Cruizer: sertraline / Zoloft nightmare

[Cruizer]

I am more than happy to not drink alcohol if it is contributing to the way I feel now. That is a no brainer.

My biggest concern at the moment is I don't want to do the wrong thing regarding the pace of my taper. It is very hard to tell whether symptoms are arising as result of a side-effect of the meds and poopout or whether it is from withdrawal. I feel like that is the answer I am searching for to get me on the right path. The symptoms can be similar with either case.

All I know is I have always felt better whilst I have been tapering down until I get to a point where I crash which is generally after a year of consistent tapering. But then if I hold too long I begin to feel worse and Brass identified this as Poop Out. I will say though that these head symptoms both now and when I crashed in March are worse than I ever remember.

I will also add that my restless legs that I had for years whilst on higher doses has basically gone since getting lower which suggests I am much less stimulated.

AArgghh it is so hard to work out what is going on and I am confusing things more by looking up others on here and reading their stories of hell. I just don't want to go too fast and end up in protracted withdrawal for months/years, but I also don't want to go too slow if my symptoms are in fact a side-effect.

[Cruizer]

I wanted to write this post because I am really struggling at the moment and I am starting to think (and so does my wife) that I am entering Poopout again. My reason to believe this is because every time I have held in the past things have been very similar.

 

In a post a early last year Brass Monkey identified poopout with me and this made complete sense. I have been on 1 drug (Zoloft) for nearly 10 years at that stage and I had to updose only 12 months after being on 100mg. as I started to get symptoms again and that was about 9 years ago. Looks like I could have already been experiencing poopout way back then.

 

What confused me when I first started tapering again in May 2019 was after a small reduction of about 6% and feeling better for about 20 days, I had a sharp increase in symptoms again that were very acute! The same thing happened to me in September 2018 when I had held for 7 months and then dropped about 6%. I felt better for about 3-4 weeks and then got slammed with acute symptoms. Brass commented on this and said that I should start to drop quicker as the "feeling good for 3 weeks followed by a big spike in symptoms" was classic poopout and the meds were catching back up and creating chaos. This was very accurate because as soon as I continued to taper more regularly, I did not get a big spike in symptoms and the next 8 months were a lot more bearable and almost normal. That was until March this year when I had continued tapering at 0.5mg per 2 weeks which meant my drops were getting larger and larger. I worked out that from 9mg. down to 4.5mg I should have taken 32 weeks where I did this in about 20 weeks. So a bit too fast and was met with some withdrawal. During that 1st 6-8 weeks of holding symptoms were very up and down through each day. Mainly consisting of head pressure and irritation. Not really any depression or anxiety present though. I found that I started feeling better at around the 2 month mark of holding and had a solid 18 day window where I felt more like I had leading up to the crash. After the 18 days I started feeling a little off again and just thought that this was a bit of a wave. BUT..... now the symptoms were different. I now was feeling more depressed and very unclear. Now starting around 2 weeks ago I have very acute symptoms. I am having crying spells almost every day, my head is pounding and I feel sick in the stomach, have lost my appetite, have no sex drive and can't think. Anxiety has increased also and have had some cortisol spikes early in the morning. These symptoms have been gradually getting worse and also feel worse around an hour after taking my Zoloft in the morning.

 

I have now been holding at 4.5mg for almost 20 weeks now which should have more than allowed be to catch up with where I should have been. But now my symptoms are more acute and I have been at my worst.

 

Yes I had some alcohol thrown in there but I have never had issues that are related more than 4 weeks later. I can't possibly be feeling this bad 4 weeks after having maybe 6-7 beers.

 

I have drank more than this before and been effected a few days to a week later, but not 4 weeks later to this degree.

 

I read something that Brass Monkey said to another member hear which was that "he personally did not find he noticed improvements with poop out until he was below 3mg. and was better when he was below 1mg. He also said throwing a long hold in can mean the body starts to lose control again and thinks the drug is winning and reverts back into a WD situation. Tapering out of Poopout is a delicate balancing act." I think I maybe on the other end of that balancing act now where I felt WD for about 2 months, then stabilized for those 18 days and now have been progressively getting worse in the past 2 months as I am still holding. I get so hung up on looking at everyones horror stories on WD and I don't want to get to that point, but I feel I maybe suffering because of holding and poopout and not WD anymore.

 

So key points:

- Symptoms now are worse and have lasted longer than when I first held back in March.

- Symptoms are acute and I am having crying spells as well as depersonalization and unclear thinking (same as when I did not drop fast enough after a small reduction).

- I feel worst after about an hour of taking the meds in the morning.

- I have had 3 long holds (all between 5-7 months) during my 4 and a half year taper, all of which I felt better from once I resumed tapering.  

