mlbz: Zoloft and klonopin with TD suspected - is quicker taper indicated?

October 23, 2020

Hi, all-- I am so grateful to have found this site. It is helpful to know that I'm not alone. This is my first post, I will try my best to be succinct.

I'm a 42 y/o female. I've been on Zoloft for 12 years, anywhere from 50mg daily to 175mg. I'd say my average over the years is probably around 125mg daily. My signature has a breakdown of my history.
I've also taken klonopin during this time, but I take it PRN as I have never agreed with the doc suggestions to take this med multiple times daily. So in terms of my average klonopin dosing, during acute anxiety or hospitalization I take it multiple times daily but otherwise I take it maybe once or twice a month (more or less). My pills are 0.5, but I have a sensitive system so I take one quarter of that or maybe a half. A full pill usually means I am heading into a major depressive episode or something pretty difficult is going on.
I smoked marijuana for about 7 years, but had to stop that in July 2020 due to cannabinoid hyperemesis syndrome (CHS).
Lastly, I began a magnesium supplement around July 2020, and it has greatly helped with daily anxiety. The difference has been pronounced for me.

For the past five/six years or so, I noticed that I occasionally got facial tics when I wake up in the morning. They were small, brief, and random, usually my jaw jiggling or shutting, or my eyes shutting closed due to my cheeks lifting. I thought it might be the Zoloft, but I didn't look into it too much. Well, now I've looked into it and I'm terrified. For the past 6 months, I'd say, the tics have started to happen during the course of the day and not just when I wake up in the morning. A couple of days ago, I was lying in bed and my throat/esophagus just started twitching up and down a few times-- that one was scary.

I have an HMO, so I am in the process of seeking out a holistic psychiatrist on my own. I've seen the list on this site, that's been very helpful! I have a few questions for anyone that can help:

In your experience, is it okay to have a long-distance psych? Does it make a difference? I'd rather see someone who knows what they're doing and is far, far away than someone close by who doesn't know or believe in patient-centered care. How might this hamper care?
Do the TD symptoms indicate that I should follow a quicker taper? Or is this a matter of doing the 10% and then waiting/hoping that TD symptoms don't get worse?
Can klonopin cause TD? I haven't seen anything about this, but I'd love to hear others' experiences.
I will ask my psych the same thing, but are there any supplements that folks here recommend to help with the taper? I've tried tapering once before back in 2011-2013 (I thought I was tapering slowly, but given the info we have now I can see I was most definitely not going slowly. I was also following bad advice about taking my SSRI "every other day" to even out the amount of med in my bloodstream), and had what I now recognize to be an acute and quickly-manifesting depressive episode as a result of withdrawal. I understand that everyone's body is different, but any experiences with supplements is very welcome.

Of course I am impatient to get off of this drug which could now be causing me a lot of harm. I have done loads and loads of work with therapists on my PTSD and depression, but the Zoloft did help me with that at the beginning, very much. I have so many conflicting feelings, but fear overrides them all because I would very much love to retain my ability to swallow and chew voluntarily (the cosmetic fears are also there, but to a lesser degree). I am a Buddhist and humanist and practice daily in one way or another, but as I'm sure many of us know a strong depression can and will obliterate reason, faith, belief, you name it. Thankfully I have a wife who shares my beliefs, and she is a rock.

Thank you so much for any help. I am terrified of this journey, but I am very heartened that at least I have others to share it with.

October 23, 2020

Welcome to SA, mlbz. Thank you for completing your signature. Could you add your current dose of Zoloft? It's better to be on a stable dose before beginning your taper.

Account Settings – Create or Edit a signature.

Here's a link to one of our threads on tardive dyskinesia. There are several others. Google survivingantidepressants.org tardive dyskinesia

Tardive dyskinesia or involuntary movements - Symptoms and ...

To answer your questions:

1. I would say that the ability of the psychiatrist would far outweigh whether he/she was long-distance, as long as he/she could prescribe the Zoloft you'll need for your taper. The most important abilities would be an understanding (and belief in) antidepressant withdrawal and safe tapering. The vast majority of psychiatrists don't believe in the existence of withdrawal, so I'd be careful in your choice. It would certainly be to your benefit to find a psychiatrist who recognized that tardive dyskinesia (if that's what you have) can be caused both by drugs and withdrawal. A holistic psychiatrist would likely be more in line with your beliefs than a mainstream psychiatrist, but alternative practitioners can be equally ignorant of psychiatric drug withdrawal.

