marconyc: introduction

[ChessieCat]

1 hour ago, marconyc said:

I have a couple of questions regarding tapering. First, I reduce by weight using a scale. If I have reduced the amount I take by 10% of the weight, what does that mean in terms of medication dosage? Does that mean I'm taking 190mg of sertraline now, since I was at 200mg?

 

10% off the weight and 10% off the dose will give the same result.

 

For example if your dose is 200mg then the 10% reduction is 180mg (200mg x 0.9).

 

If the 200mg tablet weighs 2mg (physical weight of tablet) then the 10% reduction is 1.8mg (2mg x 0.9).

 

If you check out this topic you would see that there are 2 different measurements. 

 

mgai = mg active ingredient = dose of drug

 

mgpw = mg pill weight = physical weight of tablet

 

Some members crush a batch of tablets (eg 10) and work out the mgai and mgpw and use that to work out what they need to take.  Have a look for the posts by Brassmonkey in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

[ChessieCat]

You could start by looking at these posts:

 

https://www.survivingantidepressants.org/search/?q=mgpw&quick=1&type=forums_topic&item=1596

[marconyc]

10 hours ago, ChessieCat said:

 

Some members find that as their dose gets lower they need to reduce less and/or hold for longer.  There is no rule about when this might happen (if it does); it can be different for different people/drugs/doses/situations.  The 10%/4 week taper protocol is only a guide.  The important thing is to listen to your body/symptoms and not make another reduction unless you are stable.  If you are experiencing an illness or additional stress it is generally better to hold.  Generally it is better to hold for longer than to reduce too soon.

 

Even if you are stable you might get up with tapering and decide to have a "tapering holiday" and just have some time when you can enjoy some form of "normality".

 

The goal is to get off the drug with minimal discomfort and live your life as normally as possible.

 

Non-drug techniques

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

Thank you, @ChessieCat This is very helpful. I like the idea of a tapering holiday as well. Life needs to be more than reaching goals, even when the goals are worthy ones. 

 

To be honest, I'm nervous about tapering again because the withdrawal last time was brutal. But back then, before coming to SA, I didn't know about the 10% rule, nor did I know how severe or prolonged AD withdrawal could be. In addition, I had a number of intense, unusual stressors going in my life at that time. I'm hoping that I'm better educated and prepared this time around. Being able to successfully taper off of the clonazepam and aripiprazole was a big deal for me, and if I can now reduce the sertraline to my original dose of 150mg/day, I'll be pretty happy and will then take it from there.

[marconyc]

10 hours ago, ChessieCat said:

 

10% off the weight and 10% off the dose will give the same result.

 

For example if your dose is 200mg then the 10% reduction is 180mg (200mg x 0.9).

 

If the 200mg tablet weighs 2mg (physical weight of tablet) then the 10% reduction is 1.8mg (2mg x 0.9).

 

If you check out this topic you would see that there are 2 different measurements. 

 

mgai = mg active ingredient = dose of drug

 

mgpw = mg pill weight = physical weight of tablet

 

Some members crush a batch of tablets (eg 10) and work out the mgai and mgpw and use that to work out what they need to take.  Have a look for the posts by Brassmonkey in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

Thank you @ChessieCat! Very helpful. Yes, 180mg, not 190. 

[marconyc]

On 3/16/2022 at 10:52 PM, ChessieCat said:

 

10% off the weight and 10% off the dose will give the same result.

 

For example if your dose is 200mg then the 10% reduction is 180mg (200mg x 0.9).

 

If the 200mg tablet weighs 2mg (physical weight of tablet) then the 10% reduction is 1.8mg (2mg x 0.9).

 

If you check out this topic you would see that there are 2 different measurements. 

