pecanut: Taper off Sertraline

[pecanut]

Hi

I'm new here.  Hoping to come off sertraline and lithium.  I believe that my 13 years on lithium have caused me to have cognitive impairment and a severe lack of motivation and my executive functioning is just awful.  I've only been on sertraline for about 10 months so I'm hoping it will be a bit easier.  Any advice or encouragement would be really welcome.  I'd also really like to start a support group for people here in Belfast but I've no clue how to do this.

 

Bye for now and good luck to all

[Gridley]

Welcome to SA, pecanut.  It's very good you contacted us before starting your taper.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  

 

Account Settings – Create or Edit a signature.

 

We recommend tapering no faster than 10% of your current dose every four weeks.

 

Why Taper by 10% of my Dosage?

 

We recommend you taper only one drug at a time.  Otherwise, if problems arise you won't know which drug taper is causing it.  We suggest you taper the more activating drug first, which in your case would be Sertraline, leaving the more sedating drug to act as a buffer to be tapered later.

 

Taking Multiple Psych Drugs. Which Drugs to Taper First.

 

The following link is specifically about tapering Sertraline, including how to obtain the small nonstandard dosages you'll need for your taper.

 

Tips for tapering off Zoloft (sertraline)

 

This is your Introduction topic, where you can ask questions and connect with other members.  Again, welcome.

 

 

 

 

 

 

 

 

Edited March 5, 2021 by getofflex
edited to include links which were accidentally left out

[pecanut]

Thanks Gridley

 

I've added my signature as you suggested.

 

I'd be really grateful for some help and I'm aware you are all volunteers so I really thank you for all the time and energy you clearly invest.

 

I have been off sertraline since September and have the most dreadful and persistent insomnia - accompanied now by tremendous anxiety, low mood and suicidal ideation.  As you will see from my signature I have made a lot of mistakes and been on an off drugs for a long time so it is difficult to know what is causing what.  My psychiatrist is not conversant with long-term withdrawal effects and is telling me that this is relapse.  She wants to prescribe a low dose antidepressant and/or Quetiapine in addition to Lithium.  

 

The insomnia is very difficult to bear and I have v  limited support.  I feel torn b/w a conviction that I have been damaged by pysch drugs (and a bipolar diagnosis) and an anxiety that I do in fact have a long-term chronic and severe illness that requires management.

 

Do you have any sage advice or pointers please?

 

Thanks again - I hope you are well yourself...

Paula

[getofflex]

Hello Peanut, and welcome to SA.  I'm confused, because in your introduction you said "Hoping to come off sertraline and lithium", but then in your drug sig you say you have already come off sertraline.  I'm assuming you have come off sertraline as stated in the signature?  I just want to make sure I have the facts straight, so I can make good suggestions.  

 

I would be extremely cautious about starting another psych drug at this point.  Your system is already destabilized, and another drug could very well make matters worse.  The health care system often wants to throw a drug at a person as a quick fix, but sometimes less is more, and we need to be patient and endure.  In m own personal experience, time is the best healer.  

 

Did you read the links above about tapering 10% and tapering off sertraline?  

 

Here is some more information for you.  

 

How Psychiatric Drugs Remodel Your Brain

 

Withdrawal Insomnia

 

Assuming you are no longer on the sertraline, and you haven't had any since September 2020, you could consider a very small reinstatement.  Reinstatement can be tricky, because on the one hand it could help reduce your withdrawal symptoms, but on the other hand, if your system is sensitized, it could make things worse.  That is why we suggest a very small dose at first for reinstatement.  Please read the following: 

 

Reinstating and Stabilizing

 

After you read this, let me know what you think.  

 

I know how frustrating and challenging severe insomnia is, because I went through that for a long time.  Please be assured that your chances for recovery are very high.  Try reading some of the success stories - you will be amazed!  Good luck.  

Edited March 12, 2021 by getofflex
change word "recommend" to "suggest" and soften wording

[pecanut]

Thanks Getofflex

 

It is so lovely to get a same day response.  Yes, I posted in November 19 and went ahead with the taper of sertraline and reckon I am in withdrawal despite a slow (not slow enough?) taper.    I did read the 10% information, for which thanks. 

