Cruizer: sertraline / Zoloft nightmare

[Cruizer]

6 minutes ago, ChessieCat said:

 

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

 

 

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

 

 

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?

 

 

Hi Chessie,

 

I didn't find the trip stressful at all and this was also 2 weeks ago now.

 

Protein has different ingredients and higher protein and carbs per serve (trying to put on some weight). But I don't feel over stimulated at all, it is just the head symptoms.

 

Not sure what to say about the beer. I didn't feel any type of alcohol effect at the time of drinking them, but the headaches and head symptoms have increased significantly since the weekend just gone.

 

No overstimulation that I can say was out of the ordinary. Yes a couple of later nights and less sleep by maybe an hour but this has not been any different from other times during the past 7 months. I generally feel better when I am doing more i.e. socialising and working harder/exercising/playing with the kids. I always listen to loud music in the car and when working out and this has never been an issue even through the last 7 months. Bright lights don't really effect me and I drive a lot without even using sun glasses.

What I am saying is that nothing I have been doing I would classify is out of the ordinary too much. I talk to people all day with my job so going to a social event is no different. Sometimes I feel a bit off when going away for work, but this is more missing my kids and wife and quickly disappears when I am home.

[Cruizer]

Heineken 0.0

• Score: 45%
• RRP: $0.66/100ml ($12.99 per 6-pack)
• Alc/Vol: 0.04%
• Weight: 330ml bottle

This is what I was drinking. 0.04% x 8 over 2 nights is not even equivalent to having 1/10th of a normal bottle of beer.

[Cruizer]

Just a question I have. I have been looking through this site regarding Kindling. I haven't really found a definitive answer to what it is both here and on other websites. 

My understanding is that Kindling generally happens with drastic changes in drug doses up and down like full dose to zero back to full dose for example. Symptoms seem to be more of feeling activated I.e. anxiety, panic, rapid heart beat etc. And i am assuming quite constant. 

 

I am assuming if you have only reduced the drug through your taper and never increased by a large amount, than Kindling is pretty much not a consideration? I dont think I'm kindled as such just looking for more information on what people think it actually is. 

 

Ps: I have read the link on this site so more after someones opinion on what it is. 

[ChessieCat]

You might get some/more responses if you ask in the kindling topic.

[Cruizer]

Update from me and it comes with some frustration and also looking for guidance.

I have now been holding at 4.5mg for 9 months after a slightly too fast taper from 17mg down to 4.5mg in about 10 months. 

Without going over previous posts, I feel i have become stuck again with what to do next. After 9 months of holding after a crash, i feel that i am still pretty up and down. I had a decent 40 day period where i had not had a severe day. They were not great days by any mean but they were more manageable and mainly just consisted of flatness, irritation and anhedonia. I was starting to feel very similar to when i was in poopout, just not interested in much and flat. Then i started a course of antibiotics for an ear infection about a week ago.This was amoxicillin and since starting that i have had a big up kick in symptoms within about 4 days. I am just assuming this is what has caused the upkick. 

My question really is here and i will direct this @brassmonkey. When should i look to begin tapering again? Everyone talks about stability here before you start to taper again, however i have read where you have said several times that poopout is the exception to this rule! I sit here frustrated because it has been 9 months of holding and i feel like im getting worse in some ways. Everytime i think im doing the right thing and holding I feel very average at best. It will be 5 years in February since i began tapering albeit with a lot of holds. I have always felt better once i began tapering but am petrified that what happened to me 3 months ago will happen again if i drop dose. 

I have been able to get 0.1mg tablets so I can drop from 4.5mg to 4.4mg which is around 2.2%. I had planned on dropping this amount every 2 weeks which would give me a 5% taper roughly every 4 weeks. 

But Brass, how am i supposed to gauge whether my symptoms are indeed poopout or Withdrawal? I have really not been able to tell the difference in the past. I am trying to get in the right mindset as what to do here. Like you say in poop out to hold is just prolonging it and the only way is down. Do you think after 9 months of holding I should start tapering again? And my main question is if I was in poopout and have not come off the drug totally at any stage, is poopout likely to still be occuring at a lower dose? Thanks in advance. 

[ChessieCat]

Please condense your drug signature so that it doesn't take up so much room.  Since the software upgrade, some of the topics appear on the left side of the screen.  I'm using a desktop computer and your drug signature takes up the whole length of my screen so it makes it difficult to read posts.

 

I suggest that you post your current drug signature into a post so you still have access to the information.  Once that is done you can copy the link location and include that in your drug signature if you want to do that.

 

The section that I've changed to black font could be removed.

 

Also, there is no need to state the year for every date, just on the first mention of the new year.  And you only need to state the new dose not both the old and new:  6.0mg-5.5mg

 

Thank you.

 

Started Sertraline (Zoloft) September 2009. 50mg then to 100mg within a week. Severe reaction straight away. Severe agitation, anxiety and depression

Moved to 150mg in November 2010 and floated between 150mg and 100mg for the next 6 years. Always felt better on lower dose.

February 2016 began tapering: 150-125mg

for 4 weeks.

