apace41: tapering Zoloft / sertraline

[bromor]

Thanks for that tip on kavinace ~ will gradually wean off of that. The mag & l theanine have been very helpful in relaxing as well. Wishing you sweet dreams tonight!

[Sertramean]

Jealous re the 8 hours sleep Andy! Pleased for you.

[apace41]

Thanks, Sertramean.  Much appreciated.

 

You will appreciate that as an added bonus of taking Shep's suggestion and working from home today, I can watch the Man U/West Ham FA Cup semi!  Working out to be a nice day on that front.

 

LOL.

 

Andy

[Sertramean]

You're having a good day mate. It's on over here too. Come on you Hammers!

 

You can follow live on line whilst you watch it too. No reason why you would but here's the link anyway :-) The Guardian live blogs can be quite amusing at times.

 

http://www.theguardian.com/football/live/2016/apr/13/west-ham-v-manchester-united-fa-cup-quarter-final-replay-live

[Shep]

Andy, one of the great things about taking Wednesdays off is when you go back in the office on Thursday, you can keep reminding yourself that tomorrow is Friday. Works like a charm, even if your sleep is still a bit off. 

[apace41]

Shep,

 

I could use something to be happy about right now.   After a really good day yesterday (from home thanks to you) I had the worst night yet.  I didn't sleep at all again but this time instead of being only frustrated I was also agitated with cortisol surges not just when trying to fall asleep but all night.  

 

Started off just like the prior night so I thought I was in good shape.  I was reading and the book kept falling out of my hand so I thought it was time to fall asleep.  As I did I got hit with this "dizzy sensation" in my brain that made it feel like my brain was doing a somersault.  I've had that before for a second or two but this time it lasted for like 20 seconds -- enough time for me to work on breathing through it.  When it was over I was on "full alert" and there was no way my mind was going to let my body sleep.  I kept hoping but no luck.  I had the nocturia and just a rough night overall.

 

I did the benadryl again last night and added about 1.5 of melatonin.  I'm not sure if the benadryl went adverse on me or if the combo of the 2 meds was just too much for the system.  Or, it could be neither of them and I simply had this symptom that triggered me into a panic state that I couldn't get myself out of.

 

No matter the reason got a long day ahead.  

 

I find one of the hardest things to be the one step forward, one and a half steps back that sometimes takes place.  Like I said, yesterday was really a pretty good day and I was seeing light at the end of the tunnel.  Today that light looks like an oncoming train.

 

Hoping it swings back in the right direction tomorrow.

 

Best,

 

Andy

[Shep]

I'm thinking this may be a paradoxical reaction, Andy, but I'm hoping others will chime in with some guidance for you.

 

I would suggest working with only one thing at a time - either the melatonin or the benadryl. Personally, if it were me, I would opt for the melatonin because of the type of problems that histamine drugs can cause (they are, after all, the origin of the SSRI). And since you're still on a SSRI, I would go with melatonin first. 

 

Also, you came off your benzo November 2014, which puts you about 17 months off. I've noticed a LOT of benzo survivors still having waves at the 18 month mark (myself included), so you may also be still navigating the benzo waves. This means extra caution is advised for your CNS. 

 

This is good thread on melatonin and how to adjust the dose:

 

http://survivingantidepressants.org/index.php?/topic/189-melatonin-for-sleep/

 

Altostrata gives a really detailed, best-practices type of critique. I'm finding that staying at the same dose for 3 - 4 nights really does help me assess the situation regarding my reactions as well as letting my CNS kind of settle into any changes. 

 

The biggest problem I've had so far is the early awakening due to melatonin's short half life. So I'm looking into different types of magnesium for this, but again, giving it a good 3 - 4 nights before making any changes.

 

Just remember tomorrow is Friday and then you have the weekend to rest and read over all your options. This really is going to get better, but it will be a challenge. 

[apace41]

 

The biggest problem I've had so far is the early awakening due to melatonin's short half life. So I'm looking into different types of magnesium for this, but again, giving it a good 3 - 4 nights before making any changes.

 

Shep,

 

Thanks as always for your thoughtful and kind words.  I think the point on paradoxical reaction may be correct and that the key (at least for me) might be to rotate the different sleep aids, never taking one two nights in a row, and never mixing and matching.