 

I get these mad involuntary movements in the night and I also shout really loudly and involuntarily - enough to wake the dead!  They did predate the taper but have become worse.  And I probably get 2-3 hours of very broken sleep at night, since tapering, making me anxious, terrified, and lowering my mood.

 

I will read the additional information later but I just wanted to say thanks first.

 

Paula

[pecanut]

Thanks Getofflex

 

I've now read what you recommended.  Thank you.

 

In terms of reinstating, I know that the likeliehood of a response is going to be pretty low after 5 months.  I need to weigh this against the possibility of further destabilisation, and this is a difficult choice.  I foolishly went from 4mg to zero at the end of my taper, which I really regret.  If I decide to try to reinstate, is this the level at which I would start again?  And would a one week trial be sufficient?  So many questions...and I'm aware there are probably no 'correct' answers but I would love your informed opinion.  My psychiatrist knows nothing about this stuff and believes if it's more than 6 weeks it is relapse and requires heavy medication.

 

I feel like I'm stuck between that old rock and a hard place.

 

Thanks and I do hope you're having a pleasant weekend

 

Paula

[Nomansland]

Hello pecanut,

 

iam sorry youre in this difficult situation.

 

Did you see the thread about the recent, official leaflet by the Royal College of Psychiatrists in UK?

Its the first time they explain slow tapering and many withdrawal symptoms. Your Psychiatrists should

absolutely read this and change his uninformed mind.

 

Greetings

 

Nomansland

[pecanut]

Thanks Nomansland

 

This is really helpful and I will show it to my psychdoc for sure.

 

Best

Pecanut

[getofflex]

@Paula you said "I foolishly went from 4mg to zero at the end of my taper, which I really regret".  You nailed it when you assume this is the cause of the withdrawal issues.  What you describe are hallmarks signs of withdrawal from psych meds.  However, please don't beat yourself up.  You did the best you could with the information you had.  Unfortunately, very few people understand what these drugs really do to our brains, and how it affects us when we go off them.  

 

Since you have been off the drugs for 5 months, it is probably best to go back to a tiny dose.  I just noticed there is no dosage info in your drug signature, so I can't suggest a reinstatement dose until you add that.  Please make a detailed account of your starting dose of Sertraline, and the date and dosage amount of each taper.  See my sig for an example of how I listed my Lexapro taper. 

 

Here is some more information to help you deal with symptoms in the meantime.  

 

Anxiety Blog

 

Cope with Anxiety by Claire Weekes  Audio

 

Fear Terror Panic Anxiety

 

Emotional Spirals

 

Emotional Pain or Clinical Depression

 

Neuro Emotions

 

"My psychiatrist knows nothing about this stuff and believes if it's more than 6 weeks it is relapse and requires heavy medication."  I'm sorry to say this, but this is a typical response of a psychiatrist.  Unfortunately, these people are usually pill dispensers, and know very little to anything about getting off the meds properly. These psych drugs have not been adequately tested.  Their test trials usually only go for a few weeks, and they only publish the trials that give favorable results.  

 

I want to reassure you that I believe you can and will recover.  Our brains have amazing healing abilities, but it takes time and is very gradual.  It takes patience and endurance.  Hang in there.  

 

 

Edited March 12, 2021 by getofflex
soften wording, to suggest instead of recommend

[pecanut]

Dear Getofflex

 

You are superkind and this means so much.  Thank you.

 

I have added a little about my taper - I think it was ill-considered and rushed and I do not have any record of it.

 

Thanks for the additional resources and reassurance.  As someone who has been given a diagnosis of Bipolar Disorder, this is all so scary; it is difficult to go against medical opinion when, if they are correct, the symptoms I am having are relapse-markers and require acute management.  Both arguments, ie withdrawal and relapse, can be persuasive to me at the moment and so there is an enormous terror of 'doing the wrong thing' with catastrophic consequences whichever way I turn....

• failure to address relapse leading to protracted illness course and chronicity.
• failure to address withdrawal leading to polypharmacy with drugs with serious side-effects and questionable long-term efficacy and difficult/impossible withdrawal.

I can easily set up a lose-lose situation for myself

 

I don't have a spouse/partner or kids and the luxury of fantastic support systems and this makes it even more challenging...

