SwingCobra: recently started taking sertraline and want off it - what should I do now?

[SwingCobra]

Admin link - link to benzo forum thread - SwingCobra: Choosing Ativan taper method

 

Hello everyone,

 

Ever since my first manic/psychotic episode back in October of 2012, I have been using a variety of psychiatric drugs, most of which being antipsychotics. Up until late July of this year, my drug regimen included 5 mg of olanzapine and 0.5 mg of lorazepam nightly; I had actually stopped taking lorazepam from March to mid-July, but restarted taking it due to the presence of stressful circumstances in my life. However, the same stressful circumstances led me to a state of anxiety for which my psychiatrist prescribed me sertraline. After reading a bit about antidepressants online and seeing how long-term use of these drugs can be troublesome, I'm not too interested in continuing taking sertraline on the long term. Right now, I've been taking 50 mg every morning for 8 days straight, and I'm not seeing my psychiatrist until August 19th, nine days from now. What would be the safest option for me to stop taking sertraline? My guess is I should wait to see my psychiatrist in order to discuss tapering methods with her, but I thought that receiving input from people on these forums would be beneficial.

Edited October 27, 2019 by Shep
added link to benzo forum thread

[SwingCobra]

I think I should add that right now, I only have access to sertraline in capsule formulation.

[Sassenach]

Hello SwingCobra and welcome to SA.

 

This site run by volunteer Administrators and Moderators who all have experience of  Antidepressant Withdrawal (W/D).

Your question is somewhat different to the norm.

Have the stressful circumstances changed?

At 8 days in the drug is likely just beginning to work.

You are correct that long term use can cause cessation problems.

This site is indeed dedicated to helping people wean off these drugs carefully.

We do however believe that they can be effective short term, if they are properly prescribed and monitored.

What has changed in the last 8 days to make you believe you no longer need the drug.

Have you noticed any side effects or symptoms since you began taking it?

Experience tells us doctors and psychs now little or nothing of withdrawal from these meds.

Please do not take from this that are unsypmpathetic or unwilling to help, but our aim is harm reduction.

We need to be sure that our advice is correct.

For the moment do not change doses or time taken, slow and steady is essential.

https://www.survivingantidepressants.org/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

Sassench

[SwingCobra]

Thanks for your reply.

 

Quote

Have the stressful circumstances changed?

 

Well I had time to think them through, and they aren't as bad as they were, but I wouldn't say they have gone away completely.
 

Quote

At 8 days in the drug is likely just beginning to work.

 

Well I do have to admit that I still have anxiety, but it's less severe than a week ago.

 

Quote

 

What has changed in the last 8 days to make you believe you no longer need the drug. 

Have you noticed any side effects or symptoms since you began taking it?

 

 

Actually, the fact of taking the drug is making me anxious. I didn't really notice any side effects, apart from the unpleasant feeling of not knowing where my emotions come from.

 

Quote

Experience tells us doctors and psychs now little or nothing of withdrawal from these meds.

Well I plan to discuss the matter with my psychiatrist and weigh in her advice. 

 

 

[SwingCobra]

I'll eventually decide to start tapering this drug, so I was wondering if anyone had tips on tapering Zoloft in capsule form. My plan would be to mix the capsule powder in water and to use an oral syringe to measure out the correct quantities of liquid but, as I have never done this before, I feel a little nervous about it. Has anyone been through a similar procedure before?

[SwingCobra]

Up until last night, I was sleeping around 6 hours per night without much problem, but last night I only slept 5 hours of what felt like restless sleep. I didn't feel as energized waking up. Could this be an adverse reaction to sertraline? Whatever the case, I'm now inclined to discontinue the drug as soon as it is safely possible to do so.

[Petunia]

 

On 8/12/2019 at 4:51 AM, SwingCobra said:

I was wondering if anyone had tips on tapering Zoloft in capsule form

 

Hi SwingCobra, you should find the information you need in these two topics:

Tips for tapering off Zoloft (sertraline) - Surviving Antidepressants

How to make a liquid from tablets or capsules

[SwingCobra]

So I started tapering off sertraline on Thursday, taking a 45 mg using liquid titration. So far my sleep has improved. I'll keep you updated about what happens next. For now, I was wondering on what would be an adequate tapering schedule, knowing I have only taken sertraline for two weeks and a 10% every four weeks taper would probably be inappropriately slow.