 

I am so lost at the moment. My wife says she has recognized this from previous experience with me and thinks I should start to taper again which I am definitely leaning towards. A slow taper obviously. The acute symptoms I have now have only been like this when I have held for too long in the past. I just really can't believe that my symptoms now can last longer and be more acute 5 months into a hold than what they were at the start of the hold. It just doesn't make sense to me. Yes I went too quick from 9mg. to 4.5mg but I still took 20 weeks to get from 9-4.5mg. Too fast but certainly not a cold turkey to that etc. Feeling better after 2 months of holding for 18 days followed by progressively getting worse with no windows is screaming poopout to me again. I would appreciate your thoughts @brassmonkey @Altostrata.

Edited August 3, 2020 by Altostrata
added line breaks

[ChessieCat]

It sounds like you and your wife have been very careful observers of your taper and symptom pattern.

 

My suggestion would be to make a test reduction of a small percentage to see how things go.  That would be the easiest way to work out whether you need to continue holding or you are in poop out.  If things didn't worsen or improved you would know that it is okay to continue.  If things improved you could make a larger reduction.  If things remained the same you could make another small reduction as a precaution.  If things worsen then you will know that you need to hold for longer.

[brassmonkey]

Chessie has a pretty good plan there.

 

I can see the pattern that could indicate continuing to poopout after long holds, and I think both you and your wife see it too. As I mentioned earlier the alcohol can have a very profound and long lasting affect on the situation. It's not the alcohol itself, that clears the body in a day or so, but rather the chaos that it causes on the various systems of the body.  Tapering is a very delicate balance of trying to fool the body into thinking that nothing is happening while you reduce the amount of the drug being taken. Any disruption to that balance can lead to a period of acute symptoms. 

 

I think carefully resuming your taper would be a good course of action. I would start with a very small reduction and see what happens.  Then follow up with further reductions if the coast is clear. This would be a good time to institute a Brassmonkey Slide, except for the first few reductions add in a longer hold time, say two or three weeks, to let things settle and see what your reaction is. I would try four (4) reductions of 2.5% every two weeks and an additional three (3) week hold to start.

 

For the record, my taper lasted five and a half years. For about the first two and a half I was fighting my way out of poopout and didn't see much improvement in my symptoms. From that point on there was steady for slow improvement that I could see over the course of several moths. There was a big shift in my symptom load when I broke under three (3) mgai. At that point my symptoms showed faster improvement which was more noticeable over a shorter time frame.

[Altostrata]

20 hours ago, Cruizer said:

Yes I had some alcohol thrown in there but I have never had issues that are related more than 4 weeks later. I can't possibly be feeling this bad 4 weeks after having maybe 6-7 beers.

 

I have drank more than this before and been effected a few days to a week later, but not 4 weeks later to this degree.

 

I don't think I can stress strongly enough that intermittent drinking can throw a nervous system sensitized by withdrawal into even more destabilization.

 

Although your intermittent drinking caused no odd symptoms when your nervous system was stable, it may very well be contributing to what you think is "poop-out" now. I mean no condemnation by that, what I'm saying is that the intermittent alcohol is another drug you've added from time to time. This makes it impossible to interpret your symptom pattern. Brassmonkey might not have had this information when he suggested you are suffering from poop-out.

 

Please do not ingest any alcohol at all, including near beer or low-alcohol content beer. None, or you may be making your own problems.

 

What is your current daily symptom pattern? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

[Cruizer]

Hi guys,

Thank you to all 3 of you for responding and offering advice. It is much appreciated and you guys are my lifeline at the moment when things go south.

Firstly I completely understand everyone's point with regards to alcohol. I will NOT be drinking any alcohol moving forward. The situation is confusing enough to understand what is going on without throwing alcohol into the mix. The reason why I don't think it is alcohol related this far out is because right before I crashed in the middle of March I had a very large session of alcohol (much larger than what I did 4 weeks ago) and the result was not as bad as I have felt now and that was right as I was crashing and not after a 5 month hold.

However point well and truly taken. No alcohol moving forward.

Brass and Chessie, I have taken your advice and dropped today. I have dropped .25mg which is around 5.5% and plan to hold for 4-6 weeks. Finger crossed I see something that resembles a reduction in symptoms so I know I am on the right track. Brass I know you said 2.5% every 2 weeks but currently the smallest compounded tablet I can get is 0.25mg. I will ask the question of my compounding pharmacy if they can do 0.1mg capsules as that would help greatly.

My original plan when I started to taper again was to use the 0.25mg drop every 4-6 weeks until I got down to 2.5mg. From there I was then going to attempt to make my own liquid.

I was going to switch to using a combination of tablet and liquid i.e. 2mg tablet plus liquid solution from a .5mg capsule and then syringe. I am a little sceptical of making a liquid now in case I get it wrong especially when we are trying to work out whether a reduction has a positive effect. Wish me luck guys, I will write my findings on here in a week or so and hopefully they will be positive. Alto I will continue to keep my daily journal going to identify symptoms. Thank you.

[Cruizer]

Hi all,

 

I had 3 days at 4.25mg. But found a sharp increase in symptoms including vomiting and mostly headaches, like pounding headaches that have stopped me functioning as well as insomnia the last 2 nights and agitation . The headaches have been present for around 2 weeks now and getting worse. I may have accidently taken the wrong dose amount around a day prior to having these headaches come on. I take a 4mg and a .5mg tablet daily and i remember one morning thinking to myself "did i just take two" of these. 