 

Sorry to be so needy / dramatic and Happy weekend to you...

 

Pecanut

[getofflex]

@pecanut what about searching for a therapist who is well versed in Bipolar Disorder who supports you staying off the drugs?  He or she could monitor you for a possible relapse.  And, by the way, there is a man named Will Hall, who was diagnosed with schizophrenia, who went off his psych meds.  He still has hallucinations, but has learned how to manage them without drugs.  So drugs are not the only way to deal with mental health issues.  

 

Since your last dose was 5 months ago, there is a chance reinstatement won't help, especially since you have gone on and off various meds in the past.  Doing this causes our nervous systems to be sensitized. (kindling). Here is information about that: 

 

Hypersensitive Nervous System or Kindling

 

As I see it, you have 2 options: 

 

1) tough it out, and wait for your nervous system to heal.  This involves staying on whatever drugs you are on now, and not going on any new drugs, nor changing the dose of any current drugs you are on.  It takes patience and perseverance, but it will give your nervous system a chance to heal.  At this point, this may be the less risky option.  Our systems heal best with stability, and there are non drug ways to cope with withdrawal symptoms.

 

2) try a very small reinstatement - I would say no more than 0.5 mg.  This may do one of 3 things: you may feel better, you may feel the same, or you may feel worse. 

 

Only you can make this decision.  Please let me know what you decide and we can take it from there.  

 

I personally have a kindled nervous system.  It's been tough, but I have survived it.  It has slowly gotten better.  I have good days and not so good days.  

 

Just realize that your brain has amazing healing powers, but it is gradual and takes time.  

Edited March 7, 2021 by getofflex

[pecanut]

@getofflex thanks so much for your great ongoing generosity - it really helps me enormously to get these morale-boosting responses.

 

I am aware of Will Hall from his harm reduction guide.  And also that many mental health diagnoses are shorthand for emotional distress and trauma and devoid of the consistent meaning they purport to.  I do believe that my mental health problem has been precipitated, and exacerbated, by psychiatric drugs, and specifically antidepressants.  Even though I believe this there is also a part of me that is terrified of walking away from conventional medicine, which has provided temporary but life-saving 'fixes'.  Perhaps a middle path - ie toughing it out w/o entirely dismissing the medical model - is possible?  Keeping it on the back-burner as a safety net which I sincerely hope I will not have to use...(I'm just thinking aloud here)

 

So, in terms of your proposed choices, I reckon I will work with my therapist and tough it out for now and I will let you know how I get on.  I think a reinstatement is just too risky.  I will go for harnessing those amazing healing powers!

 

I hope you are doing ok too and send my sincere thanks

 

Happy Monday

 

pecanut

[getofflex]

@pecanut, your reasoning sounds very rational and insightful.  I'm glad I can be of help.  I couldn't agree with you more when you said "And also that many mental health diagnoses are shorthand for emotional distress and trauma and devoid of the consistent meaning they purport to."  I believe that was the case with me.  I personally believe that mental health professionals are often lazy, (or perhaps bound by insurance companies to see so many patients)  and don't want to take the time to really sit with someone and help them work through their emotional pain and their issues.  

 

I think you made a very good choice.  Early in my taper, before I found this place, I was tapering too fast, then reinstating by big amounts, and it kindled my nervous system.  I finally decided, after coming here, to just tough it out, and stick with an extremely slow and conservative taper program.  It has paid off, because I feel so much better now that I did a year ago.  I have to say it required a lot of patience and endurance on my part.  We have this idea to avoid suffering at all costs, but that is what got me into trouble in the first place - going on the pills to avoid pain. 

 

I'm not sure if I gave you the link for non drug coping techniques, so here it is.  These truly do help.  

Non Drug ways to Cope with Withdrawal Symptoms

[pecanut]

Thanks @getofflex

 

I am feeling horribly depressed at the moment and spoke to my psychiatrist today - I've been feeling v below par since November but my mood has plummeted.  My pdoc wants to introduce Lamotrogine or a new SSRI and I am wondering how I can manage this depressive episode, which I believe is withdrawal related, without resorting to additional meds.  I have read all the material you have provided and I guess what I need is some reassurance and encouragment to continue if you are able to provide some.  May I ask how you coped?