[Sassenach]

There is no such thing as

43 minutes ago, SwingCobra said:

inappropriately slow.

when it comes to tapering, see

why-taper-by-10-of-my-dosage/

I think you are seeing your psych on monday, who will doubtless tell you tapering is unnecessary.

It will be your choice but remember they know nothing about W/D.

You are not experiencing W/D symptoms at present so why take chances?

 

Sassenach

 

 

 

[SwingCobra]

Turns out my psychiatrist told me she was OK with me tapering sertraline slowly using liquid titration. It's good to know I can get support for my project of slow tapering without having to switch to a different psychiatrist, as my psychiatrist has been following me for quite some time and we've developed a positive relationship.

[SwingCobra]

As you can see, I've updated my signature to reflect my drug history up to now. I'd have quite a story to tell about it, but right now I've gotten in a rough spot with my taper of sertraline and I'd like to have advice about it. In hopes of improving my sleep quality, I made some rapid changes to my dosage; right now, I'm at 35 mg, and while my sleep seemed to improve going down from 50 mg to 45 mg, its quality has deteriorated quite a bit when going down to 35 mg. I have to admit that my sertraline dose might not be the only thing influencing my sleep; actually, things like being more active during the day seemed to have a more direct impact on it. But I still haven't recovered the sleep quality I had before August 12th and I strongly suspect sertraline might be interfering with my sleep, thus prompting me to want to reduce my dosage faster; however, it seems that lowering my dosage too fast also causes sleep problems. So I'm kinda torn between wanting to stop sertraline faster, holding at 35 mg or re-upping my dosage.

[Sassenach]

Was this taper on the advice of your psychiatrist?

[SwingCobra]

No, I decided to change those dosages myself, basing my decisions on the sleep quality I had and my general mood. I might have made too hasty changes.

[Sassenach]

 

 

Wait, wait! Please don't change any dosages until we work this out.

 

Please see following post from Alto.

 

 

 

Hello SC.

 

I am intrigued you said you trusted your psych, so why do this without speaking to her?

You situation has been discussed and below is the view of one of our senior mods.

 

It's going to hurt, but you could probably get away with 25% straight cuts every two weeks.  Given the mess of reductions in 2018 I surprised that there aren't more symptoms floating around.  Once the zoloft is done, then a good long hold would be a good thing to let everything settle out and stabilize.

 In general if a person has been on the drug for four weeks or less then they are a candidate for a fast taper.  Over four weeks things start getting iffy.  Like with reinstatement, the sooner the better for best results.  I hate sentencing someone to a 10% taper if they've only been on for a month or so, but too many times it comes back to bite us if we don't.

 

There is a huge component of how the person reacts to the drug, and their history of other drugs.  In this case there doesn't seem to be any adverse reaction which is a plus for a quick taper being successful, and there is a messy past which would help to "mask" the WD symptoms caused by a fast taper.  Like I said, it's going to hurt, but will probably be less painful than dragging things out the the three or four years a 10% taper would require.  A fast taper of this sort or of the "I only took it for a week" sort by it's self would tend to stabilize and clear up in 18 months to two years.  Which is about the same amount of time it will take the mess from last year to resolve.  With them compounding each other it could take longer.  That all depends on how things go down the road, how you stabilize and if you continue changing drugs and doses.

 

The choice of which option is entirely yours, but either way it will take a long time to fully recover.

This does not mean you will be in full withdrawal all this time.

The windows and waves pattern will begin,

the-windows-and-waves-pattern-of-stabilization/

Please let us know your decision.

 

Sassenach

 

Edited August 25, 2019 by ChessieCat
added note

[Altostrata]

Wait, wait! Please don't change any dosages until we work this out.

While it's unusual, you may be experiencing withdrawal from the sertaline reductions.

 

SwingCobra, when did your sleep break up? From now on, please keep daily notes about when you take your drugs, the dosages, and your symptoms throughout the day, including your sleep pattern. Please post 24 hours of these notes at a time, here in your Intro topic.

 

On 8/10/2019 at 1:10 PM, SwingCobra said:

However, the same stressful circumstances led me to a state of anxiety for which my psychiatrist prescribed me sertraline.

 

I am wondering if your Ativan use might be responsible for that "state of anxiety" and consequent sertraline usage, and may be causing sleep disruption now.

 

If you take Ativan for a while, you can become physiologically dependent on it and get interdose withdrawal, which you may feel as anxiety and sleep problems. Taking it inconsistently can also make problems.

 

How often did you use Ativan after you went off it in July? Are you still using it occasionally? Be sure to put it in your daily notes. I'll let @Shep know we're looking at your Ativan history.

