ShrimpDoria: low doses of sertraline turned me into a near psychopath

[ShrimpDoria]

Hello. I want to begin my introduction with a detailed case report on my hypersensitivity to sertraline… I hope this helps someone.

 

I am a 21-year-old childless female who, up till recently was taking 25 mg of sertraline every 6–8 days. Three months ago, I began seeking professional help for self-loathing, difficulty in trusting others, and intense fears of abandonment during certain social situations. There was only one psychiatrist in my area still on Blue Shield’s panel. She quickly diagnosed me with social phobia and instructed me to take 25 mg daily for one week, then to double the dose to 50 mg daily afterwards. After a mere three days, I found that I was completely unable to feel fear. (This may have started even earlier, however I was unable to evaluate my emotional state during the first three days due fatigue and sleeping in excess of 15 hours a day when I began the drug.) Were a raging grizzly bear to attack me, I would have no appropriate emotional reaction to it, or maybe even none at all. Combined with the fever (at least six hours long), increased heart rate (30 seconds long), and hand tremors (1 minute long) that I would experience 20–40 minutes after taking the sertraline (half of a 50 mg tablet), and non-existent appetite, I decided to try taking 25 mg only every other day. This was sufficient to prevent the tremors and increased heart rate, but the elevated body temperature and lack of appetite persisted at this dose. (When I later lowered my dose to 25 mg every three days, the fever disappeared and my appetite would partially return.) I called my psychiatrist’s office to inform her that I would be lowering my dose as I found the fear-blocking too effective and the other effects troubling. I emphasised that I had never experienced those symptoms at the times that human interaction caused me distress. But for the next three months, the psychiatrist would maintain that these were manifestations of my anxiety and insisted that I take the full 50 mg daily. She ignored the fact that I was entirely incapable of feeling fear for those three months.

 

I had many peculiar reactions to the sertraline. To begin with, for the first two weeks, I really wanted to be “a good dad,” as if I were already a father and desired to remain a good and humane parent. (I am a 21-year-old childless female.) And whenever I took the sertraline, I would also feel as if my two of my closest human relations were still alive… I wasn’t (at least not by typical definitions) delusional, I knew they weren’t alive and I didn’t experience any hallucinations of their presence. But I was overwhelmed by the warmth of their company, a warmth that I thought I’d never feel ever again. …It felt like I had come home again, like my feelings could reach them and their feelings could reach me. I felt love as if all three of us were together again. These spells would last twenty minutes, and all I felt like doing was hugging something to my chest and telling them how much I missed them. When these occurred at work, I mustered enough self-restraint to take only a five-minute break and continue working afterwards. These would be the only instances I would feel any emotion for the next three months.

 

My strangest reactions occurred after eating foods rich in tryptophan: a euphoric restlessness that was accompanied by a wonderfully pleasant burning sensation in my brain. My partner and I called these episodes “the cuddles”, because all I wanted to do was cuddle, very vigorously. (I now think this was a “happier” form of akathisia.) My partner perceived this as the return of my normally energetic, cheerful, and affectionate demeanour; I had always been a cuddler and my hugs and handshakes had always been very strong. But, I knew I was getting high, so I began timing my sertraline doses to take them before eating red meat—to guarantee the high. These foods also triggered some other reactions—eating tuna sashimi turned me into a happy drunk, I was laughing harder than usual and even turned “as red as a tomato”, according to my partner. Cheesecake would trigger a burning sensation in my frontal lobes so overwhelming and do pleasurable it was almost debilitatingly painful, I couldn’t focus on anything else around me and had to eat very slowly, as I felt as if my brain would fry if I ate the cheesecake any faster. Now when I see cheesecake I get anxious, and if it is on my plate I even have trouble lifting my fork because the anticipation makes me weak. I’ve always loved cheese—one of my most prized possessions is the World Atlas of Cheese—so whenever I asked my partner to buy me cheese he didn’t interpret it as substance abuse. (Cocaine is an illicit substance widely known for its addictive qualities. Cottage cheese is not.) After a particularly good meal, e.g. all-you-can-eat at the sushi bar, I would be high for hours! I had to eat instant ramen on my lunch breaks because I didn’t want to risk getting high at work.