 

mgai = mg active ingredient = dose of drug

 

mgpw = mg pill weight = physical weight of tablet

 

Some members crush a batch of tablets (eg 10) and work out the mgai and mgpw and use that to work out what they need to take.  Have a look for the posts by Brassmonkey in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

 

Hi @ChessieCatI was hit with strong withdrawal symptoms the other day. I almost had several panic attacks and was very emotional. It's difficult, however, for me to sort out what is withdrawal from what might be external stressors that might have caused an increase in anxiety and depression symptoms even if I hadn't tapered. Sometimes I think the sertraline helps me take on too much, and eventually either the stress overpowers the medication or a small decrease in dose reveals how unsustainable my life has become. I have a beautiful daughter who is now a little older than 2 years' old, but being a new parent during the pandemic has been tough. My wife and I moved across the country away from all of our family and friends, purchased our first home, and I started a new job, all at the same time. Being a father is wonderful. At the same time, I haven't had real down time in 2 years. Things have gotten particularly stressful in the past month. My close friend out here got divorced and ended up in a psychiatric hospital for severe depression, and I'm pretty much the only person he talks to. His ex-wife said she has to detach herself from his care and so I'm now what feels like his only support. I've been worried about him and also have been on call for a while when he has suicidal thoughts. 

 

Then this past week, we found out that one of our beloved dogs has kidney disease and we aren't sure how long he has to live.

 

At the same time, our house is being renovated, everything is upside down, my wife and daughter are visiting her brother in San Francisco, and I'm here alone trying to take our dog to the vet and being the main point of contact with all these contractors, all while trying to work a full-time job. It was this past week that I started to feel really crummy. Until then, I think the taper had been going okay, although you know with the sometimes delayed reaction to tapering, I can't be sure that it's not simply withdrawal. I actually called in sick at work one day, which I haven't done in years, and I panicked and went back up to my regular dose of sertraline 4 days ago. I'm feeling quite a bit better, so I do think withdrawal is part of it. But I have also spent quite a bit of time over the past few days getting in touch with my feelings, talking with my therapist and friends, spending time with our dogs, and exercising. So maybe what I really needed was down time and self care. 

 

Anyway, I feel like a wimp, but it scared the heck out of me feeling that way. The experience a few years' back with withdrawal was so intense and prolonged that whenever I have a whiff of it, I get really anxious. I think about how much harder it would be to go through withdrawal now that I'm a father and the sole breadwinner in the house. 

 

I'm not sure I'm even asking for any specific advice. I just wanted to reach out to someone here because this has been a supportive environment for me before.  

[marconyc]

14 minutes ago, marconyc said:

 

Hi @ChessieCatI was hit with strong withdrawal symptoms the other day. I almost had several panic attacks and was very emotional. It's difficult, however, for me to sort out what is withdrawal from what might be external stressors that might have caused an increase in anxiety and depression symptoms even if I hadn't tapered. Sometimes I think the sertraline helps me take on too much, and eventually either the stress overpowers the medication or a small decrease in dose reveals how unsustainable my life has become. I have a beautiful daughter who is now a little older than 2 years' old, but being a new parent during the pandemic has been tough. My wife and I moved across the country away from all of our family and friends, purchased our first home, and I started a new job, all at the same time. Being a father is wonderful. At the same time, I haven't had real down time in 2 years. Things have gotten particularly stressful in the past month. My close friend out here got divorced and ended up in a psychiatric hospital for severe depression, and I'm pretty much the only person he talks to. His ex-wife said she has to detach herself from his care and so I'm now what feels like his only support. I've been worried about him and also have been on call for a while when he has suicidal thoughts. 

 

Then this past week, we found out that one of our beloved dogs has kidney disease and we aren't sure how long he has to live.

 

At the same time, our house is being renovated, everything is upside down, my wife and daughter are visiting her brother in San Francisco, and I'm here alone trying to take our dog to the vet and being the main point of contact with all these contractors, all while trying to work a full-time job. It was this past week that I started to feel really crummy. Until then, I think the taper had been going okay, although you know with the sometimes delayed reaction to tapering, I can't be sure that it's not simply withdrawal. I actually called in sick at work one day, which I haven't done in years, and I panicked and went back up to my regular dose of sertraline 4 days ago. I'm feeling quite a bit better, so I do think withdrawal is part of it. But I have also spent quite a bit of time over the past few days getting in touch with my feelings, talking with my therapist and friends, spending time with our dogs, and exercising. So maybe what I really needed was down time and self care. 

 

Anyway, I feel like a wimp, but it scared the heck out of me feeling that way. The experience a few years' back with withdrawal was so intense and prolonged that whenever I have a whiff of it, I get really anxious. I think about how much harder it would be to go through withdrawal now that I'm a father and the sole breadwinner in the house. 