Anyway I have gone back to 4.5mg today which is what I have been at for 20 weeks aside from the past 3 days. I am also on my way to get my head checked to make sure nothing more sinister is going on as the headaches are excruciating. Thanks for the continual support 

 

On 8/4/2020 at 4:47 AM, brassmonkey said:

Chessie has a pretty good plan there.

 

I can see the pattern that could indicate continuing to poopout after long holds, and I think both you and your wife see it too. As I mentioned earlier the alcohol can have a very profound and long lasting affect on the situation. It's not the alcohol itself, that clears the body in a day or so, but rather the chaos that it causes on the various systems of the body.  Tapering is a very delicate balance of trying to fool the body into thinking that nothing is happening while you reduce the amount of the drug being taken. Any disruption to that balance can lead to a period of acute symptoms. 

 

I think carefully resuming your taper would be a good course of action. I would start with a very small reduction and see what happens.  Then follow up with further reductions if the coast is clear. This would be a good time to institute a Brassmonkey Slide, except for the first few reductions add in a longer hold time, say two or three weeks, to let things settle and see what your reaction is. I would try four (4) reductions of 2.5% every two weeks and an additional three (3) week hold to start.

 

For the record, my taper lasted five and a half years. For about the first two and a half I was fighting my way out of poopout and didn't see much improvement in my symptoms. From that point on there was steady for slow improvement that I could see over the course of several moths. There was a big shift in my symptom load when I broke under three (3) mgai. At that point my symptoms showed faster improvement which was more noticeable over a shorter time 

 

[Cruizer]

Hi All,

Just a quick update from me. After dropping to 4.25mg. on Tuesday last week, I noticed a sharp increase after the second day and this continued to get worse so on Friday I went back to 4.5mg and will hold. Since going back up the symptoms have lessened a little bit but I am still having significant issues. On the third night after the drop I had one of the worst nights of my life. I was so severely agitated and my head felt like someone was stabbing me in both sides. I ended up going to hospital in attempts to have a brain scan just to double check there was not anything more serious going on just due to the head pain. I did not end up getting a scan due to the wait I would have had so I have seen my GP this morning and will have a precautionary MRI to be safe. I don't think there is an issue though.

Seeing my doctor this morning was difficult as I don't really have a regular GP I see. This guy seems to be quite supportive about my taper and has a similar opinion about these drugs to what I do and many on here do in that he feels they are completely wrong. However despite this opinion, he still does not grasp the concept that withdrawal can last for years. His advice to me today was just stop taking them and ride the bad couple of months out and then be free!

Anyway, I know better and will continue to taper slowly once I have stabilised again. I can't be positive what has set me off this time but all I know is this sucks big time and I don't want to be suffering like this. I may not have totally given respect to how fragile my nervous system is at the moment and I just tried to live my life and socialise with a few beers here and there plus a couple of larger sessions in the month proceeding this crash again. This could be likely the cause and perhaps an mucked up dose one day. I will never really know but have to understand that there is no blue print to this withdrawal game. I am trying to look on the positive side and see that I came from 17mg down to 4.5mg with relative ease and was feeling quite clear. I have gone too fast with not enough holds and now I am picking up the pieces. I would much rather deal with the slight apathy and irritation as I am coming down slowly than the nightmare I have gone through the last few weeks. Thanks for the continuous support.

[composter]

45 minutes ago, Cruizer said:

Seeing my doctor this morning was difficult as I don't really have a regular GP I see. This guy seems to be quite supportive about my taper and has a similar opinion about these drugs to what I do and many on here do in that he feels they are completely wrong. However despite this opinion, he still does not grasp the concept that withdrawal can last for years. His advice to me today was just stop taking them and ride the bad couple of months out and then be free!

Do you plan to make this doctor your regular GP? It’s good that he is supportive of your taper and desire to come off the medication. Perhaps you could point him towards resources like the scientific papers linked in the Journal articles page of this site. I find doctors are usually willing to learn and read if you share printouts of resources with them. (Look for the Full Text links.)
 

https://www.survivingantidepressants.org/forum/16-from-journals-and-scientific-sources/

 

Still, it’s good you know better than that and will aim to stabilize before resuming the taper. You’ve come very far!

[Cruizer]

1 hour ago, composter said:

Do you plan to make this doctor your regular GP? It’s good that he is supportive of your taper and desire to come off the medication. Perhaps you could point him towards resources like the scientific papers linked in the Journal articles page of this site. I find doctors are usually willing to learn and read if you share printouts of resources with them. (Look for the Full Text links.)
 

https://www.survivingantidepressants.org/forum/16-from-journals-and-scientific-sources/

 

Still, it’s good you know better than that and will aim to stabilize before resuming the taper. You’ve come very far!