125mg-100mg for 4 weeks

100mg-87.5mg for 2 weeks

87.5mg-75mg for 6 weeks (this drop was ordinary for a week or so if severe symtoms)

75mg-68mg for 4 weeks

68mg-62.5mg for 2 weeks

62.5mg-56mg for 3 weeks. Had 3 weeks of basically no symptoms and then I crashed hard. It was like it all caught up with me. Went back up to 60mg and have been there since 5th August 2016.

At no stage has this medication made me feel better than I did before I was on it. I never had 95% of the symptoms I have now before I went on this poison

60mg-55mg on 28th December 2016; 55mg-50mg on 27th January 2017; 50mg-45mg on 20th March 2017; 45mg-40mg 1st June 2017; 40mg-38mg 1st July 2017; 38mg-36mg 15th July 2017; 36-34mg 31/07/17; 34mg-32mg 15/08/17; 32mg-30mg 30/08/17; 30mg-28mg 15/10/17; 28mg-27mg 30/10/17; 27mg-25mg 14/11/17; 25mg-24mg 29/11/17; 24mg-23mg 14/12/17; 23mg-22mg 29/12/17; 22mg-21mg 13/01/18; 21mg-20mg 28/01/18; 20mg-19mg 12/02/18. Held for 6 months at 19mg. 12/08/18 19mg-18mg; 10/09/18 18mg-17mg; Held for another 7 months. 17/04/19 17mg-16.5mg; 10/05/19 16.5mg-16mg; 24/05/19 16mg-15.5mg; 07/06/19 15.5mg-15mg; 21/06/19 15mg-14.5mg; 05/07/19 14.5mg-14mg; 14mg-13.5mg 19/07/19; 13.5mg-13mg 29/07/19; 13mg-12.5mg 08/08/19; 12.5mg-12mg 22/08/19; 12mg-11.5mg 05/09/19; 11.5mg-11mg 19/09/19; 11mg-10.5mg 03/10/19; 10.5mg-10mg 17/10/19; 10mg-9.5mg 31/10/19; 9.5mg-9mg 14/11/19; 9mg-8.5mg 28/11/19; 8.5mg-8mg 12/12/19; 8mg-7.5mg 26/12/19;

7.5mg-7.0mg 09/01/20; 7.0mg-6.5mg 23/01/20; 6.5mg-6.0mg 06/02/20; 6.0mg-5.5mg 20/02/20; 5.5mg-5.0mg 05/03/20; 5.0mg-4.5mg 19/03/20;

 

 

[ChessieCat]

2 hours ago, Cruizer said:

how am i supposed to gauge whether my symptoms are indeed poopout or Withdrawal?

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

The easiest way to work out if you are okay to taper after such a long hold is to make a small test reduction and see what happens.

 

If you get symptoms after making a reduction and then they improve that is withdrawal.

 

If you start to feel a bit better after making a reduction and then start to feel worse, that is poop out.

[brassmonkey]

Before the reaction to the antibiotics it sounds like you were getting stable. Antibiotics have a nasty habit of tripping off a wave for people who were felling pretty good. I would give yourself a few weeks to restabilize from the wave and then go head with your taper. Try the small reduction and see how it goes for a couple of weeks.

 

CC pretty well covered the difference between WD and Poopout symptoms when restarting a taper.

[Cruizer]

Thanks guys. As always appreciate your time and efforts to reply. I think in the new year i will begin my taper again and see how it goes. 

[Cruizer]

I made a very small reduction of .1mg which was around 2.3%. 

Unfortunately once again the symptoms have increased significantly within a couple of days. Last night insomnia hit again and today I feel like death warmed up. 

I am very discouraged as i am obviously still suffering withdrawal from earlier last  year. I am trying to keep my spirits up by telling myself I am probably still very sensitive due to alcohol back in July, then 2 attempted 6% drops in August and September which i had to updose and that really rattled me. Then i had a reasonable Oct and Nov but got smashed in December for about 3 weeks which seemed to be due to antibiotics I took. This only just let up about 5 days before i then reduced and now i am here. 

 

I am very upset with where I am currently at but feel it is best to go back to 4.5mg for a long while. 

 

I am looking for any encouragement from people as i really need it and am not in a good place at the minute. 

 

It seems this is no longer Poop out but rather normal withdrawal. 

Should I be looking to return to how i felt prior to the crash in March last year as my stability? And is it expected that at these lower doses withdrawal symptoms do increase with each drop? 

[Cruizer]

Hi All,

Just thought i would post to make record that at the start of this month marked 5 years since i began tapering back in 2016.

When i started the journey it was like a light bulb moment. Wow the drugs are making me feel this way and now i have found the path to get better i thought. 

Nothing could have prepared me for some of the tortuous periods i would go through in the last 5 years coming down the doses. Getting confused with Poopout and holding when i should have been tapering followed then by going too fast and crashing into actual withdrawal which is where i am still at now. This is truly an inhumane experience to go through and i feel for anyone that has been on these drugs and going through something similar. 