[SwingCobra]

5 hours ago, Altostrata said:

SwingCobra, when did your sleep break up?

 

My sleep broke up on the night from Sunday, August 11th to Monday, August 12th, while I was taking 50 mg sertraline (so before I started to reduce my dosage). That night, I had very restless sleep, which left me feeling tired in the morning. Since then my sleep had its ups and downs, and it doesn't seem to be directly affected by the sertraline dosage I'm taking. It got better while I was traveling in Montreal, from August 13th to 16th. When I dropped at 35 mg on August 17th, its quality dropped a little. Still, I lowered my dosage at 30 mg on August 21th and my sleep quality has improved since August 22nd, the day I decided I would stop panicking about drug tapering and withdrawal as much as I did. I tend to get from 4 to 5 hours of decently restful sleep every night, which still leaves me a little tired in the morning, but it's not as bad as it was on August 12th so right now I'd say it's a mild annoyance.

 

6 hours ago, Altostrata said:

How often did you use Ativan after you went off it in July?

 

I actually restarted taking Ativan around July 20th. Since then I've been taking 0.5 mg every night.

 

6 hours ago, Altostrata said:

I am wondering if your Ativan use might be responsible for that "state of anxiety" and consequent sertraline usage, and may be causing sleep disruption now. 

Well I took 1 mg Ativan every night from May of 2018 to March of this year, and while I had anxiety problems during this 2018/05 - 2019/03 time frame, I tended to be more anxious during the time I took Ativan only as a PRN (from March to July). Maintaining a job I didn't like at all during this period also didn't help, but still, I do suspect that stopping the Ativan was a factor in generating the state of anxiety I was in. Unaware of the possibility of me being in Ativan withdrawal, I restarted taking Ativan, and was prescribed Zoloft a few days later, again for anxiety. Oh well. But I must note that stopping the Ativan back in March didn't seem to affect my sleep quality; I maintained a good 5 to 6 hours of sleep during the process.

 

Take note that I dropped at 25 mg sertraline this morning before reading your post. I'll be writing my notes for the day tonight, before going to bed.

 

20 hours ago, Sassenach said:

I am intrigued you said you trusted your psych, so why do this without speaking to her? 

She said I could pretty much do the reductions as I please. The regular course of action at the clinic I'm going to would have been to cut to 25 mg for a few days, and then to 0. I considered I was on my own regarding the sertraline. My psych might not be the best around when it comes to knowing about withdrawal, but still, she helped me by tapering down my Haldol (which another psych had put me on during my manic psychosis of 2018, and which had a paralyzing effect on me) and we get along quite well. I'd say it would be hard finding a better treatment team in the city where I live.

 

That being said, I'm glad of the advice I'm receiving here. Seeing how things are going with the sertraline, I'd be inclined to go for the fast taper. Are the 25% reductions calculated on the original or on the current dosage?

 

[SwingCobra]

I thought I'dd add my notes for yesterday :

 

August 24th, 2019:

3 AM woke up, then quickly got back to sleep

6 AM Woke up after around 5 hours of sleep in total

8 AM Got up, ate breakfast, took 30 mg sertraline

11 AM Ate lunch

Spent the afternoon at my parent's house. Some stressful conversations with my mother.

18 PM Had dinner

During the evening : Felt kinda bad after those stressful conversations

21:15 PM Took 5 mg zyprexa and 0.5 mg ativan, then went to sleep (earlier than usual)

 

 

[SwingCobra]

So here's my log for today :

 

August 25th, 2019

1 AM Woke up and fell asleep shortly afterwards

6 AM Woke up after around 5 hours of sleep in total

8 AM Got up, ate breakfast, took 25 mg sertraline

11 AM Ate lunch

17 PM Had dinner

22:45 PM Took 5 mg zyprexa and 0.5 mg ativan

23 PM Went to bed

 

A good day overall. A little anxious, mostly about medication and tapering. Spent time reading, writing some music, taking a bike ride, and having a night with friends.

 

[Altostrata]

15 hours ago, SwingCobra said:

Still, I lowered my dosage at 30 mg on August 21th and my sleep quality has improved since August 22nd, the day I decided I would stop panicking about drug tapering and withdrawal as much as I did. I tend to get from 4 to 5 hours of decently restful sleep every night, which still leaves me a little tired in the morning, but it's not as bad as it was on August 12th so right now I'd say it's a mild annoyance.