2. I wouldn't recommend a faster taper. A quick Internet search reveals that Zoloft is one of the drugs implicated in tardive dyskinesia. However, withdrawal is also a major cause of TD, and a faster taper would put you at risk of worsening the TD and causing other symptoms.

What is withdrawal syndrome.

Generally speaking, reduction in dosage can result in a lessening of side effects. But that reduction must be done slowly.

Why taper by 10% of my dosage?

This link is specifically about tapering Zoloft. Zoloft comes in a liquid in the U.S., and that's the method we'd recommend using for your taper. I know you're in an HMO, which may not pay for the liquid. The link also explains how to make your own Zoloft liquid. The willingness of the psychiatrist to prescribe liquid Zoloft would be another important factor in your choice.

Tips for tapering off sertraline (Zoloft)

3. I've not seen anything indicating Klonopin is a cause of TD.

4. We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (which you're already taking) and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker

Omega-3 fatty acids (fish oil)

Add in at a low dose in case you do experience problems.

Your spiritual practices will be a big help. Please don't be terrified. You're in good company and good hands here. I suggest you read through the Success Stories forum on the site's main page. Also, take a look at the non-drug techniques in this link.

Non-drug techniques to cope

This is your Introduction topic, where you can ask questions and connect with other members. We're glad you found your way here.

Edited October 23, 2020 by Gridley

October 23, 2020

Thank you so much, Gridley. I'll check out the links immediately. I've changed my signature to better reflect my current dose of Zoloft.

Also, found a psych who seems to check off all the boxes, but am waiting to hear back from her.

Thanks again,

Michelle

October 24, 2020

I have tried tapering in the past (2011-2013 was my first and last big push), and kept detailed notes of my symptoms and other things. I have always kept a journal of any med journeys, and it's helpful. Based on my notes, it would appear that I did have some mild-to-moderate symptoms while going from 150mg down to 75mg.

In terms of my lifestyle then and now, I was working out pretty religiously then, and I'm not working out at all now, so I'm guessing that starting that up again at some level is recommended. Perhaps yoga. I was also working a LOT more in 2011, and I am able to work a lot less now. Lastly, I'm much, much more healed now in terms of my CPTSD, and how I relate to my varied childhood traumas.

I've read Coming Off Antidepressants, is that book now outdated? In Coming off Antidepressants, we are told that symptoms of withdrawal typically begin within 3-5 days, peak between days 7-10, and if they last longer than 2-3 weeks, the taper was too much. Is there a newer/more informed book for me to read, or is it the same stuff?

Is alternating doses recommended as a way to taper (i.e. Day 1, 150mg; Day 2, 125mg; Day 3, 150mg; Day 4, 125mg)? That's what my shrink at the time recommended, but it seems less than ideal and my notes show that when started doing straight reductions instead of alternating, I did much better.

Here was the schedule. Two or three days of diarrhea is typical for me, and can be assumed whenever dosage changes. Heart palps, night sweats, fatigue, insomnia, and dizzy spells, hot flashes & weepiness, were my main withdrawal symptoms. Prob a few that I'm forgetting, as well.

3/2011: 14% reduction: 175mg -->150mg.

6/2011: 8.3% reduction: 150mg -->137.5mg (measured as an average of alternating doses for the month).

7/2011: 9% reduction: 137.5mg -->125mg (measured as an average of alternating doses for the month). Started having more anxiety symptoms here, mainly anxiety upon waking up. Work was also very stressful at the time. So I held off on tapering until later that year.

12/2011: 10% reduction: 125mg-->112.5mg (measured as an average of alternating doses for the month). Experienced some trauma here, made me pretty anxious. Was having hot flashes, dizzy spells, and other signs of withdrawal plus anxiety. So I held off on taper again for a few months.

3/2012: 11% reduction: 112.5mg -->100mg (measured as an average of alternating doses for the month). Lots and lots of heart palps.

7/2012: 25% reduction: 100mg -->75mg. At this point I stopped alternating doses and noted, about a week in, that my w/d had been much smoother than previous. I was taking B-Complex, Vit D, and a probiotic at the time. For whatever reason, I put off any other tapers until the following year.

1/13: 33% reduction: 75mg -->50mg. Had many stressors (huge work trip, etc.), taper was way too big, crash & burn.