 

I'm not sure I'm even asking for any specific advice. I just wanted to reach out to someone here because this has been a supportive environment for me before.  

@ChessieCatBTW, seeing how I'm reacting to my emotions right now, I think one of the reasons withdrawal is so hard, or was for me, was how much I panicked at those feelings. 

[marconyc]

Last night, my friend who was recently hospitalized for depression asked me to take him to Catholic Mass. I'm Catholic and go to church once in a while but I'm not that religious and disagree with the church on lots of issues. Anyway, my friend's OCD is really bad right now because of the recent divorce, and his OCD takes the form of what's called "scruples," or obsession with sin. As we approached the church, he became increasingly distraught because neither he nor I had been to confession. He was terrified that if we stepped on the church property we'd commit a mortal sin, be excommunicated, and go to hell. He was yelling and twitching and crying. I had to flag down the priest, whom my friend knows, and ask the priest to talk to him. The priest was able to come him down some, but not much, and then I drove my friend home and tried to talk with him a little and calm him down some more. I actually suggested he take a tablet of the Klonopin he was prescribed, which also helped. I called to check on him when I got home and he seemed stable and was going to try to get some sleep.

 

I really care about my friend, but the experience left me pretty shaken. I didn't sleep well last night and had a nightmare about him and his wife. I don't want to abandon my friend but I don't know how much more of this I can handle. 

[marconyc]

Hi, I haven't posted much in the past few years. I'd been on 150mg of sertraline for a long time, then tapered without realizing it was too fast and ended up back on sertraline but at 200mg plus 2mg of Abilify. I managed to taper off the Abilify, but every time I reduce the sertraline, the anxiety and depression that I feel pushes me to reinstate. The last time I tried it, I made a 10% drop and reinstated to the full 200mg after a few weeks. This time, I dropped by 2.5% for 4 weeks and felt fine and dropped another 2.5%. It's 2 weeks later and I'm feeling pretty bad. I've had one or two small anxiety attacks, trouble falling asleep, and some crying spells. One of my dogs is 14 and I don't know if we're going to have to put him down for health reasons, so that is making me incredibly anxious and depressed. I think I'd be feeling really bad even without the reduced sertraline, but I can also tell I'm dealing with some withdrawal. There never seems to be a good time to go through withdrawal. I'm more reluctant now than I was years ago to stick it out because I have a young child now and I'm the sole breadwinner in the family. I just can't afford not to function. 

 

Should I try sticking it out a little longer or should I increase by 2.5% or just go back to 200mg? Any advice would be appreciated.

[ChessieCat]

8 hours ago, marconyc said:

This time, I dropped by 2.5% for 4 weeks and felt fine and dropped another 2.5%. It's 2 weeks later and I'm feeling pretty bad.

 

Q:  Did you experience any withdrawal symptoms during the 4 weeks after you reduced by 2.5% the first time?  If yes, did they appear during the first 7-10 days?

 

Q:  How did you feel when you made the second reduction of 2.5%?  Did you feel okay during the first 7-10 days and then you started to feel worse?

 

These questions are very similar but are different.  Please read them very carefully.

[ChessieCat]

clonazepam .5mg 2x/day

 

 

Q:  Are you still taking clonazepam?

 

[marconyc]

4 hours ago, ChessieCat said:

 

Q:  Did you experience any withdrawal symptoms during the 4 weeks after you reduced by 2.5% the first time?  If yes, did they appear during the first 7-10 days?

 

Q:  How did you feel when you made the second reduction of 2.5%?  Did you feel okay during the first 7-10 days and then you started to feel worse?

 

These questions are very similar but are different.  Please read them very carefully.

 

Hi @ChessieCatI did not experience withdrawal symptoms during the first 7-10 days of the first cut. I don't think I experienced any withdrawal symptoms at all during those 4 weeks. 

 

I definitely started to feel withdrawal during the first 7-10 days of the second cut.

 

What do you think that means?

 

Edited August 8, 2022 by marconyc

[marconyc]

P.s. I know that my dog dying is a big part of this. I have never done well with anticipatory anxiety. I am trying to manage those feelings better in therapy and through self-care, but it's hard. This is the first pet I've ever had. He's been with us for a long time and I love him more than I can say.

