zma1: Lexapro withdrawal on very low dose?

[zma1]

I have no idea what my dose is in mg. Somewhere btw 5-1mg. I can’t do that kind of math and I can’t find a chart that’s tells me. 
I time my taper with the worst of it hitting me on my days off. 
oh. My understanding was that Prozac was the easiest to stop because of the longer half life and Zoloft was not as bad as Paxil, but quite difficult regardless

[ChessieCat]

1 hour ago, zma1 said:

I have no idea what my dose is in mg. Somewhere btw 5-1mg. I can’t do that kind of math and I can’t find a chart that’s tells me. 

 

If you are taking Zoloft prescription liquid the concentration is 20mg/1mL according to https://www.drugs.com/pro/sertraline-oral-solution.html  This equates with your drug signature amount 6.25mg = 0.31mL.

 

From my calculations your current dose of 0.2mL is 4mg.

 

I've been able to use the mL information in your drug signature to calculate the percentages you have dropped by.  Check out the decreases you have made from 13 March to 16 April this year.  So yes, you have been tapering too quickly.

 

Feb 13, 2022: crossover from 6.25mg dose tablet to 6.25mg dose/.31ml liquid;

Mar 13 2022: 0.28 ml    9.67742% decrease

14 days

Mar 27, 2022: 0.25ml   10.7143% decrease

6 days

Apr 3, 2022: 0.23ml     8% decrease

7 days

Apr 10, 2022: 0.22ml   4.34783% decrease

6 days

Apr 16,2022: 0.20ml    9.09091% decrease

 

1 hour ago, zma1 said:

My understanding was that Prozac was the easiest to stop because of the longer half life

 

Different psychiatric drugs have different bad side effects.  If you change to a different drug then you might get withdrawal symptoms from the old drug and/or adverse/side effects from the new drug and because there have been two variables it can be difficult to know what is causing any issues.  When I was taking Prozac I ended up with weak muscles.  My hip muscles were so bad it felt like they did when I was in the last trimester of pregnancy when the muscles get loose in preparation for birth.  I had a lot of trouble walking.  Zoloft made me very tired, I was okay on citalopram until it pooped out, and then I ended up on Pristiq and when the dose was increased I ended up with mild serotonin syndrome.  That will give you an idea of how different drugs can have different issues.

 

One of the issues with Prozac can actually be the long half life.  It can take 2-3 weeks for the brain to fully adapt to a dose so if you end up taking too much, then the reverse is also the same, it can take several weeks for the new lower dose to come fully into effect.  So you could end up being in discomfort for about 6 weeks.  Erell did a Prozac switch because she was having difficulties getting off Paxil, but even now 2 years later she is still having issues, and she ended up adding a benzo 4 months after the switch.

 

Also, you are now on a low dose of Zoloft and apart from your recent issues which are most likely from reducing too quickly (see earlier in my post) you don't seem to have had any problems with the drug.

 

One thing to note is that many members find that the lower their dose gets the slower then need to go, reducing less and/or holding longer.  This is possibly due to the SERT occupancy of the drug.  This post (which gives a like to SA's SERT topic) is fairly easy to understand:

 

  

On 4/29/2022 at 1:41 PM, Scrountz said:

 

Even low doses of SSRIs can have a pretty potent effect on the nervous system. A lot of doctors don't appreciate that the minimal dose of an antidepressant medication is still really strong. This link here illustrates this. If you don't have a science background it can be a bit hard to understand, but basically even the lowest dose of an antidepressant still fills about 80% of the receptor sites that its supposed to. Increasing the dose of medication does not increase its effectiveness proportionately.

 

 

[zma1]

So is 0.1ml = 2mg? 
 

I have that hip thing too! I remember that last trimester feeling. But now it sort of flares it’s not 100% of the time, but it gets bad when I’m laying down. I get lots of joint pain on and off but chalk it up to perimenopause. Actually anything could be peri or Zoloft they’re all the same symptoms. 
 