Separately, I've found a doc nearby who seems like a good fit, although she said that she typically recommends serotonin supplements as we go down in SSRI-- does anyone have experience with this that they could share? I think theanine and 5-HTP were things she mentioned as possibilities? She is an energy healer, so my taper would involve lots of Chinese energy work as well as possibly herbs. I don't want to get serotonin poisoning!

Thank you for any help!!

October 24, 2020

1 hour ago, mlbz said:

In terms of my lifestyle then and now, I was working out pretty religiously then, and I'm not working out at all now, so I'm guessing that starting that up again at some level is recommended.

While some members do well with strenuous exercise during tapering and withdrawal, for many members strenuous exercise is too stimulating/activating. More gentle exercise, like a walk in nature, is recommended. Some members do well with yoga. I'd recommend restorative yoga, which is calming.

1 hour ago, mlbz said:

In Coming off Antidepressants, we are told that symptoms of withdrawal typically begin within 3-5 days, peak between days 7-10, and if they last longer than 2-3 weeks, the taper was too much.

It takes a dose change around a week to register in the blood stream and brain. It's normal to feel symptoms a few days after a reduction. These symptoms should resolve before making the next drop. If they haven't resolved by the time you're ready to make another reduction, then you're tapering too fast. With a 10% of current dose every four weeks taper, if they haven't resolved by the 4th week, a hold is in order until they do resolve. You could then modify your taper by tapering a smaller percentage, like 5%, or holding longer than 4 weeks. I don't know of a newer book. I'd tend to rely on the information on this site, which I'd consider up-to-date and and well-informed. Here are some links:

What is withdrawal syndrome. (link previously provided)

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF)

The Windows and Waves Pattern of Stabilization

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

These explain the healing process really well.

Brain Remodelling

Video: Healing From Antidepressants - Patterns of Recovery

1 hour ago, mlbz said:

Is alternating doses recommended as a way to taper (i.e. Day 1, 150mg; Day 2, 125mg; Day 3, 150mg; Day 4, 125mg)? That's what my shrink at the time recommended, but it seems less than ideal and my notes show that when started doing straight reductions instead of alternating, I did much better.

Alternating doses is a terrible way to taper much beloved, for unknown reasons, by psychiatrists. It causes the amount of the drug in your bloodstream to go up and down, battering your nervous system and making withdrawal worse. I would guess that much of the difficulty you had in your previous taper was caused by skipping doses.

NEVER SKIP DOSES TO TAPER

1 hour ago, mlbz said:

she typically recommends serotonin supplements as we go down in SSRI-- does anyone have experience with this that they could share? I think theanine and 5-HTP were things she mentioned

We do not recommend serotonin supplements during tapering and withdrawal, as they tend to have an undesirable stimulating effect and also increase the activity of antidepressants. Many herbs also have unusual side effects in people with withdrawal syndrome.

Important topics about tests, supplements, treatments, diet

1 hour ago, mlbz said:

Chinese energy work

I would make the same suggestion that we make to members using acupuncture: the work should be sedating, not stimulating.

Edited October 24, 2020 by Gridley

October 24, 2020

Thank you, I'm checking out all of the links! Can you tell me why it is that some folks are able to stop cold turkey without symptoms? Or is it simply that withdrawal sickness isn't recognized by the medical community? If there are any posts about this, or good search terms, I would appreciate them. I am definitely not one of the people that can do this, but I know someone who stopped Zoloft after like 10 years and she said she felt fine. ?? This doesn't track with the trellis metaphor (which is great).

October 25, 2020

14 hours ago, mlbz said:

why it is that some folks are able to stop cold turkey without symptoms? Or is it simply that withdrawal sickness isn't recognized by the medical community?

It's both and one contributes to the other. There are few studies about the percentage of people who can quit cold turkey without symptoms. Some can, which feeds into the belief in the medical community that there's no such thing as withdrawal. This belief is bolstered by the pharmaceutical industry, whose bottom line would certainly be affected if the fact that X% of people are going to have significant and long-lasting withdrawal, and big pharma is where doctors get their information. Another factor is that withdrawal is typically (what percentage? We don't know, except anecdotally) misdiagnosed by doctors as "return of the underlying condition," leading the doctor to throw more drugs at the withdrawal-suffering patient. That's why doctors say, "I've never seen withdrawal in all my years of practice," because they've (1) been taught in school and by big pharma that it doesn't exist and (2) therefore they've habitually misdiagnosed it.