 

I highlighted the above because I've seen several companies that make an "extended release" version of melatonin (I believe Natrol has it in varying sizes) which might fit for the needs you expressed above.

 

Best,

 

Andy

[bromor]

Andy ~ I find that Benadryl has quite the adverse effect on me. It causes those crazy surges like you described. I've read enough that I totally concur with what Shep said. Try melatonin & magnesium ~ I take a lot of mag. What your body doesn't use ~ you simply void out. Started with 3 mg melatonin & now I use 6. I sleep & am so very grateful for it!

[apace41]

Thanks, Bromor!  Appreciate your input.  I will back off the Benadryl and work on the melatonin.

 

Appreciate your input.

 

Andy

[brassmonkey]

Hey Andy-- Sorry to hear about the bad sleep, that's a tough one. I have a question about your exercise plan, if there is one. How hard and what time of day? (okay two questions)  Why I'm asking is that heavy exercise releases cortisol, especially that night and a lot of what you're describing is cortisol spikes.  Just a thought that hit me.

[apace41]

Hey Andy-- Sorry to hear about the bad sleep, that's a tough one. I have a question about your exercise plan, if there is one. How hard and what time of day? (okay two questions)  Why I'm asking is that heavy exercise releases cortisol, especially that night and a lot of what you're describing is cortisol spikes.  Just a thought that hit me.

 

Thanks, Tom.  I actually have stopped exercising since I've started this problem.  All I'm doing is walking about 20 minutes/2x daily.

 

I am trying to let my CNS calm down.

 

Best,

 

Andy

[apace41]

So, I am now apparently on the "every other day" sleep program.

 

Slept Sunday, none on Monday.  Slept Tuesday, none on Wednesday.  Slept Thursday...

 

Hoping to break the cycle tonight and get two nights in a row.

 

Took the melatonin last night at nightfall per Alto's thread as opposed to taking it an hour before bed.  Not sure if that accounted for a difference but it will try that again.  I think it is more consistent with the idea of trying to retrain the circadian rhythm rather than simply trying to knock myself out. 

 

The difference in functionality with sleep and no sleep is really astounding.  The other thing is the nocturia -- during insomnia I got every 45 minutes to hour.  When I'm sleeping, I get up once or not at all.

 

Best,

 

Andy

[apace41]

Update on the sleeping front:

 

Slept Thursday, Friday and Saturday.  Thought I had busted the cycle.  Didn't sleep last night.  Did not, however, have nocturia.  Instead, had a very rough time with my stomach.  Not sure if perhaps that was the driver, or at least key contributor, to last night's insomnia.  Had some of the cortisol rushes and mind was racing at times, but the overwhelming symptom was my stomach.

 

If I didn't sleep last Sunday I would think perhaps it had to do with the stress of a new work week, but it seems to be all over the place.

 

Need to remind myself on the positive front that it is trending in the right direction.  After 4 sleepless nights in a row a short while back, I slept 3 nights in a row so I should be grateful.  Easter to be grateful the day after sleeping than not, but...

 

I tried the extended release melatonin both Saturday night and Sunday.  Not sure if switching melatonin brands was a great idea.

 

Best,

 

Andy

[Shep]

Hi, Andy. How's the sleep going now? I was wondering how the extended release melatonin was treating you. I'm thinking of trying it myself and would be interested in your feedback. 

 

I hope your stomach has settled down. I think switching melatonin brands could definitely trigger stomach issues, especially if you're susceptible. I have to be very, very careful of every little supplement and dietary change due do a compromised GI system from withdrawal.

 

Hope the sleep is better. At least tomorrow is a work-at-home day. 

 

[apace41]

Hi, Andy. How's the sleep going now? I was wondering how the extended release melatonin was treating you. I'm thinking of trying it myself and would be interested in your feedback. 

 

Thanks for the post, Shep.  Last night was another "on again" night and I slept from 10:45 until 5:30 or so.  Up once (I think -- can't really recall clearly).  The extended release melatonin is probably worth trying.  Not sure if it helped me or not because I had the stomach issues. It might help you sleep a little longer.

 

Tomorrow is a work from home day so that is a good thing.

 

Thanks again,

 

Andy

[Shep]

Thanks very much for the feedback, Andy. Much appreciated.

