Kernol: was doing well on my sertraline taper but now in hell and doc reinstated

[sunnysideup69]

Kernol, I'm praying for you that you'll get your prescription extended. Love and hugs xxx

[Kernol]

31/3

 

9.00pm lights out (30th)

11.00pm-4.00am sleep ok a couple of nightmares and waking with teeth clenching and sizzling burning skin on back

4.00am - 7.00am strong cortisol rushes and emotionally painful anxiety with dread and electrified raw feelings

8.00am get up have shower feel raw emotionally painful anxiety. Feel a bit of nausea. Still fatigued but not as much as yesterday. Period still here

9.00am take 2mg diazepam and have oat smoothie. Feel same as earlier with lots of emotional painful anxiety can’t even think of my parents without getting it

10.00am do some work but lots of intrusive memories of past very random but coming with this emotional pain for no reason. My back is sizzling burning quite badly. My Teeth still feel clenched like my jaw wants to bite down all the time 

11.00am manage to do work conference call but still getting bizarre emotionally painful reactions to things and I’m scared of my own emotions even though I know they are not my authentic emotions I don’t know what’s coming next

12.00pm have a short crying session and feelings of hopelessness come over me as can’t see tapering bringing can’t relief either and holding my dose has not worked

1.00pm take 1.5mg diazepam no appetite for lunch so drink kefir

2.00pm same as earlier lots of emotional painful anxiety feelings car pretty much anything, memories , thoughts. Take 16mg sertraline 

3.00pm manage to do some work emails . Feel bombarded by intrusive memories but not coming with quite as much sting so I carry on 

4.00pm still working 

5.00pm the sting is back and the emotional pain has cranked up again and my back is burning 

6.00pm take 2mg diazepam. 
7.00pm manage dinner. Emotional pain dampened a tiny bit but still some spikes. Back is burning 

8.00pm loud tinnitus has started 

8.30pm Lau in bed feeling hot knees burning. Feel strong dread and emotional pain. Everything seems distorted emotionally. / can’t feel normal authentic feelings about anything. Just this chemical horror. Feel hopeless. Don’t know how I will ever get better 

8.45pm lights out. Praying for a little respite tomorrow 

[Kernol]

Hi @Shep @Altostrata I have now taken the increased dose for 7 days of the diazepam today is 8th day and it has not made any difference to any of my mental or physical symptoms. In fact I have a new one tinnitus now to add to the list. I don’t think I will get more from the Gp I only got a few extra as an emergency measure. 
 

where should I go from here? I just don’t stabilise and with new things cropping up and no respite I Feel like I need to have some kind of plan of what to do but I don’t know what is best?  Is it worth trying a tiny updose in sertraline or is that not going to help? 

[Kernol]

1/4

 

12.00am can’t sleep but I don’t mind as my brain is thinking about normal things like what needs doing in the house etc and I am so grateful for normal train of thought 

1.30am-5.00am - restless sleep. Hot In night but no nightmares 

5.00am cortisol rushes and teeth clenching and back burning pain 

8.00am get up feel very depressed and despairing at my situation. Some derealisation but mainly deep dark dread and fear 

8.30am have shower. Mouth feels so odd bite is all messed up and teeth are sore 

9.00am take 2mg diazepam and have oat smoothie 

10.00am walk to local shop and have extremely strong spoke of chemical dread and doom so painful emotionally in the shop 

11.00am upset that I felt such an intense reaction attempting to go anywhere 

12.00pm lots of intrusive memories and emotional anguish with them. Feels so raw in my chest so painful emotionally I can barely stand it 

1.00pm take 1.5mg diazepam. Still same as above. Can’t even do my work. Sit on floor just breathing. No appetite can’t eat. Feel so depressed and hopeless

2.00pm take 16mg sertraline. Same feelings  above. Lots of intrusive memories again and time travelling and emotional pain so strong 

3.30pm do some work emails but the more I seem to concentrate the more flashbacks I have 

5.00pm lie down in bed trying to ease the Chemical feelings of anxiety and dread and doom by breathing 

6.00pm take 2mg diazepam. Get into bed 

6.30pm skin burning on back bit worse and knees start to burn

7.00pm manage some pasta and dial into Baylissa’s healing reflections call

8.00pm just want day to be over now. Very tired 

9.00pm lights out 

10.30pm - 4.00am restless sleep some nightmares and night sweats

5.00am woken with strong cortisol rushes and brain whirling around with flashbacks and horror

[Altostrata]

Kernol, I have done some more mapping of your drug changes and potential drug-drug conflicts.

