Rach222: Sertraline taper… do I need to reinstate?

[Rach222]

Hi everyone. So my history is: I was put on sertraline 150mg over a decade ago when I was about 16 for depression and anxiety. About 2 years ago I dropped down to 100mg and then eventually 75mg. Starting April 2024 I started a 10% taper. My therapist/ doctor told me to go from 25mg (after 4 wks) to 12.5mg for two weeks skipping a day or two here and there and then stopping. Against my better judgement I did that and my last dose was 12/1 (a week and 2 days ago) and since about 3 days ago I have been consistently overwhelmed, angry, irritable and crying. I feel emotionally dysregulated. I can’t rely on myself to control my emotions. On top of this I also got my period and it was 100x worse than it’s ever been so that doesn’t help. 
I’m not sure if I should reinstate at 12.5mg or just ride it out and hope withdrawal symptoms subside? I don’t know what to do. Any advise or experience is appreciated!

[Emonda]

Welcome @Rach222

 

9 hours ago, Rach222 said:

About 2 years ago I dropped down to 100mg and then eventually 75mg.

 

Dropping from 150mg, to 100mg and then 75mg is certainly way too fast.

 

9 hours ago, Rach222 said:

Starting April 2024 I started a 10% taper.

 

Good to hear you slowed the process down. Just to confirm you've got it right, the reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc.

 

9 hours ago, Rach222 said:

My therapist/ doctor told me to go from 25mg (after 4 wks) to 12.5mg for two weeks skipping a day or two here and there and then stopping.

 

Not good advice, unfortunately: Never skip doses to taper

 

9 hours ago, Rach222 said:

since about 3 days ago I have been consistently overwhelmed, angry, irritable and crying. I feel emotionally dysregulated. I can’t rely on myself to control my emotions.

 

Those that taper too quickly often develop very unpleasant withdrawal symptoms. This Daily checklist of antidepressant withdrawal symptoms is a helpful summary of what many experience. What you describe below sounds like predictable WD symptoms.

 

9 hours ago, Rach222 said:

On top of this I also got my period and it was 100x worse than it’s ever been so that doesn’t help. 

 

I have no personal experience in this department, but I have seen this link, which may be beneficial:

 

 

9 hours ago, Rach222 said:

ride it out and hope withdrawal symptoms subside?

 

CT is not recommended at all. It'll likely get worse and can drag on for months/years.

 

9 hours ago, Rach222 said:

should reinstate at 12.5mg

 

You should read these two links:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

Kindling

Everyone responds differently. However, you are only two weeks out from stopping. The guide I have seen suggests that at two weeks from a CT, reinstating 50% of the amount you jumped off from may be a reasonable amount to consider.

 

That said, your description above doesn't quite match your signature. Can you please fine-tune your signature. I can see:

 

4 weeks at 25mg

2 weeks at 12.5mg

Then you were skipping doses? Is this right? For how long? Were you taking 12.5mg every second day...you say every day or two. If you were, then maybe you reinstate 6.25mg.

 

It's a best guess. It is always best to reinstate too low, and you can reasess from there.

 

Some general info:

Emotional Spirals

Non-drug coping strategies

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

Omega-3 fatty acids (fish oil)

Avoid alcohol.

Don't change the manufacturer of your AD (if you reinstate).

Once again, welcome to S.A.

Emonda

[Evelyne]

Hey @Rach222 and welcome to SA!

 

I'm really sorry for what you are going through right now. But please know that you can recover and get to a good place again!

 

I relate to many things in your story. I was also pretty young when I was put on Duloxetine, and I was on over a decade before starting to cut it down. Unfortunately, much like you, I received bad/insufficient advice and ended up with a pretty bad situation.

 

11 hours ago, Rach222 said:

Against my better judgement I did that and my last dose was 12/1 (a week and 2 days ago) and since about 3 days ago I have been consistently overwhelmed, angry, irritable and crying. I feel emotionally dysregulated. I can’t rely on myself to control my emotions. On top of this I also got my period and it was 100x worse than it’s ever been so that doesn’t help. 

 

It really is a horrible feeling when one's own emotions are doing whatever without one having little to none control over them. WD induced neuroemotions are so strong, but it helps (at least it does help me) a bit when I know they are caused by the medication changes in my body, and they are not me.
Periods can be so much worse, since WD messes up with body's overall balance so efficiently, including hormones relating to menstrual cycle. And also the natural hormonal changes feel amplified because of WD, so it's an awful two-way street.  I've felt this too, it really does not help at all.

But it does get better! I'm glad you've found this place, moderators like Emonda can help you so much. Look through those links they provide and go through other topics here as well, there's so much helpful information. And visit other people's threads and communicate if you feel like it, peer support can do so much for your wellbeing at this state.

I hope you feel better soon ❤️

[Rach222]

12 hours ago, Emonda said:

Welcome @Rach222

 

 

Dropping from 150mg, to 100mg and then 75mg is certainly way too fast.