 

Thank-you

Pecanut

[getofflex]

Hello, good to hear from you again. I'm very sorry to hear you are depressed.  Depression is a classic WD symptom.  I want to reassure you that you could very well be in a wave.  When we are in withdrawal, we have times of feeling good, and times of feeling bad.  These are called windows and waves.  I believe you can probably manage this depression without drugs.  

 

Windows and Waves Pattern of Stabilization

 

Here are some threads about depression.

 

 Neuro Emotions

 

Audio Tracks for Depressin, Anxiety, Recovery  (go to the end of the thread, because the links at the beginning no longer work.)

 

Cognitive Behavior Therapy for Anxiety and Depression

 

Self Help Course in Cognitive Behavior Therapy

 

Sometimes what we call depression could be legitimate emotional pain and grief.  Life is filled with losses and difficulties, and being sad and grieving is a normal part of life.  But many people these days want to numb and avoid this pain, hence the widespread use of drugs, alcohol, and other addictions.  This thread explores that idea.  

 

Bona Fide Emotional Pain or Clinical Depression

 

I'd be more than happy to explain how I have coped with depression and emotional pain.  I believe that a lot of my own depression was based on emotional pain turned inward.  I had no coping skills at all for dealing with emotions, and I had a lot of trauma and several tragedies as a child.  So I had to learn to grieve in a healthy way, and not bottle up my sadness and hurt.  Do a google search on grieving, find a grief support group, or a therapist who knows about grief, if you feel you have unresolved grief.  

 

You asked me how I cope.  I have to say my relationship with Jesus and my faith is central to my emotional health.  I spend time praying and reading the Bible.  Here is a thread about that.  

 

Faith in Jesus

 

Other important things I do are walking outside every day.  Exercise boosts our endorphins, which are natural feel good chemicals our bodies produce.  Sunlight is very good for depression, so get outside a lot.  I make a point to do activities I enjoy which are painting, cooking, gardening, reading, spending time with people I care for.  I also get involved in groups and get out and be with people, which I know is a challenge now with COVID19.  Another thing is doing something to help other people.  Help out at a soup kitchen, or do some type of volunteer work. When I see people less fortunate than I, it puts things in perspective.  I avoid negative and toxic people - people who complain a lot, put me or others down, are angry a lot, etc.  Try to find positive uplifting and kind people.  Having a pet you love can help a lot, especially if you are lonely and have limited options for friends and socializing.  

 

I hope this helps!  

 

 

[JustBella]

@pecanut

i just read through your posts.  I can totally relate.  I am on my own as well and really struggling.  I have a similar history of on and off ADs and benzos many times.

 

I only found this site about a month ago and 17 months after stopping 10 mg escitalopram in a rapid 3 week taper. I the tapered lorazepam.  All not knowing why I progressively got worse.  
 

Just want to try to encourage you and let you know I do know how hard and scary this is.

 

 

 

[pecanut]

@getofflex

Thanks for your response.  I am now considering that I may want to reinstate a small amount of sertraline to see if I can stabilise on this for a while before tapering again.   I just don't think I can withstand this and it seems like the least dangerous option.   I realise that with 6 months off this carries risks.  I tapered from 50mg and got to 4mg before I quit.  What would be a reasonable dose to reinstate at?  I've read all the advice on reinstatement but am unclear on this point.

 

Thanks again

 

[pecanut]

@JustBella

I'm sorry you are also having such a difficult time.  It is scary, indeed.  Maybe reading some of the success stories might give us some encouragement.  I hope you find some relief, and soon, though I understand that this is a long path we are on.

Sending warm wishes for a little relief

[getofflex]

Hello @pecanut.  Since you have been off of the Sertraline for 6 or 7 months, I would try a very small reinstatement.  I would go with 0.5 mg.  The reinstatement may or may not work since you have been off if a while.  See how you feel.  Please let me know how you feel after you make this reinstatement.  Make sure you take this each day at the same time, and keep your dose as close to 0.5 mg as you can.  I would suggest the use of a small syringe, which is good at measuring small amounts of liquid.  Give it at least a week to work.