 

I really only see doctors for prescriptions, not to get support or work out a plan to withdrawal as they know very little and I use this site for that.

I have had other doctors flat out refuse to give me prescriptions for 4mg. as they say 25mg. is the lowest you should be taking. I have also had Dr's say things like 4.5mg would not be doing anything and look at me like I am crazy. This doctor did upset me today though (more angry) as he stated he thought I was scared to make the jump off of medication. I said I didn't appreciate him saying that in which he then repeated saying it. I had to check myself coz I really did not like being insulted like that, especially when I am fragile at the moment. However we got back on better terms towards the end. He was a bit nuts though, and he was going on about spirituality and whether I believed in Jesus and a higher power.

He said I just need to have faith that I will be healed. At one stage he mentioned satan and hell and I thought to myself "is this guy trying to test me here" but he was actually fair dinkum. At the end of the day, if he is going to write me scripts, that is all I need from him. I will work closely and gain support from my family and the wonderful people on this forum. Thanks for commenting and your encouraging words about how far I have come.

[ChessieCat]

1 hour ago, Cruizer said:

and he was going on about spirituality and whether I believed in Jesus and a higher power.

He said I just need to have faith that I will be healed. At one stage he mentioned satan and hell and I thought to myself "is this guy trying to test me here" but he was actually fair dinkum.

 

If he says anything like this next time you could say that you are there for a medical reason and that you would like to leave religion out of it.

[ChessieCat]

1 hour ago, Cruizer said:

This doctor did upset me today though (more angry) as he stated he thought I was scared to make the jump off of medication. I said I didn't appreciate him saying that in which he then repeated saying it. I had to check myself coz I really did not like being insulted like that, especially when I am fragile at the moment.

 

If this is brought up again, you could say that you would prefer to be cautious.

[Cruizer]

Hi All,

I have dropped today from 4.5mg to 4.25mg. I did this about 4-5 weeks ago but only for 3 days and thought it made me worse, however I remembered later that it takes at least 4 days for this to become stable in the blood and then a few more days for the brain to register the change. After this acute period 4 weeks ago I had a nice 6 day window with the first 2 days feeling like I was back to normal (this was around day 15 from the drop but then quick updose).

However after the 6 days it turned again and over a period of about a week built back up to very severe which has peaked in the past week with severe cortisol spikes every morning and also not being able to sleep the past 2 nights much at all. I am having vivid dreams that I call micro dreams which is where I am drifting off and then a really random dream will pop into my head like feeding a goat or someone I haven't seen for years pop into my head. This is then met with me waking in a “fright”. This could repeat for hours during the night.

 

Now these exact symptoms I am having now I have had before. . . .

- Right when I started taking the medication

- Going to a higher dose

- Holding for too long during Poopout where I would feel much better for 3 weeks and then be met with the above.

 

I sit here after holding for 6 months and I am in a much worse state than what I was when I first held back in March. I actually looked back through this thread and was nodding my head when I was reading about when this happened to me back in 2018 when I had held for 6 months and then dropped about 6% and had a great first 5 weeks then got smashed with the above symptoms. I held for a further 7 months and when I then dropped 3% I had a great first 3 weeks and then got smashed with the above symptoms. That was when I was thinking this could not be right and Brass helped me out by identifying Poop Out.

I think (and I wrote this on page 3 of this thread) that I tend to get hung up on what other people have gone through and how long they have suffered for if they went too fast or CT. I may have gone a little quick (10mg - 4.5mg in 5 months) but holds should be stabilizing that, not getting worse 6 months later. The fact that I have had great success when tapering consistently over the past 4 and a half years but struggled greatly in periods when holding, is still screaming out to me that these drugs have more than outstayed their welcome.

Rather than reading what others have gone through and scaring myself, I think I would be better just listening to my own body and reading the daily journals I have written about how I am feeling. They have painted a pretty clear picture especially after this recent spike. I feel the drug has caught back up after holding for 6 months and my body is now at war with it with both trying to gain control. 4.5mg of Zoloft is quite low and when compared to other SSRI’s is getting to around the 1-2mg mark. It is around 3% of my original dose when I started tapering 4.5 years ago. I just sit here and really say to myself, how can I be suffering this much when still taking Sertraline.  

So the plan for now is to start tapering again. Still below the 10% per 4 week mark. I am going to see if my compounding pharmacist can make 0.1mg tablets so that I can drop smaller but more regularly. I am also going to continue to taper for the next couple of months at least just to make sure I can once and for all identify the best course of action i.e. holding or tapering.

Oh and before anyone asks I have not had a drop of alcohol for over 7 weeks now and its been over 9 weeks since I was last intoxicated and that was still only 7 or so drinks. Back in December last year I had a rough patch of about 4 days which was the only rough patch in my 7 months of good tapering. About a week before that rough patch I got totally hammered at my Christmas show so yes I do see how alcohol can create a spike in symptoms, but I have never had problems arise this bad 2-3 months later and with much less to drink so I have all but ruled that out as contributing to these current symptoms. I promise not to add that fuel to the fire again though in order to avoid confusion.