I did read the info yesterday actually. I read the entire thread and still only have a general understanding and not total understanding of Sert occupancy. It’s fine tho. I understand enough. Im just anxious to be rid of this damn drug so I can try to solve all the sh*t that is still bothering me but I can’t sort anything out until im done w the Zoloft. My relationship, career, life is on hold until I can get free to try something else. At this point I don’t even know if my trauma therapy worked or if I need more? Do I need HRT? I can’t even try a new thing until this is over. It’s so frustrating.  
my main prob w Zoloft and why I want off,  is low energy, gaining a ton of weight and zero libido. I have every perimenopause symptom of th30-60 that are listed and I don’t know if it’s ssri or peri so that’s the prob w zoloft.

yes it helped my anxiety but the downsides are too much.

I’ll go slower. I’m an adjunct professor and my semester is ending so I was wanting to take the summer to be insane and go through final withdrawal but my professional career is in the toilet because of my mental problems I guess my teaching career is next. Sucks

[ChessieCat]

42 minutes ago, zma1 said:

So is 0.1ml = 2mg? 

 

Yes, that is correct.

 

I've just noticed this in your drug signature:

 

Periodically or as needed: Flonase

 

Some members have issues with steroids, even sprays and eye drops.

 

https://prednisonepharmacist.com/prednisone-warrior-stories/steroid-withdrawal-from-flonase/

  

See:

 

On 3/16/2012 at 10:26 AM, Altostrata said:

 

I have springtime allergies, too.

 

I use Pataday eyedrops for itchy eyes and fluticasone (Flonase) nasal spray.

 

UPDATE: Since 2012, I've changed to ketotifen eye drops and azelastine nasal spray -- they are non-steroidal. Steroidal drops and sprays can advance cataracts or glaucoma.

 

I'd avoid taking an antihistamine if you have withdrawal symptoms. They affect the histamine receptors http://en.wikipedia.org/wiki/Histamine_receptor , which may be involved in withdrawal syndrome.

 

Saline rinses (use sterilized water!) can reduce nasal symptoms.

 

 

[Altostrata]

9 hours ago, zma1 said:

I have no idea what my dose is in mg. Somewhere btw 5-1mg. I can’t do that kind of math and I can’t find a chart that’s tells me. 

 

Are you using prescribed liquid? Please talk to your pharmacist to find out how much you're taking in milligrams now. We need this information.

 

You may be experiencing instability from your prior irregular tapering. Suggest you hold at your current dosage for a month to allow your nervous system to settle down. You may be pushing your taper too far.

[zma1]

I haven’t taken the Flonase for about two months. I’ve read it’s not that great so I’ll do it when I’m having extreme allergy symptoms. It’s also usually period related but I can often get by w nasalchrom and quercetin. 
 

I will try to go to a Kaiser pharmacy and speak w someone, and yes I’m not planning another reduction soon. 
btw got my period yesterday and The depression has lifted but I’m still feeling “edgy”. Like a hangover from a anxiety spike. 
thank you for the guidance btw

[Altostrata]

Many women find their withdrawal symptoms get worse at times in their menstrual cycles.

[zma1]

So how are so many women going on and off SSRIs for PMDD each month— or doubling their dose during the last 2 weeks and then reducing by half the other two weeks every month? Is it because PMDD works differently on you than say GAD or depression? I def don’t think I could do that without feeling awful and on edge all the time.

[zma1]

I’m confused. If I went on ssri to help w anxiety disorder then felt ok then started tapering then the anxiety comes back w a vengeance — I know this is withdrawal anxiety but then when folks finally heal from the withdrawal they no longer have the problem they initially went on SSRIs for? 

[getofflex]

2 hours ago, zma1 said:

I know this is withdrawal anxiety but then when folks finally heal from the withdrawal they no longer have the problem they initially went on SSRIs for? 

Actually, many of us do deal with the issues that we were originally put on the drugs for.  It's just that we learn non drug ways to overcome, or cope with it.  Some of us learn to live with it.  There is even a guy called Will Hall who is drug free, and he lives with auditory (I think) hallucinations and accepts them.  I have more anxiety now that I'm almost off Lexapro, but I use various ways to cope with it without drugs.  

