Polly54: Tapering off Sertraline

[Polly54]

Hello, I have a very long history of antidepressant use, about 23 years. At the end of 2022 I came off Duloxetine after nearly 4 years on 90mg. I did this over a 6 week period on my GP's advice and started on Citalopram. The reason for switching was excessive sweating on Sertraline and feeling too revved up. By Feb/ March I was in the grip of the worst relapse I didn't even know was possible. The Citalopram had zero effect and I got worse and worse with horrendous insomnia, rapid cycling negative thoughts and off the scale anxiety which rarely abated. The Citalopram was ditched in April and Sertraline started ( had successfully been on this for 3 years several years previously). I still failed to improve and started to think I would no longer be able to function as a wife and mother.

My saving grace was watching the BBC Panorama documentary in June and hearing witness accounts of others' experiences. I subsequently contacted one of the doctors on the programme and he confirmed I had all the symptoms of acute withdrawal from Duloxetine. Not relapse, withdrawal. I slowly started to improve after 12 months but was now on 200mg Sertraline. By January of this year I decided to try reducing the Sertraline.

January - 200mg to 175mg

April - 175mg to 150mg

Some bumpy days but generally this went well. 

I felt confident enough to go to 125mg in June but I have been declining since August and in last few weeks a lot of my old symptoms have come back. I've been so distressed and panicked by this that I've reinstated at 150mg just a few days ago and feel better already. 

So I think it was withdrawal again rather than relapse. 

I would like to go lower again in the future but am terrified to try. 

Does anyone have any advice on how to taper more slowly down from 150mg please? I have solid tablets(no grains inside), and have been told solution/ liquid is not available.

Thank you 

Edited November 6, 2024 by Emonda
Name to title

[Jane318]

Greetings @Polly54 and welcome to SA!   We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes.   

 

I am sorry for all you have gone through.  You are not alone.  You are in the right place to get support as you continue your journey to taper off sertraline.

 

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.

 

4 hours ago, Polly54 said:

My saving grace was watching the BBC Panorama documentary in June and hearing witness accounts of others' experiences. I subsequently contacted one of the doctors on the programme and he confirmed I had all the symptoms of acute withdrawal from Duloxetine. Not relapse, withdrawal

This was providential indeed!  From your narrative, I would have suggested that you were likely experiencing withdrawal from a too-fast taper off of the Duloxetine perhaps in combination with subsequent rather quick changes in drugs and doses.  Slowly, people are starting to realize that these symptoms are due to withdrawal from a powerful drug(s) to which our bodies have adapted rather than relapse.  Every change we make, especially sudden ones, is like sending a shock wave through our bodies.

 

4 hours ago, Polly54 said:

By January of this year I decided to try reducing the Sertraline.

January - 200mg to 175mg

April - 175mg to 150mg

Some bumpy days but generally this went well. 

I felt confident enough to go to 125mg in June but I have been declining since August and in last few weeks a lot of my old symptoms have come back. I've been so distressed and panicked by this that I've reinstated at 150mg just a few days ago and feel better already. 

Your history reveals a faster taper than we would advise.  You were wise to up-dose from 125 mg and that your symptoms improved right away is a very positive sign.  I advise holding at 150 mg for as long as it takes for you to stabilize - this may take several months.  I am currently in month 4 of holding after an updose this past July, necessitated by severe withdrawal from a too-fast taper.  It takes time for our brains / CNS to re-establish homeostatis after each cut in the drug.  When we go t0o quickly, our bodies can't keep up.  It may not be obvious for a while - The symptoms can "pile up" in the background.  It sounds as though this is what happened to you.  You want to hold at current dosage and support your body's healing / catching up before you resume tapering.

 

4 hours ago, Polly54 said:

Does anyone have any advice on how to taper more slowly down from 150mg please? I have solid tablets(no grains inside), and have been told solution/ liquid is not available.

Yes - here at SA, we advise following a hyperbolic tapering protocol.  You can read about it here:   Why taper by 10% of my dosage?

 

As you 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

 

Here are other threads that you might find helpful:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

 Hypersensitivity and kindling

 

I recommend that you track your symptoms daily.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need!  You can use the this list of typical withdrawal symptoms as a template for a journal, if you wish:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).  Note that you will not likely experience all these symptoms and there may be some you note that are not on this checklist.  Just adapt for you.