 

[ChessieCat]

1 hour ago, Cruizer said:

that was still only 7 or so drinks.

 

That is not an insignificant amount.

 

1 hour ago, Cruizer said:

I promise not to add that fuel to the fire again though in order to avoid confusion.

 

That is good to hear.  However you aren't doing it for us.  It's for your own benefit.

 

Edited September 7, 2020 by ChessieCat

[Cruizer]

HI All,

Well the last 4 days at a lower dose have been an absolute nightmare! 

On the second day I had the most insanely intense crying spell which and was extremely aggitated to the point where I had to go stay at my parents house so that my 2 young sons didn’t see me. This is heartbreaking. I have had severe cortisol spikes for the past 4 days since dropping as well as the week leading up to it. I have now had to take a few days off of work as I am not even functional. Last night I had a severe panic attack I think where I needed to just get out and almost felt like running down the street. It lasted about 5-10 minutes and then just stopped and I almost felt a giddy feeling after. Slept a little better last night but still woke through the night with high pulse rate around the 80-85BPM range. Today I felt slightly better on waking but by the time I got to work at 9am I was severely anxious and aggitated (like akathisia where I could not sit still). I left work and had to walk the streets to calm down. My head has a fair amount of pressure in the temple area and I have not been able to eat much at all. 

I am on day 4 of the drop and I figured if things were going to improve they would have started to by now. After over analysing all my notes in my journal, I arrived at the fact that I thought this was poop out again and this was just the sharp increase I get right when I should be dropping (i.e. the drug and the body at war). However I failed to really identify that in the first 5 months of my hold after crashing in March, I had just 1 day of cortisol spikes and anxiety has been quite minimal. That was until I dropped a dose by 5.5%

I think like I said in my other posts above, I may have really underestimated where I was at and thought I could just do the normal things like drink alcohol etc. I still don’t know fully what has happened but it could well be the alcohol sensitised me again as I started getting the headaches and then the drop 4 weeks ago compounded it and here I am. 

I think when I started to get the cortisol spikes again about 2 weeks ago I just simply thought to myself that this has to be the drug and not the fact that I had probably sensitised myself from the drop last month and this was simply a wave resulting from that. 

So my question to you @brassmonkey and anyone else who would like to weigh in, is:

Now that is has been 4 days from the drop from 4.5mg to 4.25mg. And the results have certainly not gotten better and if anything gotten worse with the panic and agitation, should I updose back to 4.5mg? I need relief and I think 4 days was a big enough test period to see if the drop was going to help. If I do updose I plan to take a rather large tapering holiday and regain some normality hopefully. I am thinking another 6-12 months but I will let my body decide that. 

It is amazing how much you under appreciate the little things in life until simply going to work, playing with your kids and sleeping and eating are taken away. It is soul crushing and so cruel. I am hoping with a long tapering holiday I can get back to where I was the months leading up to my crash which was quite mild symptoms mainly consisting of some fatigue and mild irritation. It would be 1000 times better than this now. 

 

Thanks all!

[ChessieCat]

Is there anything else that happened at the same time?

 

Alcohol?

 

Are you taking any supplements and missed taking them?

 

Did you have any Chinese food or anything containing MSG which is a neurotoxin?  Many savoury package foods contain MSG, eg flavoured crisps/chips, chicken salt that they put on hot chips, frozen foods, canned soups.

 

17 minutes ago, Cruizer said:

Now that is has been 4 days from the drop from 4.5mg to 4.25mg. And the results have certainly not gotten better and if anything gotten worse with the panic and agitation, should I updose back to 4.5mg?

 

If it was me I'd be making a smaller updose, not going back to 4.5mg

 

Edited September 10, 2020 by ChessieCat

[Cruizer]

4 hours ago, ChessieCat said:

Is there anything else that happened at the same time?

 

Alcohol?

 

Are you taking any supplements and missed taking them?

 

Did you have any Chinese food or anything containing MSG which is a neurotoxin?  Many savoury package foods contain MSG, eg flavoured crisps/chips, chicken salt that they put on hot chips, frozen foods, canned soups.

 

 

If it was me I'd be making a smaller updose, not going back to 4.5mg

 

Hi Chessie, thanks for the reply.

I have most definitely not drunkn alcohol for 7 weeks. I have definitely eaten Chinese in the past 2 weeks as well as hot chips with chicken salt and chips. I have never looked into MSG. Could you tell me more about this as i really dont avoid any foods. I eat quite healthy though. My wife cooks basically every night but I have been known to eat my fair share of packet chips etc. Never found that has changed anything though. I have only ever noticed ham and other processed meats occasionally give me a bit of a spike for the day. 

In regards to an updose, I can only go to 4.5 as my tablets are compounded. Once I restart my taper in many months time i am going to look into making my own liquid solution so I can do smaller drops like the Brass Monkey slide method. At present I only have .25 as my smallest tablet. Cheers

[manymoretodays]

Hi Cruizer,

 

So........ it looks to me like you've been doing .5 mg tapers every 2 weeks, which sometimes equates to even more than a 10% taper from the previous dose in a 4 week period.

