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London1979 - advice please on reducing sertraline & amitriptyline


London1979

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Hello I've just joined this site to get advice on how to stabilise and then start tapering off properly, having made a mistake in how I reduced my meds.

 

I was taking 50mg sertraline daily (for anxiety) and 10mg amitriptyline daily (to prevent migraine) for the past 18 months after post natal depression. This was the third time in my life so far I needed antidepressants for anxiety.

 

My GP is not very helpful and thinks I should be able to cope without the meds, and should reduce dose quickly. I live in a very overcrowded area of London where it's extremely hard to get a GP appointment, so I don't imagine switching to another GP would help much.

 

Reasons for wanting to come off are: 1) I gained weight every time on meds and feel miserable about this, I have tried diet and exercises but want to be off meds 2) we want to try for another baby in summer and I want to be meds free by time we try to conceive 3) my GP this I should be off the meds by now.

 

Basically 3 weeks ago I decreased both meds by taking the same dose but every 36hrs rather than daily. I felt up and down but kept going. I had a bad panic attack in week two but thought the symptoms would pass in a few days. After week three I felt stable so then, two days ago, I dropped down to same dose but every 48hrs. I instantly feel awful. This afternoon I got angry and tearful and shouted at my toddler. This feels like a red flag so I immediately took a 50mg sertraline tablet hoping to ward off any further volatile mood.

 

From reading this site I understand my reduction method was wrong and I should have kept taking meds every 24 hrs but tapered the dose by 10%.

 

Please can someone advise how to switch to this method from where I am? My priority is to 1) stabilise my mood so I don't shout at my lovely toddler again 2) get a route map of how I should be tapering off and then 3) present this to my GP and ask for her support, I have an appointment next Tuesday ( which I booked months ago, im not exaggerating how long you have to wait for an appointment in my area).

 

Thanks in advance for help.

Took 50mg sertraline + 10mg amitriptyline daily for 18 months to help with anxiety and migraine. Started reducing frequency of both meds to 36hrs then 48hrs but got bad withdrawal and realised I used wrong withdrawal method. Now signed on here to try and do it properly.

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Welcome London.

The wonderful folk will be in shortly to give you good advice.

In the meantime its best not to skip doses.

nz11

4am...ugh!

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.

http://www.parliament.scot/GettingInvolved/Petitions/PE01651   

Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017

 

 

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Hi London.  Welcome.

I'm sorry that you have had  such a hard time.  It would be best if you tapered one drug , at a time. Since Elavil has a mild tranquilizing action , I would think Zoloft would be the one to taper first. We don't recommend tapering two drugs at once.

Taking multiple psych drugs? Which drug to taper first?

Alternating dosages can destabilize your CNS.  Not recommended here. Have a read of these links , before you see your doctor. They might help.

http://survivingantidepressants.org/index.php?/topic/4463-how-do-you-talk-to-a-doctor-about-tapering-and-withdrawal/?hl=+talk%20+doctor

http://survivingantidepressants.org/index.php?/topic/2746-what-should-i-expect-from-my-doctor-about-withdrawal-symptoms

This is your thread/journal to ask questions , and track progress. Let us know how you go , and come back with any questions you might have.

Ali

Many SSRI's and SSNRI's over 20 years. Zoloft for 7 years followed by Effexor, Lexapro, Prozac, Cymbalta, Celexa, Pristiq, Valdoxan, Mianserin and more - on and off. No tapering. Cold turkey off Valdoxan - end of May 2014

 

                                                  Psych Drug - free since May 2014
.
         

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  • Moderator Emeritus

Welcome London,

 

So glad you found this site when you did.  There will be lots of info and support for you here. 

 

I'm unsure why your doctor would have you on two antidepressants at once, as he/she must know there are better ways to help migraines.  The Drug Interactions Checker shows that those two have a major interaction: 

------------------------------------------------------------------------------------------------------------

Interactions between your selected drugs
Major amitriptyline sertraline

Applies to: amitriptyline, sertraline

Before taking amitriptyline, tell your doctor if you also use sertraline. You may need dose adjustments or special tests in order to safely take both medications together. This combination may increase the effects of amitriptyline in your body. You should notify your doctor if you have symptoms of sedation, dry mouth, blurred vision, constipation, or urinary retention. You might also have altered consciousness, confusion, poor muscle coordination, abdominal cramping, shivering, pupillary dilation, sweating, high blood pressure, and high heart rate. It is important that you tell your healthcare provider about all other medications that you are using including vitamins and herbs. Do not stop using your medications without first talking to your doctor first.

 

------------------------------------------------------------------------------------------------------------

 

We will need to know:  Are you now back on the full dose of both drugs or just Sertraline?  For how long have you been back on that full dose?  You will want to wait at least a month to get properly stable before beginning a gentle tapering plan of one drug at a time.  AliG gave you some useful links to read about that. 

