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  1. Hi there, I'm growing quite concerned that this high dose of sertraline that I'm on may be causing great difficulty in stopping myself from engaging in BFRBs (Body-Focused Repetitive Behavior), particular picking & biting my nails & the skin on my fingers. To be honest, I didn't even know these behaviors had an umbrella title until looking it up, just now. The reason I think it might be associated with sertraline is this behavior seemed to start shortly after dosage increases that went beyond prescribing guidelines for this medication. I used to have a problem with BFRBs but I haven't engaged in that behavior for 15-20 years, if I had to guess, & I don't remember it ever being this compulsive & automatic. Another reason I suspect sertraline might be the cause of this these BFRBs is the very high dose that my doctor has me on. In U.S. prescribing guidelines, it appears the maximum recommended dosage is 200 mg QD & my doctor has me at 300 mg QD. His rationale for exceeding the recommended maximum daily dose was that we were seeing no symptom improvement at 200 mg & he believes he can govern what dosage that I can tolerate by monitoring the medication & subsequent concentrations in my urine. I didn't & still don't buy that hypothesis fully, but I've gone along with it until now because I've been desperate for relief from the debilitating symptoms of my depression. I went to get the pertinent lab work done a week ago & the results have yet to return but considering how problematic this BFRB is getting, those lab values seem comparatively unimportant. My fingers are becoming quite painful & it's requiring a great deal of constant mindfulness to keep the damage to my fingers from getting into the range of what I would consider quite significant & would take a long time to heal. I also appear to be picking at my fingers in my sleep as well so there's no amount of mindfulness that's going to stop that from happening, as far as I know. Ultimately, it is my intent to titrate off sertraline altogether with the aid of my psychiatrist and I am going to make sure that is done safely, which probably is going to entail a long titration period. I'm looking for answers to help me in the here & now, like, is this something that other people here have experienced & possibly some tips for managing these BFRBs in the interim until I the root cause can be addressed. If it weren't summer here, I would consider wearing something like thin cotton gloves to keep me from destroying my fingers, as much as possible, for the time being. Even if it weren't summer here, I don't think that solution would be very practical + I'd rather not have people ask why I'm wearing gloves all the time. Any help or feedback would be greatly appreciated. Thanks for taking the time to read this.
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