That might be catching up to you.  And so yes, I think it might be a good time to take a long HOLD.  That's just my opinion.

 

You've just been tapering by 1 mg every month(.5 mg every 2 weeks) for a long time now, irregardless of the previous dose.  That can and does sometimes have a funny way of catching up to one.......kind of a cumulative effect vs. basing each taper on the previous months dosage.

 

10 hours ago, Cruizer said:

In regards to an updose, I can only go to 4.5 as my tablets are compounded. Once I restart my taper in many months time i am going to look into making my own liquid solution so I can do smaller drops like the Brass Monkey slide method. At present I only have .25 as my smallest tablet. Cheers

 

Whatever you decide to do with the updose.......after that, and then a good long HOLD, I think the above is a great idea!  You could even go with weighing if you'd like.

 

Tips for tapering Zoloft(sertraline)

this will help you decide when you do resume tapering

 

I'm sorry it's gotten so tough lately, but also......look how far you've come.

 

Best,  L, P, H, and G,

mmt

 

 

 

 

 

Edited September 10, 2020 by manymoretodays
clarity

[Cruizer]

45 minutes ago, manymoretodays said:

Hi Cruizer,

 

So........ it looks to me like you've been doing .5 mg tapers every 2 weeks, which sometimes equates to even more than a 10% taper from the previous dose in a 4 week period.

That might be catching up to you.  And so yes, I think it might be a good time to take a long HOLD.  That's just my opinion.

 

You've just been tapering by 1 mg every month(.5 mg every 2 weeks) for a long time now, irregardless of the previous dose.  That can and does sometimes have a funny way of catching up to one.......kind of a cumulative effect vs. basing each taper on the previous months dosage.

 

 

Whatever you decide to do with the updose.......after that, and then a good long HOLD, I think the above is a great idea!  You could even go with weighing if you'd like.

 

Tips for tapering Zoloft(sertraline)

this will help you decide when you do resume tapering

 

I'm sorry it's gotten so tough lately, but also......look how far you've come.

 

Best,  L, P, H, and G,

mmt

 

 

 

 

 

Thanks MMT for weighing in on my situation. 

Yes the .5mg every 2 weeks was something that i did for close to 12 months. I was feeling better and better and just figured i would keep going that way until i noticed a shift and then I would slow down. Well i never imagined that shift would just be me falling off the side of a cliff. The headaches in that first 6-8 weeks back in March / April were intense to say the least. However I had noticed a turn for the better about 2-3 months from holding. I was working out again and just living ok. I was still having waves but they were only lasting a few days of severity with no real spike in cortisol or anxiety. 

Then i began drinking again (not massive, but a few beers here and there plus 2 larger sessions in mid June and early July). Then the headaches came back and after 3 weeks of intense headaches and some tears i decided to drop .25mg which brought me all the real acute symptoms of cortisol spikes, agitation, insomnia etc. Which is 100 times worse than anything i get. 

I know everyone on here is suffering or has suffered greatly, I just get so frustrated with my situation because I was in poopout for so long and it is very very difficult to tell the difference between that and actual withdrawal and what is side effects from meds and what is withdrawal etc.  The only really noticeable thing I can tell is the intense headaches i get in actual withdrawal. The rest of the symptoms can all be similar. Anyway, I have updosed to 4.5mg today which is where i have been for the majority of the last 6 months. I am expecting to see some quite ordinary waves in the coming months and then hopefully see them become less and less the months after. 

It honestly does not bother me much to take another 5 years to get off if i can get back to the mild symptoms I had before I crashed. 

Thanks again for your input.

[Altostrata]

You cannot drink alcohol.

 

17 hours ago, Cruizer said:

Now that is has been 4 days from the drop from 4.5mg to 4.25mg.

 

Please let us know how you're doing on 4.5mg.

 

With the upset from the alcohol, you may need to hold for a while, to let your system settle down.

[ChessieCat]

  

2 hours ago, Cruizer said:

I was wondering how you are taking your 2.2mg of sertraline I.e. your own liquid, cut and weighing tablets or are you getting them compounded? 

I currently get mine compounded which has worked really well and made it so much easier. However i am now down to 4.5mg. And the smallest increments my pharmacy does is 0.25mg so it will start to become too larger drops when I start to taper again. 

 

It's easy enough to make your own liquid from sertraline tablets.  I think some members have had a white substance settle at the bottom but you can add a tiny amount of alcohol to overcome this.  The amount you add would need to be included in the measured liquid. 

 

how-to-make-a-liquid-from-tablets-or-capsules

 

If you do decide to change to liquid it is gentler on your system to do a cross over.  Do not make a reduction at the same time.  You would take your dose:  3/4 tablet + 1/4 liquid for 3 or more days, 1/2 + 1/2, then 1/4 + 3/4 before going to all liquid.  If you find that your symptoms increase you hold for longer on that combination.