 

I can make a semi-educated guess that you are experiencing an incomplete substitution of diazepam for lorazepam. Lorazepam conflicted with sertraline less. Now, sertraline and diazepam are blocking each other's metabolism.

 

Currently, sertraline and diazepam are conflicting vigorously. The increase in diazepam increased blood level of both drugs.

 

Vortioxetine was also involved in the metabolism traffic jam. Removal of vortioxetine relieved this a bit (cyp jam score change -8), but major jams still occur in cyp 3A4, 2C19, and maybe 2D6. This explains why you felt relief for maybe a week after going off vortioxetine -- then the jam reasserted itself.

 

If we could, I'd suggest a switch back to lorazepam, but it doesn't sound like your doctor will be sympathetic. If you can't go back to lorazepam, I think the best thing to do now is to relieve the drug-drug conflict by reducing sertraline, with the intention of going off and letting diazepam do its work.

 

Would you be willing to reduce sertraline by 1mg? Keep notes as ever.

•  

[Kernol]

Thanks so much @Altostrata for all the time and effort you have put into trying to figure this out - I really appreciate it.

 

you are correct they would not give me lorazepam and in any case I had become tolerant to that after a couple of months which is one of the reasons I was Switched to diazepam to taper off. I also cannot get any more diazepam so I guess I have to go back down to the dose I was on before the latest increase. Should I do that before reducing the sertraline? I am so scared to reduce sertraline in this destabilised state but I guess I have run out of options as stabilisation just hasn’t happened for me by holding. 

[Kernol]

2/4

 

8.30am get up have shower. Feel depressed and dread at another day. Feel strong chemical anxiety in my stomach raw emotions 

9.00am take 2mg diazepam. Drink oat smoothie

10.00am do some work emails but lots of intrusive memories and horror 

11.00am feel depressed that there is no way out for me. The Caw of the pigeons outside is making me feel dark doom 

11.45am starting to peak now. Getting stronger can feel the electric raw emotion in my stomach so strong 

12.30pm try to do some work

1.00pm take 1.5mg diazepam carry on working

2.00pm take 16mg sertraline. 
3.00pm I feel same as earlier just so anxious so depressed and strong derealisation. Tinnitus has been continuous today but skin is not as strong burning 

4.00pm eat a sandwich 

5.00pm have bath feel weight of depression on me feel trapped in this 

6.00pm take 2mg diazepam. 
7.00pm eat dinner. Still getting spikes of strong chemical raw painful emotions. back is burning more now. 

8.00pm try and watch tv - v strong reaction and intrusive memories weird acid trip feeling

9.00pm lights out 

10.00pm-3.00am restless sleep with cold night sweats 

4.00am strong cortisol rushes and teeth clenching until 7.00am 

 

 

[Altostrata]

Kernol, if I were you, I would reduce sertraline before reverting to your earlier dose of diazepam.

 

You can maintain 5.5mg diazepam per day for a few more days, correct?

 

Please disregard the issue of dependency. You are dependent on both sertraline and diazepam. The diazepam being singled out for disapprobation is a bizarre cultural artifact arising from medicine not understanding psychotropic drugs. We will help you taper off the benzo when the time comes.

[Kernol]

Thanks @Altostrata I have not reduced it yet as the nausea, hypersalivation and chills kicked in yesterday and have made me feel so ill and the cortisol is off the charts. I have realised the nausea happened at exactly same time in my cycle last month in the first half. I believe my hormones are all over the place as I am in perimenopause and I think it is having a major impact on my withdrawal. Do you still think it is wise to reduce the sertraline in this state? I am just scared of what might happen I suppose although it’s intolerable as it is I just fear getting any worse 

[Altostrata]

I think your symptoms might be affected by your cycle and hormonal activity, yes. Perhaps you can plan to reduce in a few days, when this part of your cycle is past.

