withdrawal symptoms around month 6, including neurological symptoms like twitching muscles, electrical pins and needles sensations that move around, some involuntary movement stuff, as well as increased insomnia, and that got me a bit worried. Is it normal to have an uptick in symptoms around 6 months?

This is not at all unusual.   One of the senior moderators here has remarked that it is at the six-month mark that things he see thing can seem to fall apart for people.  I've seen this is my relatively short time here as well.  So try not be alarmed, although I know this is upsetting.

 

Please clarify for me though - to what event/change does this six month refer?  

 

Also, your drug signature is missing some critical information:

On 10/28/2024 at 4:15 PM, PBJallday337 said:

in May 2024 i decided to switch to the liquid form of sertraline. I went from 6mg of the pill to 5mg of the liquid, was fine for a couple of weeks and tapered much too quickly again to 4mg of the liquid, withdrawals followed shortly after and i held the dose. Awful w/d and then i reinstated back to 4.4 mg of the liquid june 23rd. there was maybe a small improvement and i held there for another month and a half, until August 31st i reinstated again to 4.8mg of liquid sert. had 1 amazing day and then crashed at day 3 and dropped back to 4.4 mg of the liquid, which is where i've been since september 2nd.

i'm currently considering potentially reinstating back to the pill at roughly the same 4.4 or 4.5mg to see if that makes a difference.

Please add the dates and dosages described above to your signature.

 

6 hours ago, PBJallday337 said:

I'm currently holding at around 5.6 mg of liquid sertraline

This is quite a bit more of an updose than we had been discussing.  Curious why?  Once you update your drug history, perhaps this will make more sense to me.

 

You need to settle on a dose and hold for many months.  It appears you are quick to make a change in dose almost immediately upon noticing an improvement or decline in your symptoms.  Sertraline has a relatively long half-life of 26 hours.  On average, it takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain - it takes longer for sertraline.   Constantly changing doses wreaks havoc.  You need to hold constant to give your brain and body a chance to catch up with all these sudden changes.  In withdrawal, your symptoms will likely follow the Windows and waves pattern of stabilization, as discussed above.  You need to continue to hold dose constant until you stabilize.

[PBJallday337]

@Jane318

 

Thanks for the response. the syringe info is very helpful and I'm bummed i messed up how i was using it in the beginning.

 

The six month mark is in relation to the beginning of withdrawals at June 1.

 

As for the additional dates and dosages, if you read my recent comment from yesterday, my measurements in the beginning when going to liquid were off by roughly .06 ml (which is about 1 or 1.2 mg higher of a dose) due to including the bottom of the syringe. So from the beginning back in june I was actually higher than I thought, but there were likely inconsistencies due to the variability that comes with pumping liquid out of the bottom of the syringe .

 

My drug signature is currently accurate, just adjusted based on that additional .06 ml of dosage I was getting but not accounting for. The only thing I've done to correct my dosage since september is on December 1, 2024 in order to get better consistency/accuracy I stopped pumping out the bottom of the syringe and instead added the .06 ml into the bulk of the syringe (which means my dose is still the same, but i've just eliminated the variability of the syringe bottom - with this there was mayyyybe a potential updose of .1 mg due to eliminating variability / the drops that didn't come all the way out of the bottom of the syringe when i was using it improperly but hard to say). I hope that makes sense. Let me know if you need clarification.

[Jane318]

@PBJallday337

9 hours ago, PBJallday337 said:

The six month mark is in relation to the beginning of withdrawals at June 1....My drug signature is currently accurate, just adjusted based on that additional .06 ml of dosage I was getting but not accounting for. ..I hope that makes sense. Let me know if you need clarification.

Apologies for my confusion!  Yes, this helps, thank you for clarifying.

 

I think I've addressed your questions for me, right?  Please do not be discouraged - you are on the right track.  It will possibly take several months to stabilize, but you will get there.  

[Jane318]

How are you doing @PBJallday337?  Wishing you the best for the holidays.

[PBJallday337]

@Jane318

 

Thanks for checking in. I hope you had an amazing holiday yourself. On my end, the holidays were good and I caught a window that included Christmas Eve as well as Christmas day. It was really great.

 

Today I'm struggling though. It's been a really tough couple of days and improvement has been slow since the beginning of December. I think that slight adjustment in how I was using the syringe back at December 1st did result in an ever so slight updose that helped. I noticed the neurological symptoms like pins and needles, involuntary movements, and muscle twitches rapidly improve though they haven't completely gone away, and everything else has slowly improved, though this last couple of weeks has felt really stagnant.

 

I've got a couple of questions for ya.

 

What is your opinion of stable that I'm shooting for? is it feeling mostly normal for a period?

 

I also have been sick and its verging on what i think could be an infection. I've heard antibiotics can mess with us while in withdrawal. Do you have any info on taking antibiotics while in withdrawal?

[Jane318]

So glad to hear you were feeling good and able to enjoy the holidays.  It is not unusual to experience a "down" after a period of feeling good.  This is the typical windows and waves pattern of recovery.  And I think for many people (including myself), it always feels down/blah after the holidays anyway.   It is always frustrating though, to feel badly again after having had a chance to feel good.  It is good that you able to notice some overall improvement though.  For me, improvement does seem to come in spurts, I think the pauses are periods when our bodies are just settling.

1 hour ago, PBJallday337 said:

What is your opinion of stable that I'm shooting for? is it feeling mostly normal for a period?

Here is a good post that describes what we mean by stability:  https://www.survivingantidepressants.org/forums/topic/23081-are-we-there-yet-how-long-is-withdrawal-going-to-take/#findComment-492493.  Does this make sense to you?  When I was holding, I was wondering how I would know when I was stable and ready to taper again.  What I found was that I just knew, my body just felt "stable."  I didn't necessarily feel "good" or "normal," but my symptoms were much reduced and tended to stay at the same intensity for the last few weeks / month or so.  

 

1 hour ago, PBJallday337 said:

I also have been sick and its verging on what i think could be an infection. I've heard antibiotics can mess with us while in withdrawal. Do you have any info on taking antibiotics while in withdrawal?

I am sorry you have been sick and wish you rapid recovery.

 

I personally haven't had to make this decision since I started tapering, but I do know antibiotics have caused big problems for some people.  Here is our thread on this topic:  Cipro, Levaquin, Azithromycin (Z-Pack), and other antibiotics.  You might also Search the site to read about others' experiences.