Mysteriioo: Sertraline; failed reinstatement/kindling/adverse reaction (?)

[Mysteriioo]

I was on 50mg Zoloft for 2 years until June 2024 when I was CT from Zoloft by my doctor. 

I was still doing good emotionally, even during mid July when I began experiencing a couple nights of night-sweats and some minor anxiety. I was starting to get a little irritable with my boyfriend just thinking I was hangry. At work I noticed I would feel restless/anxious and felt like pacing around just thinking it was boredom. 

Early August while sleeping/napping I suddenly began to wake up suddenly with a racing heart.

I didn’t know what I was experiencing was WD. 

August 3rd, I figured out it was WD and unknowingly reinstated at a full dosage of 50mg.  (Huge mistake)

While I felt my physical anxiety symptoms go away, within a few weeks I started to experience SEVERE racing thoughts where I couldn’t concentrate on anything. I reinstated too high, my CNS was hypersensitive to the Zoloft but I didn’t know that yet.

September 12, my doctor increased my dosage to 75mg which slightly lessened the severity of my racing thoughts but suddenly I began experiencing DPDR, panic attacks, loss of libido, loss of basic motivation and anhedonia. General low mood.

3 weeks later, it’s October, I am taken to the hospital and get my dosage increased to 100mg due to the panic attacks. 

October, while on the 100mg for a couple weeks, I noticed that I began experiencing night sweats again, hypnagogic jerks, heart palpitations, absolutely no apetite, and just overall worse. 

Something wasn’t right…the more my dosage was increased the worse I felt. I decided to quickly get off Zoloft entirely. By November 2nd I am at 0mg.

Since I’ve stopped in November I’ve continued to feel DPDR 24/7, no libido, anhedonia, constant rumination, literally no motivation to do anything, no appetite, fits of rage/panic, SI due to no positive change in symptoms.

 

Sorry it’s long, but my story is really complicated, lots of increase in dosages, and lots of bad reactions to those increases. In hindsight I wish I never reinstated, or even did so at a way smaller dose. Either way, my WD symptoms were way better to manage than whatever hypersensitive/kindling/adverse reaction happened when I would increase my dosage each time.

Edited January 7 by Emonda
Name to title

[Jane318]

Greetings @Mysteriioo and welcome to SA.

 

Thank you for adding your drug signature.  For clarity, can you please list July 2024 as 0 mg sertraline?

 

You have been through a lot - I am sorry for all you have suffered.  It sounds like you have done a lot of reading since then to figure out what is going on, and I commend you for that.  As you now realize, cold turkeys and fast tapers are enormously hard on our bodies / CNS's.   It is not unusual for withdrawal symptoms to appear weeks or even months after a CT or too-fast taper.

 

At this point, you are now a little over two months after a fast taper to zero, so you have two choices.  Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  It isn’t a guarantee of diminished symptoms but it’s the best tactic available. The only alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  

 

Reinstatement.  Reinstatement predictably works up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. Your system has become sensitized and if you take too much it may be too much for your brain and can cause you become unstable.  Sometimes it can be hard to regain stability after this happens.  Then, once you've stabilized on that dosage, which can take several months, you can begin a 10% per month taper down to zero.   Please read:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

Hypersensitivity and kindling

 

Since your symptoms are so bad right now, I would be inclined to try reinstatement again if I were you.  However, this is a decision you need to make as only you know your circumstances and your body.

 

If you decide to reinstate, I would suggest 10 mg (or less).  You would take 10 mg, and as long as symptoms do not worsen, hold at 10 mg for a week or so and assess.  If you are getting better, hold at that dose until you stabilize.  If no better, you could try to increase another 2 - 5 mg and repeat.  You want to find the lowest dose at which your symptoms start to abate. It is somewhat trial and error to find this dose.  

 

Windows & Waves.  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:   The Windows and Waves Pattern of Stabilization

 

 

Tracking your Symptoms.  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 to track the severity of your symptoms over time:  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. 

 

 

When adverse reaction is suspected:  If you suspect an adverse reaction, keep daily notes in a chronological format.  This does not rate intensity of symptoms but WHEN symptoms occur relative to your drug doses. This is important to understanding the effects of your drugs. Drug adverse effects tend to be most prominent shortly after taking the drug.  https://www.survivingantidepressants.org/forums/topic/1779-using-dr-glenmullens-checklist-to-track-symptom-patterns-and-progress/

 

Supporting your Healing.  There are a few things you can do to help your nervous system heal.   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.

 

 

Supplements. We recommend only two supplements here - magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

If you decide to try a supplement, even those we recommend here, add in one at a time and at a low dose in case you do experience problems.  If you tolerate it well, you can increase the dosage slowly over time.  

 

Managing your Symptoms. 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.

 

Again, I am so sorry for all you have been through, but I am glad you found us.   I look forward to following your journey, and helping out in any way I can.

[Mysteriioo]

Hey, thanks for your response I’ve updated my signature.

 

I’m just really scared and worried of even touching Zoloft again since I’ve gotten progressively worse after each updose.

I don’t want to make myself worse again.  

 

 

 

[Jane318]

21 hours ago, Mysteriioo said:

I’m just really scared and worried of even touching Zoloft again since I’ve gotten progressively worse after each updose.

I don’t want to make myself worse again.  

I can totally understand your aversion to taking Zoloft again after your experience!  And certainly not reinstating is an option, and one that many choose for the same reason.  The advantage is that you are off the drug completely.  The disadvantage is it will take longer to stabilize and you will likely feel poorly longer - this can affect how well you are able to function.    We want to make sure you are safe.   