 

Hang in there, Kernol.

[Kernol]

Hi @Altostrata I have reduced the sertraline yesterday. I discovered I have actually been taking 16.67mg all this time since September 2019 so I reduced 1mg to 15.67mg. I have had to go back to 5mg diazepam as I couldn’t get any more. 

[Kernol]

9/4

 

8.00am get up strong derealisation from minute I open my eyes 

8.30am have shower. Some nausea. Derealisation high

9.00am take 2mg diazepam. Have oat smoothie

10.00am derealisation lowered slightly. Able to do work video call 
11.30am do work emails 

12.30pm derealisation has become v strong again, electric anxiety and intrusive memories coming in. Skin burning on stomach strong and nausea 

1.00pm take 1mg diazepam. No appetite can’t eat lunch 

2.00pm take 15.67mg sertraline 

3.00pm derealisation remains high all afternoon. Some skin burning on back 
4.00pm derealisation still high feel totally unfamiliar in surroundings and electric anxiety in stomach strong 

5.30pm lay down and deep breathe 

6.00pm make dinner quickly but do get painful emotions and intrusive memories. Take 2mg diazepam. Eat dinner. Nausea strong after eating 

7.00pm lay down and look at pictures of lovely travel destinations on Pinterest. Still feel derealisation. Feet are vibrating inside 
8.00pm get into bed. Thighs are burning hot 

9.00pm can’t sleep So just browsing internet 

12.30am still can’t sleep 

1.00am put fan on as too hot 

1.30am-6.00am sleep okay couple of nightmares and cold sweats

6.00am wake with panic rushes heart pounding and cortisol but no burning on skin.

7.00am-9.00am very tired so in and out of sleep and cortisol rushes but not as severe as some mornings 

 

Derealisation seems to be my constant companion this week from morning til night 

[Altostrata]

Hang in there, Kernol. The diazepam might be causing what you describe as derealization. You'll get through this and reduce the diazepam.

 

Please continue to post daily notes.

[Kernol]

10/4

 

8.00am still in and out of sleep can feel derealisation there when I wake. Emotional painful anxiety when I get up strong. I don’t feel grounded I feel deranged like I don’t know where I am totally disconnected. Feel nausea 

9.00am take 2mg diazepam. Have oat smoothie and shower. Derealisation strong. Emotional pain at memories and any triggers like hearing birds or children playing 

10.00am derealisation calms enough I can put laundry on and sit in shade outside. I have a bit more clarity and less emotional anguish 

11.45am the chemical terror rises and I feel the derealisation so strong. Everything triggers me I can’t do a crossword without the clues triggering me, I feel disconnected like I’ve traveled into the past and Feel huge emotional anguish in my stomach like a volcano. Nausea is very strong 

1.00pm take 1mg diazepam 

1.30pm anguish calms a bit and volcano Of emotion  is less strong and derealisation has lowered by about 30%. Nausea is less although still no appetite. 
2.00pm take 15.67mg sertraline 
3.00pm feel very tired so fall asleep on sofa 

4.00pm wake in totally disorientation confusion and off scale derealisation

5,00pm lie on bed trying to calm down and feel grounded. Doing breathing but I still feel so peculiar and disconnected 

6.00pm take 2mg diazepam 

7.00pm diazepam didn’t help. Getting strong spikes of emotional anguish and time travelling and memories and I can’t seem to stop them. The volcano is rising in my stomach 

7.15pm eat small meal. Strong nausea after eating but do not vomit

8.00pm try and watch tv/ big mistake. Major spoke volcano of dread doom electric anxiety and just total emotional dysregulation at only 20 seconds of what used to be my favourite soap opera. Feel despair turn it off.

9.00pm feel strong derealisation and some terror I am not sure if I will sleep it’s so strong and I dread tomorrow already 

10.00pm-5.00am sleep ok few nightmares and night sweats and cortisol rushes at 5am with teeth clenching and strong nerve burning pain across my back

6.00am-8.00am - in and out of sleep cortisol rushes but not as severe as some mornings. wake with strong derealisation and dread 

[Altostrata]

Hang in there, Kernol. The change in sertraline is probably only now registering in your system.