 

Some background. My aspiration of fatherhood was definitely drug-induced, but I do know where it came from. The older of my two friends, thirty-one years old, was a good, strong man who had to assume the responsibility over a preadolescent boy and was basically a single father. My other friend was his fourteen-year-old ward, a bright and sensitive jokester who came to insist that artists had a responsibility to be both humane and truthful. His mother became addicted to opioids, and her male “friends” abused him; he developed very little interest in relating to the people around him, but was very gentle to anyone falling on hard times. My friends both died as pedestrians on June 30, 2016, three months after I had moved back to California in search of employment, and eight months before I started seeking professional for what my psychiatrist diagnosed as “social phobia”, which stemmed from a physically and emotionally abusive childhood. I didn’t fully appreciate it at the time, but my friends had been helping me work through my fear of other people. My older friend was a very caring, incisive, and thoughtful person, qualities which he engendered in my younger friend. He had a serious interest in history, which was his favourite discussion topic second only to jazz music, and he could easily have become a history teacher—he was better than all the ones I had in school, anyway. When guardianship was thrust upon him, he took the time to read parenting books and material on child abuse. I don’t know if he knew it by name (I certainly didn’t), but he was teaching me the foundations of DBT. His boy became like a brother to me, and we discussed art and played video games together.

 

After their deaths, my unresolved social phobia, which was compounded by grief, the unpleasant work environment at the hospital where I found employment, and the painfully close proximity of my entire extended family that had engraved into me my fear of human beings in the first place (I had moved out of California specifically to escape them!), understandably led to a worsening of my mental health. When I was finally starting to heal, I myself was hit by a car while crossing the street, but escaped serious injury. I developed a reflexive hatred of all cars, my own insecurity and self-loathing was complicated by survivor’s guilt, and I considered suicide numerous times. I knew I needed help. I wanted psychotherapy, but all the mental health professionals whom I had wanted to see had been taken off of Blue Shield’s panel. I settled for the one psychiatrist in my area still remaining on their panel. At our first meeting, I was frank with her about my aversion to the idea of treating my problems with psychotropic medication, and discussed with her the objective vulnerabilities and subjective conditions that kindled my social phobias. She immediately prescribed me sertraline and said I that could obtain a therapist if the drug did not adequately treat my anxiety. I was disappointed, and remained firm in my believe that drugs would not resolve my issues. But at the well-intentioned encouragement of a close colleagues of mine (she has been diagnosed as bipolar and regularly takes prescribed psychotropic drugs), and out of the desire to meet this psychiatrist at least “half way”, I began taking the sertraline.

 

It was in the first month that I began perceiving that I had lost all capacity to emotionally respond to anything at all, even the treasured jazz songs that my friends has introduced me to. I lost my creative spark, my interest in the world and art and everything else that I liked. Aside from my loyalty to my two friends who died, I lost all interest in other humans, and all capacity for empathy. At best, I felt apathy towards people in the same way a man might feel apathy toward livestock. At worst, I felt unequivocal annoyance and contempt, the kind of sentiment reserved for an annoying mosquito. The only reason that the people around me didn’t notice a change in my demeanour was because I was keen to keep up a perfect façade—if anyone had noticed a change, it would be more inconvenient dealing with that than with faking empathy and interest. I was aware of all these changes, and I knew that they were bad. However, I didn’t care. The only thing that caught me was the thought of my two friends. At times, I realised how sad they’d be if they saw how I’d changed, and for a little while, I’d try to be a better person.

 

On my second appointment with my psychiatrist, a month after our first, I reported the apathy, the food highs, and the “dad” feelings to my psychiatrist. The entire time I explained the food euphoria, she looked at me as if I were crazy. I did not mention to her the “it feels like my friends are still able to experience life and that makes me so happy” feelings, as at the time they did not strike me as a bad or disconcerting thing. But I did voice the observation that perhaps even 25 mg every other day was too strong for me.