[brassmonkey]

 Sertraline will dissolve at a rate of 3.8mg/mL in water and 3mg/mL in 90 proof vodka.

[bubbles]

6 hours ago, brassmonkey said:

 Sertraline will dissolve at a rate of 3.8mg/mL in water and 3mg/mL in 90 proof vodka.

 

I'm sorry, not my thread, but this confuses me a little. Does that mean that I can get 3.8mg as a maximum amount of active ingredient in 1ml of water? But also more dilute if I wanted to?

[Cruizer]

Hi All,

Thanks for the replies and information regarding making your own liquid etc. Bubbles, don't worry that this is on my thread, ask as many questions as needed as we are all in this together and the information is key for me too.

I too find it a bit confusing and am also curious in how that works?

[brassmonkey]

@bubbles yes.  1mL of water will dissolve a maximum of 3.8mgai of  Sertraline. So 1mL of water will dissolve all of a 2mg tablet but not all of a 4mg tablet.  At most you can get a dilution ratio of 3.8:1(mg/mL). If you use a 2mg tablet you would get a 2:1 dilution ratio of if you use a 1mg tablet you would get a ratio of 1:1. But if you used a 4mg tablet or bigger, you would only get a 3.8:1 ratio.

 

Hope that helps.

[Cruizer]

2 minutes ago, brassmonkey said:

@bubbles yes.  1mL of water will dissolve a maximum of 3.8mgai of  Sertraline. So 1mL of water will dissolve all of a 2mg tablet but not all of a 4mg tablet.  At most you can get a dilution ratio of 3.8:1(mg/mL). If you use a 2mg tablet you would get a 2:1 dilution ratio of if you use a 1mg tablet you would get a ratio of 1:1. But if you used a 4mg tablet or bigger, you would only get a 3.8:1 ratio.

 

Hope that helps.

 

Thanks for clarifying Brass. Do you think it would be ok to create a liquid solution from the compounded tablets we both buy? So if I had my compounding pharmacy make me say a 5mg. tablet and then I put this into 10ml of water to dissolve and then drank 9ml giving me my current dose of 4.5mg. Does that sound accurate?

I think this would be a lot more accurate than if I started trying to crush 50mg Sertraline tablets up which is the smallest tablet they offer here in Australia. It would be far less time consuming and more accurate in my eyes to use the compounded tablet to make a liquid solution if you don't see any issues with that? I think bubbles would agree on this also

[bubbles]

My 2mg doses come as capsules. I hadn't thought of using the contents to make a suspension, but it's an interesting thought. The smallest tablets available here (unless things have changed in the last few months) are indeed 50mg as far as I know. (Well, really more than 50, but that's what the label says.)

[brassmonkey]

Yes that would work. Working with 10mL of liquid would give a lot of flexibility for your dose size. The trick is coming up with a cross taper plan to move from the tablets to the liquid is several steps.

 

The same goes for you Bubbles. This would be an actual solution and not just a suspension which would be easier to work with. Again the cross taper will present a bit of a challenge.

[ChessieCat]

I hadn't thought of using my capsule contents to make a liquid.  I'm trying it now.  I'm using a mini whisk to mix it up and it's gone very frothy, a bit like beaten egg whites.  It will be interesting to see if I end up with a usable liquid once the bubbles have broken up.  I'll let you know what happens.

[brassmonkey]

You're going to have to let it stand for several hours, preferably overnight, to allow for the dissolving to take place. Don't forget that moving to a liquid will need to have a cross taper.

[bubbles]

11 minutes ago, ChessieCat said:

I hadn't thought of using my capsule contents to make a liquid.  I'm trying it now.  I'm using a mini whisk to mix it up and it's gone very frothy, a bit like beaten egg whites.  It will be interesting to see if I end up with a usable liquid once the bubbles have broken up.  I'll let you know what happens.

 

Please let us know how it goes.

[ChessieCat]

7 hours ago, bubbles said:

 

Please let us know how it goes.

 

 

Everything dissolved, even the couple of very tiny pieces of pink tablet which I could see when I first put the contents of the capsule in the water.  My capsules are made with slow release formula and I imagine there is filler as well added.  It's good to know that I have this option available if needed.

[Cruizer]

Thanks for investigating Chessie. I will look into this also when i decided to move to liquid. 

Can you let us know if you do use this method moving forward so we know how you go. 

Brass and Chessie, when you say cross taper does that just mean holding the same dose when you switch between tablet and liquid or is it more along the lines of what Chessie said with doing some tablet and some liquid for a period of time (a few days etc.) 

[ChessieCat]

11 hours ago, Cruizer said:

Can you let us know if you do use this method moving forward so we know how you go.

 

It won't be until the last half of 2021.  I've already got my capsules prepared.  However, if I find my reductions are too large at any time at least now I know I can easily updose by a small amount if needed.

 

11 hours ago, Cruizer said:

Brass and Chessie, when you say cross taper does that just mean holding the same dose when you switch between tablet and liquid or is it more along the lines of what Chessie said with doing some tablet and some liquid for a period of time (a few days etc.) 