Current dose for me is 4.5mg of zoloft which when i started 5 years ago was at 150mg. I have come along way but still have a long way to go. For the time being i have put the thought of tapering on hold and just look to regain stability and enjoy life as much as possible in the meantime. 

One day this year after many months of stability, i will look to switch to making my own liquid solution and continue tapering at a snails pace. All the best

[RachelSusan]

@Cruizer

Hi Cruizer,

 

I have been following your journey. Thank you for the update. I have put my taper on hold many times during my journey because leading a stable and happy life is also the number one priority in my life. I want to wish you well in your desire for the same.  I think you will do great.

 

Warm wishes

[Cruizer]

Hi all, I think it's about time I reached out and asked for a little help. I've been holding my dose now for around 13 months which is 4.5mg of Sertraline. I have these compounded into a 4mg and .5mg tablet. 

I wanted to ask as I am hoping this might be the case @brassmonkey, I have read where you talk about the 8, 10 and 12 month waves. I have had 3 significant waves in the past 6 months and they coincide with these exact months of my hold. My latest wave has actually lasted the longest out of all my waves since I started my hold. Day 22 today and it started within a week of the 12 month mark of my hold. 

Prior to this wave I had the best period I have had for around 6 months. The good period lasted around 18 days but now I am finding the current wave to be the longest with quite severe head symptoms. My head symptoms are sinus pain over my right eye which comes and goes, and then just a real spacey feeling where it feels like my brain is floating in my head. This can follow on to a lot of head pressure in the sides of my head. Anxiety and depression aren't too bad, can come and go but I manage it pretty well. The previous bad wave was almost smack bang on the 10 month mark where I felt similar but probably higher anxiety for a few days. 

My sleep is ok, and I am not waking with any cortisol spikes, but my head is all over the place and I sometimes feel off this planet. 

I just wanted to ask for some advice as I started tapering over 5 years ago now albeit I have actually only tapered for about 28 months of that 5 years as there has been so many holds. I am managing life at the moment and am busy with full time work, 2 young boys and now coaching a football team. Am I busy yes, does that stress me, not really, it helps being busy and distracting myself from how poor I can feel. When I was in poop out a couple of years ago my main symptom was anhedonia. After this long hold that is not really the case. The head symptoms are the worst. 

I guess I am not asking a specific question other than can the 8,10 and 12 month waves hit a fast taper that hasn't quite got to zero? I read someone's post a while back saying fast tapers that don't quite get to zero still have similar wd issues and timing, the person just still has a small amount of drug they are still on. 

Prior to this wave nothing out of the ordinary happened I.e. no stressful event, no alcohol, nothing. In fact I stopped lifting weights well over 3 months ago now as I was worried that might have been effected me. No change after I cut that out, I'm just a skinny rake now lol. 

If Brass or @Altostrata might be able to review my situation that would be much appreciated. The only slight change happened about 1 week before the wave hit as I had to change the timing of my dose. This was only half an hour later though. I can feel the head pressure as soon as I wake but I reckon the majority of my symptoms come around 45 minutes to an hour after I take my daily dose in the morning. Thank you so much. 

[Altostrata]

Hello, @Cruizer I have not personally seen any pattern such as 8, 10 and 12 months regarding waves. Your perceived pattern may be coincidental.

 

It looks like your sleep improved since January? Can you remember how long it took to get back to normal-ish?

 

What times of day do you take your drugs, and their dosages? Are your symptoms better or worse at any particular times of day? Did sertraline always make you feel foggy? Did it always give you head pressure? Does it make you sleepy?

[Cruizer]

17 minutes ago, Altostrata said:

Hello, @Cruizer I have not personally seen any pattern such as 8, 10 and 12 months regarding waves. Your perceived pattern may be coincidental.

 

It looks like your sleep improved since January? Can you remember how long it took to get back to normal-ish?

 

What times of day do you take your drugs, and their dosages? Are your symptoms better or worse at any particular times of day? Did sertraline always make you feel foggy? Did it always give you head pressure? Does it make you sleepy?

Thanks for replying so quickly @Altostrata. Sleep has been OK for the majority of my hold, I was just getting some cortisol spikes in each wave which might last for a week for example. Outside of these waves my sleep has been fine. This wave I haven't really had any cortisol spikes that is all. I take my tablet at 8am in the morning and right on 8am every day give or take 5 mins here or there. 

For the most part my symptoms are worse in the morning and specifically around 45mins to an hour after tablet. This can last a couple of hours or more. I would say generally by about 230 3pm ish I start to feel a little better. 

No Sertraline did not always give me head pressure. Not until I started to taper 5 years ago. The head pressure comes and goes but has been the most prevalent during this 13 month hold. That was the first symptom that really showed up and made me hold my dose.

I have tried a few times to start my taper again but each time I dropped I felt a significant shift in symptoms. I have tried starting my taper again 3 times. Once in August, then September and then a tiny reduction in Jan this year. All 3 times I did not last more than 4 days when I retreated and updosed. I can say with hand on heart that my symptoms began getting worse since that first reduction in August and that's when I have had real problems. I had already been holding my dose for 4 months at that point. 

