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

[SwingCobra]

In case it might help, I'll post my notes here :

 

August 28th, 2019 :

4:30 AM Woke up after 6 hours of continuous sleep -- encouraging and restful

8:00 AM Got up, ate breakfast, decided not to take sertraline

Feeling a bit anxious about my decision throughout the day

12:00 PM Took a fish oil capsule

13:00 PM Had lunch

More anxiety during the afternoon

18:00 PM Had dinner

21:50 PM Took 5 mg zyprexa and 0.5 mg ativan then went to bed

1:30 AM Finally fell asleep

2:30 AM Woke up, fell asleep shortly afterwards

 

August 29th 2019 :

4:00 AM Woke up, for around 3:30 hours of sleep in total

6:00 AM Got up

8:00 AM Ate breakfast

Felt anxious about my lack of sleep during the morning

11:30 AM Had lunch

Afternoon was less stressful

18:00 PM Had dinner

22:20 PM Took 5 mg zyprexa and 0.5 mg ativan then went to bed

22:30 PM Fell into some sort of half-sleep, like a waking dream state

23:30 PM "Woke up" from it. Just rested for the rest of the night.

 

 

 

[Altostrata]

You quit 25mg Zoloft on August 28, your sleep deteriorated after. It's up to you whether you want to reinstate or put up with withdrawal syndrome.

 

If you decide to reinstate, you might try 5mg or 10mg. I hope it's effective.

[SwingCobra]

Well, my sleep has already improved a little over the last three days. I got between 3 and 5 hours of sleep with vivid dreams that leaves me tired in the morning, but still functional. And the insomnia is pretty much the only withdrawal symptom that has shown up up to now. I actually feel less anxious than when I was on sertraline. I'll see how it goes over the next days, but I think I'll only consider reinstatement if things really start going downhill.

[SwingCobra]

That being said, I really wish I did not stop sertraline cold turkey. I have no idea how long my predicament will last; it could be weeks, or even months, whereas I could have maintained a better sleeping schedule, and thus a better quality of life, while doing a gradual taper. As such, I think my case is a good illustration that a gradual taper is almost always preferable to cold turkeying, even in cases where the medication hasn't been taken for very long.

[SwingCobra]

I thought I would give you an update about my situation. My sleep has improved since I last posted here. Some nights are better than others, but I generally get between 5 and 7 hours of fragmented sleep every night. There has also been an improvement in how I feel when I wake up; I don’t feel fully rested yet, but things are better now than they were six weeks ago.

 

I have to say, though, that I have tried a 5 mg reinstatement twice and, while it did seem to improve my sleep quality, the improvement didn’t seem consistent and I couldn’t bear the thought of having to take Zoloft for a few more years while knowing my sleep could have improved on its own. Basically, reinstatement made me too nervous and the first time, I started tapering down after one day at 5 mg. This first reinstatement lasted for 5 days total, from September 24 through September 28. The second time, I decided to test if reinstatement could really work, but I could only manage to stay on 5 mg for 3 days, then I went on 2.5 mg for two days and afterwards I stopped. This was from October 7 to October 11. After the first reinstatement, my sleep returned to the level it was at and kept progressing at the rate it did beforehand. After the second one, it also kept improving (even a bit faster) but has also been following a pattern where it tends to be better every other night.

 

I kept notes of my sleeping schedule since I started having sleep problems and, as I’ve said before, taking a Zoloft reinstatement seemed to have a positive though inconsistent effect on my sleep. I’m aware, though, that more time would have been required in order to really know if it could have a lasting effect. However, I would be strongly hesitant to try reinstatement again, first because of the risk of kindling due to stopping and restarting Zoloft so many times, and second because knowing myself, I risk of not being able to pursue the decision of reinstating throughout the days, as it has happened in the past. The one thing that might make me consider it would be if more withdrawal symptoms suddenly started appearing, but even then, I would still be unsure about it.

 

So for now, I’ve decided to keep recovering slowly without resorting to reinstatement. I also plan to eventually taper my Ativan at a rate of no more than 10% per month (I’d probably try dividing it in 2.5% cuts every week), but I think I should wait for my sleep to get better and more consistent before attempting this taper. Once I’ll have tapered down the Ativan (in a few years, probably), I plan to slowly lower my dose of Zyprexa, but to be extra careful and maybe even stop at a lower dose without trying to taper it all down if I find I’m comfortable with it.

 

I was wondering if you had any suggestions regarding my situation. I’m not demanding advice unconditionally as I know my situation is kind of messy and I can’t even guarantee I’ll follow your suggestions if you give any, but I at least thought I could give you an update on how things have been going for me and what I plan on doing about my situation.

 

[Shep]

13 hours ago, SwingCobra said:

So for now, I’ve decided to keep recovering slowly without resorting to reinstatement. I also plan to eventually taper my Ativan at a rate of no more than 10% per month (I’d probably try dividing it in 2.5% cuts every week), but I think I should wait for my sleep to get better and more consistent before attempting this taper. Once I’ll have tapered down the Ativan (in a few years, probably), I plan to slowly lower my dose of Zyprexa, but to be extra careful and maybe even stop at a lower dose without trying to taper it all down if I find I’m comfortable with it.