 

Okay, this sounds like you've logically excluded the Zoloft reduction as a cause of sleep disruption.

 

Is getting 5 hours of sleep a night normal for you?

 

Why do you take Zyprexa and Ativan together at night?

 

Yes, it's possible you got interdose withdrawal or rebound anxiety when you were taking Ativan intermittently, plus withdrawal anxiety when you went off, and that was the source of the anxiety for which you're taking Zoloft. Benzos make their own gravy in this way -- they cause symptoms for which doctors would prescribe anxiolytics.

[SwingCobra]

6 hours ago, Altostrata said:

Is getting 5 hours of sleep a night normal for you?

 

I wouldn't say so. Before March of this year, I used to sleep around 7 to 8 hours per night. From May of 2018, I developed the habit waking up at least 2 hours before I got out of bed. When I started my job in March, I had to get up earlier, and thus woke up earlier, which meant I also had less time to sleep. As such, I started sleeping only 5 to 6 hours a night around this time. But come to think of it, stopping the Ativan (which came slightly afterwards I started the job) might have had some negative impact on my sleep pattern. It's hard to tell. Also, having stopped working, I have the luxury of getting up later (at around 8 AM), but this did not magically extend the duration of my sleep.

 

7 hours ago, Altostrata said:

Why do you take Zyprexa and Ativan together at night?

 

It's what my psychiatrist told me to do, and it makes sense to me. The Ativan is supposed to help me sleep.

 

Tonight, my sleep has improved again. I slept a good 5 and half hours of restful sleep with no breaks, and just felt a little sleepy in the morning. I'll hold at 25 mg sertraline for at least a few days to see how the pattern evolves. I'd also like to reiterate my question : how would the 25% reductions be calculated in my case?

[Shep]

On 8/25/2019 at 3:07 AM, Altostrata said:

How often did you use Ativan after you went off it in July? Are you still using it occasionally? Be sure to put it in your daily notes. I'll let @Shep know we're looking at your Ativan history.

 

 

SC, I just want to touch base on the Ativan. 

 

 

10 hours ago, SwingCobra said:

A little anxious, mostly about medication and tapering.

 

From your symptoms notes, I'm not able to tell if you're experiencing any upticks in anxiety during the day. With Ativan's short half-life, that can happen. Please post if you feel that you are getting any upticks in anxiety during the day. Sometimes splitting up the nightly Ativan so you have a small amount to take during the day can help if these feelings of anxiety become severe. 

[SwingCobra]

So here is my log for today :

 

August 26th, 2019

5:30 AM Woke up after 5 and a half hours of quite restful sleep, still feeling a tad sleepy

8 AM Got up, ate breakfast, took 25 mg sertraline

Felt unusually calm during the morning, the calmest I have felt in days.

11 AM Ate lunch

Felt some anxiety (not too severe, but still) during the afternoon. Took a walk and rode my bike.

17:30 PM Had dinner

In the evening : felt better, wrote some music (really happy about it)

21:50 PM Took 5 mg Zyprexa and 0.5 mg Ativan

22 PM Went to bed

 

I might consider splitting my Ativan dose throughout the day if I keep getting these anxiety waves in the afternoon.

[Shep]

9 hours ago, SwingCobra said:

 

I might consider splitting my Ativan dose throughout the day if I keep getting these anxiety waves in the afternoon.

 

We recommend only moving your dose one hour a day, so you may want to take 1/4 to 1/2 of your daily Ativan dose and move that one hour a day until it's where you want it spaced. Please gage your anxiety to match the dose. If your symptoms aren't that severe, you'll want to take less during the day. 

 

Keep in mind that you'll need to keep the dose high enough at night to help with sleep.

 

Does the Zyprexa also help with sleep or can you tell at this point since you take the Ativan at the same time?

Edited August 27, 2019 by Shep
edit - added information

[SwingCobra]

42 minutes ago, Shep said:

Does the Zyprexa also help with sleep or can you tell at this point since you take the Ativan at the same time? 

 

It's hard to tell. I'd be inclined to say it does, since I didn't notice much change in my sleep pattern when I stopped taking Ativan regularly back in March. I can't remember whether or not my sleep was affected when I tapered the Zyprexa from 15 to 5 mg under my psychiatrist's supervision last year, but it must not have had that much of an impact for me to not remember it.

[Shep]

If you move part of the Ativan to earlier in the day, by doing so only an hour at a time, you'll get a better feel for how the Ativan affects you apart from the Zyprexa. If you notice a decrease in sleep, you may want to keep more of the Ativan for use at night as a sleep aid.