I am really lost as to what to do here. Yes I tapered quickly but it wasn't that quick. I went from 17mg to 4.5mg over a 10 month period and was feeling better and better during that 10 month period. I crashed in March last year after a large alcohol session about 3 weeks prior. Alcohol is no longer an issue. I have not had an alcoholic drink since July 2020. I have the occasional Heineken zero to be social but they are few and far between also. The brain fog and floating head are quite new to me during the last 13 months of holding. During the 6 years of taking Sertraline before beginning to taper, there was no real brain fog or floating head and pressure. 

[brassmonkey]

Because you are still taking the medication these waves would be a coincidence. The "late breaking waves" (8, 10 and 12 month) that I have talked about are a post "0" experience that happens to some people. Windows and waves that happen while still taking the medications are just that, windows and waves. They happen when they happen and sometimes hit at the same timing as the "late breaking waves".

 

I'm not seeing any reference to your three recent "failed taper attempts" in your signature. Would you please bring us up to date on what happened and where you are now.

[Cruizer]

Thanks @brassmonkey, was just a theory on the timing. I'm obviously clutching at straws as to why I am feeling worse for longer periods. 

I will try to tidy up my signature to shorten it and update. 

For now the 3 failed attempts went like this:

My last reduction was in march last year from 5mg - 4.5mg. As you can see by signature I had been dropping .5mg every 2 weeks for around 10 months and went from 17mg to 4.5mg. You said at the time an ever increasing percentage with no holds has caused a backlog and I have crashed

 The crash coincided with a large alcohol session a few weeks prior. So my hold began at 4.5mg in mid march 2020. 

The first 3 months were ok in terms of mood and emotional symptoms, it was just mainly headaches and head pressure. 

By June I was having longer windows and feeling far better which included an 18 day Window. I began drinking alcohol again in July and the headaches came back. 

My first attempt at dropping was to 4.25mg in August 2020. I lasted 3 days on this dose before going back to 4.5mg. During the 3 days I had a massive increase in anxiety and panic and felt extremely restless. On the first day of the updose I immediately felt a little better. Around 4 weeks later I was still having significant waves of anxiety and cortisol spikes in the morning which i wasn't having in the prior to trying to taper in August so I thought it might be poop out again. I made the same reduction in early September 2020 to 4.25mg and lasted 4 days this time. Same symptoms increased, extreme anxiety, panic and insomnia at night. I retreated again back to 4.5mg and again within a day felt more calm. October and November were better months and I had some particular clear periods in November. In December I took an antibiotic for an ear infection and that sent me into a wave of headaches and and anxiety again for around 3 weeks. Once this lifted I attempted to make a small 0.1mg reduction in early January. Again I noticed a difference within a day and by the 3rd day I wasn't sleeping and having vivid dreams etc. So I retreated back to 4.5mg. 1st day of updose was a little weird, I was really unsettled and cried uncontrollably. 2nd day of updose felt a little better. After early January this year I have not moved dose. 

My real problems and the Waves and Windows have come since I tried the first of 3 reductions. 

I am a little concerned how accurate my compounded tablets are. It's the only thing I can think of as to why there might be so much fluctuation still. I changed batches around 2 weeks ago and the headaches have really started up since then. When I did the last drop by 0.1mg I had to take my normal 4mg tablet + 4 x 0.1mg tablets made up. When you think about it, my compound pharmacist is making my capsules from a 50mg. Tablet. How accurate could a 0.1mg. tablet be? I mean it would be a spec of tablet. 

Perhaps my next move is to change to making my own liquid? 

I am just so lost as to why my waves are getting longer, and my head is pounding almost every day. I had a good window prior to this wave which was good and I thought from then on my waves would be shorter and windows longer, but it's not happening that way. Brass, if I was suffering from poop out before and I haven't come off all together could the med still be my problem? And could my 3 attempts to taper not been long enough to test whether I would feel better? Thanks for your input. 

[Altostrata]

Alcohol can pretty seriously upset the neurological apple cart when you're already vulnerable to sertaline withdrawal.

 

17 hours ago, Cruizer said:

For the most part my symptoms are worse in the morning and specifically around 45mins to an hour after tablet. This can last a couple of hours or more. I would say generally by about 230 3pm ish I start to feel a little better. 

 

This sounds like the effect of the tablet is too strong. You might do better with a split dose, such as 3mg in the morning and 1.5mg in the evening.

 

If you drink again, all bets are off.

 

Please let us know how you're doing.

[Cruizer]

3 minutes ago, Altostrata said:

Alcohol can pretty seriously upset the neurological apple cart when you're already vulnerable to sertaline withdrawal.

 

 

This sounds like the effect of the tablet is too strong. You might do better with a split dose, such as 3mg in the morning and 1.5mg in the evening.

 

If you drink again, all bets are off.

Hi Alto, I have not had any alcohol since July 2020. That's 9 months. Occasionally I have a zero alcohol beer to be social but they have no alcohol. 