 

But all that mattered to her was that the sertraline was effectively dealing with my anxiety, and she was pleased with that. As for the adverse effects, she insisted that I take 50 mg daily in order to “habituate” myself to the drug. I very diplomatically stood my ground, again raising concerns about how my heart rate would increase after taking 25 mg daily. She relented—but said that I should schedule my next appointment three months later instead of one month later, since I was taking such a low dose. I had enough sense to perceive that this was dangerously negligent in her part, and gently nudged her, saying, “OK. So three months is a good time to check in?” She changed her mind, made it two months. I didn’t tell her, but after this visit I began reducing my sertraline dosage to 25 mg every three days. After two weeks of this, I found that the food-highs were still too disruptive on my daily life, so I began taking it every four days.

 

Even though I’d decreased the dosage, the apathy worsened, and my patience for people was shorter than before. I was beginning to actively dislike all the people around me. I looked back at my previous relations and memories with scoffing contempt. I mistakenly thought I was falling out of love with my partner. I even started enjoying being a psychopath; life felt easier if all that mattered was number one. In retrospect, had the sertraline been more stimulating—if I had only the compulsion or motivation, I would’ve been capable of committing the most horrific crimes without a shred of remorse or moral discomfort.

 

After that second appointment with the psychiatrist, I began seeing the one local psychologist still remaining on Blue Shield’s panel. I expressed my desire to work through my childhood-rooted social phobia using talk therapy. I mentioned told her about the sertraline-induced personality changes with her. She quickly sidestepped the subject of medication and advised me to talk to my psychiatrist about any adverse effects. The psychologist said that the sertraline seemed to be dealing with my social phobia well enough, and suggested that I may naturally be an introvert and that the sertraline was allowing me to enjoy being myself, that I was too concerned with what other people thought of me and that I needed to focus more on myself.

 

Though I didn’t care, I understood that her attitude grossly complacent. I saw this psychologist two more times afterwards, and each time she said I seemed fine and that there was nothing I really needed to work on (though my own drug-induced apathy would not have allowed me to benefit much from therapy anyway), except perhaps my grief—I refused, saying I wasn’t having any trouble grieving. I wasn’t being entirely honest. I said that partly because I doubted she would’ve been able to seriously help me, partly because the sertraline had stopped me from grieving or feeling much of anything, really.

 

After two months on sertraline, I stopped listening to music entirely—it had done nothing for me and I gave up attempting to evoke any sort of emotional response in myself. I was determined to happily live out the rest of my life as a psychopath and enjoyed the highs that the drug afforded me. Ironically, the only thing that drove me to stop taking sertraline was my chasing of the next high—the last thing I wanted to become was habituated to the drug. At the end of my second month, I began tapering to 25 mg every six days for a period of eighteen days, with the intention of taking 25 mg sertraline daily for four days afterwards to get as high as a kite. But on this lower dose, I finally began to personally care that what I was doing was wrong and that it would be best if I stopped taking the drug at all. From every six days, I tapered to every seven, then every eight days… Interestingly, that dose was still enough to give me a buzz when whenever I ate a cream cheese wonton, and I began to want to be a psychopath again. (I think, as others have reported, that the steady discontinuation of the drug made me more sensitive to low doses.) But I sensed that I owed a debt to my friends—which I treated as if it were a business obligation, not a moral or spiritual one—, and persisted in trying to quit.

 

While attempting to find other accounts of hypersensitivity to sertraline, and material on how to come off SSRIs, I found Dr Peter Breggin’s The Antidepressant Factbook. I was very pleased to discover that people who produce inactive or “dud” forms of the CYP2D6 enzyme are unable to metabolise antidepressants at the rates most other people do. I have not gotten this or any sort of pharmocogenetic testing, and I don’t intend to as I will NEVER use a psychiatric drug again, but I suspect I may be one of those people. In my third and most recent appointment with my psychiatrist, I informed her that I had tapered off to 25 mg every eight days but that even this was enough to blunt my emotions and give me a little euphoria when I ate cheese or tuna. I mentioned that I had heard about the CYP2D6 enzyme and asked if she was aware of any good commercial genotyping facilities. She claimed that a blood draw for a liver function test would be enough and that I didn’t need to resort to genotyping…