The following is from the link (which offers good reading on the question you pose):

Why taper by 10% of my dosage?

"Many people seem to be able to taper off psychiatric medications in a couple of weeks or even cold-turkey with minor withdrawal symptoms perhaps for a month or so. Doctors therefore expect everyone can do this.

However, estimates dating from the 1990s suggested 20%-80% cannot go off quickly -- they suffer acute withdrawal symptoms and then post-acute withdrawal symptoms for much longer.. A recent paper, Davies and Read, 2019, found about 45% experienced significant withdrawal symptoms."

There you have it: 20% to 80%. That's a wide range, so no wonder there's such a disparity of opinion.

There's growing awareness, however. The U.K. recently revised its guidelines regarding withdrawal.

UK's NICE health guidelines now caution about severe and ...

Edited October 25, 2020 by Gridley

November 2, 2020

CHS (from Cannabis) and Starting a Taper

Hello, all-- so i was diagnosed earlier this summer with cannabinoid hyperemesis syndrome (CHS). Basically, my system overloaded on cannabinoids and the result was hell in a handbasket. I'd smoked for about 7 years, certainly too much as it made me feel happy and good in a way that nothing ever had. But that's behind me, I quit cold turkey (continued use wasn't even possible, bc it would only make symptoms worse) as CHS was awful and I never want to feel that again. Also, quite luckily, I caught it and stopped ingesting cannabis soon enough that I did not hit hyperemesis. For that I am thankful, I know folks that vomit dozens of times a day for weeks, their esophagi tear, they have heart attacks from the force of the expulsion. Even worse, with CHS you are experiencing panic attacks while this is all happening. Wave after wave of panic, not even my klonopin could tamp down these panic attacks. They are something entirely different than a typical panic attack, idk if they come from our gut or what. This legalized weed craze is about to hit a very real wall as my guess is that CHS will soon go from a "rare diagnosis" to something far more common.

In any case, I'm about 3.5 months without cannabis at this point. However, my system still cannot process any foods that contain cannabinoids-- there are many, but this includes cinnamon, black pepper, white pepper, rosemary, basil, oregano, kale, cabbage, carrots, broccoli, cauliflower, omega-3's (!) and others. The impact of marijuana and CHS on my gut health has been extreme, but I am slowly, slowly healing. The silver lining is that I basically eat the same exact thing almost every day, so it is easy for me to tell when i eat something that disagrees with me. I made the mistake of eating two scrambled eggs last week, and was rewarded with immediate nausea and crazy diarrhea for a couple of days (thanks to the omega-3s).

Today, my psych agrees with me that it might be time to start tapering my Zoloft. I'm getting strange tics and other movement stuff, and don't want to risk tardive dyskinesia or pariknsonsism or anything else. That said, I'm hesitant to start a regular taper now while my gut and nervous system are still healing from the CHS. I'm nervous about not being able to take in omega-3 right now. Not to mention that docs know next to zero about CHS-- what they know about CHS now is like what they know about AD withdrawal 15 years ago: they give awful and dangerous advice (my GI told me to "smoke less," than I had before...? The only way to stop CHS is to stop ingesting cannabis, period. New episodes will happen otherwise, and each will be worse than the last.).

Idk what I'm looking for here, any advice or relating would be very welcomed. I am someone who has symptoms whenever my Zoloft dosage changes (guaranteed diarrhea for 2-3 days), so that doesn't make me feel great about the whole thing. I might just wait another few months before official starting the taper? I worry that there is never a good time to start, anyway...

Edited November 2, 2020 by ChessieCat
added topic title

November 2, 2020

I've moved your new topic to your Introduction topic.

Please note: This is your own Introduction topic which is the best place to ask questions about your own situation and journal your progress. This way your history is in one place and you will not need to repeat yourself. Also, the mods regularly check for new posts in the Introduction forum. Because of how busy SA is and the large number of members if you post elsewhere the mods might not see the post.

November 2, 2020

Please provide more details about when and at what doses you have been using klonopin over the last 3 months. If you are taking it PRN you may be experiencing interdose withdrawal.

November 2, 2020

9 minutes ago, ChessieCat said:

Please provide more details about when and at what doses you have been using klonopin over the last 3 months. If you are taking it PRN you may be experiencing interdose withdrawal.

