zolofellow: severe WD Symptoms following sertraline

[zolofellow]

Hi All -

 

I am glad I found this forum! I am currently dealing with severe Withdrawal symptoms following stopping Sertraline on 28th Oct 2018. I was on 50 mg dose and my taper was just for 5 week on 25 mg. 

 

Before I get into that a brief history -

 

16 Feb 2011 - 28 May 2012 - Venlafaxine 75 mg - I was put on Venlafaxine for anxiety disorder and panic attacks following a troubling blood work report showing high cholesterol. I was able to come off this drug very easily without any real Withdrawal symptoms.

 

Next episode was in September 2013 when I again started having severe heath anxiety (cardiac health + infections) following the untimely death of a close friend. I tried to manage this without medication for 2 months but eventually started medication again -

 

15 Nov 2013 - Oct 2014 - Cipralex - did not work for me. There were days where I felt good but then it all went downhill.

 

Nov 2014 - March 2017 Venlafaxine with one attempt of approximately 3 weeks in Oct 2016 to stop the meds. 

 

After stopping Venlafaxine in March 2017 i stayed normal for another 35 days and then the anxiety came crashing back. I tried to manage it with Yoga and meditation but eventually gave in an started on another SSRI - Sertraline 50 mg

July 2017-Oct 2018 Sertraline 50 mg (tapered to 25 mg for almost 5 weeks before stopping)

Nov and Dec went well but were extremely stressful on the personal side.

And then on the 28th of December the anxiety came crashing back. 

It initially started with Overwhelming thoughts, racing mind, uncontrollable negativity and generalized worry about my health. It was intermittent with a few good days interspersed in between.

But following a business trip that involved some alcohol on 4 consecutive days the anxiety is back for good since the 18th Feb and I am not having any good days any more. In fact symptoms are intensifying each day.

Current Symptoms - Severe anxiety, shivering, waking up in the night with palpitations, insomnia, diarrhea, scary thoughts, racing mind, tightness in chest, shivering

 

My Personal Conditions - I have just moved to a new property and have been through a very stressful time. On the personal side I am expecting my first child in June 2019 which makes it even more difficult as I have to be there for my partner. I have a moderately stressful job but have some other temporary stresses from some financial transactions.

 

In the light of the above can you please advise -

 

1. Is this withdrawal or do I need to be on the medication longer? Any advise would be appreciated.

2. I did not know about this website and the tapering strategies mentioned here? Will it make sense for me to go back on the meds and then do a formal taper over a long period of time (2-3 years)? Can it reduce the chances or intensity of the Withdrawal syndrome?

3. Are there support groups here locally in London that you can introduce me to?
 

[WiggleIt]

Dear zolofellow,

 

Welcome to the site!  We're glad you've found SA for support, but of course sad that you are going through this.  There is a lot of information to address in your intro post, and I'm going to do my best to be informative without being overwhelming.

Members here have reported that going on and off psych meds can exacerbate their original anxiety.  WD can also create anxiety (including health anxiety) in people who have never experienced it.  You are likely looking at a situation where your original anxiety has been magnified by antidepressant WD, and it seems apparent that the WD has also added physical withdrawal problems, too.  

You wrote that you dropped from 50 mgs to 25 mgs of sertraline in 5 weeks.  On this site, we recommend an approach of tapering down even more slowly by 10% of your current dose.  So, if you were on 50 mgs, you'd go down by 10% of 50.  You'd hold there for approximately 30 days, then you would reduce by 10% of that dosage (not 10% of the original 50 mgs).  Don't sweat that you didn't go by the 10% taper method; so many people don't because there are not enough resources or doctors safely guiding them to do so.  I'm just explaining the method to you so that you can have it in your arsenal of knowledge. Here is a link about it:

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

But, like I said, don't sweat the fact that you didn't do it that way.  I didn't, either, and I'm here with lots of recovery under my belt anyway.