 

Quick follow up question - does your time release melatonin have added B vitamins? I was looking online, and the only melatonin I found that was time release for 1 mg had a B vitamin added. I can't process B vitamins well so it made me wonder if that might have caused your stomach issues. B vitamins can do that, especially if your CNS is destabilized from withdrawal.

 

Really happy to hear you got almost 7 hours of sleep! That makes the day easier. 

[apace41]

Quick follow up question - does your time release melatonin have added B vitamins? I was looking online, and the only melatonin I found that was time release for 1 mg had a B vitamin added. I can't process B vitamins well so it made me wonder if that might have caused your stomach issues. B vitamins can do that, especially if your CNS is destabilized from withdrawal.

 

Good thought, Shep.  Yes, it has a small amount of B6.  I also ate something that night that might not have agreed with me so I'm not sure if it's the B6 or the food.  I will probably try the non-timed release tonight and see how that goes.

 

Best,

 

Andy

[apace41]

Another rough night last night.  The one day on, one day off, cycle continues.  I took melatonin without the B6 but it seemed to first sedate me and then have a paradoxical effect.  Very agitated all night and had the hypnic jerking when I was actually nodding off.  I think I finally got a little sleep between 4 and 6 am.

 

Good thing I'm working from home today on the "Shep plan."

 

This is a very challenging period.  Finding it hard to cope these days.

 

Best,

 

Andy

[Shep]

I'm sorry you're going through so much insomnia, Andy. I know how frustrating and difficult this is when you're working. 

 

Do you think it would be worth decreasing the melatonin in case it's turning paradoxical? If I take a second dose of melatonin later in the evening, it turns paradoxical on me. I get very restless and can't go back to sleep. At least you know it's not the B vitamin in the time release melatonin, so you've wisely narrowed down the cause. 

 

Also, I'm looking at your signature and wondering what your Sertraline game plan may be. You've been holding for 6 months, but your symptoms are now getting worse. I came off my last AD cold turkey due to a manic reaction, but I do know these drugs can stop working ("poop out" as big pharma calls it). And I'm wondering if that may be a factor in your recent insomnia wave?

 

Hope it settle down for you soon. 

 

Sending healing vibes your way. 

[apace41]

Do you think it would be worth decreasing the melatonin in case it's turning paradoxical? If I take a second dose of melatonin later in the evening, it turns paradoxical on me. I get very restless and can't go back to sleep. At least you know it's not the B vitamin in the time release melatonin, so you've wisely narrowed down the cause. 

 

Thanks for your thoughts, Shep.  Much appreciated.  I am concerned the melatonin has turned paradoxical or at best has little effect.  I may well reduce the dosage if/when I take it next.  Very frustrating.  Seems like when the insomnia is really "on" nothing wants to touch it.

 

Also, I'm looking at your signature and wondering what your Sertraline game plan may be. You've been holding for 6 months, but your symptoms are now getting worse. I came off my last AD cold turkey due to a manic reaction, but I do know these drugs can stop working ("poop out" as big pharma calls it). And I'm wondering if that may be a factor in your recent insomnia wave?

 

Your note was a good reminder for me to update my signature.  I think that during my hold from October to February I didn't see the improvement I was hoping for but I remained fairly constant.  It coincided with the bouncing around on my dose as I started to taper again that I had the onset of symptoms along with the insomnia.  I also went through a couple of emotionally intense family things and I'm sure that hit an already destabilized CNS and threw it over the edge.  Not sure that there was poop-out although I'm not sure what, if anything, the drug is doing for me other than what little it is doing to keep me out of full-blown withdrawal. 

 

Per our other discussions, if the insomnia might be related to the benzo 18 months after being off of it, that could suggest the balance of my issues are from the SSRI, are relatively constant and have only been exacerbated by the lack of sleep.  Interestingly, I will say that during this really bad insomnia phase my "health anxiety" and other withdrawal issues have been greatly reduced (other than dizziness which is my constant companion).  It's kind of like, at least for me, the symptoms cycle and don't hit all at once.  (Of course, now I've probably jinxed myself and I'm going to regret that last sentence.)

 

Best,

 

Andy

 

I appreciate your input, Shep. 

[Shep]

Oh I'm sorry, I didn't realize what all you had been through back in the February / March timelines.  But I looked back at the previous page on your Intro, and I see what you mean about the "bouncing" doses. 