[ChessieCat]

2 hours ago, zma1 said:

but then when folks finally heal from the withdrawal they no longer have the problem they initially went on SSRIs for?

 

The drug doesn't magically cure or get rid of the reason why we went on it for in the first place.  As getofflex said we need to learn non drug ways to cope.  I often suggest to members who have been on a psychiatric drug since their 20s to see a counsellor and learn general life coping skills, because if they have been numbed during their early years they have not experienced life without the drugs so have probably not learned how to deal with the normal ups and downs and stresses of living.

[zma1]

I started in my 40s. I’ve always been cautious and sensitive but my anxiety got unbearable and more problematic after I gave birth to my child at 39. Bad postpartum and never felt “right” since. I’m wondering if I’m cursed w needing a drug to get by until after menopause. I dunno. Having a wave today and it doesn’t seem to be related to period flux just wdrawal I guess

[Altostrata]

On 5/4/2022 at 7:50 PM, zma1 said:

So how are so many women going on and off SSRIs for PMDD each month— or doubling their dose during the last 2 weeks and then reducing by half the other two weeks every month? Is it because PMDD works differently on you than say GAD or depression? I def don’t think I could do that without feeling awful and on edge all the time.

 

Good question. If you have any reports or papers about how well those women are doing, or how often this type of treatment is successful, please post them here. To my knowledge, nobody knows whether this works well, or if most women give up on it after getting intermittent withdrawal symptoms. If doctors prescribe it, it's because drug companies claim it works.

[zma1]

Oh I don't see any research on this but when I look up PMDD this intermittent dosing schedule seems to be the first thing that is recommended. It seems terrifying to me

[zma1]

Extreme depression now

[zma1]

I need some input please. I’ve stayed at 0.18ml of sertraline liquid (approx 3mg?) for about a month and I’m suffering terribly w depression and suicide ideation. I can’t stop crying. I felt horrible physically but I don’t care compared to the mental torment. I think this is because I’m perimenopause and should never have gone on ADs but rather HRT. It’s too late now and I’m trying to get on a low dose HRT hoping it will help me stabilize. Im not convinced the depression I’m feeling is from my withdrawal from sertraline because it extremely acute either before or after my period. My periods are getting more and more erratic. 
what should I do here? I’m so desperate I was on my way to walk into my psych doc office at Kaiser to beg for help but realized they’ll just up my dose and have no idea how perimenopause would play into this. The gyno had no knowledge of HRT and would have no knowledge of ssri wd. 
 

Could I be having wd symptoms daily from the low dose of sertraline? Because I’m terrible in the morning (I take med mid morning) then by evening I usually hopefully get a window but again it could be nothing to do w ssri but just intense perimenopause symptoms. 
 

im not sure what to do but I’ve got a daughter and I can’t be like this.

thank you

 

[ChessieCat]

1 hour ago, zma1 said:

Could I be having wd symptoms daily from the low dose of sertraline? Because I’m terrible in the morning (I take med mid morning) then by evening I usually hopefully get a window

 

Q:  Is this a regular pattern?

 

Q:  How often are you taking:  Lorazepam .5 -.25 mg?

 

Please note that I am assuming that you are not taking, or very rarely take, the Lorazapem.  If you are taking it 2 or more times a week then the following might not be applicable.  And what I am going to write is only my thoughts and not a definitive answer.

 

There are a couple of things that you could investigate to see if it helps.  BUT only make one change at a time.  Zoloft has a half life of of 24-26 hours.  However if you are a fast metaboliser this might be less for you and what you experience in the morning may be interdose withdrawal (it might be morning cortisol which you can research yourself).  This issue might also be combined with you now being on a very low dose so it might not be covering you for the full 24 hour period.

 

I am going to provide 2 possible options:

 

You could move the mid morning Zoloft dose 1 hour earlier each day until you are taking it earlier, eg at 8 am (you will need to take it at this time on a regular basis so choose a time that suits you).  You would take note of when you symptoms start to ease in the afternoon.  If they start happening earlier then it may be a sign that the Zoloft isn't covering the full 24 hour period, and then the next option might be the answer, depending how the symptoms affect you.