 

Also, ever since my daughter was born (almost 3 years ago now) my wife and I have struggled in our marriage. We had so many good years with our two beautiful dogs and now we barely have time for them or for us. I feel like I've let years go by that could have been great ones with the dogs because I've been overwhelmed with parenting, work, and owning a home for the first time. I feel like a jerk complaining because I'm really really lucky but still, I've barely had time to brush my teeth these past few years. We have no family near us to help, and during the pandemic it's been hard to even find a babysitter.

Edited August 8, 2022 by marconyc

[ChessieCat]

6 hours ago, marconyc said:

I did not experience withdrawal symptoms during the first 7-10 days of the first cut. I don't think I experienced any withdrawal symptoms at all during those 4 weeks. 

 

I definitely started to feel withdrawal during the first 7-10 days of the second cut.

 

What do you think that means?

 

I was trying to work out if you might be experiencing poop out.

 

tolerance-or-poop-out-or-tachyphylaxis

 

The general pattern of poop out is that you gradually start to feel worse whilst making no changes to the dose.  In my case I didn't notice any gradual worsening (but it might have been happening) but when I experienced several moderate life stressors in a short period of time I ended up having a break down at my daughter's wedding reception.  It was as if I wasn't taking the drug (citalopram) at all.  When I cold turkeyed it I felt better than I had done in a long time but a few months later I experienced delayed withdrawal and was bedridden for 2.5 weeks.  When I came to SA I realised that it was poop out.  When in poop out, generally what happens is that after making a reduction you can feel improvement and then gradually start to feel worse again, which is the opposite of regular tapering WD which generally happens soon after a reduction and then gradually improves.

 

When the drug reaches tolerance, if the dose is increased generally you will feel better but then after a while the same thing happens.

[Altostrata]

9 hours ago, marconyc said:

I definitely started to feel withdrawal during the first 7-10 days of the second cut.

 

How many days has it been since this second cut? How has your symptom pattern changed?

 

8 hours ago, marconyc said:

P.s. I know that my dog dying is a big part of this. I have never done well with anticipatory anxiety. I am trying to manage those feelings better in therapy and through self-care, but it's hard.

 

It may be best not to taper during this difficult time. Your emotions may be due to circumstances, not withdrawal.

[marconyc]

14 hours ago, ChessieCat said:

clonazepam .5mg 2x/day

 

 

Q:  Are you still taking clonazepam?

 

No, not for a long time--several years

[marconyc]

50 minutes ago, Altostrata said:

 

How many days has it been since this second cut? How has your symptom pattern changed?

 

 

It may be best not to taper during this difficult time. Your emotions may be due to circumstances, not withdrawal.

It's been 12 days since the second cut. I noticed symptoms pretty soon after the second cut and they haven't improved; if anything, they are a little worse. 

 

I think this might not be the best time either. 

[Altostrata]

What symptoms have gotten worse?

[marconyc]

3 hours ago, Altostrata said:

What symptoms have gotten worse?

The anxiety predominantly, maybe the insomnia as well. I don't think the depression has gotten worse, maybe because I'm better at feeling emotional pain and talking about it with people I love. Also, I haven't experienced the obsessiveness that happened when I went through severe withdrawal and that has accompanied episodes of depression before I went on medication. 

 

But the anxiety could be intense right now in part because we're on the fence about whether to euthanize our dog. Anyway, anxiety has always been something I've struggled with. Sometimes I think it's more of a problem than depression for me. 

[Altostrata]

My intuition is that anxiety is not from withdrawal.

[ChessieCat]

20 hours ago, marconyc said:

Anyway, anxiety has always been something I've struggled with.

 

 

SA strongly encourages members to learn and use non drug coping techniques.  I have found that the non drug coping skills that I learned during my taper have become part of my life and I use them for general life and health coping.

 

Non-drug techniques to cope

 

I have found relaxation techniques very helpful.  With the relaxation I think it is better to do short periods of it throughout the day, regardless of whether you feel you need to do it.  Think of it like an old fashioned kettle on stove, the sort with the whistle.  If you keep turning the heat on and off the whistle will never blow because the steam won't build up.  Relaxation techniques work in a similar way.  You probably won't get rid of the stress completely but you keep bringing it down a bit so that it doesn't get to the build up.