 

We call it a cross over (same drug different form), to differentiate it from a cross taper/bridge (changing from one drug to a different drug).

 

On 9/15/2020 at 5:45 PM, ChessieCat said:

If you do decide to change to liquid it is gentler on your system to do a cross over.  Do not make a reduction at the same time.  You would take your dose:  3/4 tablet + 1/4 liquid for 3 or more days, 1/2 + 1/2, then 1/4 + 3/4 before going to all liquid.  If you find that your symptoms increase you hold for longer on that combination.

[Cruizer]

Wanted to give an update and just make some notes. Since spending 4 days at 4.25mg and then up dosing back to 4.5mg on the 11th of September, I have had a better run of it in terms of severity of symptoms. My daily ratings/journaling was reflecting that and the anxiety is far lower. I have been a bit more enthusiastic about work and doing things, and also went away on a small family trip for 3 days which I enjoyed. I also went away for work for a few days and was in decent spirits for the trip.

In the last 3-4 days I have started getting significant head pressure again accompanied by fatigue and brain fog. Yesterday it was predominately around my eyebrows but today it has moved straight into the side of my head near my temples. Same type of head pressure as early on after my crash in March and again in July. Anxiety and depression are quite minimal which is good, but it is extremely hard to concentrate and put sentences together which is a problem as I am in sales for work. I am extremely forgetful too.

Nothing has really changed in the past month. I did swap my protein powder to another brand last week but it is still a natural one and wouldn't think that would be it. I was fine for the first week of using it. I also had 4 Non Alcoholic beers on Friday and Saturday just gone at some events, but they have no alcohol so that shouldn't be it either I wouldn't have thought. I am thinking maybe this is just a bit of a wave coming through but it is still a little confusing and also frustrating as I was hoping by now I would not be experiencing these ups and downs i.e. stabilizing. I have now been on 4.5mg since crashing in March so 7 months. This is aside from the 3 day and 4 day attempts to drop in July and August which increased anxiety 10 fold.

 

I have been tracking my daily symptoms and an average day looks like:

6-7am waking and feeling decent through the morning period just getting ready for work and sorting the kids out but can be mildly flat and irritated.

7:30-8am normally eat breakfast which is a protein shake with banana, berries, spinach and milk.

8:30am take my 4.5mg of Sertraline compounded and go to work

9:20am-10am is generally when I feel a shift in things which can be headache, irritable, brain fog, flatness.

12-1pm I eat lunch. Generally a roll or leftovers from dinner

2pm onwards I normally notice a shift for the better. Head symptoms can lift, mood better and a bit more productive at work or around the house on weekends

By late arvo/night I am normally feeling a lot better and play with the kids and do the night time routines. Gym at night time twice a week generally gives me a boost for a couple of hours and generally fall asleep at night pretty easily by 10:30-11am.

 

Above has been quite regular for about 6 weeks. There has been some ups and downs and changes to this, but overall that is an average day for me.

I generally feel a shift downwards everyday about 45 minutes to an hour after tablet in the morning which then starts to pick up in the afternoon. I am still stuck on whether this is a side effect / being caused by the medication, or whether this is still just me trying to stabilize after going too fast. I have been in poop out before on this drug and worked past it, but I am still obviously on the same drug just at a much lower level.  I want to wait this wave out before trying to taper again as this has brought me undone in the last couple of months by dropping. I kind of feel that if I dropped now and went South again to the severe agitation and panic that I would just be setting myself back again rather than seeing how things change over the next few months of holding. The good news is my compound pharmacist can do 0.1mg tablet so when I do decide to begin tapering, I can drop as little as 2.2% to begin with to test the waters.

 

I understand the waves and windows of recovering and have read through this often, but I am not off this med completely and am still so confused on whether this is withdrawal, a side-effect or poop out.

[ChessieCat]

15 minutes ago, Cruizer said:

also went away on a small family trip for 3 days which I enjoyed.

 

This can be stressful before, during and after, even if you don't feel it.  Simply because it is a change in routine.

 

16 minutes ago, Cruizer said:

I did swap my protein powder to another brand last week

 

Are they any different ingredients in it?  Or a higher/lower amounts of anything?

 

18 minutes ago, Cruizer said:

I also had 4 Non Alcoholic beers on Friday and Saturday just gone at some events, but they have no alcohol so that shouldn't be it either I wouldn't have thought.

 

Non alcoholic does not necessary mean that they are 100% alcohol free:

 

Non-alcoholic beer review | CHOICE

https://www.choice.com.au/food-and-drink/drinks/alcohol/articles/non-alcoholic-beer-review

"Is there any alcohol in non-alcoholic beer? Like decaf coffee, which does in fact contain a small amount of caffeine, non-alcohol beers can include some alcohol, up to 0.5% alcohol by volume (ABV), according to Food Standards Australia."

 

Also, were you overstimulated at the events, eg bright lights, loud noise/music, late nights?