 

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.  

 

Coping with symptoms is the most challenging part of this.  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.

 

Yes, most health care professionals believe that it is easy and quick to get off these drugs.  It is not, as you and thousands here and elsewhere know.  However, it is possible and our brains will heal, and many here will attest!

 

Please do ask questions here after you have a chance to read the information linked above.  I look forward to following your journey, and helping out in any way I can.

 

Best wishes, Jane

 

 

Edited November 6, 2024 by Jane318
editorial

[Polly54]

Thank you so much for your very thorough response to my post Jane. I have found it all very reassuring. Sorry for my slow reply, I've just been very up and down but definitely going in the right direction now I think. I'm taking the pressure off to taper for 4 months. 

[Jane318]

On 11/23/2024 at 1:13 PM, Polly54 said:

I've just been very up and down but definitely going in the right direction now I think.

This is encouraging to hear.  

 

On 11/23/2024 at 1:13 PM, Polly54 said:

I'm taking the pressure off to taper for 4 months. 

I think this is a good idea.  Once I made the decision to hold for several months, I felt a lot of relief - I didn't even realize how much pressure I was putting on myself to taper to zero by a certain date.  Now you can just focus on supporting your healing as best you can and just waiting.  TIME + PATIENCE.

[Polly54]

Hello again,

I'm going to go to my GP after Christmas as I've found out that Sertraline is available in solution form. I'm still planning on holding at 150 mg until then but want to be thoroughly prepared for my next taper. 

I did some basic maths the other night and worked out that with a slow 10% taper it will take about 6 years to come off completely. Does this sound about right? I feel quite depressed to think I'm still on a big dose but in the positive side still less than a year ago. 

[Polly54]

Sorry meant to say I'm holding until March 25, not January. 

[Jane318]

@Polly54

11 hours ago, Polly54 said:

I did some basic maths the other night and worked out that with a slow 10% taper it will take about 6 years to come off completely. Does this sound about right? I feel quite depressed to think I'm still on a big dose but in the positive side still less than a year ago. 

Six years sounds about right.   I know, a long time...  But the time will go by regardless, MUCH better to spend it in a safe place.  We've learned that slow tapers are only sure way to avoid severe withdrawal.  I'm at a low dose but facing another 2-3 years to get low enough to jump to zero.  After experiencing what I did this past summer, I am okay with that.

 

FYI - I plugged 150 mg into the Brass Monkey taper worksheet (download here:https://www.survivingantidepressants.org/forums/topic/27883-the-brassmonkey-slide-method-of-micro-tapering/#findComment-412439).  if you tapered 10% per month with no holding periods yields:

dose after	Year 1	51.79	mg
	Year 2	17.88	mg
	Year 3	6.18	mg
	Year 4	2.13	mg
	Year 5	0.76	mg
	Year 6	0.26	mg
	Year 7	0.09	mg

 

[Jane318]

@Polly54 - We still need to see your drug signature please.

On 11/5/2024 at 4:06 PM, Jane318 said:

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.

 

 

 

[Polly54]

On 12/9/2024 at 4:47 AM, Jane318 said:

@Polly54

Six years sounds about right.   I know, a long time...  But the time will go by regardless, MUCH better to spend it in a safe place.  We've learned that slow tapers are only sure way to avoid severe withdrawal.  I'm at a low dose but facing another 2-3 years to get low enough to jump to zero.  After experiencing what I did this past summer, I am okay with that.

 

FYI - I plugged 150 mg into the Brass Monkey taper worksheet (download here:https://www.survivingantidepressants.org/forums/topic/27883-the-brassmonkey-slide-method-of-micro-tapering/#findComment-412439).  if you tapered 10% per month with no holding periods yields:

dose after	Year 1	51.79	mg
	Year 2	17.88	mg
	Year 3	6.18	mg
	Year 4	2.13	mg
	Year 5	0.76	mg
	Year 6	0.26	mg
	Year 7	0.09	mg

 

Thank you Jane that is very helpful. On another matter, I seem to be unable to add my drug signature despite following the instructions. I have emailed admin about this but wondered if you can advise as you are a moderator? 