If I was to split the dose, wouldn't that make my levels inconsistent kind of like alternating days? I am more inclined to thinking perhaps my compounded tablets aren't accurate enough. 

[Altostrata]

21 minutes ago, Cruizer said:

If I was to split the dose, wouldn't that make my levels inconsistent kind of like alternating days?

 

No. I would not suggest it if it was likely to trigger withdrawal symptoms.

 

Your symptom pattern suggests your morning dose is too strong. But you are having trouble reducing, so splitting the dose probably will be more comfortable for you.

[Cruizer]

On 5/1/2021 at 6:30 AM, Cruizer said:

Thanks @brassmonkey, was just a theory on the timing. I'm obviously clutching at straws as to why I am feeling worse for longer periods. 

I will try to tidy up my signature to shorten it and update. 

For now the 3 failed attempts went like this:

My last reduction was in march last year from 5mg - 4.5mg. As you can see by signature I had been dropping .5mg every 2 weeks for around 10 months and went from 17mg to 4.5mg. You said at the time an ever increasing percentage with no holds has caused a backlog and I have crashed

 The crash coincided with a large alcohol session a few weeks prior. So my hold began at 4.5mg in mid march 2020. 

The first 3 months were ok in terms of mood and emotional symptoms, it was just mainly headaches and head pressure. 

By June I was having longer windows and feeling far better which included an 18 day Window. I began drinking alcohol again in July and the headaches came back. 

My first attempt at dropping was to 4.25mg in August 2020. I lasted 3 days on this dose before going back to 4.5mg. During the 3 days I had a massive increase in anxiety and panic and felt extremely restless. On the first day of the updose I immediately felt a little better. Around 4 weeks later I was still having significant waves of anxiety and cortisol spikes in the morning which i wasn't having in the prior to trying to taper in August so I thought it might be poop out again. I made the same reduction in early September 2020 to 4.25mg and lasted 4 days this time. Same symptoms increased, extreme anxiety, panic and insomnia at night. I retreated again back to 4.5mg and again within a day felt more calm. October and November were better months and I had some particular clear periods in November. In December I took an antibiotic for an ear infection and that sent me into a wave of headaches and and anxiety again for around 3 weeks. Once this lifted I attempted to make a small 0.1mg reduction in early January. Again I noticed a difference within a day and by the 3rd day I wasn't sleeping and having vivid dreams etc. So I retreated back to 4.5mg. 1st day of updose was a little weird, I was really unsettled and cried uncontrollably. 2nd day of updose felt a little better. After early January this year I have not moved dose. 

My real problems and the Waves and Windows have come since I tried the first of 3 reductions. 

I am a little concerned how accurate my compounded tablets are. It's the only thing I can think of as to why there might be so much fluctuation still. I changed batches around 2 weeks ago and the headaches have really started up since then. When I did the last drop by 0.1mg I had to take my normal 4mg tablet + 4 x 0.1mg tablets made up. When you think about it, my compound pharmacist is making my capsules from a 50mg. Tablet. How accurate could a 0.1mg. tablet be? I mean it would be a spec of tablet. 

Perhaps my next move is to change to making my own liquid? 

I am just so lost as to why my waves are getting longer, and my head is pounding almost every day. I had a good window prior to this wave which was good and I thought from then on my waves would be shorter and windows longer, but it's not happening that way. Brass, if I was suffering from poop out before and I haven't come off all together could the med still be my problem? And could my 3 attempts to taper not been long enough to test whether I would feel better? Thanks for your input. 

@brassmonkey would you be so kind as to give me some feedback/advice on above? Thank you

[brassmonkey]

The one thing you didn't mention is if you are still drinking. Even just a few nights several months ago can destabilize things for a very long time.

 

Once a person has tapered out of poopout it is still possible for it to happen. If there are prolonged holds it is possible for the poopout to catch up and start causing problems again. As with the first time the only way out is down.

 

I'm not a fan of compounded tablets, especially at very small doses. The manufacturing tolerances are just too big for my taste and can cause inconsistent dosing.

[Cruizer]

2 hours ago, brassmonkey said:

The one thing you didn't mention is if you are still drinking. Even just a few nights several months ago can destabilize things for a very long time.

 

Once a person has tapered out of poopout it is still possible for it to happen. If there are prolonged holds it is possible for the poopout to catch up and start causing problems again. As with the first time the only way out is down.

 

I'm not a fan of compounded tablets, especially at very small doses. The manufacturing tolerances are just too big for my taste and can cause inconsistent dosing.

Thanks for the reply mate. I haven't had an alcoholic drink for 9 months. I occasionally have a few Heineken zeros at an event but not often. This last wave just came out of the blue and has lasted a long time. My main symptom is headaches, and floating brain. I'm often raising my eyebrows or scrunching my face because of the weird feeling which is what I used to do in the past for the first couple of days after a drop. 

It has been on my mind for a while regarding the compounded tablets. I reckon my next step is to switch to making my own liquid. I will look into buying the right equipment I.e. syringes etc. 