 

I now find that I more quickly pick up when I am starting to feel "different" (tired, confused, anxious etc) and it's second nature now to do some sort of non drug technique (self talk, breathing exercise, get up and look at something different) to cope with whatever it is that is happening.

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk
 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

  

On 4/28/2017 at 4:03 AM, brassmonkey said:

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.

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AND

 

  

On 6/16/2022 at 2:53 AM, getofflex said:

APPLE Technique

 

I just came across a very nice technique that really helps me.  It's called APPLE. I have printed it and have it where I can see it every day and be reminded of it so I internalize this technique. 

 

A - Acknowledge Notice and acknowledge the thought or uncertainty as it comes to mind. 

 

P - Pause Don't react as you normally do.  Don't react at all.  Just pause and breathe.   

 

P - Pull Back Tell yourself this is just the thought or worry talking, and this apparent need for worry or analysis or certainty is not helpful and not necessary.  It is only a thought or feeling.  Don't believe everything you think.  Thoughts are not statements or facts.   

 

L - Let Go Let go of the thought or feeling.  It will pass.  You don't have to respond to it.  You might imagine the thought floating away in a bubble or cloud.   

 

E - Explore Explore the present moment, because right now, in this moment, you are OK.  Notice your breathing and the sensations of your breathing.  Notice the ground beneath you.  Look around and notice what you see, what you hear, what you can touch, what you can smell.  Right now.  Then shift your focus of attention to something else - on what you need to do, on what you were doing before you noticed the thought or worry, or do something else - mindfully - with your full attention.  

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Edited August 10, 2022 by ChessieCat

[marconyc]

17 hours ago, Altostrata said:

My intuition is that anxiety is not from withdrawal.

I think you're right @Altostrata. In fact, having gotten in touch with my grief and fear about my dog over the past few days, and expressing those feelings to people I trust, my anxiety has dissipated. I have to learn this lesson over and over again in my life. 

 

You and your counselors are an absolute treasure. I don't know how you manage to respond so promptly and thoughtfully to so many people in distress. One of the reason I have always trusted your judgment @Altostratais the flexibility in your thinking--your ability to assess situations individually. 

 

I also want to apologize for not being a more regular contributor after I stabilized. Right after that, my daughter was born, and I felt overwhelmed. She's doing great, and I'm proud of the fact that I've been able to work full-time and be a dad, but I do wish I had been able to give back more to SA after all the help I received.

[marconyc]

17 hours ago, ChessieCat said:

 

 

SA strongly encourages members to learn and use non drug coping techniques.  I have found that the non drug coping skills that I learned during my taper have become part of my life and I use them for general life and health coping.

 

Non-drug techniques to cope

 

I have found relaxation techniques very helpful.  With the relaxation I think it is better to do short periods of it throughout the day, regardless of whether you feel you need to do it.  Think of it like an old fashioned kettle on stove, the sort with the whistle.  If you keep turning the heat on and off the whistle will never blow because the steam won't build up.  Relaxation techniques work in a similar way.  You probably won't get rid of the stress completely but you keep bringing it down a bit so that it doesn't get to the build up.

 

I now find that I more quickly pick up when I am starting to feel "different" (tired, confused, anxious etc) and it's second nature now to do some sort of non drug technique (self talk, breathing exercise, get up and look at something different) to cope with whatever it is that is happening.

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk
 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

  

 

AND

 

  

1

•  

 

I love this. So smart. I tend to employ coping strategies in a reactive way, but you're absolutely right: you have to practice consistently. I remember when I was first diagnosed with anxiety and depression, I learned a relaxation technique with a little "trigger"--I would touch the tips of my finger and thumb on each hand. I did that every single night before bed for about a year, to the point where if I was anxious during the day, I would touch my thumb and fingers and not only would I relax, sometimes I would even yawn. It was a very powerful conditioned response. When combined with calming self-talk, it helped avert many anxiety attacks as they were building. 

[Altostrata]

Thanks for the kind words, @marconyc It looks like you have a lot to offer, if you have time to participate in the community. You are always welcome.

[marconyc]

36 minutes ago, Altostrata said:

Thanks for the kind words, @marconyc It looks like you have a lot to offer, if you have time to participate in the community. You are always welcome.