 

 

Good to hear you slowed the process down. Just to confirm you've got it right, the reductions should get smaller and smaller each month, for example: 10mg, 9mg, 8.1mg, 7.3mg etc.

 

 

Not good advice, unfortunately: Never skip doses to taper

 

 

Those that taper too quickly often develop very unpleasant withdrawal symptoms. This Daily checklist of antidepressant withdrawal symptoms is a helpful summary of what many experience. What you describe below sounds like predictable WD symptoms.

 

 

I have no personal experience in this department, but I have seen this link, which may be beneficial:

 

 

 

CT is not recommended at all. It'll likely get worse and can drag on for months/years.

 

 

You should read these two links:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

Kindling

 

 

Everyone responds differently. However, you are only two weeks out from stopping. The guide I have seen suggests that at two weeks from a CT, reinstating 50% of the amount you jumped off from may be a reasonable amount to consider.

 

That said, your description above doesn't quite match your signature. Can you please fine-tune your signature. I can see:

 

4 weeks at 25mg

2 weeks at 12.5mg

Then you were skipping doses? Is this right? For how long? Were you taking 12.5mg every second day...you say every day or two. If you were, then maybe you reinstate 6.25mg.

 

It's a best guess. It is always best to reinstate too low, and you can reasess from there.

 

Some general info:

Emotional Spirals

Non-drug coping strategies

 

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

 

 

Magnesium

Omega-3 fatty acids (fish oil)

Avoid alcohol.

Don't change the manufacturer of your AD (if you reinstate).

Once again, welcome to S.A.

Emonda

 Hi Emonda!

thank you for your response! To confirm, I was on 12.5mg for two weeks and was told by my doctor to “skip a day here and there” so that’s what I did for those two weeks, then stopped. I’m struggling to decide if I should reinstate at 6.25mg, as I’m afraid that I will still end up with WD symptoms like these when I try to tapper off again. Idk what to do. 

[Emonda]

If you choose to reinstate, it is best to start low and reassess from there.

 

6.25mg doesn't sound unreasonable, but it's your choice.

 

27 minutes ago, Rach222 said:

I’m afraid that I will still end up with WD symptoms like these when I try to tapper off again.

 

If you reinstate, hold for months for stability. Once stable, you taper off very slowly to minimise WD symptoms.

 

I've been at this for 3 years, and think I am halfway. I still have WD symptoms, but I go about my day/life and do all that I need to do. This is the goal of tapering.

 

I hope this helps.

 

Emonda

[Rach222]

1 hour ago, Emonda said:

If you choose to reinstate, it is best to start low and reassess from there.

 

6.25mg doesn't sound unreasonable, but it's your choice.

 

 

If you reinstate, hold for months for stability. Once stable, you taper off very slowly to minimise WD symptoms.

 

I've been at this for 3 years, and think I am halfway. I still have WD symptoms, but I go about my day/life and do all that I need to do. This is the goal of tapering.

 

I hope this helps.

 

Emonda

I decided to reinstate at 6.25mg. I will have to figure out how to taper lower than that with pills (I quartered a 25mg tablet) but will cross that bridge when I get there. Hopefully this will work for me. Thank you again for your help and advice, I appreciate it 🫶 I will keep you updated

[Rach222]

18 hours ago, Evelyne said:

Hey @Rach222 and welcome to SA!

 

I'm really sorry for what you are going through right now. But please know that you can recover and get to a good place again!

 

I relate to many things in your story. I was also pretty young when I was put on Duloxetine, and I was on over a decade before starting to cut it down. Unfortunately, much like you, I received bad/insufficient advice and ended up with a pretty bad situation.

 

 

It really is a horrible feeling when one's own emotions are doing whatever without one having little to none control over them. WD induced neuroemotions are so strong, but it helps (at least it does help me) a bit when I know they are caused by the medication changes in my body, and they are not me.
Periods can be so much worse, since WD messes up with body's overall balance so efficiently, including hormones relating to menstrual cycle. And also the natural hormonal changes feel amplified because of WD, so it's an awful two-way street.  I've felt this too, it really does not help at all.

But it does get better! I'm glad you've found this place, moderators like Emonda can help you so much. Look through those links they provide and go through other topics here as well, there's so much helpful information. And visit other people's threads and communicate if you feel like it, peer support can do so much for your wellbeing at this state.

I hope you feel better soon ❤️

Thank you Evelyn! I appreciate you sharing your experience, it makes me feel better knowing I’m not alone. Be well ❤️

[Emonda]

This should be of help:

 

 

and this

 

 

 

 

[Rach222]

Just an update: I restarted at 6.25mg, it’s been almost two weeks since then and I’m still having episodes of crying spells, emotional dysregulation, dissociation/derealization (that’s a newer WD symptom) Today I increased back up to 12.5mg and will wait about a week to reassess.