CloudFox: Considering reinstatement

[CloudFox]

Good Morning Everyone,

 

I wanted to go ahead and introduce myself to this wonderful community.  I believe I may be experiencing some protracted withdrawal from SSRIs and have some questions.

 

I started my SSRI use around 10 years ago with Sertraline, with 150mg being my eventual dosage.  This helped to eliminate some physical symptoms I had been experiencing that my doctor and I thought might be stress and anxiety related.  After a few years I complained of some sexual side effects and Wellbutrin XL 300mg was added to my regimen.  This didn't really resolve the issue, but I remained on both medications until I abruptly stopped about 4 months ago.

 

As implied, I quit cold turkey.  I now know that was not a smart thing to do and potentially dangerous.  If I could go back knowing what I know now I would have started a long tapering process.  Unfortunately I did not.  To make matters worse, the time that I quit was right before I moved to a new state to pursue a promotion and new work environment.  Writing this now makes me feel quite foolish.

 

I did not experience any noticeable withdrawal symptoms during the typical acute withdrawal time period.  I felt great up until about 2 weeks ago, when I fell into a state of constant anxiety and likely also some depression.  I had begun to become very introspective about my career and the move I had just undertaken.  I feel that my existential concerns and my added stress at work led to me falling into this state of anxiety and depression.  I feel a high level of anxiety all day that will not go away and it particularly bad when I wake up in the morning.  The anxiety level fluctuates a bit throughout the day, but is always there.  It is extremely taxing and I am generally tense and slightly nauseous most of the time.  It has become very hard to get things done at work and I am concerned about my ability to continue to hold onto my job.  

 

Since falling into this state I have been doing a lot of reading here and elsewhere and have now become familiar with the concept of protracted withdrawal.  I am unsure at the moment if this is withdrawal or not, as I don't have symptoms beyond the extreme anxiety.  However, the level and duration of anxiety I am experiencing is unlike anything I have ever experienced before, including before I started taking AD drugs.

 

As I am finding it hard to cope and am concerned about the effect this is having on my life, I am considering reinstating the Sertraline to try and stabilize.  Especially since I stopped my AD use cold turkey, it seems like it might be a good idea to try to reinstate and stabilize and then begin a slow taper once I am in a better place.  

 

While I know that the members here cannot diagnose me or give me medical advice, I am hoping that your insights might prove useful in helping me make a decision on reinstatement.  I am currently seeing a GP and a therapist, and both are supportive of reinstatement if it is what I want.

 

I have read the thread on reinstating and know that it seems to have worked for some and not for others and that we are all different.  Given this, do I seem like a candidate for reinstatement?

 

I see some recommended reinstatement dosages for various SSRIs, but since dosages between the drugs differ, I was unsure on what a good reinstatement dosage might be.  I see it is recommended that a very small does to start is recommended due to potential hypersensitivity.  For Sertraline, is there any consensus on what this kind of does would look like?

 

Thank you for any insight you can provide.  It has been a very challenging few weeks and I am so glad that there are communities like this for me to reach out to!

 

 

[ChessieCat]

Hi cloudfox and welcome to SA,

 

It 's good to see that you have been doing your research so that you can make an informed decision.  I will give you a list of links, some of which you may have already seen, but we like to know that you have been provided the information in case you haven't.

 

With regards to a reinstatement dose, after several months off a drug it is a good idea to start with a test dose to see how your react.  Some members have reinstated too high a dose and destabilised their CNS and have been unable to stabilise.  You could try 0.5mg or 1mg.  This is just to see how things go.  Keep daily notes on paper.  If after a few days you don't feel worse you could increase it by another small amount.  It is better to increase slowly than to increase too high.

 

It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.  It is important to remain patient and not panic and increase your dose too soon.

 

Withdrawal Symptoms - Delayed Onset

 

Is it withdrawal or relapse?  Or something else?

How do I know it's withdrawal and not relapse?

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Tips for tapering off Zoloft (sertraline)

 

Windows and Waves Pattern of Stabilization

 

Why taper by 10% of my dosage?