 

Does the Zyprexa help with sleep or do you rely on the Ativan for sleep? If you find that the Ativan is what is helpful the most for sleep, you may want to come off the Zyprexa first. 

 

Zyprexa has a very long list of potentially dangerous side effects, so it may be a better one to remove first. Be careful about coming off it at too high a dose (you mention "without trying to taper it all down") because some people find themselves with more severe symptoms toward the very end of the taper. If you're doing well on a taper, it's best to see it all the way down to a very low dose than to risk problems when the finish line is so close in sight. Just some thoughts. 

[SwingCobra]

Quote

Be careful about coming off it at too high a dose (you mention "without trying to taper it all down")

 

What I meant by that is that I might decide to stabilize at a lower dose of Zyprexa (say 4, or 2.5 mg) rather than going all the way down to zero. I cannot know yet how things will turn out in this regard and I have to be extra careful with the Zyprexa because a psychotic relapse could be disastrous in my case, as it has already been when I attempted to wean down Seroquel under my psychiatrist's supervision back in late 2017.

Quote

Does the Zyprexa help with sleep or do you rely on the Ativan for sleep?

 

I haven't yet tested if the Ativan really helped my sleep by moving the time I take at least a part of my dose. I'm still waiting to make sure my sleep is stable enough but once that is established (I'm giving myself at least a few days, maybe a week or two), I'll try this experiment.

[Shep]

On 10/22/2019 at 8:31 AM, SwingCobra said:

What I meant by that is that I might decide to stabilize at a lower dose of Zyprexa (say 4, or 2.5 mg) rather than going all the way down to zero. I cannot know yet how things will turn out in this regard and I have to be extra careful with the Zyprexa because a psychotic relapse could be disastrous in my case, as it has already been when I attempted to wean down Seroquel under my psychiatrist's supervision back in late 2017.

 

Thanks for clarifying this. This is from the About section of SA:

 

On 3/16/2011 at 8:02 PM, Altostrata said:

Taking a harm reduction approach to psychiatric drugs, we recommend reducing your dosage to the lowest effective dose for you, minimizing your drug burden for the sake of your general health. Many will continue to wean off psychiatric drugs entirely.

 

If your goal is to reduce your drug burden without coming completely off, that's something that's supported here. 

 

On 10/22/2019 at 8:31 AM, SwingCobra said:

I haven't yet tested if the Ativan really helped my sleep by moving the time I take at least a part of my dose. I'm still waiting to make sure my sleep is stable enough but once that is established (I'm giving myself at least a few days, maybe a week or two), I'll try this experiment.

 

We recommend moving your dose an hour a day. This gradual method of moving is gentlest on your nervous system.

 

Please post if you want more information / feedback on this. 

 

[SwingCobra]

Since I last posted here, I experimented with modifying the time I'm taking the Ativan. Moving it a whole hour in a single day seemed to have a slightly negative effect on my sleep, so I moved it by increments of fifteen minutes every few days and my sleep quality remained relatively consistent throughout. So it seems I can tolerate changes in the timing of my Ativan as long as they are gradual enough.

 

However, I had a very hard time falling asleep the last two nights. It took me more than three hours to fall asleep, and it was the first time this happened in a month. I fear this might be symptoms of withdrawal from Zoloft flaring up almost three months after I abruptly ended my taper of it. If this situation persists, I might consider reinstating Zoloft, but I'll have to talk about it with my psychiatrist first since I don't have any of it left. She might suggest some alternative drug to help with my sleep. Either way, I'll have to make a decision about it. For now, I've decided I would wait for at least a few days and see how that sleep situation evolves and not change anything medication-wise. I was wondering if you had any suggestions (i.e. if I should make a case for reinstating Zoloft when talking to my psychiatrist), as they might be helpful.

[Shep]

11 hours ago, SwingCobra said:

For now, I've decided I would wait for at least a few days and see how that sleep situation evolves and not change anything medication-wise. I was wondering if you had any suggestions (i.e. if I should make a case for reinstating Zoloft when talking to my psychiatrist), as they might be helpful.

 

This is a good plan. Since you're already familiar with liquid tapering, you'll be able to get a very low dose to start, if this is what you decide to do.

 

11 hours ago, SwingCobra said:

However, I had a very hard time falling asleep the last two nights. It took me more than three hours to fall asleep, and it was the first time this happened in a month. I fear this might be symptoms of withdrawal from Zoloft flaring up almost three months after I abruptly ended my taper of it.

 

A lot of people report delayed withdrawal of several months so this very well could be it.

 

How are you doing otherwise? Did moving the Ativan help with any of your symptoms? 

 

Let us know how you're doing over the coming days. 