 

It was on that third appointment that she finally started to take my adverse reactions seriously. By a stroke of good luck, I expressed a new reaction to the sertraline that very same day, just before my appointment with her. Prior to seeing her, I had to attend a mandatory employee meeting at my workplace, and I experienced my first ever hallucination in my life. Among the audience was an older gentleman—didn’t seem odd, he was wearing glasses, a clean business shirt and tie, trousers, had a white beard, and he wasn’t acting out of place. And he seemed familiar—I must’ve seen him in passing, he actually might’ve worked at the hospital somewhere. The only reason I knew he was a hallucination was because he was floating two feet above the rest of the audience. He faded away like a ghost after three seconds. 

 

When I reported this hallucination to my psychiatrist, she pursued a line of questioning that indicated to me that she had tuned out and believed I was being paranoid and worrying for no reason about an actual living coworker—“So, no one else at the meeting seemed to notice he was there?” I nearly lost ALL my patience with this woman. My reply was immediate and firm: “He was floating two feet above the audience!” Her eyes widened and she asked me if I was taking street drugs. (“No.”) She began asking about all the other symptoms I had reported to her over the past three months. She ordered me to discontinue taking sertraline as quickly as possible (of course, she gave no advice on how to withdraw from such a small dose) and advised me against taking any other SSRIs. But she denied that the sertraline was responsible for ANY of the symptoms; she wrote an order for extensive blood work (without any diagnosis, so the next day I had to return to her office to have her secretary write it in…) and referred me to a neurologist to get an MRI of my brain. (I am still waiting for my scheduled appointment at this time.) When I saw that the order included thyroid function testing, I asked her if thyroid dysfunction could cause hallucinations. She responded, “I really have no idea what’s causing any of this. A thyroid problem could be the cause of your mood disturbances.” (I think she was referring to the tryptophan-rich food euphoria, but I’m really not sure.) The only thing that she admitted was that if these symptoms completely ceased after a month of being off sertraline, then we could conclude that they were drug-induced and not organic in origin.

 

Since coming off the sertraline, I’ve begun to fully appreciate how I was emotionally unavailable to my partner, and how I took advantage him for three months; that I was unable to like people for three months; that in those three months I could’ve tortured and killed anyone, and I lacked only in inclination; that I hadn’t sang or grieved or felt anything… I am ashamed and guilty over what I became. I feel worse than before I sought and “received” that professional mental healthcare. All I want to do now is apologise to my friends. I know I haven’t done anything wrong, and I know I tried my best… But it’s difficult for me to accept that I’m still a good person. I feel like I’ve betrayed everyone behind their back. I’m trying to be gentle to myself, to think about what my friends would say if I could talk to them. I am trying to keep in mind that despite everything, I was able to honestly and objectively assess my own mental deterioration, and I acted as best as I could under the circumstances. I do not want to let those three months destroy my soul after the fact. I’m trying to live… I’m realising how much I missed out on everything. I forgot how much I liked the grass, and rocks, and kittens, and books. I forgot how nice it was to like other people, in spite of my fear that they’d never reciprocate those feelings. I forgot how much fun drawing was, and how funny my partner’s dumb jokes are. I hadn’t used smileys in my texts for three months, and I even walked differently! And I hadn’t realised how much of my acuity had dulled until I got off the sertraline. It’s like I have to live again for the first time in three months. I’m not as confident as I was three months ago, and I don’t like myself as much as I used to.

 