Thanks 

[Jane318]

4 hours ago, Polly54 said:

I seem to be unable to add my drug signature despite following the instructions

The Admin team are the ones to help.  Just to make sure:  This link should go directly to your own signature: Account Settings – Create or Edit a signature.  You should be able to edit directly there.  There is an editing tool bar at the top.

[Polly54]

On 12/13/2024 at 8:49 PM, Jane318 said:

The Admin team are the ones to help.  Just to make sure:  This link should go directly to your own signature: Account Settings – Create or Edit a signature.  You should be able to edit directly there.  There is an editing tool bar at the top.

Thank you I have done my signature now. I've been reading other people's signatures and am feeling very overwhelmed and worried about the huge dose I am still on compared to most members. I'm trying to stay positive but I am so afraid this nightmare will never truly end. Has anyone else been on maximum doses or still is? Or has anyone else successfully tapered from a maximum dose of their ad? I can't seem to find anyone like me. Thank you 

[Jane318]

2 hours ago, Polly54 said:

I have done my signature now

Thank you!

 

2 hours ago, Polly54 said:

I've been reading other people's signatures and am feeling very overwhelmed and worried about the huge dose I am still on compared to most members. I'm trying to stay positive but I am so afraid this nightmare will never truly end. Has anyone else been on maximum doses or still is? Or has anyone else successfully tapered from a maximum dose of their ad? I can't seem to find anyone like me.

This site has more than 22,000 members, and I can assure you there are many that began or are still at or near maximum dose.  There are also many who have had to overcome dependence on multiple drugs and/or many more fast tapers / cold-turkeys, all of which can complicate recovery.  You might check out the success stories.  They did it, and you will too.    While it is helpful to read others' stories, I encourage you to not waste your precious mental energy comparing yourself to other people.  We are all different.  If you choose to taper sufficiently slowly to keep withdrawal symptoms in check, as we advise, you will be continually reducing your dose while still being able to function.  The time will go by regardless.  Your attitude is sooo important - negative thoughts and worry will work against you.  One day at a time!

[Polly54]

On 12/17/2024 at 1:35 AM, Jane318 said:

Thank you!

 

This site has more than 22,000 members, and I can assure you there are many that began or are still at or near maximum dose.  There are also many who have had to overcome dependence on multiple drugs and/or many more fast tapers / cold-turkeys, all of which can complicate recovery.  You might check out the success stories.  They did it, and you will too.    While it is helpful to read others' stories, I encourage you to not waste your precious mental energy comparing yourself to other people.  We are all different.  If you choose to taper sufficiently slowly to keep withdrawal symptoms in check, as we advise, you will be continually reducing your dose while still being able to function.  The time will go by regardless.  Your attitude is sooo important - negative thoughts and worry will work against you.  One day at a time!

Thank you, I have read a couple of success stories and resisted the temptation to read too many. I'm still having lots of anxiety surges but some good parts of the day and the odd almost fully good too. Trying hard not to obsess that there is a degree of relapse and trust this is all protracted withdrawal taking its course. The worst part for me is that I can wake up with physical anxiety and this then fuels repetitive negative thoughts. Trying to sit with my feelings until they pass but they don't pass for a very long time some days.

 

I realized I omitted my HRT meds from my drug signature. I have been on oestrogel for about 3 years for menopause symptoms and family history of severe osteoporosis. I apply it morning and evening. 

About a year ago I was also prescribed testogel (testosterone) but have tended to use this on and off as I think it makes me more irritable/ angry, even at very low dose 

I need to take the oestrogel but don't know if the testogel is beneficial and think I should stop it completely even though my gynaecologist says it shouldn't make things worse.

Does anyone have any experience of this? 

Thanks 

[Jane318]

11 hours ago, Polly54 said:

I'm still having lots of anxiety surges but some good parts of the day and the odd almost fully good too. Trying hard not to obsess that there is a degree of relapse and trust this is all protracted withdrawal taking its course. The worst part for me is that I can wake up with physical anxiety and this then fuels repetitive negative thoughts. Trying to sit with my feelings until they pass but they don't pass for a very long time some days.

What you describe can be chalked up to "normal" withdrawal, following windows and waves pattern of stabilization.  You might find this video helpful:  Patterns of Recovery.  It was eye-opening to me to learn that these horrible negative thoughts I was having in the worst part of my "crash" were due to withdrawal. 