You asked about going back on the med and re-tapering more slowly.  We refer to that as "reinstatement," and it works for some people, but does not work for others.  Generally, the longer someone has been off meds, the more unpredictable reinstatement can be, but we do have some cases on this site where people have reinstated after a long time and then tapered off successfully.  If people decide to reinstate, we recommend going back onto teeny-tiny doses (even less than 25 mgs).  Here is a link about reinstatement:

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-33809

You asked about London support.  I'm not sure about face-to-face support, but there are British sites and doctors discussing the realities of antidepressant WD. Professor John Read from the University of East London and James Davies of the University of Roehampton have co-published research about the ubiquity of AD WD.  Perhaps that  might be a place to start?  Dr. David Healy of Wales is involved in this type of research, too.

Here is an introductory link to Davies and Read's research:

https://www.ncbi.nlm.nih.gov/pubmed/30292574

I'm going to ask some additional mods to weigh in about your reinstatement question, too!

Edited March 1, 2019 by WiggleIt

[Gridley]

Zolofellow,

 

You could reinstate 5 mg Zoloft to see if that gives you relief.  The following link has information about how you get nonstandard doses of Zoloft:

 

Tips for tapering off Zoloft (sertraline)

 

It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.

 

 

 

[Altostrata]

Welcome, zolo.

 

It sounds like you got withdrawal symptoms while you were tapering sertraline, that's what that intense anxiety was.

 

12 hours ago, zolofellow said:

Current Symptoms - Severe anxiety, shivering, waking up in the night with palpitations, insomnia, diarrhea, scary thoughts, racing mind, tightness in chest, shivering

 

These are severe withdrawal symptoms. Taking 5mg is best done with a liquid, which you can make yourself, this topic explains how Tips for tapering off Zoloft (sertraline)

 

Liquid sertraline is also available by prescription from your doctor. Please take the drug at the same time each day and let us know how you're doing.

[zolofellow]

Thanks everyone for your response! Just need some reassurance here that I can do this. This is certainly withdrawal as some of the symptoms are brand new ... never had them before.

I want to start the RI today but do not have the right equipment to measure 5 mg out of a 50 mg pill. I will ask my GP for a liquid zoloft prescription.

 

The GP is suggested reinstatement but to go to 25 mg. Any thoughts? 

 

Would you say most ppl trying  a 10% taper succeed?

[WiggleIt]

Hi zolofellow!

In my opinion, going back to 25 mg is a lot, especially since you've been off for so long.  @Altostrata, what do you think?

Also, zolofellow, have you tried calling around to any other doctors to see if you can find one who is familiar with AD WD?  Perhaps if you find a doc who knows about AD WD, then that doc might be more likely to help you with a liquid prescription for cautious dosages.  You don't have to ditch your current doc, but a few phone calls might yield a surprising result.  I lucked into finding a great doctor just by cold-calling a bunch of different offices until I talked to one who was nice and open-minded.

Also, have you check out the Success Stories on SA?  In addition to us reassuring you, it sounds like reading about people who've also lived through this will help keep you going: 
https://www.survivingantidepressants.org/forum/28-success-stories-recovery-from-withdrawal/  

 

[Altostrata]

Yes, I think 25mg is a rather high dose for reinstatement. We recommend starting very low to avoid risk of kindling. You might tell your GP that when you call back for the liquid.

 

Very few doctors know anything about withdrawal syndrome.

 

This topic explains how to make your own liquid from a tablet, if necessary. Tips for tapering off Zoloft (sertraline)

 

If you cannot get liquid Zoloft, you might consider taking 1mg Prozac liquid. After stabilizing for some time, you'd taper off by tiny amounts later.

[zolofellow]

HI Alto - I believe I had kindling which was like a deluge of adrenaline within an hour of taking the first dose of 12.5 mg. Had to go the ER which did not help as. Absolute insomnia with crazy symptoms and no heart rate at 120.

 

Yesterday I was able to see an out of hour GP who finally gave me diazepam which didn't help much either. However, the doc suggested that I go back to 50 mg and stabilize for 3-4 months before I start my taper with the 10% / month rule. They kinda forced me to have the 50 mg Sertraline once which kind helped as symptoms subsided for the next 18 hours. Anxiety back since morning as I took another 12.5 mg.

 

The GPs are suggesting that I go back to the last stable dose before I try and taper. I am confused now. They also suggested that if I want a slow ramp up I can do 12.5 mg both in the morning as well as evening.