 

Please disregard my comment about SSRI poop out. I think you're right - the bouncing doses are probably to blame, along with lingering benzo withdrawal issues. And family stress can definitely take a toll on the CNS.

 

You've done so very well throughout a benzo and now the SSRI taper, hopefully you'll regain ground quickly. Getting the insomnia under control is the biggie right now. 

 

To be honest, I don't see you having a lot of health anxiety (or really any anxiety) once you heal from this. That's a pattern I've seen in a LOT of long term psychiatric drug survivors. There's definitely a hard won feeling of empowerment and serenity that comes with all of this. It's a beautiful take away. We just have to survive long enough to get there and be able to take that long look back at where we came from and see exactly how strong we really are. 

 

 

 

 

[apace41]

You've done so very well throughout a benzo and now the SSRI taper, hopefully you'll regain ground quickly. Getting the insomnia under control is the biggie right now. 

 

Thank you for the kind words, Shep.  I don't begin to hold a candle to you.

 

To be honest, I don't see you having a lot of health anxiety (or really any anxiety) once you heal from this.

 

As the saying goes, "from your lips to God's ears."

 

Thanks for your thoughts, as always, Shep.

 

Best,

 

Andy

[KarenB]

Hey Andy,

 

Just wanted to say sorry it's been hard for so long now for you.  Hoping for your sake that your sleep pattern keeps improving steadily. 

 

Sending 'anti-wave-hugs' to you,

Karen

[apace41]

Karen,

 

Thanks so much for stopping by my thread. Very sweet of you.

 

It has been a rough month or so. Hoping that I come out of this wave soon. The sleep is improved from where it was but still a ways from where it was for me. I will continue "good sleep habits" and hope for the best. Last night was a night that I expected little sleep based on the "every other day" pattern that has arisen. I took no meds and slept 11-1:30, up until 4 and slept until about 6. Of course, it's always hard to know how you REALLY slept.

 

Anyway, it wasn't great but not awful and not 0!

 

Thanks for checking in!

 

Andy

[AliG]

Andy .  As you know , there is no rhyme or reason to this . I'm not going to say , this is going to end , tomorrow. It is likely not.  It might take a little while .  However , that is ok .  Hang in there , and regroup, and then keep moving on .  You are fortunate to be tapering .  Imagine what I'm dealing with !  None of this is easy . Just to put it into perspective , I haven't slept for 2 years.

You are doing ok .This  is temporary ! You can do this .

Ali

[Shep]

Andy, the fact that you were able to go back to sleep again at 4 am is a really good sign, since that's when cortisol is usually getting high. So hopefully this insomnia trend won't be as bad.

 

Ali, I've also had chronic and severe insomnia for years, since my c/t off Sonata (z-drug) back in 2013, and then came the benzo withdrawal. But like you said, it's temporary.

 

And it's Friday. 

[apace41]

Andy, the fact that you were able to go back to sleep again at 4 am is a really good sign, since that's when cortisol is usually getting high. So hopefully this insomnia trend won't be as bad.

 

Thanks, Shep. 

 

Brief update.  I have finished moving from part tablets and part liquid Sertraline to all liquid as a means of being more accurate going forward.  Downside is that liquid sertraline is awful tasting and needs to be put into another liquid (like water) otherwise it burns.  Has to be the worst of the liquid solutions.  A necessary evil I suppose. 

 

Sleep has improved somewhat. Over the past 4 days the pattern has been the same.  In bed all night (way better than prowling the house all night long) with a fair amount of tossing and turning and blocks of time where I am awake.  But, I keep falling back to sleep so I'm thinking I'm probably getting between 4 and 6 hours a night depending on the night.  Plus, I'm doing this without any sleep aids which gives me a lot more peace of mind that I won't wind up down a different rabbit hole.

 

I know I must be doing better on the insomnia front because I'm back to having some health anxiety -- when I was full-time focused on sleep my brain didn't have space to deal with fear of dropping dead I suppose.

 

This process continues to be so much fun!

 

Hope all are well.

 

Andy

[bubbles]

What is it with vile-tasting liquid ssris? Surely they don't *have* to be so awful? I haven't tried liquid sertraline, but the liquid lexapro was dreadful.

 

Still, progress!