 

As hard as it is, maybe impossible right now, I urge you to find strategies you can use to distract yourself from these thoughts rather than dwelling on them.  Suggest you click through the links on the Home Page.  You might also check out this post: https://www.survivingantidepressants.org/forums/topic/31899-great-resources-that-have-helped-me-so-far/.  Search for topics applicable to you.  I find taking even a short walk works wonders to break that mental cycle.  I listen to a lot of audible books.  Doing chores that don't require  a lot of mental focus.  It can be hard to get myself moving, but once I take that first step, I'm so glad I did.

 

11 hours ago, Polly54 said:

I realized I omitted my HRT meds from my drug signature. I have been on oestrogel for about 3 years for menopause symptoms and family history of severe osteoporosis. I apply it morning and evening. 

About a year ago I was also prescribed testogel (testosterone) but have tended to use this on and off as I think it makes me more irritable/ angry, even at very low dose 

I need to take the oestrogel but don't know if the testogel is beneficial and think I should stop it completely even though my gynaecologist says it shouldn't make things worse.

Does anyone have any experience of this? 

Please add these and any other meds / supplements you take on a regular basis to your drug signature.

 

I have no experience with HRT, but others do and may chime in.  You might also search the site.  Based on my quick, there are others that do HRT - it seems like anything can be problematic when in severe withdrawal, but can sometimes be better tolerated once we stabilize.  The thing is our CNS affects EVERYTHING in our bodies - endocrine system, immune system, etc. - not just our brains.  As with everything, the important thing is to pay attention to your body.  Best to try in small amounts, and if not a problem, can gradually increase.

 

[Polly54]

On 1/6/2025 at 2:47 PM, Polly54 said:

Thank you, I have read a couple of success stories and resisted the temptation to read too many. I'm still having lots of anxiety surges but some good parts of the day and the odd almost fully good too. Trying hard not to obsess that there is a degree of relapse and trust this is all protracted withdrawal taking its course. The worst part for me is that I can wake up with physical anxiety and this then fuels repetitive negative thoughts. Trying to sit with my feelings until they pass but they don't pass for a very long time some days.

 

I realized I omitted my HRT meds from my drug signature. I have been on oestrogel for about 3 years for menopause symptoms and family history of severe osteoporosis. I apply it morning and evening. 

About a year ago I was also prescribed testogel (testosterone) but have tended to use this on and off as I think it makes me more irritable/ angry, even at very low dose 

I need to take the oestrogel but don't know if the testogel is beneficial and think I should stop it completely even though my gynaecologist says it shouldn't make things worse.

Does anyone have any experience of this? 

Thanks 

Thank you 

 

On 1/7/2025 at 2:06 AM, Jane318 said:

What you describe can be chalked up to "normal" withdrawal, following windows and waves pattern of stabilization.  You might find this video helpful:  Patterns of Recovery.  It was eye-opening to me to learn that these horrible negative thoughts I was having in the worst part of my "crash" were due to withdrawal. 

 

As hard as it is, maybe impossible right now, I urge you to find strategies you can use to distract yourself from these thoughts rather than dwelling on them.  Suggest you click through the links on the Home Page.  You might also check out this post: https://www.survivingantidepressants.org/forums/topic/31899-great-resources-that-have-helped-me-so-far/.  Search for topics applicable to you.  I find taking even a short walk works wonders to break that mental cycle.  I listen to a lot of audible books.  Doing chores that don't require  a lot of mental focus.  It can be hard to get myself moving, but once I take that first step, I'm so glad I did.

 

Please add these and any other meds / supplements you take on a regular basis to your drug signature.

 

I have no experience with HRT, but others do and may chime in.  You might also search the site.  Based on my quick, there are others that do HRT - it seems like anything can be problematic when in severe withdrawal, but can sometimes be better tolerated once we stabilize.  The thing is our CNS affects EVERYTHING in our bodies - endocrine system, immune system, etc. - not just our brains.  As with everything, the important thing is to pay attention to your body.  Best to try in small amounts, and if not a problem, can gradually increase.

 

Thank you Jane, this has made me realise there are things I have done previously that I have let slide.  I am currently reading the Maudsley Deprescribing Guidelines, I'm finding many extracts of this so enlightening and reassuring. They are good to go back to. I have done a lot of work on myself over the years and have quite a few strategies in my toolbox:

 

No caffeine or alcohol for 2 years

Daily walks

Deep breathing exercises

CBT for obsessive thinking (1 year ago)

Acceptance of not expecting to be totally symptom free. 