@brassmonkey I have read about people cross tapering to liquid but as I am having a 4mg and a 0.5mg tablet compounded I can't really do this. Would you think a switch straight to liquid from 4.5mg of sertraline give me too many problems? Thanks again

[brassmonkey]

Some people have problems adjusting to the liquid, whether homemade of commercial, which is why we recommend a crossover. The switch can be made without doing it, but pay close attention to your symptom pattern.

[Cruizer]

7 minutes ago, brassmonkey said:

Some people have problems adjusting to the liquid, whether homemade of commercial, which is why we recommend a crossover. The switch can be made without doing it, but pay close attention to your symptom pattern.

Not sure on how else I could do it. I could perhaps ask the compounding pharmacist for a 2mg tablet or even a 3mg. And make the rest liquid. How long should the cross taper be over and in how many steps ideally? When you say watch my symptom patterns, what symptoms do people normally expect when doing a cross over to liquid and how long do they normally take to settle out? Thanks

[brassmonkey]

The normal crossover is to replace all of the 4.5mg dose with liquid. So you would do 75% solid 25% liquid for a week or two, then 50/50 for a couple more weeks then 25/75 and then finally 100% liquid.

 

For each 4mg tablet dissolve it in 1mL of vodka and then add 3mL of water. Let  it sit in a closed bottle over night. This will give a solution of 1:1 which is easiest to calculate dose size with. You will have to make up two tablets at at time to get the extra 0.5mg of dose, but the extra will store for several days in the refrigerator.

 

Any uptick in symptoms that is more that the norm for a reduction could be a indication that things aren't right. It may take a few days to settle into each stage, which is why you need to hold for a week or two each time. Any symptoms should settle by the time you are ready for the next step.

[Cruizer]

HI @Rusty1, I hope you don't mind me tagging you in my thread. Wanted to have somewhere to review later. 

Firstly congrats on reaching zero. Looks like your doing well. 

I was hoping you might be so kind as to answer a couple of things for me. I read your thread and it appears we have some similarities in symptoms and issues at lower doses. I have been getting my sertraline compounded for the past 4 years or so. I have come from 150mg down to 4.5mg with a lot of holds involved along the way. I tapered from 17mg to 4.5mg in 10 months and after a large alcohol session seemed to crash. I have been holding close to 15 months now and I really haven't seen any major improvements. I have Windows where the symptoms are much milder for anywhere between 4-18 days, but then I get hit with another bad wave. I keep a daily journal and have noticed a pattern of when I get a new batch of compounded tablets, something changes either for the better or worse within a short time. This last for a couple of weeks and then it changes again. I take two compounded tablets, 1x4mg and 1x0.5mg.both at the same time each morning. I am starting to wonder whether the compounded tablets have too greater variance between batches and perhaps that is why I'm still suffering despite holding for 15 months. I had issues with poopout earlier on too. 

 

My question to you is

1) how long after you changed to a liquid solution did you notice A significant difference in stability? 

2) Did you change to liquid and then taper straight away or did you hold for a while to see how you went?

3) When tapering from liquid, was it a lot smoother? Did you still have significant waves and windows during tapering with liquid or was it more stable? 

 

Anything else you might like to add would be appreciated. I'm in a wave again and it is extremely disheartening to be feeling this bad and still on the medication. This med has never agreed with me fully, and the symptoms I'm having now were similar to when I was on a full dose. That is aside from the head pressure and sinus pain which seem to be new since crashing 15 months ago. 

 

Thanks in advance and again, congratulations on getting to zero after a long taper. 

[Rusty1]

1 hour ago, Cruizer said:

HI @Rusty1, I hope you don't mind me tagging you in my thread. Wanted to have somewhere to review later. 

Firstly congrats on reaching zero. Looks like your doing well. 

I was hoping you might be so kind as to answer a couple of things for me. I read your thread and it appears we have some similarities in symptoms and issues at lower doses. I have been getting my sertraline compounded for the past 4 years or so. I have come from 150mg down to 4.5mg with a lot of holds involved along the way. I tapered from 17mg to 4.5mg in 10 months and after a large alcohol session seemed to crash. I have been holding close to 15 months now and I really haven't seen any major improvements. I have Windows where the symptoms are much milder for anywhere between 4-18 days, but then I get hit with another bad wave. I keep a daily journal and have noticed a pattern of when I get a new batch of compounded tablets, something changes either for the better or worse within a short time. This last for a couple of weeks and then it changes again. I take two compounded tablets, 1x4mg and 1x0.5mg.both at the same time each morning. I am starting to wonder whether the compounded tablets have too greater variance between batches and perhaps that is why I'm still suffering despite holding for 15 months. I had issues with poopout earlier on too. 

 

My question to you is

1) how long after you changed to a liquid solution did you notice A significant difference in stability? 

2) Did you change to liquid and then taper straight away or did you hold for a while to see how you went?

3) When tapering from liquid, was it a lot smoother? Did you still have significant waves and windows during tapering with liquid or was it more stable? 

 

Anything else you might like to add would be appreciated. I'm in a wave again and it is extremely disheartening to be feeling this bad and still on the medication. This med has never agreed with me fully, and the symptoms I'm having now were similar to when I was on a full dose. That is aside from the head pressure and sinus pain which seem to be new since crashing 15 months ago. 

