gdtrfb: 8+ years of sertraline

[gdtrfb]

Hello World,

 

I have been lurking here for a couple months now and decided it is time for me to join the discussion. After browsing through a couple dozen threads both in the introductions and success stories I hope that by tracking my progress that it may inspire hope to those that follow along. This site has validated many experiences that I encountered in my life that I brushed off as "other issues" -- whereas now I realize that these were and are related to Sertraline use.

 

My story up to this point:

 

As a child I was extremely anxious. There was a family dynamic that played into my development of anxiety, without getting too personal. I also had some health issues that were extremely embarrassing and discomforting as a child. By the time I reached my mid-teens the anxiety was reaching an all-time high as I was putting myself in new situations -- due to embarrassment over my health issues I never had many friends growing up. There was a crippling fear within me that everyone was judging me, criticizing me, making fun of me; I generally felt like I was never "good enough" for people.

 

Eventually this culminated into unrelenting anxiety to which I finally confided to a family member I was experiencing; more of a plea for help. In a visit to my GP she advised my family to take me to the ER to be evaluated for hospitalization. Repeated I was asked about self harm, suicidal ideation, depression, etc. I reiterated many times that I have never harmed myself in anyway and had no intention of doing so. I was strictly pleading for help in dealing with this unrelenting anxiety being experienced. You can probably guess I was hospitalized. 

 

Sitting with the doctors and my parents I expressed I did not want to be medicated. We were hit with the famous "chemical imbalance" mumbo jumbo and that these medications were safe. Being a minor and hospitalized there was limited medical autonomy. This is where I started Sertraline 25mg. Without boring with details here I dabbled a little bit with lithium but did not last long. Eventually I ended up on Sertraline 100mg. 

 

There I stayed from about Mid-2012 through Approx. Dec 2018 / Jan 2019. 

 

During this time I was very stable. To be honest, I do not think I experienced a ton of side effects (or so I thought). I experienced manageable amounts of anxiety, although there were times the thought "my emotions seem very dull" crossed my mind. "Highs" were not always very high and "lows" were not very low. This got me through college well enough. I started my career post-college as well. Knowing it can be difficult to get off these "medications" I always put off tapering because of school... new job... the excuses. 

 

After years and years of being "stable" on Sertraline 100mg I confided to my ("new") GP that I thought it was time to come off. From about Mid-Dec 2018 to maybe Feb 2019 I tapered. Went from 100mg->50mg for a month, maybe 50mg-> 25mg for a month then a week or so of 25mg every other day. The experience was emotional. Essentially my entire adult life to that point was to take 100mg of Sertraline before bed. From 17 to about 25 that was my ritual. 

 

Then I crashed. Over the next couple of months I experienced debilitating anxiety. At first I thought "push through it, it is your body adapting" but as time kept passing eventually those thoughts dissipated. These thoughts became truly obsessive to the point I thought I had OCD. Any sort of critique would send me into an emotional rollercoaster. I doubted everything I did. Everything felt so flat, even things that used to bring me bliss, including hobbies, friends, sex, I felt so flat.

 

At some point therapy became an option. This is who my true self is. Called a local mental health center and signed myself up. Over a few sessions I poured myself out to my therapist (who I still go to today) proclaiming that yes I have had anxiety my entire life but I have never felt like this. I felt like every day I was fighting for survival. Anything stimulating fired off extreme reactions: scary movies, which I used to love would create days long adrenaline rushes, for example. 

 

This continued for a few months which then coincided with a major health issue which took about six months to recover from. This led us into the Coronavirus pandemic which did no favors. During the early stages of intense panic I felt necessary to re-instate Sertraline. I could not function. 

 

After a few weeks of ramping up to Sertraline 100mg I began feeling "whole" again. This did not save a long lasting relationship that had been strained over the prior 14mo, partly due to coming off medication.

 

In the middle of this year I met a knew partner. They are absolutely wonderful but for the first time I truly realized that I have not physically desired sexual contact in quite some time. I decided that it is likely due to Sertraline and wanted to taper off.

 

Where We Are Today: 

 

I found this website after looking for information on sexual side effects of AD use. I noticed in 2019 after coming off Sertraline that my libido had significantly dropped, I assumed was due to the "real me" anxiety coming back. I tied many side effects back to the discontinuation of Sertraline which I will outline below. 

 

In early October after tapering from 100mg to 50mg for a few weeks, then tapering from 50mg to 25mg for a few weeks I tried to go to 12.5mg for a week (at the discretion of my psych) and ceasing. I did it for two weeks. After a few days I noticed intense w/d symptoms (brain in vice feeling, pressure in head, agitation/restlessness, increased emotional flatness, continued sexual dysfunction). After finding this site and realizing that I was apparently not one of the lucky few that can taper that quickly I decided to re-instate at approximately 6.25mg daily in attempt to see if I can stabilize there before doing anything else. I think this allows me to see if I need to move up in mg without completely re-instating. I did find some relief from re-instating to 6.25mg.