 

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Windows and Waves Pattern of Stabilization

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

Keep it Simple, Slow and Stable

Keep Notes on Paper

 

Rate Symptoms Daily to Check Patterns and Progress

Tapering Calculator - Online

 

The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil.  Try a small amount one at a time to see how you react.  It is best to make only 1 change at a time.  It is also better not to start taking a complex vitamin because if you experience issues you will not know what exactly is causing it.  B vitamins can be stimulating especially B6.  hypersensitive-to-b-vitamin-or-b-vitamin-complex  If trying anything new, start with a small amount to see how you react and build up to the recommended amount.  

 

Even with a careful and slow taper you will most likely experience times of discomfort.  It is best to learn and use Non-drug techniques to cope

 

There are many existing topics and discussions on this site.  You can use the site search function on the main page of the site at the top right, or use a search engine and include survivingantidepressants.org in your search string.

 

This is your own Intro topic where you can ask questions and journal your progress.  We suggest that members visit each others Intro topics so that can support and encourage each other.

[CloudFox]

ChessieCat - Thanks for your welcome and all of the great information you have shared.

 

I experienced some symptom changes today, so I wanted to log them here both for the record but also because they have given me some new questions I would like to ask the community.  First a run down of my symptoms and some things I have noticed:

 

Symptoms began with a build of anxiety and depression related to me questioning the direction of my life after moving to a new town and starting a new job.  However, the anxiety and on edge feeling never dissipated but only seemed to get stronger. Almost like I was stuck in the fight or flight response.  Severe anxiety, depression, feelings of despair.  This lasted persistently for the last 2.5 weeks.  Over the last week I noticed that the anxiety and other bad neuro-emotions would dissipate around 5pm or so, leaving me feeling fairly "normal" for the rest of the night.  Conversely, I would wake every morning earlier than normal (6am) with quite severe anxiety.  Cortisol perhaps?  

 

I write some of this in the past tense today because today was the first day since this all started that I felt good mentally for pretty much the whole day.  I woke up with the same morning anxiety, dragged myself out of bed, dragged myself through the shower, and dragged myself to work.  However, instead of dragging the rest of the day, I found that my severe anxiety and uneasiness had pretty much gone by the time I settled in at work.  I marveled at this for a few hours, at which point I did notice a numbness/weak feeling in my legs.  I am still trying to process this, as it feels like maybe the disappearance of one symptom and the emergence of another.

 

So with this in mind, I had some questions on what is going on here and wanted to see if the community had any similar experiences.  I know that everyone is experiencing this differently as far as symptoms and timing, and I also have read that this healing process seems non-linear.  I have seen the analogy to a rubik's cube and the references to windows and waves.  While I know there is likely not a single answer to these questions, I am hoping to hear about other people's experiences, as we don't have any hard scientific data or research to rely on.  So with those caveats in mind, here are some questions I have for anyone that may have some answers:

 

• Has anyone experienced the disappearance of one symptom followed by the emergence of another symptom almost right away?
• If so, has this meant for anyone that the symptom that has disappeared is now over and future waves will consist of different symptoms?
• Conversely, am I likely just in a window from the anxiety symptom which will inevitably return?  Or is there any hope that my brain has "fixed" or "relearned" the process that controls that symptom and has moved on to fixing other damaged pathways?

 

Any insight anyone has to similar experiences would be most appreciated.

 

At this point I am still trying to decide whether it would be beneficial to try and reinstate and do a proper taper since I cold turkeyed.  Ultimately this is a decision I have to make myself, but I am trying to get as much wisdom from this community as possible, since there seems to be very few other resources out there.  I feel like there may be value in trying to reinstate, stabilize, and do a proper taper, in effect undoing my decision to cold turkey.  Is this just wishful thinking or a viable strategy?

 

Finally I do want to mention that I have updated my signature to reflect the fact that I did re-start the ADs for about a week in February 2018.  This was about 2 months after starting the cold turkey and 1.5 months before the emergence of withdrawal symptoms.  Anyone have any idea if this would mean I have been cold turkey for 4 months or only 2 months?  I suspect it is more complicated than either.....

 

Thanks again for anyone who reads this and can provide some guidance or share their own experiences.

 

Much love,

 

Fox

 

[ChessieCat]

Thank you for completing your drug signature.