My partner has been very supportive. I’m now experiencing sertraline withdrawal reactions. I get disoriented easily; the other day when I left my workplace building and when I reached the parking lot, I couldn’t place where I was at all; like which part of Earth I was located in, let alone which end of the campus. I’m noticing memory problems; subjects I’d just discussed with my partner I would raise again only a few minutes later. I used to be able to play my favourite songs in my head, especially the pieces that my friends introduced me to. For a while I couldn’t remember the lyrics, the titles, the artists, or even the melody. My memory is improving, but those songs play like a broken record, my brain skips over parts and I have to listen to the song again to recall it completely. My stomach hurts every now and then. I’m sensitive to light, and I get akathisia now. The first episode was bad enough to leave me writhing and crying in pain while clutching my head—as if something were clashing and tearing away from the inside of my brain. Now, it feels like a bunch of fleas jumping on and nipping at the surface of my frontal lobes, not debilitating, but annoying enough to prevent me from falling asleep at times. My appetite has returned, but increased to the point where I have to be careful not to overeat or risk massive weight. I’m thankful that I’m one of those odd people who hears rainstick noises near the top of their spine whenever they’re hungry; now I pay attention to that and ignore the empty feeling in my stomach. I have sudden spells of sadness and anxiety during which I cry a lot, which I didn’t have before taking sertraline.

 

I’m worse off than before I started taking psychiatric drugs, but at least I’m no longer chemically lobotomised. I’m trying to exercise my brain by the throwing myself back into singing and reading, and I draw more seriously now. I hope this case history helps someone. I’m looking forward to weaning myself safely.

[Altostrata]

Welcome, ShrimpDoria.

 

Well, that is an unusual introduction.

 

Taking an antidepressant every few days is recommended nowhere. However, it's unlikely it would lead to withdrawal syndrome. 

 

More likely, you are indeed one of those individuals who are genetically unsuited to taking any serotonergics. For these people, they cause immediate adverse reactions from which it can take a long time to recover.

 

5 hours ago, ShrimpDoria said:

Combined with the fever (at least six hours long), increased heart rate (30 seconds long), and hand tremors (1 minute long) that I would experience 20–40 minutes after taking the sertraline (half of a 50 mg tablet), and non-existent appetite

 

^ This is an adverse reaction to sertraline.

 

Emotional numbing is a very common side effect or, as some believe, the entire point of taking an antidepressant. Your food reactions sound like tyramine reactions (see food restrictions for those taking MAOIs, a different but related class of antidepressants). For some people, adverse reactions can include psychoses-like experiences .

 

Although your state is not exactly withdrawal syndrome, it is similar in that it's basically drug-induced autonomic nervous system dysfunction. Your task is to let your autonomic nervous system settle down: Stay as calm as possible, keep regular hours, get a good amount of sleep, eat good food; avoid junk food, artificial flavorings, sugar, alcohol, street drugs.

 

Many people find fish oil and magnesium to be helpful:

 

King of supplements: Omega-3 fatty acids (fish oil)

Magnesium, nature's calcium channel blocker

 

Please let us know how you're doing.

[ShrimpDoria]

Thanks! I haven't heard of magnesium supplements before. I'll try to find some magnesium citrate at my local pharmacy store, since that's easier on the stomach, or if not, I'll settle on magnesium carbonate. I'll try to find some decent fish oil capsules, too. I don't think I'll be sensitive to it, as eating raw salmon has never caused me any problems, but I'll start with one capsule a day just to be on the safe side. I don't know if my brain-burning sensations are the same as the brain zaps (mine were actually fun instead of painful), but either way, it is a symptom of nervous system dysfunction that I have to take seriously.

 

I've heard about tyramine migraines, but I wasn't aware that people on MAOIs had to reduce their tyramine intake. It's interesting to know that other people have experienced similar reactions to certain foods because of their antidepressants. I haven't heard of other people on SSRIs needing to restrict tryptophan due to similar reactions; if there are other people, I hope my post will show them that they're not alone.

 

I don't have a history of liver problems and I don't drink alcohol and my most recent lab test showed that my liver is fine, so all I can guess is that I'm a very poor metaboliser. I have still have four bottles of 50 mg sertraline tablets (my psychiatrist instructed my pharmacy to refill them quickly, I guess?), I'm going to try making suspensions out of the halves using the guides posted on this forum. If my withdrawal reactions worsen, I'll try taking extremely small doses of sertraline to alleviate them.

 

This biggest withdrawal symptom kicking me in the guts right now is insomnia, I wake up in the middle of the afternoon heat and I can't get back to sleep again for my night shift. I admit I haven't seriously exercised in a week due to my other withdrawal symptoms. I think as soon as I get back into my workout routine I'll be able to catch a better day's rest.