 

what do you suggest?

[Altostrata]

Very few doctors, including that GP, know anything about withdrawal symptoms or tapering. If kindling occurred at 12.5mg before, it's too high a dose for you. More is not going to be better.

 

Taken regularly, diazepam is addictive. It is a poor solution to your problem.

 

If you have 50mg Zoloft tablets, you can make your own liquid in order to try a very, very small dose, even 1mg, see Tips for tapering off Zoloft (sertraline)

 

In the future, you will need to be firm in your requests for a prescription.

 

Please let us know how you're doing.

[zolofellow]

Thanks Alto!

 

In order to stabilize again what dose should I try to achieve. My last stable dose was 50 mg back in Oct. I am very cautious with the diazepam and only use it sparingly.

 

Some stabilization is required before I can even plan my 10% taper. I am hoping I could stabilize around 25 mg. How do I reach that number. Are you suggesting I do that in 1 mg increments? 

 

I first child is due in 3 months I want to be stable at that time and hence a bit desperate.

[Altostrata]

How often have you been taking diazepam, and at what dosage? If you've been taking it every day, that could be a problem.

 

We can't predict how long it will take you to stabilize, or what dosage will be effective. It's unlikely you'll be taking as much as 25mg. 1mg-5mg might be sufficient.

 

If you try reinstatement of a low dose, we will need to observe for a while to see what it does. Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. Post your notes here in your Intro topic.
 

[zolofellow]

One last question for the day - Is not a good idea to stabilize at the previous dose and then start a formal tapering program? I l know that might mean I will lose any adjustments the body has made in the last 2 months

[WiggleIt]

48 minutes ago, zolofellow said:

One last question for the day - Is not a good idea to stabilize at the previous dose and then start a formal tapering program? I l know that might mean I will lose any adjustments the body has made in the last 2 months

I'm sorry that I don't have a solid answer to your question, and, in fact, I'm going to add another question:

Based on how your body is reacting at 12.5, do you feel like you can handle going back up to 25 or 50?

You said you were kind of forced to take 50 at one point, and you settled down for 18 hours.  Then, you wrote that taking 12.5 caused anxiety and increased BP.  If you take detailed notes as Alto suggested, it could help you spot patterns for how your body is reacting.  Spelling things out on paper may help you make your decision.     
 

Edited March 4, 2019 by WiggleIt
Added rationale for daily symptom notes

[ChessieCat]

What we see is that going on and off psychiatric drugs and having adverse reactions to them causes the nervous system to be hypersensitive to drugs and sometimes supplements and even foods.

 

Nervous system hypersensitivity causes a little to go a long way.

 

57 minutes ago, zolofellow said:

I am hoping I could stabilize around 25 mg.

 

52 minutes ago, Altostrata said:

It's unlikely you'll be taking as much as 25mg. 1mg-5mg might be sufficient.

 

Please note that taking too much of the drug can end up making things worse.  It is better to start with a small amount and increase by a small amount if necessary.

 

It seems that you are thinking in terms of "therapeutic dose".  Therapeutic dose is an arbitrary term which the pharmaceutical companies use.

 

Here at SA we try to find the "lowest effective dose".  The lowest effective dose is the amount of drug that works best for you at this current time.

 

51 minutes ago, Altostrata said:

Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

[RachelSusan]

3 hours ago, zolofellow said:

HI Alto - I believe I had kindling which was like a deluge of adrenaline within an hour of taking the first dose of 12.5 mg. Had to go the ER which did not help as. Absolute insomnia with crazy symptoms and no heart rate at 120.

Hi Zolo,

 

Nice to meet you, however I am very sorry you are in this situation.

 

I am no Moderator but I am a Zoloft survivor who has been exactly where you.  What I am going to say is based on what I went through so take it for what it is worth, only my opinion.  So here goes... You know how that 12.5 mg sent you to the hospital?  Well I did that same thing and it damn near killed me. Please think twice about going back on a dose other than what your mods recommended.  It was my doctor that put me on a dose of 12.5 mg, so while the docs are educated and mean well they don't always know as much about withdrawal as those of us that have lived through it. Please Please start low like your mods suggested and then report back to them, who by the way are the same ones that helped to save me. They will guide you to stability.  I reinstated and I got relief  ---after much too high of a dose from the doctors. I am now down to 3.125mg of Zoloft and leading a fairly normal life, granted some ups and downs when I taper, but over all it is good.  If you have any questions feel free to ask, or visit my page and see what is up with me.