 

The other option would be to split your dose.  You would need to be careful that you don't move the second dose too much later so that it doesn't (possibly) interfere with your sleep.  And again you need to move it to a time that you can take it regularly.  You would do this by move 1/2 of the earlier each day by 30 minutes and at the same time move the other 1/2 later by 30 minutes each day.  If you get the 2nd dose to the time that you can take it regularly but the first dose isn't as early as you want it (or the reverse) you could continue moving it by either 30 minutes or 1 hour, whatever you think.

 

As I said, these are just ideas, but  

[zma1]

I never take the lorazepam. Maybe 1-2x per year. I want to take one now because I feel so bad but I’m not used to depression and I think it could lower my more, then I won’t make it through tomorrow. 
It’s not a regular pattern because this eve I’m having a wave again. I guess it just comes and goes . 

[zma1]

Should I just go back up on sertraline maybe to 0.20ml? And stay there until I’m over menopause? I need to do something I can’t take the suicide ideation and crying 

[ChessieCat]

2 minutes ago, zma1 said:

Should I just go back up on sertraline maybe to 0.20ml? And stay there until I’m over menopause? I need to do something I can’t take the suicide ideation and crying 

 

 

Q:  How accurately are you getting your doses?  It might be time to start diluting your liquid so you can measure more accurately.

 

Regarding updosing, it's up to you.  I cannot make the decision for you and you have to do what you think is best in your situation.  However if you do decide to updose my suggestion would be to increase by only a small amount.  You have been on 0.18mL for at least 3 weeks.  If you can measure 0.185mL that would be my suggested updose to start.  If not then 0.19mL.  I definitely would not be going back to 0.2mL.

 

Don't forget that the mL and the mg are different amounts so the mL seems like it only a tiny amount but when you translate it to mg it gives the true amount.

 

You can use this calculator to easily work out the percentage.

 

percentage-decrease-calculator

[zma1]

I think my dose is pretty accurate. Thh hun ere are lines for 0.2, 0.19, 0.18 but not lower so going to 0.185 would be impossible w my dropper. I just ordered some new droppers which may help. 
mom fearful of diluting my liquid because I find the math confusing and I don’t trust I’ll do it correctly. 

[zma1]

Do you think this is wd or is it too intense for wd and possibly perimenopause hormonal shift too?

[ChessieCat]

15 minutes ago, zma1 said:

Do you think this is wd or is it too intense for wd and possibly perimenopause hormonal shift too?

 

I have absolutely no idea.  I am 64 (so well past menopause) and now 8 months post 0mg of Pristiq after having taken an AD for 25+ years.  In the last few months, every now and then I will get what I think is a cortisol spike in the early hours of the morning.  It is really obvious when it happens (it is similar to a hot flash/flush) and when it passes.  If I was going through menopause I probably would have thought it was due to that, but in my case it isn't.  Is it WD or is it just a stress reaction?  There is no way of knowing the cause.  And I think you are in a similar situation.

 

Worrying about it is not going to help and will only add extra stress and possibly make things worse.  When I was tapering I got a symptom I would try to think what non-WD thing might have caused it.  If I couldn't think of anything that it might have been I would just think, oh well it's possibly WD and try to accept it.

 

Q:  Are you currently taking any hormones?  I don't know much about these but I did have a bad experience (irritability bordering on anger/mild rage which was not my normal nature) with progesterone a long time before taking an AD.  Once I stopped it I was okay.  I'm telling you this to help you understand that hormones can have a huge affect on us, just like ADs and WD can. 

[zma1]

I’m not on any hormones. I too tried a progesterone cream once, maybe 10 yrs ago and became so mad at nothing. Rage. Also not my temperament. I’m just thinking of hormones could stabilize me then I may have a better chance at getting off this sertraline and helping my anxiety. But I think chances are that I might confuse an already confusing situation. I’m just really so desperate. 

[ChessieCat]

  

On 5/3/2022 at 12:03 AM, zma1 said:

I haven’t taken the Flonase for about two months. I’ve read it’s not that great so I’ll do it when I’m having extreme allergy symptoms.