Do you mean benzo withdrawal in relation to the tics?

I've stopped tracking when I take it bc it is so irregular and infrequent, though I may as well start-up again since I've got all this stuff going on. I can explain how I typically use it, though: I will take .25g and go up to .5g if there is consistent mid-range anxiety (i.e. anxiety that threatens to get bigger). I don't do this for more than two consecutive days, and this might do this once or twice a month.

Occasionally I will have something acute going on (a dreaded visit to the dentist, for example) and may take .25g or .5g.

In October I think I've taken .5g total throughout the month.

In September it was closer to 2.5g total throughout the month (in .5 chunks, so about 5 doses total), due to dentist visits.

My usual klonopin withdrawal occurs about 24 hours after a dose. This withdrawal includes heart palps, low-grade anxiety, and shakiness.

November 2, 2020

Three and 1/2 months is not very long since you quit cannabis. As stated in my previous post you may be experiencing interdose withdrawal from klonopin. We need to know more about your usage. It might be that you will need to start taking it every day and stabilise on that before starting the Zoloft taper.

However I will give you some information about your options so that you can start planning your taper.

SA recommends tapering by no more than 10% of the current dose with a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

Why taper by 10% of my dosage?

taking-multiple-psych-drugs-which-drug-to-taper-first

Dr Joseph Glenmullen's Withdrawal Symptoms

the-brassmonkey-slide-method-of-micro-tapering

Tips for tapering off sertraline (Zoloft)

With regards to when you might be able to start tapering, once we know more about klonopin, my suggestion would be to hold for at least a full 6 months after you quit cannabis. It is best to start from a nice stable place before you commence tapering. What you are experiencing may be from having stopped cannabis. I do not have any knowledge about cannabis withdrawal. You might find some information about it on the internet.

From https://www.withdrawal.net/marijuana/how-long-does-it-last/

Quote

Although the majority of symptoms last about two weeks, some chronic users have reported having insomnia, night sweats and unbalanced emotions for several months.

If you think you are ready to start tapering the Zoloft you could try doing a test reduction and only reduce by a small amount, instead of 10%. No more than 2.5% reduction. You are taking 175mg which is a high dose. If you check out the graphs in this topic you can see the SERT dose occupancy.

Why taper paper: dose-occupancy curves

If after a couple of weeks you feel okay you could then try a larger reduction, eg 5% reduction and wait another 2 weeks.

November 2, 2020

I'll ask one of the benzo mods to drop in and assess your situation.

November 2, 2020

Thank you for explaining how to post! Yes, I agree that 3.5 months off weed might be too soon. 😕

I am confused about what you mean when you say "what you are experiencing may be interdose withdrawal." Do you mean what I have experience with what I identified as my CHS symptoms? If so, I am absolutely confident that CHS is what is going on in terms of my GI issues. There is absolutely zero question about that.

I will track my klonopin usage more closely now that I'm preparing for a taper in the future. Thank you again for helping me, and for alerting the benzo mod.

November 2, 2020

7 hours ago, ChessieCat said:

Please provide more details about when and at what doses you have been using klonopin over the last 3 months. If you are taking it PRN you may be experiencing interdose withdrawal.

Taking a drug intermittently can cause interdose withdrawal. Klonopin has a fairly long half life but if you took it every 4th day, you might have some time prior to the next dose when you feel withdrawal symptoms.

20 minutes ago, mlbz said:

I will track my klonopin usage more closely now that I'm preparing for a taper in the future.

You need to be extremely careful with benzos. It is very easy to become kindled. That is why I asked for the details of your recent benzo use.

Kindling_(sedative–hypnotic_withdrawal)

Read the beginning and then 3.1 Benzodiazepines

November 2, 2020

5 hours ago, ChessieCat said:

Taking a drug intermittently can cause interdose withdrawal. Klonopin has a fairly long half life but if you took it every 4th day, you might have some time prior to the next dose when you feel withdrawal symptoms.

I take it maybe once every 12 or so days. Sometimes I go a month or two without taking any. If I'm going through something acute, I take it more frequently, log the time and my dose, and wean myself off according to my physical withdrawal symptoms (if any). The last time I did this was July/August when I was sick w CHS.

Thank you for the additional info on benzos, I will read it now.

November 2, 2020

5 hours ago, ChessieCat said:

You need to be extremely careful with benzos. It is very easy to become kindled. That is why I asked for the details of your recent benzo use.