 

As the sertraline and diazepam block each other's metabolism, adjustment is to be expected. I wonder if your reaction to the 6 p.m. diazepam dose is a sign of conflict with the sertraline dose you take at 2 p.m. What happened when you were taking diazepam later in the evening?

 

Please continue to post daily notes.

[Kernol]

Thanks @Altostrata I moved the diazepam earlier in the evening so I could eat something for dinner as I have no appetite otherwise and because I was simply desperate for it by that time - a sorry state of affairs to be so desperate for any kind of relief. I know previously when tapering the sertraline it would take 2-4 weeks before I noticed the bad symptoms but I’m hoping that won’t happen as I was doing massive drops back then. 
 

I am noticing that the nausea is present first thing before diazepam dose and then returns at lunch when the morning dose effect wears off and then it returns late afternoon again. I don’t know why the diazepam would be helping the nausea but maybe there is a reason. 

[Altostrata]

Diazepam is a muscle relaxant. The sertraline may be making you tense.

 

When you were taking diazepam in the evening, you were also taking vortioxetine? Is that why we spaced the drugs out?

 

Taking the evening dose a little later may prolong its effect overnight.

 

Let's let the change in sertraline settle.

[Kernol]

11/4

 

8.30am get up have shower. Strong derealisation and nausea with hypersalivation 

9.00am take 2mg diazepam. Have oat smoothie

9.40am derealisation lowers a bit and nausea goes. Able to sit in garden and do some quizzes 
11.45am feel the emotional pain in my stomach rising and derealisation going out of control. Everything is now triggering me. Time travelling and emotional pain over anything. I looked at a photo of some eggs in the newspaper - that made me feel dread. No logic whatsoever. So strong have to deep breathe. Tell myself I am just in flight fight response and everything will trigger it but it will pass.

12.00pm nausea is strong Now. 
1.00pm take 1mg diazepam. No appetite for lunch. Still nauseated but comes down a little 

2.00pm derealisation still strong. take 15.67mg sertraline 

3.00pm derealisation still strong and some intrusive memories bringing emotional painful anxiety for no reason.

4.00pm watch husband play rally game - even the rally course gives me anxiety imagining myself there - feel crazy can’t calm down. Tell myself it will pass and my nerves will calm 

5.00pm now lying on bed waiting in hope of diazepam doing something to dampen it

6.00pm take 2mg diazepam. Still feel same maybe 10% less but not much different

7.00pm look at pictures of nice travel destinations on Pinterest try and calm myself. Nausea is strong lots of hypersalivation. 
7.30pm manage a sandwich. 
8.00pm looking at positive affirmations 

10.30pm lights out 

11.00pm -4.00am very hot in bed very restless some bad nightmares and a feeling of dark depression feels painful in my stomach so deep - haven’t had this for a while. Feeling Keeps coming waking me with cortisol rushes. Teeth. Clenching same as usual and some nasty burning on back and stomach. Feel like maybe my system has noticed the reduction in sertraline but not sure 

 

 

[Altostrata]

Hang in there, Kernol.

 

Is the morning diazepam perhaps having more of a beneficial effect now? I am seeing less derealization in your reports.

 

When you report "nausea," are you actually vomiting? What is the sensation?

[Kernol]

Hi @Altostrata i think the morning dose is having some effect it brings the derealisation down a little.

 

i am not vomiting it is just nausea with lots of saliva in my mouth. It starts as soon as I get up and lasts till I go to bed at night but is less for a while after the diazepam doses 

[Altostrata]

I think the sertaline needs to get out of the way of the diazepam. As they block each other, you may feel some changes. I hope they are small changes and gradually move in a better direction.

 

The adjustment to a sertraline reduction will take effect over perhaps 4 days. Also, please be aware you had increased diazepam and then decreased it about the same time you decreased sertraline. That change will gradually lower the diazepam level in your system over several weeks.