 

When we have that info we can help you work out what to do next. 

 

Best wishes,

Karen

2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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Thanks very much nz11, Ali and Karen.

 

I have read those links you sent me Ali, thanks. Re talking to my doctor - seems the easiest thing is to just say I would like to taper off slowly, and hope she will agree. My pharmacist is more sympathetic so I can ask him about cutting pills or making a liquid solution once I know what dose to aim for.

 

Karen, the reason I'm taking the 2 drugs together is that before I got pregnant (Oct 2013) with my first baby I had been on a low dose of fluoxetine for about 18 months, and I had slowly reduced it until I was off it. I always had migraines too but never took preventative medication, until my second trimester  (Feb 2014) when due to hormones my migraines became daily and the hospital put me on 10mg amitriptyline as apparently it has been used for years during pregnancy without harming the baby. After birth  I had post natal depression and anxiety (September 2014) so was put on 50mg sertraline (SSRI which is most breastfeeding compatible apparently) and continued the 10mg amitriptyline as migraines were still an issue.

 

I took 50mg sertraline + 10mg amitriptyline from Sep 2014 to beginning of Feb 2016. During the past 3 weeks of Feb 2016 I took 50mg sertraline and 10mg amitriptyline every 36 hours. Then for the past 5 days I took 50mg sertraline + 10mg amitriptyline every 48 hrs and got a bad reaction. 

 

I will follow Ali's advice and reinstate the 10mg amitriptyline to every 24 hrs and not change that whilst I reduce the sertraline.

 

My question now is: having read this site and discovered the best way is to taper slowly, what dose of sertraline should I go back to? Do I have to go all the way back to 50mg every 24 hrs (this feels like losing ground) or could I try doing a lower dose every 24 hrs and see if the symptoms settle down on that? I seemed to be getting through ok on 50mg every 36 hrs, but my maths is terrible and I don't know what that equates to every 24 hrs. Or whether my nervous system would agree with my calculation and settle down!

 

Grateful for any thoughts, thanks again.

Took 50mg sertraline + 10mg amitriptyline daily for 18 months to help with anxiety and migraine. Started reducing frequency of both meds to 36hrs then 48hrs but got bad withdrawal and realised I used wrong withdrawal method. Now signed on here to try and do it properly.

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PS I forgot to say - back in August 2015 I forgot to collect my prescription so I went cold turkey and took no sertraline for about 10 days. I felt fine for a few days and then suddenly awful, with extreme mood swings and rage, I tried to ride it out but was too concerned about staying safe around my toddler andhusband so went back to 50mg sertraline and was fine within about 2 days.

Took 50mg sertraline + 10mg amitriptyline daily for 18 months to help with anxiety and migraine. Started reducing frequency of both meds to 36hrs then 48hrs but got bad withdrawal and realised I used wrong withdrawal method. Now signed on here to try and do it properly.

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  • Moderator Emeritus

Hi London , if you follow the recommended drop of 10% that would take you to 45mg.

How about you split the difference and try to stabilize on 48mg every 24 hours?

If you don't feel better enough in another couple of weeks you could updose to 50mg if required.

 

bw , Fresh

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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Thanks v much Fresh, I will have a go at 45mg.

Took 50mg sertraline + 10mg amitriptyline daily for 18 months to help with anxiety and migraine. Started reducing frequency of both meds to 36hrs then 48hrs but got bad withdrawal and realised I used wrong withdrawal method. Now signed on here to try and do it properly.

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HI, just posting an update:  I saw my GP, she suggested to alternate doses ie 50mg every 3 days and then 25mg on the 4th day - I knew from this website this wasn't a good method but no point in arguing with her, so I just said I preferred to do the 10% method and she agreed, told me to speak to pharmacist about how to break up the 50mg tablets into smaller doses. Pharmacist sold me a tablet crusher and said to dissolve each 50mg tablet in 10ml water so that 1ml = 5mg. 

 

I've gone back to 50mg for a couple of weeks and then will drop down to 45mg and take it from there.

 

Thanks everyone for your help, much appreciated.

Took 50mg sertraline + 10mg amitriptyline daily for 18 months to help with anxiety and migraine. Started reducing frequency of both meds to 36hrs then 48hrs but got bad withdrawal and realised I used wrong withdrawal method. Now signed on here to try and do it properly.

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  • Moderator Emeritus

You go girl!!!  Good on you for sticking to your guns and it sounds like you did it in an assertive, non-aggressive way.

Please DO NOT TAG me - thank you

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions. 

  MISSION ACCOMPLISHED:    (6 year taper)      0mg Pristiq      on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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