I read everything you sent over. I guess my first question is how does one know if one is experiencing benzo withdrawal? As I said before, I have definitely experienced heart palps, shakiness, and heightened anxiety after 24 hours, but I do feel breathing or calm myself down and then it's gone.

November 2, 2020

16 minutes ago, mlbz said:

I take it maybe once every 12 or so days. Sometimes I go a month or two without taking any. If I'm going through something acute, I take it more frequently, log the time and my dose, and wean myself off according to my physical withdrawal symptoms (if any). The last time I did this was July/August when I was sick w CHS.

9 minutes ago, mlbz said:

I read everything you sent over. I guess my first question is how does one know if one is experiencing benzo withdrawal? As I said before, I have definitely experienced heart palps, shakiness, and heightened anxiety after 24 hours, but I do feel breathing or calm myself down and then it's gone.

Mlbz, if you're taking Klonopin every 12 days, you may not be dependent on it. The half-life is 18 - 50 hours, so even if you're a slow metabolizer hitting the 50 hour mark, you would only have 1% in your system after 300 hours (12.5 days). You can play around with the half-life numbers using this calculator:

Drug Half-Life Calculator

However, depending on the number of times you've taken it more often, you may have developed a dependency. It's really hard to gage.

It's also possible that the Klonopin is masking symptoms coming from Zoloft and then as the Klonopin decreases, those symptoms re-appear. Or it could be a combination of masking symptoms plus some dependency issues.

When are you taking the 400 - 500 mg magnesium? Do you take it all at once and at the same time you take Klonopin? If so, it's possible you may be getting some paradoxical reactions, meaning the drug/supplement is making you more restless instead of calmed down. The more you dampen down the nervous system, the more it tries to stay alert. This is the paradoxical reaction and it can manifest with heart palps, anxiety, and other symptoms.

Please go ahead and start a drug and symptoms journal. Please include your drugs, doses, and supplements. Below are the instructions and an example. After you do this for a few days, we can better help guide you in a taper.

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

The time of day, dosage, and severity of symptoms are essential information. Include

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:

Example:

DATE:

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

November 2, 2020

23 minutes ago, Shep said:

When are you taking the 400 - 500 mg magnesium? Do you take it all at once and at the same time you take Klonopin? If so, it's possible you may be getting some paradoxical reactions, meaning the drug/supplement is making you more restless instead of calmed down. The more you dampen down the nervous system, the more it tries to stay alert. This is the paradoxical reaction and it can manifest with heart palps, anxiety, and other symptoms.

I take ~250mg in the morning and ~250mg in the evening. I do not take it at the same time I take klonopin.

24 minutes ago, Shep said:

However, depending on the number of times you've taken it more often, you may have developed a dependency. It's really hard to gage.

It's also possible that the Klonopin is masking symptoms coming from Zoloft and then as the Klonopin decreases, those symptoms re-appear. Or it could be a combination of masking symptoms plus some dependency issues.

I am exploring a taper of the Zoloft because I've been having tics and random face twitches for years and they are becoming more frequent, and I am wondering whether I should wait due to my ongoing illness (Cannabinoid Hyperemesis Syndrome, or CHS). CHS restricts my diet significantly (and may do so forever) and is triggered easily by stress. I'm about 3.5 months into CHS recovery; I suppose a "full recovery" would be me being able to eat foods with cannabinoids again (i.e. black pepper and others), but it isn't clear.

I keep a med journal for when I use the klonopin more frequently (I did this in August, and have the August journal entries), but based on what ya'll are saying it makes sense to keep a journal even when I'm taking .125 or .25 every twelve days, because I'm trying to track the tics/facial movements.

Thank you.

November 4, 2020

On 11/2/2020 at 10:27 AM, mlbz said:

I keep a med journal for when I use the klonopin more frequently (I did this in August, and have the August journal entries), but based on what ya'll are saying it makes sense to keep a journal even when I'm taking .125 or .25 every twelve days, because I'm trying to track the tics/facial movements.

Exactly. That way you can compare frequent use with infrequent use, so keeping a daily journal every day will be very helpful. If you wish us to walk through it with you, please post it here on your thread.

December 28, 2022

UPDATE: I was unable to begin my taper, as the wholistic psychiatrist I tried basically told me that tapering was "not gonna happen" given the sensitivity of my nervous system due to CHS (cannabinoid hyperemesis syndrome; prevents me from ingesting many herbs and spices, some of which are found in supplements).