 

Please include when in February you restarted.  If date not known, put early mid or late.

Please include drug names and doses.

 

Feburary 2018: Restarted both medications for about a week.  Noticed startup nausea and stopped again.

 

Thank you.

[CloudFox]

Fixed signature.  Thanks ChessieCat.

 

I am still interested in people's thoughts on reinstating after a cold turkey.  Since I keep reading that cold turkey likely leads to longer and stronger w/d symptoms, would it make sense to try and reinstate (carefully), stabilize, and do a proper slow taper?  I have read the reinstatement thread and understand there are potential risks.  I also know everyone is different, but does this seem like a strategy that could work and be better in the long term?  Or is there no going back after a cold turkey (i.e. I am better off trying to tough it out).

 

Thanks!

[SkyBlue]

On 4/13/2018 at 8:49 PM, CloudFox said:

 

I am still interested in people's thoughts on reinstating after a cold turkey.  Since I keep reading that cold turkey likely leads to longer and stronger w/d symptoms, would it make sense to try and reinstate (carefully), stabilize, and do a proper slow taper?  I have read the reinstatement thread and understand there are potential risks.  I also know everyone is different, but does this seem like a strategy that could work and be better in the long term?  

 

Thanks!

 

Hi Cloudfox,

 

I'm not very familiar with reinstatement, but I will see if another moderator can tell if you are in the "reinstatement window" or not.

 

In the meantime please read this thread Chessie posted above about reinstatement:

About reinstating and stabilizing to reduce withdrawal symptoms

 

And thanks for updating your signature. 

 

[SkyBlue]

On 4/13/2018 at 8:49 PM, CloudFox said:

Fixed signature.  Thanks ChessieCat.

 

I am still interested in people's thoughts on reinstating after a cold turkey.  Since I keep reading that cold turkey likely leads to longer and stronger w/d symptoms, would it make sense to try and reinstate (carefully), stabilize, and do a proper slow taper?  I have read the reinstatement thread and understand there are potential risks.  I also know everyone is different, but does this seem like a strategy that could work and be better in the long term?  Or is there no going back after a cold turkey (i.e. I am better off trying to tough it out).

 

Thanks!

 

Cloudfox, I am talking to the other moderators about what to recommend for you. 

 

Have you made any drug changes since this post on 4/13? Knowing this will help them know the best way to proceed.

 

Thanks.

[mammaP]

Hi Cloudfox. What you are experiencing often happens in withdrawal. One symptom seems to resolve and another appears. Some are very string and hard to deal with and others come and go randomly.  The nervous system is constantly trying to regain homeostasis and it can take a very long time.  When you reinstated in February you took the same dose that you had taken before quitting and your body didn't tolerate it. That is also 'normal', most people can't tolerate the high doses they were used to.  Chessiecat suggested 0.5mg of zoloft to reinstate, this tests whether you can tolerate it and often is enough. If it  does not make you feel any worse you could hold the dose for a while to give it a chance to help alleviate the withdrawal. It takes 4 days to get a steady level in the blood.

 

Zoloft is available in liquid which makes it easier to get the tiny doses,  or you can make your own liquid from tablets. 

 

http://survivingantidepressants.org/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Let us know if you try it, anfd how you are getting on. 

[SkyBlue]

On 4/24/2018 at 3:20 PM, mammaP said:

When you reinstated in February you took the same dose that you had taken before quitting and your body didn't tolerate it. That is also 'normal', most people can't tolerate the high doses they were used to.  Chessiecat suggested 0.5mg of zoloft to reinstate, this tests whether you can tolerate it and often is enough. If it  does not make you feel any worse you could hold the dose for a while to give it a chance to help alleviate the withdrawal. 

 

Thanks, MammaP!

[Audrey88]

I'm not sure if you are drinking alcohol but from my experience alcohol and withdrawl are very toxic together ,  when ever I drank even a small amount I would have severe anxiety and depression for a week. One thing that you can drink through the day is a brand of magnesium powder called "Calm" by Natural Vitality. you just put it in your water and sip it through the day and it really helps with anxiety symptoms till you feel better. And then there is also CBD hemp oil. it has helped me greatly to relax.