[Kernol]

12/4

 

8.00am get up - derealisation and strong nausea. Some skin burning and clothes hurt my skin 

8.30am have shower

9.00am take 2mg diazepam. have oat smoothie

10.00am derealisation lessens and nausea goes. 
10.30am brave a walk around the block. Highly anxious but manage it 

11.15am sit in garden do crossword. Derealisation lower than yesterday 

12.40pm have tuna salad lunch Outside

1.00pm take 1mg diazepam 

2.00pm clear kitchen up. Take 15.67 mg sertraline 

2.45pm try and watch the film planes trains and automobiles - major spike in chemical anxiety dread and doom With intrusive memories whilst watching. It’s like a learned reaction my brain seems to do every time I try and watch anything. Get v upset. 
3.30pm my aunt texts me to wish us happy Easter. I get doom when I think of her and strong anxiety for no reason. Feel upset and think I will never be able to see her again if I get this sort of reaction. 

4.00pm make the bed up. Notice nausea is getting strong again 

5.00pm lie in bed looking at travel photos of nice places - calm a little 

6.00pm take 2mg diazepam. 
6.45pm nausea still present so can’t face dinner

7.00pm manage to do online food shop. Some spikes in dread feeling but not as bad as some occasions in the past 

8.00pm watching my husband read. Trying to feel calm. Still nauseous 

9.30pm lights out 

10.30pm - 4.00am restless sleep much same as night before 

5.00am Wake with strong cortisol rush and nasty burning and teeth clenching quite strong 

5.00am-7.00am in and out of toxic sleep with teeth clenching and cortisol rushes with feelings of panic and dread and derealisation 

 

[Altostrata]

This seems a little better? So sorry you're still having such a rough time, Kernol. But I think lowering sertraline might be going in the right direction.

 

When was the last sertraline reduction?

[Kernol]

13/4

 

8.30am get up have shower. Nausea and hypersalivation. Strong emotional pain type anxiety in stomach. Derealisation 

9.00am take 2mg diazepam

10.00am derealisation lessens and nausea goes. Have 2 slices of wholewheat toast. 
11.00am manage to do a proper clean of bathroom and shower glass. Some spikes of strong raw anxiety and emotional pain but finish the job 

1.00pm take 1mg diazepam. Have sandwich. Emotional pain type anxiety spiking in and out 

2.00pm take 15.67mg sertraline. Have psychologist Skype session 

3.00pm bit more emotional pain type anxiety now mainly because been discussing it in session 

4.30pm decide to try and make meal. Major spike of derealisation and time travelling and emotional pain when at the stove. In part think this is because I have had it every time I have cooked and my brain remembers it. Nausea is very strong now with hypersalivation 

5.30pm lie down to calm down and accept what has happened 

6.00pm take 2mg diazepam 

6.30pm Nausea calms a little so I can eat dinner

7.00pm dial into Baylissa’s forum. Feel ok 

8.00pm try and watch tv. Some spikes of the raw anxiety feeling but not as bad as the other day 

9.30pm try and sleep 

11.30pm still can’t sleep. Getting quite a few intrusive memories of places with the Chemical dread and emotional pain feeling Of anxiety 

12.00am-5.00am very broken sleep. Teeth clenching worse right from the start. Very hot. Nightmares and waking with panic and strong sizzling skin burning on back and front. 
6.00am wake with stinging tingling skull (not had this symptom for a while)  feel strong emotionally painful type anxiety in stomach. Some intrusive memories too. 

 

hi @Altostrata do you mean when did I do this first drop? 8th April. I hope things get better and not worse. I guess the next few weeks will tell. I know I have a hormonal issue playing into all of this so it may be difficult to determine what Is withdrawal from tapering and what is hormonal. 

[Cathy4]

4 hours ago, Kernol said:

Nausea is very strong now with hypersalivation 

I’m having this as well—just since my last sertraline drop.  It’s very strange & uncomfortable.  I’m holding at 51.9mgai sertraline for another month to see how it goes.
 

The hormones continue to throw a wrench in things for me, too, but not nearly to the extent of your experience.  
I’m impressed you can still do video calls at times!  

[Altostrata]

After a week, the sertraline is probably evening out. The diazepam from your previous period of increased dosage is still being metabolized.

 

Good sign that you felt like cooking! Breathe through this, Kernol. My intuition is reducing sertraline is a good direction to go in.

[Kernol]

Thanks @Altostrata I do hope so too!