So I am still on 150mg sertraline. The past few months my anxiety has uncharacteristically spiked, and I've developed some hand tremors and heart palpitations. I also became post-menopausal in 8/2022, and began HRT in 9/2022. The palpitations started in 9/2022, but the tremors have been going on all year. Psych and neurologist ruled-out TD.

So the concern now is that I've developed a tolerance to the sertraline and/or it's not working for me anymore. This is terrifying. I want to get off this drug, but right now I feel rudderless with how to taper off of a drug that I've developed a tolerance to. Does this make it more difficult? Any ideas welcome, as well as search terms for the site.

Thank you all so much.

Edit: read ChessieCat & Brassmonkey's posts re: poop-out. Thank you for that information.

December 28, 2022

My psych is recommending prazosin to help with the shakes/anxiety that I feel upon waking-up. So theoretically the prazosin would suppress anxiety dreams/nightmares, and help me to wake up feeling less anxious. The theory we are working with is that there is poop-out, and that right now I'm not in a place to start tapering (I am in the process of moving, and going on a multiple-month road trip).

He had initially suggested buspar, but I really don't want to get on another med that I then have to taper off of.

I will keep folks here updated.

December 30, 2022

Last night I took Prazosin 1mg when I went to bed, the idea being that it would help with nightmares and shaky morning wake-ups. I had one nightmare (woke up yelling), and fell back asleep, then had another nightmare. However, I did not wake up shaky in the morning so I guess the Prazosin helped with that? Not sure. Will take again tonight and see how that goes.

Since we suspect Zoloft poop-out, the new plan is to take the Prazosin nightly and also go up on the Zoloft by 12.5mg. I'm hoping that going up by this small amount will help to stabilize whatever is happening. I am also discontinuing my klonopin for at least the next week, as I notice I've been counting on it more and more to get me through these random anxiety spikes. I track my meds and symptoms, and have included a screencap of my PRN klonopin use for the past two months. I didn't even realize that I was using it this often, basically every few days. So that's left me wondering if I'm having interdose withdrawals as well, but this anxiety feels familiar to me.

Idk. I'm lost and I'm scared. I was very, very sick when I was first put on Zoloft and I'm glad that it helped, but I wish I'd have been able to successfully taper off when I tried 10 years ago. We've gained a lot of knowledge since then, so my plan is to begin tapering probably in the Spring. Poop-out is scary.

If anyone has any advice or insight, I'd love to hear it. Thank you.

Edited to add: I also have a column on my spreadsheet with a reason for taking the klonopin, but not including here for privacy purposes.

Edited December 30, 2022 by mlbz
Wanted to provide more complete info re: klonopin screencap.

December 30, 2022

On 12/27/2022 at 9:49 PM, mlbz said:

UPDATE: I was unable to begin my taper, as the wholistic psychiatrist I tried basically told me that tapering was "not gonna happen" given the sensitivity of my nervous system due to CHS (cannabinoid hyperemesis syndrome; prevents me from ingesting many herbs and spices, some of which are found in supplements).

14 hours ago, mlbz said:

Since we suspect Zoloft poop-out, the new plan is to take the Prazosin nightly and also go up on the Zoloft by 12.5mg.

Please work with your "holistic psychiatrist." We are not medical practitioners here and cannot help you add more drugs to your cocktail. The goal of the site is to taper off the drugs using a slow taper, but you're adding in a new drug while also increasing your Zoloft. This is beyond what we can help you with.

The only advice I can give you is it looks like you now have a Klonopin dependency, so I would take this drug at the same time(s) of the day and at the same dose until you're ready to taper off it.

December 30, 2022

45 minutes ago, Shep said:

Please work with your "holistic psychiatrist." We are not medical practitioners here and cannot help you add more drugs to your cocktail. The goal of the site is to taper off the drugs using a slow taper, but you're adding in a new drug while also increasing your Zoloft. This is beyond what we can help you with.

The only advice I can give you is it looks like you now have a Klonopin dependency, so I would take this drug at the same time(s) of the day and at the same dose until you're ready to taper off it.

Thanks, Shep. The wholistic psychiatrist was not a good fit for me, and I wouldn't recommend them to anyone.