 

Much appreciated. Along those lines, I'd like to share this resource: https://rpeurifoy.com/mp3-downloads/

 

These are free audio resources for developing a relaxation response, among other topics. He talks you through a relaxation exercise. 

 

When I first went into therapy, my therapist recommended Reneau Peurifoy's Anxiety, Phobias, and Panic. Even though my therapist is an Internal Family Systems practitioner, he recommended the book, which is more of a CBT approach. It was excellent, and in fact when I went through antidepressant withdrawal, I dusted off my copy of the book and went through it again word for word, doing all of the exercises. 

 

For anyone interested in therapy, I have had a great experience with Internal Family Systems (https://ifs-institute.com/). It is non-pathologizing, evidence-based, and intuitive. Bessel van der Kolk discusses it in his book The Body Keeps the Score. 

[Altostrata]

Please add your suggestion to Non-drug techniques to cope with emotional symptoms

 

[marconyc]

Hi SA, after about a year of leaving my sertraline dose at 200mg, I decided to try tapering again. This time, I've been making 5% cuts. I started on June 3, held for 1 month, and then did a second 5% cut on July 1. I think this reduction might work better for me than 10%. About 1 week after the first cut I felt some withdrawal for a couple of days. About 1-2 weeks after the second I felt some withdrawal. I guess I'm very sensitive to reductions after being on the medication for so many years. The withdrawal so far has been uncomfortable but manageable, in part because I've weathered withdrawal before and I'm telling myself that it will pass. I'm doing yoga and meditation again, eating more mindfully, and cutting out the wine during the week (I would usually have 2 glasses in the evening). For financial reasons, I've had to reduce my individual psychotherapy down to once a month, and then my wife and I are in couples counseling just once a month even though more frequent sessions would be better. But overall, I'm doing okay with the reductions. I'm already starting to feel more emotions--some uncomfortable, some really welcome--as well as more sexual feelings. I think I've actually had some reduced libido and even numbing over the years and didn't want to admit that the sertraline could be part of it. I decided to try reducing the dose again because I really do think I've experienced emotional and sexual numbing that has made me feel less alive and also less motivated to make the kinds of changes in my life that would reduce my risk of anxiety and depression in the first place. I want to teach my nervous system to handle stress and frustration again without medication as much as is possible. If I never get completely off sertraline, that's okay--what I want is to reduce as much as possible in order to have access to a fuller range of my emotions and feelings while still functioning in my life and not experiencing a relapse of major depression or anxiety. 

 

One thing I'm struggling with is that when I feel withdrawal, my mind brings back memories and sensations from the worst of my withdrawal/depression/anxiety in the past and I can feel a kind of hypervigilance creep in. Psychiatrists will tell us that each time we have an episode of depression, the risk of another increases drastically--and that the reason is biochemical. But lately I've begun to think it's because experiencing symptoms of anxiety and depression tends to bring back up patterns of thinking and behaving from previous episodes of depression/anxiety, reinforcing the negative feelings. So I'm trying to gently remind myself that just because I'm feeling some depression and anxiety right now, it doesn't mean I'm slipping back into a major episode. 

[manymoretodays]

Hi marconyc! 

Yep, that PTS type thing........

Great to see you posting and beginning to taper your sertraline now too.

[marconyc]

On 7/20/2023 at 7:38 AM, manymoretodays said:

Hi marconyc! 

Yep, that PTS type thing........

Great to see you posting and beginning to taper your sertraline now too.

Thank you, MMT. I am definitely feeling a lot more with the reduced dose, even though the reductions have been small so far. I think some of the emotions and sensations I'm feeling are natural and healthy responses to life--sadness over losses, nervousness about an upcoming work event, excitement about a new soccer season, and so forth. Getting used to a greater range and intensity of emotion can be challenging and even sometimes scary. It requires more self-care than I'm used to. But I also think some of the emotions and sensations I'm feeling are due more directly to the reduction in dose and not to what's going on in my life. It can be difficult to tease apart the emotions that are being given breathing room because of the reduced dose vs the emotions being directly caused by the reduced dose (what some people on SA seem to call "neuro-emotions"). In some cases, I can tell that the reduced dose is causing strong and sometimes fearful *responses* to normal emotions and the regular ups and downs of life--in other words, I am able to discern that the emotions are normal reactions to life but it's challenging to manage the way my nervous system is reacting. A good example is the change in heart rate that I'm experiencing: when something stressful occurs, or a difficult emotion arises, I might notice my heart rate increasing, and it might take longer for it to get back to normal after the "threat" passes. 