 

Q:  Are still using Flonase?  This could possibly have made things worse.

 

I've just gone back to page 1 of your topic and found the following.  I think you need to do a long hold.  An updose to 0.19mL might help, but of course there is no guarantee:

 

 

 

DILUTING:

 

41 minutes ago, zma1 said:

fearful of diluting my liquid because I find the math confusing and I don’t trust I’ll do it correctly. 

 

I think you are going to have to overcome this fear because the smaller dose you are going to be measuring the harder it will be to be accurate.

 

There are staff and other members who can help get you set up on how to dilute.  Once it is worked out all you would have to do is follow the instructions.

[zma1]

No I haven't taken flonase in many months. I should probably just remove it form my signature. And thank you I would love some help on how to dilute properly once Im at that stage. Thank you so much. I'll talk to my husband about his thoughts on upping back to 0.19. Two windows and two waves today. Really im so grateful for your input, thank you thank you.

 

[zma1]

Long hold-- is that something like 3mths? Longer?

[ChessieCat]

1 minute ago, zma1 said:

No I haven't taken flonase in many months.

 

That's good.

 

1 minute ago, zma1 said:

Long hold-- is that something like 3mths? Longer?

 

How long is a piece of string???

 

Go to the bottom of this post where I gave you links about stability.

 

[zma1]

Ah. Yes. I thought I was reaching stability with each decrease but my hormone shifts throw it all off. I feel stable for a week or two at a time then bam- Im I blithering mess. I think Ill wait out at least a couple of menstrual cycles before I attempt any shift in dosage. Thank you

[ChessieCat]

2 minutes ago, zma1 said:

I think Ill wait out at least a couple of menstrual cycles before I attempt any shift in dosage.

 

My suggestion would be to wait at least 3 months and then reassess.  Having a plan can help reduce the worry and "will I, won't I" stress.  You know that for 3 months you just plod along without additional anxiety.

 

After remembering that you have been reducing too quickly, I am beginning to think that increasing to 0.19mg might help.  However, as I said, there are no guarantees.  I am only giving you my thoughts and it sounds like the symptoms you are getting are unbearable.  If they are bearable most of the time, then my suggestion would be to not increase.

[zma1]

Thank you for your input. I feel much less alone in this I’m so grateful. 

[ChessieCat]

You are welcome.

 

If you decide to increase please add date and dose to your signature.

[zma1]

Hi can someone check my math please. I’m reducing by 10% or less about once per month. This last reduction has hit sort of hard but the previous two were easy-ish.
the previous two reductions that were easy I was also taking progesterone and I felt great. Then I added estrogen and my anxiety came roaring back so I stopped the estrogen. Im wondering if I’m going too fast again or is my reduction too steep or is my math okay, but the estrogen messed up my nervous system. Im doing oral liquid sertraline and I’m currently at .15 ml which is about 2mg maybe? Thanks all

[zma1]

Hi can someone check my math please. I’m reducing by 10% or less about once per month. . Im doing oral liquid sertraline and I’m currently at .15 ml which is about 2mg maybe? Thank you anyone

[zma1]

I’m taking liquid sertraline. If 2.5ml equals 50mg, what does 0.15ml equal in mg?

I

m not great with math. I have 

2mg=.15ml

1.5 mg= .10ml

1mg=.05ml

is this correct?

[brassmonkey]

Calculating liquid doses can be a tricky thing.

 

2.5mL = 50mg

 

50/2.5 = 20 meaning that 1mL contains 20mg

 

20 X 0.15 = 3  meaning that a dose of 0.15mL will contain 3mg of active ingredient 

 

Your calculation is correct, it just comes at it from the other direction and is missing the last step

 

"2mg=.15ml

1.5 mg= .10ml

1mg=.05ml"

 

.05mL X 3 = .15mL so 1mg X 3 = 3mg

 

Either way you are looking at a dose of 3mgai (milligrams active ingredient)

 

To make a 10% reduction you would multiply either the dose strength or the dose volume by 0.9. It is best to work with the dose volume for calculating the size of your new dose. Use the dose strength when talking about it here and use both measurements for your record keeping.