 

Warm wishes,

Rachel

Edited March 4, 2019 by RachelSusan
typos

[Altostrata]

3 hours ago, zolofellow said:

One last question for the day - Is not a good idea to stabilize at the previous dose and then start a formal tapering program? I l know that might mean I will lose any adjustments the body has made in the last 2 months

 

Your nervous system has been sensitized and you have reacted badly to your previous dose, if by that you mean 12.5mg or 25mg. What is the sense in continuing to do that?

 

Read this: About reinstating and stabilizing to reduce withdrawal symptoms

 

We still need the answers to this:

 

3 hours ago, Altostrata said:

How often have you been taking diazepam, and at what dosage? If you've been taking it every day, that could be a problem.

 

[zolofellow]

hi Alto -

 

I just tool the diazepam 4 times over two days (2.5 mg each time). I am conscious and do not want to build dependence on Diazepam at all.

 

However I have to travel for business and have personal conditions like my upcoming baby  and hence I was thinking of stabilizing at 12.5 mg or 25 mg for 3-4 months (the baby is due in June). And then being a Brassmonkey slider over 2 years.

 

As this is very new to me I still dont have a kit to measure 1 mg or 5 mg. I am reading the tapering section to understand what I need.

 

I totally appreciate everyone who dropped into my introduction for their comments. 

 

As of now I have been able to get some sleep last night though.

[zolofellow]

Also, just one more point that I would bring to your notice is that on Sunday while I was recovering from the Kindling, at around 6.00 pm in the evening my anxiety suddenly calmed down and I felt relatively normal. It stayed like that till 11.30 am next morning after which the anxiety was back 

 

Also, I am getting the syringes required to move to exact doses as I was still breaking my tablets. I have 50 mg tablets only as of now. Can I store the solution in a freezer melt it next day and consume it again?

[ChessieCat]

5 hours ago, zolofellow said:

Can I store the solution in a freezer melt it next day and consume it again?

 

No, don't freeze!  These drugs weren't designed for extremes of temperature.

[zolofellow]

Can I leave the solution at room temperature then? Will it be okay the take next days dose from the same solution?

 

Also, I am now on the 5th day of RI and my anxiety and insomnia are skyrocketing .... the GP is just saying that this will happen as the drug takes over. I am still taking a quarter of a 50 mg tablet. I know SA has advised that I should have started lower. Will it make sense to lower it now to 5 mg?

 Can i stabilize at 5 mg? Or is the strategy gradually increase the dose to a point where one can stabilize?

[ChessieCat]

Keep in a covered container in the refrigerator.

[ChessieCat]

Please update your drug signature with the dates and doses of your sertraline changes so we can see exactly what changes you have made.  Thank you.

[Altostrata]

You've been taking 12.5mg sertaline since Saturday?

 

Are you feeling better or worse since Saturday? Has your sleep improved over the last 5 days?

 

I'm very confused why you're asking about a liquid preparation.

 

[zolofellow]

2nd March - quarter of 50 mg tablet - 12.5 mg - Lead to kindling, severe akathisia, high HR, trembling, anxiety, no sleep

3rd March - Saw an out of hour GP during the day who asked me to take a 50 mg sertraline tab and i did at around 12 noon - Felt better (almost normal) in the evening at around 6 pm and this continued till 11 am on the next day, slept for 4 hours

4th March - 12.5 mg (quarter of 50 mg tablet) moderate anxiety through after 11 am, no sleep again in the night with low degree akathisia

5th March - 12.5 mg , extreme tiredness and moderate anxiety, slept 6 hours plus

6th March - 12.5 mg , extreme anxiety throughout the day and unable to sleep with tightness in stomach but lower akathisia

 

[Altostrata]

Since March 2, have your symptoms gotten better or worse? What time of day do you take 12.5mg sertraline? How do you feel afterward?