 

I am experiencing some of the "windows and waves" but to be honest it feels more like a consistently heightened state of arousal, intensifying of emotion, and reduced stress tolerance. Sometimes I wonder if I'm supposed to be experiencing more of the windows and waves instead and if what I am experiencing means I'm one of those few people who need the medication. I don't think that's true, but if anyone has thoughts, please share.

 

Most importantly for now, I guess, I'm trying to be patient with the feelings that are coming up. 

[marconyc]

Little update, I've felt better as the day has gone on. Looking back at the last time I tried to taper, which was last year, I tapered even smaller amounts then but gave up. This time, I've been able to hang in there longer already, and with slightly larger cuts. I think what happens with me is that I experience pretty powerful PTS reactions to symptoms of withdrawal AND to the feeling of emotions and nervous system arousal without the blunting effect of sertraline. The PTS comes from childhood, from previous episodes of depression, and from prior experiences of withdrawal.

 

By the way, I definitely think these drugs have a major blunting effect. I'm not sure if blunting is the only MOA of these drugs, but I'm certain that it's one of them. I'm also not totally knocking a blunting effect--for those of us with sensitive nervous systems and/or childhoods that weren't conducive to managing feelings (or even recognizing them, in my case), blunting can in fact be a lifesaver. But it's only ever a stopgap, and at what cost? SSRIs may be a cleaner drug than alcohol or weed for blunting (no pun intended), but they still have serious side effects, as everyone here knows. And I would argue they are harder to discontinue than alcohol or weed. It's probably a toss-up whether they are harder to discontinue than benzos. I mean, don't make me choose. 

 

The last time I tried to taper, my dog was on the verge of death. It was a year ago. Now our other dog is showing signs of serious decline. I think I've been coping with painful memories of his passing one year ago as well as anticipatory anxiety about what's to come for our other beloved dog. Simply knowing this is helping me. So is crying. I used to think crying was weak, then I thought it was dangerous, then I thought it was safe in very small doses, and now I think it's healthy whenever I need to and however much. 

 

Anyway, I do seem to be experiencing a predictable and manageable bit of withdrawal 3-5 days after a cut that then improves. It's just that my reactions to my symptoms and to the unmasked emotions is a more powerful overlap on top of the relatively mild and predictable withdrawal.

Edited July 25, 2023 by marconyc

[marconyc]

Still feeling good this morning. Slept well last night. I have a little bit of anxiety and sadness, but it's transient. I'm considering another small cut this weekend--I had planned on making a 2.5% cut on Sat, as it will be a month since the previous cut. I'll see how I feel over the next few days. As uncomfortable as this process can be, I'm proud that I've been able to reduce even this little bit, and I'm excited about the possibility of reducing more in order to have greater access to my feelings, reduce sexual and blunting side effects (and maybe also some weight gain), and heal my brain and nervous system. One benefit of having greater access to my feelings is that I'm being more assertive in my relationships as well as more open. I'm also more sensitive to when I need to take a break. These drugs can enable us to keep plugging away and ignore the signs that we need to take care of ourselves better. 

 

 

[DancingBee]

@marconyc It sounds like you're doing really well taking care of yourself, responding to the increased feelings, and doing a lot of good personal growth work such as being more honest and assertive in your relationships. Well done! And I'm happy to hear you have less blunting and an increase in sexual feelings. Hallelujah!

 

I relate to you re: feeling very anxious when symptoms of anxiety or depression arise. It does feel like Post Traumatic Stress from when I was in a bad state before going on ADs and the couple times I've tried to get off. Yesterday, I started having self-critical thoughts reminiscent of my dark days, and the response in my body was panic. I had to talk myself down. And like you, since these type of thoughts were part of my depression before ever taking meds, so I can't just attribute them to being withdrawal symptoms.

 

The good news is like you said: it's okay if you never get fully off the drugs. Take it one step at a time, going at a pace you can handle, being gentle with yourself. Having lowered your dose amounts is already a success!