 

14/4

7.45am get up have shower feel strong nausea and hypersalivation and derealisation 

9.00am take 2mg diazepam. Have oat smoothie 

10.30am still quite nauseated 

11.30am have work video call. Feel ok a few strong spikes and have a weird intrusive memory of an old dream during it but try and ignore it. 
12.30pm still bit upset avoid the intrusive memory of the old dream as was hoping they were lessening. Nausea is strong with hypersalivation 

1.00pm take 1mg diazepam. Have tuna salad lunch. Nausea a little better 

2.00pm hear children laughing outside and sends wave of strong chemical anxiety through me. Find it upsetting. Take 15.67mg sertraline 

3.00pm do some work emails 

4.00pm skin pain is a bit more today 

5.00pm lie on bed deep breathing and reading positive affirmations 

6.00pm take 2mg diazepam 

7.00pm have dinner. Nausea is very strong

8.00pm nausea still  strong. Get into bed. Body is burning 

9.00pm get lots of thoughts of guilt and shame and feel sick more at these. Feel anxious and strong dread when I think of places and fear I will never be able to go anywhere again. 
10.30pm lights out. Strong teeth clenching from going to sleep right through night

11.00pm-2.00am very hot have to take covers off, nightmares and night sweats and teeth clenching with sizzling burning skin 

3.00am cortisol rushes and panic

4.00am-6.00am in and out of panicky sleep 

 

[Altostrata]

Ooof, that sounds rough. The diazepam bump might be wearing off. Any chance you can get more from doctor?

[Kernol]

15/4

 

8.00am get up slightly less derealisation than previous days but nausea v strong 

8.30am shower 

9.00am take 2mg diazepam and do work video call. Nausea still strong 

9.30am have oat smoothie. Derealisation still there but not as strong as last week

10.30am do some work emails. Few spikes of strong anxiety but not horrific 

11.00am still very nauseous with hypersalivation 

12.30pm eat some dry crackers - still nauseous 

1.00pm take 1mg diazepam 

2.00pm take 15.67mg sertraline 

3.00pm still spiking anxiety and lots of feelings of shame and guilt coming through 

4.00pm work emails 

5.30pm have bath. Nausea still strong 

6.00pm take 2mg diazepam 

7.00pm have some eggs but still nauseous 

8.00pm able to watch a bit of tv with some strong spikes but not so bad I have to stop 

9.30pm lights out 

10.30pm very hot can’t sleep even with fan on full 

12.00am-6.00am really bad teeth clenching but not so strong cortisol rushes on rising - little less intense 

 

 

 

[Altostrata]

That rough patch might have been the sertraline level going down. It's been about a week, which would be approximate washout, meaning the sertraline has normalized at your current dosage level of 15.67mg.

 

Would you be interested in reducing to 15.50mg?

[Kernol]

Hi @Altostrata I would like to give it a bit longer before I reduce again as I noted these days of my cycle (Day 20-22) last month were a little less intense and then it ramped up again so just want to see what happens plus the nausea is still very strong and not sure what is causing that. 
 

16/4

 

7.00am less intensity to the cortisol rushes and lots of sneezing allergy type symptoms just like this time last month. Derealisation lower. Can feel teeth clenching has been bad though 

8.00am get up have shower. Strong nausea and hypersalivation 

9.00am take 2mg diazepam. Have oat smoothie

10.00am nausea lessened a bit 

11.30am-3.30pm dial into work video call board meeting. Take 1mg diazepam at 1pm and 15.67mg sertraline at 2pm. Manage call ok

4.00pm nausea is quite strong. Few strong spikes of chemical anxiety at Birds outside and the lawnmower sounds give me horror. Tell myself my brain has just learned this reaction and will take time to stop reacting to triggers 

5.00pm do couple of work emails. Nausea strong. Try ginger to help but it doesn’t seem to do much 

6.00pm take 2mg diazepam. 
6.45pm have pasta dinner. Nausea awful after eating 

7.30pm lie down nauseated. Some spikes of chemical anxiety coming through but not as torturous as some days. 
8.30pm can watch some tv - still getting some chemical anxiety spikes but can Tolerate 

10.00pm lights out 

10.30pm too hot even with Fan on. 
12.00am still can’t sleep

1.00am-5.00am restless sleep, some night sweats and burning skin and nightmares. Teeth clenching severe throughout whole night 

[Altostrata]

If I were you, I'd consider a fairly frequent micro-taper, of perhaps 0.25mg every 4 days. (I suggested an initial reduction to 15.50mg to make the math easier.) This may allow the sertraline to gradually dissipate (half-life is about 6-7 days) and the influence of the diazepam to take over.