 

Thanks in advance and again, congratulations on getting to zero after a long taper. 

No problem.  I would be happy to help, although when it comes to compounding, cutting pills, and making a liquid I only know how it worked with my medication (Paroxetine) I dont know the differences or how yours works.

 

I became sensitive to doses that were even slightly greater than what I was taking. Just refilling my prescription to a more recently produced pill even if I took the same amount would cause a bad reaction because my body thought it was an updose. This is when my symptoms got to their worst. 

 

What I did was when still cutting pills I would take my newly refilled prescription and time using them when I did a drop, so it would counteract any slight strength increase. I was very sensitive and

could tell within hours if my body was going to tolerate it well or not. Once I felt how my body was tolerating it I could adjust accordingly.

 

There did become a point where I felt the cutting was no longer accurate enough and I was experiencing instability so I started to make my own liquid. Some people do a slow cross taper from pill to liquid. Since I was using the same pills to make my on liquid and not changing to a manufacturer supplied liquid I just used the time when I would have been scheduled for a drop to do a straight across switch to the liquid at the same dose.

 

I was putting my cut pills in gel caps as I noticed small fragments may break off if I put them in a pill box. So to keep things similar and not switch my body to processing it much differently I would dose my liquid into a gel cap and take it. I had very minimal symptoms for a week or two when switching and then my body felt adjusted to it.

 

Once changing to liquid I noticed my body felt the benefits of being able to get a more consistent dose. It may have been coincidental but I feel like it helped me stabilize from my previous state and made all my drops after easier to tolerate. From then on i did micro-reductions as the liquid allowed me to do smaller reductions and I rarely had any withdrawal symptoms that were overwhelming. Most my remaining symptoms felt like residuals of recovering from my previous bad state and just general CNS sensitivity as our bodies are out of whack as we are tapering.

 

I hope that helps and wish you good luck!

[Cruizer]

Update from me and things are continuing to get worse. The waves of more intense symptoms are getting longer and more intense than previously. To give you an example, back in October and November last year, waves were around 1 week and were followed by decent windows where I would be more motivated etc. Now my waves are lasting far longer and consist of more intense anxiety, cortisol spikes in the morning, anhedonia (really noticed this) loss of weight, dizziness, depersonalisation at times. I'm now having intense crying spells which seem to creep up out of nowhere. Last night I could sleep for hours at the start of the night due to crying and restlessness. 

I have been holding my dose for 16 months now. I was in poopout before this. I have not drunken alcohol for over 12 months now. I have also stopped lifting weights and really any form of physical exercise around 6 months ago as I thought that might be contributing to feeling bad. But I continue to feel worse. I went through an 8 week wave starting in April which is the longest I have ever had a wave for. This lifted when I changed batches from my compounding pharmacy and I had a decent 2 week period where I thought maybe something was changing for the better. Than at the 3 week mark of the change in batch all he'll broke loose again and have been in the worst wave for the last 3 weeks. It does fluctuate daily but has had really intense periods worse than anything in the last 10 months. 

@brassmonkey sorry for rambling but I'm totally lost as to what is going on. I started tapering in 2016 and everytime I continued to hold I have felt worse until I started to taper again. This has happened 3 times before and this is now the 4th time. I just thought I might be in withdrawal this time and needed to continue to hold dose due to a slightly fast taper (10mg to 4.5mg in 5 months.) Which I then crashed from after a heavy alcohol session. That was 16 months ago though. My wife is saying I should be dropping again and changing to liquid. I am thinking it can't get much worse than it is now. What do you think? Does anything stick out to you in above? Thanks 

[brassmonkey]

It sounds like you maybe hitting tolerance again and it is time to restart your taper. Tapering out of tolerance can be quite frustrating because it often feels like nothing is happening for a fairly long time, things possibly can get a bit worse until your body understands what is happening. It looks like you have been tapering at 2.5% when you do a reduction. That would be a good place to start. Make sure to give it a nice hold, at least four weeks before the next reduction and don't expect to see any improvement for several reduction cycles. 

[Cruizer]

Thanks Brass. I am going to shift across to liquid shortly and then start to taper again. I might wait a little longer before doing this just due to my coaching commitments for my footy. Although I feel very bad now, I just don't want to feel worse whilst I still have this commitment. Once this is over it will be head down and into tapering. I am not going to coach again next year to really focus on getting back into tapering and hopefully putting myself on the right track. It's disappointing as I do get some joy from coaching but don't need the added pressure. It is a frightening place to be in tolerance, you feel completely out of control, I worry I will make things worse by tapering where it might actually get better. But if I continue to hold I may just be prolonging everything. 

Thanks again Brass

[Cruizer]

Hi @Altostrata @brassmonkey.

I need some insight please. 

Without going through what I have written previously, I have been sitting at 4.5mg of Sertraline for 18 months now. I rate my days between 0-4 on how severe symptoms are and I am worse in the 2nd 9 months than what I was in the first of holding. I've been in tolerance before and have had significant issues with the medication prior to tapering. 