 

Please let us know what you decide to do. 

[SwingCobra]

Last night, I didn't sleep so well. It took me 3 hours and a half to fall asleep, and I slept about 4 and half hours in total. The sertraline adjustments might be interfering with my sleep. As such, I'll wait until the sertraline situation has at least reached a more stable point before playing around with the Ativan timing.

 

Also, I was wondering about something. I've seen some people here say they use distilled water to make their own liquid with their pills. I've been using tap water for this purpose since I began tapering sertraline about two weeks ago. Would distilled water be better?

[Altostrata]

On 8/26/2019 at 5:44 AM, SwingCobra said:

It's what my psychiatrist told me to do, and it makes sense to me. The Ativan is supposed to help me sleep.

 

As Shep indicated, either the Zyprexa or Ativan is enough for sleep. I am confused about why you're taking Ativan, other than to avoid withdrawal from Ativan.

 

Benzos like Ativan often cause more problems than they resolve.

 

Sertraline comes in liquid form by prescription. Ask your pharmacist if he or she can order it.

 

Please do not change dosing or timing of your drugs until we can figure out your sleep pattern. Do you perhaps stay up late using the computer?

[SwingCobra]

Indeed, my main concern about stopping Ativan right now is that I might get withdrawal symptoms from it, like a worsening of my sleep.

 

 

I'll try limiting my computer use late at night. I haven't had problems with this in the past, but in the current situation, it might help.

[SwingCobra]

If it can make things clearer, I restarted taking Ativan in July because I felt more stressed, I was used to always taking Ativan at night, and I tend to sleep worse when I'm stressed, so taking the Ativan before going to sleep made sense. I didn't think of taking the Ativan at another time during the day. Also, had I known about benzo withdrawal at the time, I probably wouldn't have restarted taking Ativan.

 

Right now, I'm struggling with anxious thoughts about the sertraline tapering and my lack of adequate sleep.

 

3 hours ago, Altostrata said:

Sertraline comes in liquid form by prescription. Ask your pharmacist if he or she can order it. 

I already talked to my pharmacist about it and they said they'd have to verify the availability of such a liquid, but that they'd first need a prescription for it. I'm seeing my psychiatrist on Thursday so I'll talk to her about it.

[Altostrata]

Please continue to post your daily notes. It could very well be Ativan withdrawal and now Ativan interdose rebound cause the symptoms you call anxiety.

[SwingCobra]

So here are my notes for the day :

 

6 AM Woke up from 4 and half hours of sleep, feeling really unrested

7:45 AM Got up, ate breakfast, took 25 mg sertraline

Was rather nervous in the morning

11 AM Ate lunch

17 PM Ate dinner

Afternoon and evening were a bit more tense than the morning. Took a walk in the forest in the afternoon, but it didn't help much.

21:30 PM Took 5 mg zyprexa and 0.5 mg ativan then went to bed

 

 

[Altostrata]

How do you feel after you wake up? Do you feel better or worse after taking sertraline at 7:45 a.m.?

 

Do you have any reactions after eating?

 

How do you feel after you take Zyprexa and Ativan at night? What times do you wake up in the night? Are you able to get back to sleep?

 

 

[SwingCobra]

I know and appreciate that you're here to help, but I realized I feel uneasy answering questions and completing daily logs about myself here. As such, I will stop updating this thread regularly. Maybe I'll post updates in the future if I feel like it.

 

 

 

 

 

[SwingCobra]

As you might have guessed, I decided yesterday to CT from 25 mg sertraline. My sleep had improved on the night from the 27th to the 28th, I was fed up with tapering and I thought I could get away with it since I had only been taking the meds for a little more than three weeks. It was a hasty decision, a gamble, actually, and unfortunately, it didn't turn out as well as I wished. I only slept around 3 hours last night. At least I don't have other symptoms up to now, and I must say I don't feel too tired, so my sleep still had some restorative effect.

 

I think I'll hold off from reinstating to see if my sleep improves at first, but if I reinstate, at what dose should I start?

[SwingCobra]

Last night, I didn't sleep at all. At least I didn't feel too agitated and I could rest. Gosh, I feel so bad about myself for not following your advice and stopping sertraline abruptly.

[ChessieCat]

See Post #1 of this topic:  About reinstating and stabilizing to reduce withdrawal symptoms

 

It is better to start with a small dose and increase if needed than to risk taking too much.  It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

I've asked the other mods for assistance.