[Kernol]

Hi @Altostrata I am interested in doing a frequent micro taper but wouldn’t that take me over the 10% a month reduction overall or have I misunderstood? I will wait to see how this drop goes first for a little longer just to be sure there are no nasty surprises.

 

17/9 

 

8.00am get up feel a bit depressed on waking but ok once up and derealisation is markedly less. Nausea and hypersalivation still strong 

9.00am take 2mg diazepam 

10.00am have 2 pieces of wholemeal toast was actually hungry 

11.00am do work emails. feeling ok a few spikes of strong anxiety but nothing too horrific compared with previous weeks.

12.00pm have sandwich for lunch and make one for my husband too 

1.00pm take 1mg diazepam 

2.00pm take 15.67mg sertraline.

3.00pm a few spikes at the bird sound outside and Lawnmowers but not barbaric 
4.00pm do some work emails. Derealisation has remained low. Nausea and hypersalivation remains high - ginger capsules don’t seem to have worked 

5.00pm watch news - some spikes as expected and leave room to do some deep breathing 

6.00pm take 2mg diazepam

7.00pm eat dinner 
8.00pm watch some tv and do not get the usual horrors 

9.00pm still watching tv. Have not been able to do this since the week in December when I was finishing vortioxetine. 
10.30pm lights out

11.00pm -6.00am - restless sleep some night sweats and still strong teeth clenching all night

7.00am wake with cortisol panic but again less intense and I have the sneezing again too which happens every time my cortisol anxiety seems to  be better 

 

18/9

8.00am put tv on in bed. Again haven’t done this since that 1 week window when camE off vortioxetine. Nausea still strong 

9.00am take 2mg diazepam 

10.00am have breakfast in bed watching tv with v little spikes and no Chemical depression or dread no acid trip feelings and Derealisation much less 

11.00am get up have shower 

12.00pm read paper do crossword - get a few spikes of chemical anxiety but ok. Nausea strong again 

1.00pm take 1mg diazepam 

2.00pm take 15.67mg sertraline 

2.30pm do a thorough clean in the bathroom 

3.00pm write a note to my grandmother in the nursing home - this does bring up a lot of strong intense chemical doom dread feelings 

4.00pm birds outside  cawing spikes my anxiety 

5.00pm looking at nice landscapes and travel destinations on pinterest

6.00pm take 2mg diazepam

7.00pm eat dinner. Nausea and hypersalivation still strong 

8.00pm watch a film - a few spikes but not anywhere near as bad as usual 

10.00pm watch  another film - again same  as above 
11.00pm lights out 

 

 

[Altostrata]

It does appear you are doing better. The sertraline is causing problems.

 

It's your decision, if you feel you can tolerate the current level of drug-drug interaction, you can go slower if you wish. Or, you may wish to take a slightly more elevated risk and taper a bit faster.

 

Given your diazepam intake, my guess is the risk of sertraline withdrawal symptoms is low.

 

A reduction of 0.25mg on 15.67mg is 1.6%. If you make this reduction every week, it's still going to be less than 10% per month until you get to 10mg.

[Terry]

Hi Kernol,

 

It's so good to see small signs of improvement in your WD.  That is very positive!  Hope you decide to take Alto's advice.  She has a great deal of experience, and has your best interest at heart. 

 

Best wishes,

Terry

[Kernol]

On 4/20/2020 at 5:06 PM, Terry said:

Hi Kernol,

 

It's so good to see small signs of improvement in your WD.  That is very positive!  Hope you decide to take Alto's advice.  She has a great deal of experience, and has your best interest at heart. 

 

Best wishes,

Terry

Thanks so much @Terry  and yes I will of course be guided by Alto as always in this long journey! I hope you are doing well yourself