 

If you were to reinstate, it would be at a much, much smaller dose than you were on before.  If it worked, your symptoms would likely be more tolerable and you would be better able to function.  But then you would eventually need to SLOWLY taper off again to zero.   

 

We're here to support you whatever you decide.

[Mysteriioo]

Really confused on what to do, I feel really upset because I’m struggling so bad. I feel like ever since my dosage was increased to 75mg in September I lost my motivation to do anything; eat, do hygiene, lost interest in my hobbies, lost my bubbly personality, got DPDR, lost my libido. I’m just so scared reinstating even at a smaller dosage will make me feel worse than I do now. I’m scared I’ll lose the tiny little bit of myself that I’m holding on to.

 

Since October I have been trapped in my house, in bed or on the couch quite literally staring at my phone all day otherwise I’ll get stuck dissociating/in panic from how uncomfortable I feel because of DPDR and lack of interest in anything. It seriously weirds me out not having motivation to do a single hobby, I used to be a huge fangirl, gamer, artist, and collector of Funko pops and Sanrio stuff. Now I couldn’t care less about any of it. I feel like I’ve lost my sparkle, what made me, me.

I don’t know what to do…my family doesn’t know what to do. I’m so so scared. I’m trying to think of any positives that I have like the ability to feel fear, worry and empathy, I can sometimes muster a chuckle. Will reinstating make me lose the little I have now, albeit mostly feeling negative emotions? Will I get my positive emotions back? My libido? Appetite? 
 

I don’t know what’s going to happen to me. I feel screwed either way.  
 

 

 

[Jane318]

My heart goes out to you, I know you are in such pain right now.  I want to assure you that you will be okay.  All that you describe are symptoms of withdrawal, and they will get better and you will return to normal as you heal.  This will take time however.  Your CNS is highly destabilized due to two rapid discontinuations and multiple dose changes since July.  

 

From your narrative, it appears to me that the symptoms you experiencing in the fall were due to withdrawal.  Unless you experienced a bad reaction shortly after taking the drug, I would rule out adverse reaction.  In which case, reinstatement is not likely to make things worse for you.  Hopefully, it will help alleviate the symptoms.  You will know if it is going to help within a few days or a week.  

 

Best wishes in your decision.

[Evelyne]

Hey - I can't give you any specific advice, but I know a bit of how you feel. I, too, suffered from raising my medication dose. (Also I relate to your hobbies and the pain of losing interest in them.) It's not easy to figure out what to do, and the general advice coming from doctors really did a number on us. I'm sorry you have to deal with this all. 

 

But you can get through this. You will get better and you're at the right place to get support. ❤️

[Mysteriioo]

4 hours ago, Jane318 said:

My heart goes out to you, I know you are in such pain right now.  I want to assure you that you will be okay.  All that you describe are symptoms of withdrawal, and they will get better and you will return to normal as you heal.  This will take time however.  Your CNS is highly destabilized due to two rapid discontinuations and multiple dose changes since July.  

 

From your narrative, it appears to me that the symptoms you experiencing in the fall were due to withdrawal.  Unless you experienced a bad reaction shortly after taking the drug, I would rule out adverse reaction.  In which case, reinstatement is not likely to make things worse for you.  Hopefully, it will help alleviate the symptoms.  You will know if it is going to help within a few days or a week.  

 

Best wishes in your decision.

Thank you, but that’s why I’m really conflicted.

My WD symptoms in July were 1000x easier compared to how I’ve been feeling for the past 6 months after reinstating in August and updosing monthly afterwards. After each updose 1-2 weeks later I would feel worse. Yet I stupidly didn’t think to stop in August…I should’ve listened to my body and taken the hint.
 

I’m writing this now at 3am after having been sobbing for about 2 hours straight, mourning my life before and even during my 2 years on Zoloft. 

I give up. I’m going to reinstate at a low dosage and if I get worse then so be it. I already feel like I’ve lost every part of myself. 
 

I’m tired of waking up every morning feeling this way and being told it must be just depression. I’m tired. 

 

[Mysteriioo]

42 minutes ago, Evelyne said:

Hey - I can't give you any specific advice, but I know a bit of how you feel. I, too, suffered from raising my medication dose. (Also I relate to your hobbies and the pain of losing interest in them.) It's not easy to figure out what to do, and the general advice coming from doctors really did a number on us. I'm sorry you have to deal with this all. 

 

But you can get through this. You will get better and you're at the right place to get support. ❤️

Thank you, and I’m so sorry you have to experience this as well. It is miserable…and it’s hard to get my family to understand. It feels like they don’t understand fundamental pillars of my personality have been destroyed by this. 

 

[Evelyne]

12 minutes ago, Mysteriioo said:

Thank you, and I’m so sorry you have to experience this as well. It is miserable…and it’s hard to get my family to understand. It feels like they don’t understand fundamental pillars of my personality have been destroyed by this. 

 

I know. If one hasn't experienced this, it's very hard to explain to them how it feels. 

But your personality hasn't been destroyed. It's just hidden right now - but you do have it in you. And it will come out again. ❤️

[Jane318]

5 hours ago, Mysteriioo said:

I’m going to reinstate at a low dosage and if I get worse then so be it.

Yes, the difference is that you are reinstating at a much, much smaller dose than before.  You could even try 5 mg instead of 10 if you wish.  If you get worse, then you will just stop. 

 

Please keep us posted.