 

Current Symptoms: 

 

Heavy anxiety

emotional blunting

low libido / ed -- I have a mental desire for sex (as I know what it "was" on Zoloft the first time, but virtually no physical desire or ability)

some agitation/restlessness

cortisol spikes in morning (from this site, this is what I think I am experiencing. I sometimes wake up and feel UP with some adrenaline).

Very obsessive thoughts

 

I am thankful that my sleep for the most part has not been impacted. 

 

What am I doing now?

 

Regular use of:

~200mg magnesium

omega 3 fish oil (1000mg, I think)

multi-vitamin (I know I know...)

 

regular exercise 3-4x/wk

CBT therapy

low dose of sildenafil as needed

Remind myself that these are side effects of medication use and discontinuation. These feelings are not me. 

 

 

Closing thoughts

 

After finding some relief re-instating at 6.25mg I plan on sticking out here for quite a bit of time, at least 2mo. This will allow me to determine if I need to start the taper say at 12.5mg  instead of 6.25mg. If w/d symptoms get worse over this time then I know I may need to bump up. A time frame of at least 2mo allows me to see if I get any delayed onset symptoms. 

 

As this journey begins on SA I look forward to journaling my experience. Those who have documented their success (whether through a success thread or long term introductions which lead to suns) have inspired me to believe truly that these symptoms will go away. We all want them to go away today but there are many examples here of people who have suffered for a long time who are back to their full lives. I'd wager a lot of money that most who start threads here and disappear recover.

 

So again, while I am about 8.5 years in (about 7 on Sertraline, 1.5 on/off) I am thankful for this site. Much of what I am going through and what I have gone through has been repeatedly validated by hundreds and hundreds (thousands?) of other members documenting their experiences. It is such a relief that there are many others who understand the anguish these "medications" cause.

 

[Gridley]

Welcome to SA, gdtrfb.

 

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

 

Account Settings – Create or Edit a signature.

 

If I understand you correctly, you're considering tapering after determining if the reinstatement of 6.25mg is sufficient.  As you may be aware, we recommend tapering by no more than 10% of your current dose.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Sertraline, including how to get the nonstandard doses you'll need for a 10% taper as well as the doses you'll need if you need to reinstate higher.  Liquid prescription Sertraline is available in the U.S., and we recommend this method because of its ease and accuracy.  Other methods are also discussed in the link.

 

Tips for tapering off sertraline (Zoloft)

 

Regarding reinstatement, you may need longer than 2 months to see how that reinstated dose is doing and to let your system stabilize before tapering. Please keep in mind that the purpose of reinstatement isn't to eliminate all withdrawal symptoms, though it does for some, but rather to bring them down to a tolerable level.  Reinstating too much can overwhelm the nervous system, and if it's necessary to increase in dose we recommend doing so very slowly.  This will be easy to do if you're using the liquid.  Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

As you're aware, you tapered must faster than we recommend, causing the withdrawal symptoms you're experiencing.  The symptoms you describe are typical of withdrawal.

 

What is withdrawal syndrome.

 

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

 

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 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 one at a time and at a low dose in case you do experience problems. Get supplements that ae single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

 

[gdtrfb]

20 hours ago, Gridley said:

Quote

If I understand you correctly, you're considering tapering after determining if the reinstatement of 6.25mg is sufficient.  As you may be aware, we recommend tapering by no more than 10% of your current dose.

 

Quote

 

Regarding reinstatement, you may need longer than 2 months to see how that reinstated dose is doing and to let your system stabilize before tapering. Please keep in mind that the purpose of reinstatement isn't to eliminate all withdrawal symptoms, though it does for some, but rather to bring them down to a tolerable level.  Reinstating too much can overwhelm the nervous system, and if it's necessary to increase in dose we recommend doing so very slowly.  This will be easy to do if you're using the liquid.  Please read:

 

 

 

 

 

Thank you for the additional information, Gridley.

 

Yes, I am planning to taper more traditionally assuming 6.25mg is enough. This is actually where I am seeking guidance because I did not notice a massive / overwhelming difference between 100->50mg and 50->25mg, even 12.5mg was manageable. Once I jumped off per doctors direction is when I experienced severe symptoms so I tried a smaller dose (6.25mg) to see if that provided relief, which this community recommends. I did experience some symptomatic relief by getting back to 6.25mg.

 

If the symptoms are currently bearable should I stay at 6.25mg to see if I stabilize over time? My concern is that if I adjust the dose back up to say 12.5mg or 25mg (or higher) that I am causing additional stress. I understand that even sitting at 6.25mg the taper is faster than recommended but any changes would amount to a fifth dose change in 3-ish months.

 

[Gridley]

1 hour ago, gdtrfb said:

I did not notice a massive / overwhelming difference between 100->50mg and 50->25mg, even 12.5mg was manageable.

 

This is not uncommon. Sometimes people can "get away with" larger than recommended reductions at the larger doses then get "caught" at the lower doses, particularly below 10mg, which are more potent.