[Shep]

 

 

Sleep has improved somewhat. Over the past 4 days the pattern has been the same.  In bed all night (way better than prowling the house all night long) with a fair amount of tossing and turning and blocks of time where I am awake.  But, I keep falling back to sleep so I'm thinking I'm probably getting between 4 and 6 hours a night depending on the night.  Plus, I'm doing this without any sleep aids which gives me a lot more peace of mind that I won't wind up down a different rabbit hole.

 

 

 

 

It's good to hear your sleep has improved - and without sleep aids.   Just from the psychological perspective, that's always a relief. 

[apace41]

Latest and greatest update on sleep status:

 

I note at the outset that the uneven performance of melatonin and Benadryl led me to stop taking any sleep aid and go naked on this.

 

Prior to last night, the past week or so had a similar pattern where I would go to bed toss and turn for a few minutes and then fall asleep, waking a couple of times during the night and falling back to sleep with more or less effort -- getting somewhere in the range of 4.5 to 6.5 hours depending on how long it took to fall asleep (or get back to sleep).  Not optimal sleep but a far cry from the fully sleepless nights of a few weeks back.

 

This past weekend I drove to Boston (8 hours) to help my daughter (freshman at college) start unpacking her dorm room.  Managed to hurt my back in the process.  16 hours of driving and a bad back to boot.  Not great.  Then on Monday I finished my transition from part tablet/part liquid to all liquid sertraline in order to prepare for greater accuracy on my drops as I go forward.  I was at 24.5 on the combination and went to 24.0 on the liquid alone because it was far easier to measure accurately (even number on the syringe).  Not entirely sure what of those things caused it but I've noticed an increase in anxiety level over the past few days.  Feels like it's largely chemical in nature with my cortisol surges seemingly coming out of nowhere.

 

Last night I went to bed at around 11:15 and woke up to a strong cortisol rush about 12:30.  Went to the bathroom and was able to get back to sleep.  Woke again with an even stronger rush at 2:45.  From there it was high anxiety for the balance of the night and never was able to get back to sleep before my normal wake time of 6.

 

Frustrating because I thought I had broken the cycle and had moved past this. Obviously, 3.5 hours last night is a lot better than a shut-out but I had been doing reasonably well so it feels like a big setback.  I can only imagine that the combination of events that included the travel, moving, back pain and liquid change and slight reduction on the meds is the reason for the slippage.

 

Anyway, anyone who has thoughts is welcome to share.

 

Andy

[Shep]

Sounds like lot of cumulative stress on the CNS. It make take awhile to sort out.

 

I don't know how much the drug reduction is at play because 24.5 down to 24 is only a 2% reduction, but it's in combination with a long drive, a back injury, and any emotional issues that come from leaving your daughter at school for her first year of college. 

 

The fact that it's "chemical" and that you're able to fall asleep without any sleep aids around 11 is a good sign. 

 

Wish I had a solution, but I think it's great you're off of sleep aids. I know you feel like this is a set back, but it's really progress to be off of Benedryl and melatonin. Don't forget, drugs like Benedryl were the precursor to the SSRI, so you definitely are making progress. Maybe hold at 24 mg for a while and see if things settle down. 

 

Sending some healing vibes your way. I know how hard it is to work with only a few hours of toxic sleep. 

[apace41]

and any emotional issues that come from leaving your daughter at school for her first year of college. 

 

Thanks, Shep.

 

Just to clarify it's getting ready to bring her home!  Different set of emotional issues! 

 

Best,

 

Andy

[Shep]

 

and any emotional issues that come from leaving your daughter at school for her first year of college. 

 

Thanks, Shep.

 

Just to clarify it's getting ready to bring her home!  Different set of emotional issues! 

 

Best,

 

Andy

 

 

 

Lol! That sounds like good news. I hope. 

[AliG]

Oh . That's confusing .       However, you will get through this latest hurdle. As one who has struggled for so long , ( with sleep ) I know this will improve for you , very soon and I know , given your slow taper , you will get there very soon .  This is a temporary " Blip" !

Ali

[apace41]

I posted this in the thread on acupuncture but thought I'd post it here for those who follow my thread.  This is some very encouraging news about the benefits of acupuncture in withdrawal.  I note that the frequency of application is likely unattainable for most, but suspect that benefit would still exist with lesser use, albeit on a reduced scale.

 

https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1626-acupuncture-prevents-depression-after-antidepressant-cessation

 

Andy