 

 

[SwingCobra]

Quote

How are you doing otherwise? Did moving the Ativan help with any of your symptoms? 

 

I'm doing decently well. I still have anxious thoughts, but they're not as prevalent as they were two or three months ago; when I do have them, they mostly focus on worries about medication and withdrawal. So when I sleep less well, knowing that the sleep disturbances I have experienced since last August are probably a symptom of withdrawal from Zoloft, I tend to worry more throughout the day. But last night, I slept better than the two previous nights. I had around 7 hours of broken sleep and didn't have that much difficulty falling asleep, which is closer to the baseline I had been maintaining (more or less) during the previous month. So this morning I'm feeling a little better than yesterday. Slowly, I'm learning to remain calm even when things don't always go well. Otherwise, I'm experiencing blunted emotions and some cognitive difficulties, but that's to be expected from lacking sleep and taking Ativan and Zyprexa. I'm a long way from tapering those, but I remain hopeful that things might get better in the meantime, as they did get better in the years following my first psychotic episode back in 2012, even while remaining medicated (though at that time, I was on Seroquel and Lithium). I mean that there's probably an element of recovery from the psychotic episode itself at play here.

 

Moving the Ativan, which I now take at 20:30, might have had a slight effect of making me more calm in the hour before I go to bed at around 21:45. I don't feel particularly agitated during the rest of the day, so the effect the Ativan has on my mood is not very significant. And as I've said in my earlier post, the effect it has on my sleep is vague at best, but it seems that moving it too quickly affects my sleep negatively. Originally, I had restarted taking it regularly at the end of July because of the appearance of stressful circumstances in my life, which mostly focused on which job to choose in the future and have now mostly been resolved, as I now go to college part-time and am happy with my decision. I'd say that I'm not getting many benefits from taking the Ativan; I'm mostly just avoiding withdrawal from it, which might have accounted for why I felt worse in general during the time I had stopped taking it, between March and July of this year.

[Shep]

Thanks for the information, SwingCobra. Sounds like you're learning to cope really well with your symptoms. 

 

The fact that your sleep is improving is great. 

 

Overall, do you feel better or worse? If you're feeling better overall, you may not want to reinstate the Zoloft. However, if it's getting worse, you may want to start with a very low dose to see how you react. 

 

23 hours ago, SwingCobra said:

I mean that there's probably an element of recovery from the psychotic episode itself at play here.

 

Yes, you are correct. There's no evidence that psychosis is something that is an ongoing event. It's already been proven that the neuroleptics (antipsychotics) are what chronify it. 

 

I'm glad you're reporting an element of recovery from this. 

[SwingCobra]

I've remained mostly stable in the last few weeks since I last posted. My sleep has been fairly stable too; I still get between 6 and 7 hours of broken sleep every night. What worries me, though, is that it doesn't seem to improve as it did from September to mid-November. I rarely get chunks of more than 3 hours (these used to be more common) and I still wake up feeling only vaguely rested. I was planning to begin my Ativan taper soon but I'm now thinking I should wait for my sleep to be more satisfying before doing so.

[Shep]

Holding a bit longer is good idea. There's no rush. 

[SwingCobra]

I've begun tapering my Ativan since December 16th and things seem to go well up to now. I've chronicled my progress on my benzo thread. I still get times where I feel more depressed or worried, but I'd say that my mood is overall acceptable.

[SwingCobra]

Hey there,

 

I thought I’d post an update about my situation. It’s now been around 11 months since I cold-turkeyed Zoloft and started having sleep issues. I also began slowly tapering Ativan back in December; having then started at 0.5 mg, I am now at around 0.225 mg.

 

I would say my sleep, even though it has ups and down, keeps slowly improving on average. I get between 6 and 7 1/2 hours of sleep every night, generally split in two fragments; chunks of 5 hours are getting more and more frequent. What has improved the most in the last few weeks is the feeling I get when I wake up. I feel more rested, and a clearer separation can be felt between the days. Some nights almost feel like the normal sleep I had before I got into trouble. I sometimes had below-average sleep following a drop in the Ativan, and I was careful in these times to slow down my tapering rate. Apart from this, I didn’t have much trouble with the Ativan taper, and I’d even say I’ve felt better in general as it went on; some days are better than others, but my mood is improving overall.

 

So I’m progressively recovering from the last two years’ mess, and I feel grateful for it. Of course I’ve known happier times in my life, but I feel like I’m progressing towards a new kind of stable well-being. Once I’ll be done with the Ativan, I still plan to slowly taper the Zyprexa in hopes of improving how I feel, but I don’t think too much about that for now, as it’s still a long way to go.

 

I stay updated on many people’s stories on this forum and even though I might not post often, I’d like you to know that I’m always there rooting for you all and wishing you to get better.

 

Edited July 25, 2020 by ChessieCat
changed font for easier reading

[ChessieCat]

Sounds like you are doing well.  Thanks for updating us.  It is much appreciated.

 

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