 

Please keep daily notes on paper with times of day for when you take your drugs, their dosages, and your symptoms. You can post them in this topic with a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. Post your notes here in your Intro topic.

[zolofellow]

9 minutes ago, Altostrata said:

You've been taking 12.5mg sertaline since Saturday?

 

Are you feeling better or worse since Saturday? Has your sleep improved over the last 5 days?

 

I'm very confused why you're asking about a liquid preparation.

 

Alto - after the kindling on the first day things seemed to imprpve up after the big 50 mg dose on Sunday. but since monday morning the anxiety is back and I am unbale to sleep well (see previous comment for details)

 

thats why i was wondering if i should reduce the dosage to 5 mg by making a liquid.

 

the GP is dismissing this as increased anxiety as the drug is picking up

[Altostrata]

Has your sleep improved over the last 5 days?

 

2 minutes ago, zolofellow said:

the GP is dismissing this as increased anxiety as the drug is picking up

 

Right, so an antidepressant is supposed to make you anxious? This is a good result? I don't think so.

 

But has your anxiety actually increased? What do you mean by akathisia? Relative to when you take your dose, when does this happen?

 

Please answer my questions so I don't have to repeat them.

[zolofellow]

1. No sleep patterns have been irregular - I am sleeping only every alternate day (Saturday night - no sleep, Sunday Night - 4 hous+, Monday Night - no sleep, Tuesday Night - 6 hours plus, Tonight again no sleep

2. I take the dose in the morning around 9 am. By akathisia I mean trembling in limbs and thighs and it happens only when in the night specially when i am trying to sleep. It has reduced since the first night.

3. Anxiety has increased and has become continuous rather than sporadic

[Altostrata]

After you take 12.5mg sertaline at 9 a.m., what happens? Do you feel better or worse? How do you feel around 3 p.m.-6 p.m.?

 

Since you've taken 12.5mg consistently for only 3 days, it's hard to tell if you've got to steady-state and whether this is your baseline symptom pattern. With the other doses on March 2 and March 3, you might have a little higher level than 12.5mg in your bloodstream. Your symptom pattern may change as steady-state smooths out.

 

As you can see, I need rather specific information to determine the effect of 12.5mg. Please keep those daily notes. This is work that your doctor should be doing, by the way.

[zolofellow]

I appreciate that Alto! And i totally understand that you might find me a bit frustrating at times. But unfortunately I have no where else to go.

 

I will keep proper notes tomorrow onwards.

[zolofellow]

Update -

 

Wednesday Night - No sleep

Thursday 07/03

6.15 - leave bed with moderate anxiety and tiredness

7.20 - Breakfast and gradual increase in anxiety

8.10 - Sertraline 12.5 mg

8.30 - 9.00 - Anxiety went down

12.45 - Lunch with moderate anxiety

13.00-18.00 - Moderate to high anxiety, extreme tiredness

18.00-00.15 - Anxiety reduced significantly, mood improved - fairly normal with extreme tiredness

Slept 5 hours +

 

Friday - 

8.10 - Sertraline 12.5 mg

9.00 - breakfast

9.00 - 11.30 - Low level anxiety, Ok mood

12.30-13.00 - nap

13.00-19.00 - Moderate anxiety, low mood

 

 

 

 

[Altostrata]

We need to see more of your daily pattern, but from that one day, it looks like 12.5mg sertraline is helping.

 

You need to let your nervous system settle down from all the changes. You will have ups and downs while it does this. See The Windows and Waves Pattern of Stabilization

 

You can work on improving your sleep. See

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia 

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

[zolofellow]

thanks Alto - the sleep is the biggest problem right now. I am waking up with a jolt within 2-3 mins of trying to sleep .... and then I am just lying in the bed with eyes wide open not knowing what to do till the next jolt hits.

[Altostrata]

Yes, we're very familiar with that pattern. Please read the links and apply techniques that suit you.

[zolofellow]

Having a particularly bad day today with horrible anxiety.

 

The waking up with a jolt symptom has eased out a bit. The intensity has reduced.

 

Can you help me find a Psychiatrist in London who helps patients with Withdrawal?

[ChessieCat]

recommended-doctors-therapists-and-clinics