Separately, I am working with my regular psychiatrist to stabilize, hence the Prazosin and Zoloft increase (which is now looking like 25mg).

All of that said, I understand the goal of the site and I am not seeking "medical advice," just support and sharing of experiences. I've seen lots of other posts of folks struggling with adding and removing meds, starting and stopping tapers, even CT, and was seeking support/shared stories around that experience. I am also seeking to use my intro topic as a kind of journal of my process, as suggested by Alto. Is that no longer allowed/ok? My goal is to get off of these drugs,.and the experience I'm having right now is that I have to be patient.

Regarding the Klonopin, I do not think it has reached a dependency level, though I am also keeping an open mind about this and an eye on this with my psych. Seeing my use laid out really alarmed me.

January 1, 2023

On 12/30/2022 at 11:09 AM, mlbz said:

All of that said, I understand the goal of the site and I am not seeking "medical advice," just support and sharing of experiences. I've seen lots of other posts of folks struggling with adding and removing meds, starting and stopping tapers, even CT, and was seeking support/shared stories around that experience.

Yes, there are people who've had all of these types of experiences, generally BEFORE they come to this site. This site is about giving people much better information on these drugs so they don't continue to make these kinds of mistakes.

On 12/30/2022 at 11:09 AM, mlbz said:

I am also seeking to use my intro topic as a kind of journal of my process, as suggested by Alto. Is that no longer allowed/ok? My goal is to get off of these drugs,.and the experience I'm having right now is that I have to be patient.

Since Alto hasn't posted on your thread, so you may be referring to this post - Please start a topic about yourself in this forum

But please see this post she wrote a bit further down that thread:

On 12/24/2013 at 2:17 PM, Altostrata said:

The Introductions forum is public because it's also a collection of case histories to educate medical professionals.

What you're posting about is how NOT to do a safe taper. I say this because you have increased your Klonopin use to almost daily and at random times while adding in a new drug and wrote that you'll be increasing your Zoloft by 12.5 mg. Here are two threads I would encourage you to read:

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Hypersensitivity and Kindling

You are risking damage to your nervous system by the type of reckless drug changes.

I would continue to work with your psychiatrist until you are stabilized and then come back to this site for information when you're ready to taper.

January 1, 2023

1 hour ago, Shep said:

Yes, there are people who've had all of these types of experiences, generally BEFORE they come to this site. This site is about giving people much better information on these drugs so they don't continue to make these kinds of mistakes.

Gotcha, this makes sense. Thank you.

1 hour ago, Shep said:

What you're posting about is how NOT to do a safe taper. I say this because you have increased your Klonopin use to almost daily and at random times while adding in a new drug and wrote that you'll be increasing your Zoloft by 12.5 mg. Here are two threads I would encourage you to read:

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Hypersensitivity and Kindling

This makes sense, as I'm not currently tapering the Zoloft but rather going up until I can get to the point where I'm ready/stable enough to taper. This increase is happening under the care of my psychiatrist.

1 hour ago, Shep said:

You are risking damage to your nervous system by the type of reckless drug changes.

I definitely agree that the way I took Klonopin in December was reckless. In hindsight, I kinda can't believe it but it is what it is at this point and I have to move forward from here. I won't be taking it daily and at random times any longer that is for sure.

1 hour ago, Shep said:

I would continue to work with your psychiatrist until you are stabilized and then come back to this site for information when you're ready to taper.

In terms of the drugs that were added, these were done under the care of a psych and I'm confident that right now what we are doing is seeking to stabilize from what we think is SSRI w/d. And yes, I will come back to the site when I'm ready to taper. Thanks for engaging with my posts!

Wednesday at 06:53 PM

Hello again, everyone. I am back because I've taken all of the advice here to heart, and have re-started my taper again after more than 10 years of being scared to try.

My biggest question is: how do folks deal with the increase in emotions? I ask because I've always been an emotional person (a sad person until about the age of 40, really), and now that I've started my taper my emotions are all over the place. I did a lot of therapy and work on my trauma, so I feel good about that cognitively. But dang on 175mg of Zoloft I'd forgotten how much emotions can influence cognition! I wasn't "dead inside," but I definitely was even-keeled and had a very difficult time mustering tears (which sucked).

So I'm happy that I've been able to cry again and things, but also feel like I'm feeling all of the sads.

Thanks for listening.

mlbz: Zoloft and klonopin with TD suspected - is quicker taper indicated?

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