 

[marconyc]

12 minutes ago, DancingBee said:

@marconyc It sounds like you're doing really well taking care of yourself, responding to the increased feelings, and doing a lot of good personal growth work such as being more honest and assertive in your relationships. Well done! And I'm happy to hear you have less blunting and an increase in sexual feelings. Hallelujah!

 

I relate to you re: feeling very anxious when symptoms of anxiety or depression arise. It does feel like Post Traumatic Stress from when I was in a bad state before going on ADs and the couple times I've tried to get off. Yesterday, I started having self-critical thoughts reminiscent of my dark days, and the response in my body was panic. I had to talk myself down. And like you, since these type of thoughts were part of my depression before ever taking meds, so I can't just attribute them to being withdrawal symptoms.

 

The good news is like you said: it's okay if you never get fully off the drugs. Take it one step at a time, going at a pace you can handle, being gentle with yourself. Having lowered your dose amounts is already a success!

 

Thank you very much @DancingBee. I appreciate the encouragement. I find that it's valuable to document my experience here on SA even if nobody responds, but it's really nice when someone does. I hope your own journey with tapering is going well. One thing I have found to be helpful when I have PTS in reaction to symptoms is to remember what I read in the book "The Mindful Way Through Depression," which is that when we experience symptoms, we more or less automatically start to think, feel, and behave in ways that reinforce the depression and anxiety. It's not that our brains are permanently wired to spiral down, though: we can become aware of what is happening and gently talk ourselves down and/or find ways to sidestep that downward spiral. I remind myself that just because I experienced episodes of depression or withdrawal before does not mean I'm destined to experience it forever, and I'm more knowledgeable and capable now of managing the difficult feelings that arise. Sometimes I think of the process as being caught in a riptide: swimming directly against it doesn't help and actually makes it worse, but staying calm, staying afloat, and letting the tide run itself out is the way out. 

Edited July 25, 2023 by marconyc

[DancingBee]

So well said. I love the analogy of a rip tide—swimming sideways instead of against it. I agree that we have a lot of power to change our thoughts. I find that when I'm doing pretty well, I can remember and use the skills I've learned to stay calm, float and incline my mind toward more positive thoughts. But when I'm in the thick of it, boy is it challenging. It's as if all I've learned completely disappears....or requires so much effort to continually notice my mind is spinning and come back to center, then 3 seconds later need to do it again. 

 

And thanks for mentioning that book. I hadn't heard of it but sounds like one I'd like to read.

 

Here's wishing you all the best this week. I'll stay tuned for more updates!

[marconyc]

Update: I'm going to do a 2.5% cut tomorrow as scheduled. It's been 1 month since the last cut. I decided to do a 2.5% and give it a couple of weeks and then maybe do another 2.5%. I've decided for now to do no more than 5% cuts at a time and give myself permission to make even smaller ones, regardless of the fact that I'm only at the start of my taper. The last time I tapered, the 10% cuts went fine at the start, but I know myself and think these smaller cuts right now will work better for me. 

 

The only withdrawal symptom I've felt in the past 5 days was last night--I had done a lot of intense exercise and not eaten enough. I was probably dehydrated. Then I had a pint of beer a couple of hours before bed. As I was falling asleep, I had a brief and scary dream that kicked up some anxiety. I calmed myself down with self-talk and breathing and fell asleep. It's a good reminder that while tapering, our nervous systems can be vulnerable to overdoing all kinds of activities. Intense exercise works for me in general, even during withdrawal, but coupled with being depleted and dehydrated, I think it was a little too much.

 

One other thing: In addition to taking magnesium and fish oil supplements, which seem to help and certainly don't make my symptoms worse, I've been taking a probiotic and it seems to agree with me. I have seen some decent studies showing the benefit of probiotics for depression and anxiety. Has anyone else here taken them? If so, what has been your experience?

[DancingBee]

Hi @marconyc:

 

I wanted to respond even though I don't have any personal experience to relay (I take probiotics but haven't experienced any connection to my mood or anxiety levels). But as you said, there are several studies that show benefit. The Dr. Ruscio Radio podcast has presented some of them. Perhaps worth a try.

 

Best,

Dancing Bee

[marconyc]

Much appreciated!