Awareness that I have triggers in my hectic family life.

Gratitude

Reading at bedtime (sometimes audiobooks) I am only ever relaxed enough to do this when I am tired and have nothing else I feel I should be doing.

Windows and waves - have read this previously but not recently

 

Looking at my list, I only maintain the top 2 consistently and reading for pleasure when my mind is calm enough.

I am certainly guilty of not using all the strategies I have learned about. It's hard to prioritise 'me' time but I know this is also essential to recovery.

Having retired I now have a very part time seasonal job which makes me feel I am functioning a little better!

I will certainly look at the Patterns of Recovery video and the 'things that have helped me so far'

[Polly54]

Thank you Jane, this has made me realise there are things I have done previously that I have let slide.  I am currently reading the Maudsley Deprescribing Guidelines, I'm finding many extracts of this so enlightening and reassuring. They are good to go back to. I have done a lot of work on myself over the years and have quite a few strategies in my toolbox:

 

No caffeine or alcohol for 2 years

Daily walks

Deep breathing exercises

CBT for obsessive thinking (1 year ago)

Acceptance of not expecting to be totally symptom free. 

Awareness that I have triggers in my hectic family life.

Gratitude

Reading at bedtime (sometimes audiobooks) I am only ever relaxed enough to do this when I am tired and have nothing else I feel I should be doing.

Windows and waves - have read this previously but not recently

 

Looking at my list, I only maintain the top 2 consistently and reading for pleasure when my mind is calm enough.

I am certainly guilty of not using all the strategies I have learned about. It's hard to prioritise 'me' time but I know this is also essential to recovery.

Having retired I now have a very part time seasonal job which makes me feel I am functioning a little better!

I will certainly look at the Patterns of Recovery video and the 'things that have helped me so far'

[Jane318]

I'm encouraged that you are so knowledgeable and well-equipped.  Like you, I find it easy to drop good habits  - your list was a good reminder for me too.

 

Congratulations on your retirement, and it is good you have part time / occasional work.

 

Keep us posted on how you are doing and be sure to let us know if you have any other questions.  Wishing you the best during this season of holding / re-grouping.

[Polly54]

11 hours ago, Jane318 said:

I'm encouraged that you are so knowledgeable and well-equipped.  Like you, I find it easy to drop good habits  - your list was a good reminder for me too.

 

Congratulations on your retirement, and it is good you have part time / occasional work.

 

Keep us posted on how you are doing and be sure to let us know if you have any other questions.  Wishing you the best during this season of holding / re-grouping.

I've watched the Patterns of Recovery video and every single word resonated with me! I do have one question as I never knew excessive sunlight could be triggering. I have a lightbox which I use some mornings, especially now it is winter. Is it safe for me to continue using it? I'm not sure what constitutes excessive exposure to sunlight. I use it for short bursts on a timer. Thank you.

[Jane318]

10 minutes ago, Polly54 said:

I do have one question as I never knew excessive sunlight could be triggering. I have a lightbox which I use some mornings, especially now it is winter. Is it safe for me to continue using it? I'm not sure what constitutes excessive exposure to sunlight. I use it for short bursts on a timer. Thank you.

I use a lightbox also, as do other users on this site.  My lightbox suggests 20 to 30 minutes per day (starting slowly at the beginning), and morning is best, so that is what I do and I have not noticed any ill effects.  It sounds as though that is how you use it, and if you have not noticed that it triggers you, I would not be concerned if I were you.  To me "excessive" would be an hour or more per day.  

[Evelyne]

19 minutes ago, Polly54 said:

I've watched the Patterns of Recovery video and every single word resonated with me! I do have one question as I never knew excessive sunlight could be triggering. I have a lightbox which I use some mornings, especially now it is winter. Is it safe for me to continue using it? I'm not sure what constitutes excessive exposure to sunlight. I use it for short bursts on a timer. Thank you.

If the lightbox doesn't make you feel worse in any way, I think it's perfectly safe to use. It's not exactly the same as sunlight, and especially since you clearly use it carefully and following general instructions, I don't think there's anything wrong with using it.

 

Edit/ Like Jane said above, hahah.