4 days ago I started to make my own liquid. I only changed my 0.5mg compounded tablet to liquid and still take the 4mg. compounded tablet. Within a day I had severe cortisol spikes at night, severe nausea and insomnia. 

I have read that when people change to liquid it can be a bit more stimulating due to getting in your body quicker. Perhaps this could be confirmation my body is after less of the drug?

What makes it hard is I was already struggling with symptoms but have found the last 2 days to be particularly brutal. 

I'm so lost as to what I should do. My gut is saying keep going on the liquid and taper as to see what happens. Holding wasn't helping. 

With what I described above, should I maybe taper the liquid a bit. Does this sound like an adverse reaction or tolerance issue? The first 2 nights I woke with a burning back, like I was on fire too. 

Thanks 

[Altostrata]

@Cruizer have you been drinking, smoking, taking doses off schedule, or taking other drugs?

 

Without knowing the above and your daily symptom pattern, I cannot begin to guess if your symptoms are from the sertraline you're taking, and whether reducing your dose will help.

 

I do not assume you are in tolerance from sertraline. The concept of tolerance does not really apply when it comes to withdrawal symptoms.

[Heinz1903]

@Altostrata @Cruizerhas a good point, without knowing your symptom patterns you make it hard for yourself.

 

But i do wonder if you have taken any coffee,Smoking, drinking.

From my personal experience not the greatest thing to do.

 

Do you use sleeping medications,  Maybe it's not the zoloft u are intollerant for because everyone is.

But honestly never experienced a hot back on fire, but do notice when taking certain medications or supplements my whole nervesystem goes apeshit for 2 days.

 

Keep check on your patterns. Write everything down. Also download the check list on the website, mark everything so you stay sane.

Look i have beent there in june. It's painfully hard process. i'm now 3 months further and doing alright eventho my summer vacation was ruined by WD symptoms.

 

 

 

[Cruizer]

1 hour ago, Altostrata said:

@Cruizer have you been drinking, smoking, taking doses off schedule, or taking other drugs?

 

Without knowing the above and your daily symptom pattern, I cannot begin to guess if your symptoms are from the sertraline you're taking, and whether reducing your dose will help.

 

I do not assume you are in tolerance from sertraline. The concept of tolerance does not really apply when it comes to withdrawal symptoms.

Hi @Altostrata and @Heinz1903, No I have not drunk alcohol, drugs or smoking. I take my dose of sertraline at 8am every day within a minute or so. I do drink coffee twice a day but find this helps perk me up a little. 

 

Without rewriting it all, if you refer to my post above on Aug 2nd this is what has happened to me. 

 

Can I ask why you don't think I am in tolerance? I really just want to work out my next move. I have been holding for 18 months now and my symptoms have been getting worse not better. Brass explains tolerance as the body tolerating the drug and trying to get around it which causes withdrawal symptoms. 

It is hard for me to give a daily pattern as it does change. I am going through what you could say is windows and waves but in the past 10 months the waves are getting longer and the windows shorter which isn't what I would expect. I started tapering over 5 years ago now and prior to tapering had a lot of the same symptoms I have now. I have found in all 4 times I have held for a period of time (6months or longer) I feel worse. 

My main question was more to do with switching to liquid as this is what has caused a big upkick in the last 4 days. As per usual I feel an increase around 30 minutes after taking my dose which has basically been the same always just in varying degrees. 

Like I mentioned in previous Aug 2nd post, I basically stopped all exercise due to me thinking it maybe too activating. I have not drunken an alcoholic drink since July 2020 so 14 months ago. 

But still I feel worse. 

I was willing to accept I was in withdrawal when I crashed in March 2020. But that was 18 months ago. I was feeling better an better on the way to 4.5mg and saw no warning signs that I was about to crash. 

 

Alto, perhaps if you have no questions for me to answer in order for you to work out whether this is tolerence, withdrawal, adverse reactions / side effects of zoloft?

I take no supplements what so ever. 

[Altostrata]

If switching to liquid has caused an increase in your symptoms, I would go back to the tablet dosage you were taking before. My guess is further tapering of sertraline will not help.

 

Some people have a very difficult time going off sertraline, particularly when they get to very low doses. Your history of withdrawal syndrome is obscured by the probable adverse effects from your drinking, but you may be one of those people who need a bridge to get off sertaline.

 

Usually, doctors would use fluoxetine (Prozac) as that bridge. Citalopram may also work. See The Prozac switch or "bridging" with fluoxetine

 

A gradual crossover is best. You might start by adding 0.5mg liquid citalopram or fluoxetine to your sertraline dose and see what that does. Then, over 2 weeks, gradually increase citalopram or fluoxetine while gradually decreasing sertraline until you are taking  4.5mg citalopram or fluoxetine and zero sertraline.

 

You'd stabilize on that for some months and then gradually taper off.

 

If liquid fluoxetine or citalopram are not available in Australia, you may need to make your own liquid.

 

Are you near Melbourne, by any chance?