 

1 hour ago, gdtrfb said:

 

If the symptoms are currently bearable should I stay at 6.25mg to see if I stabilize over time? My concern is that if I adjust the dose back up to say 12.5mg or 25mg (or higher) that I am causing additional stress. I understand that even sitting at 6.25mg the taper is faster than recommended but any changes would amount to a fifth dose change in 3-ish months.

 

You analysis is sound, and I would stay at 6.25.  If you keep going up you could definitely be causing additional stress with another dose change.  There's also the risk of overwhelming your system, which you don't want to do.  As we say, keep it simple, keep it stable, keep it slow.

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

[gdtrfb]

On 10/29/2020 at 1:49 PM, Gridley said:

 

This is not uncommon. Sometimes people can "get away with" larger than recommended reductions at the larger doses then get "caught" at the lower doses, particularly below 10mg, which are more potent.

 

You analysis is sound, and I would stay at 6.25.  If you keep going up you could definitely be causing additional stress with another dose change.  There's also the risk of overwhelming your system, which you don't want to do.  As we say, keep it simple, keep it stable, keep it slow.

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

Thanks, Gridley. I’ll stay at 6.25mg for some time and re-evaluate at a point in the future. Likely doing a 10%/mo taper or another as discussed in this space.

 

Symptom-wise reinstating was a good idea. Still dealing with a good amount of symptoms BUT they are more mild. There is reduction in anxiety, agitation / restlessness, and obsessive thoughts compared to CT. Possibly some stabilization going on.

 

Dealing with a “pressure in the head” feeling. Probably related to w/d.

 

I’d like to note that there have been days or even moments of great emotion. There was a moment this past weekend I felt whole. One of those unique, innocent, moments of having a full heart. It was a nice reminder that I am going to be alright. 
 

 

[gdtrfb]

Some decent news to share: my symptoms seem to be stabilizing some. 
 

anxiety levels are dipping, and some of the other symptoms are relieving at times. The emotional blunting is distressing at times. I realized that this is something that I’ve struggled with a vast majority of my time on sertraline and only recently have I become so acutely aware.

 

Alto had a post regarding this symptom and her advice was “fake it till you make it.” Admittedly this is difficult at times but at least trying to trick yourself is a start. 
 

 

[Altostrata]

Good to hear the reinstatement is beneficial. Stabilizing may take some time. You can expect a long-time symptom like antidepressant-induced emotional anesthesia to take quite a while to gradually fade. Please let us know how you're doing.

[gdtrfb]

1 hour ago, Altostrata said:

Good to hear the reinstatement is beneficial. Stabilizing may take some time. You can expect a long-time symptom like antidepressant-induced emotional anesthesia to take quite a while to gradually fade. Please let us know how you're doing.

Thank you for the support, alto. Updates to this thread will be made as appropriate.

[Krisseyb]

@gdtrfb I'm about to start my journey also...so I will be keeping up with you as well as documenting my own journey.

Hoping for the best for you! 

[gdtrfb]

Sorry for poor formatting - on mobile.

 

Wanted to provide a bit of an update since it has been a few weeks since my last one.

 

Currently I am still taking 6.25mg / daily. I have a very sharp pull cutter that does the job well. The 25mg will break in half well. I am then able to nudge the pill perfectly in there and cut without breaking too much off.

 

I /seem/ to tolerate any small discrepancies using this method. My plan is to eventually use a compounding pharmacy or a liquid solution. 
 

My stabilization has generally improved. I still have many of of the symptoms Noted in previous posts but these are manageable.

 

After struggling for a few months (and previously) with w/d I am in no rush to shock my body again. I’ll stay at 6.25mg after I feel emotionally ready to continue the journey. Also, since I tapered too quickly (per doc recommendation) I’d like to see if any symptoms of w/d manifest over the course of a few mo. 
 

 

Everyone stay safe.

 

[gdtrfb]

Update time:

 

There has been a bit of fluctuating emotions, still.

 

My emotions fluctuate wildly, sometimes hour-to-hour. A constant battle to keep level headed. 
 

It’s working.

 

sleep habits have gotten poor over the holidays but I am trying my earnest to get it back to normal. Good sleep is the key for me — a poor nights sleep and my emotions, anxiety mostly, seem to ramp up heavily on a dime.

 

Get into healthy sleep habits! 
 

stay safe all

[DaBro]

@gdtrfb  you are not alone. Your symptoms are almost identical to mine, especially the waking alert and head pressure stuff. I also had no problems until jumping off 12.5mg.  You can see my history is like yours, but without the reinstatement.

 

PSSD resolved for me and I’m improving after a tough year at 12-24 months post 0. My supplements are identical to you. PM me if you need. I’m starting to see good sleep and longer windows at 27 months. 

[gdtrfb]

The one symptom I feel like that is not improving much is apathy. There is this feeling that I am only “here”, not that I am immersed in the world around me.

 

The feeling is one of a black cloud hovering over me at all times, sitting there, lurking. Certainly there are times where I enjoy myself but I can’t quite get it to stick. My favorite music does not illicit the same reaction; similarly with other joys in my life.

 

The good news is the intense anxiety is subsiding. The extreme intrusive thoughts. I’ve definitely built up a tolerance for allowing these thoughts to pass through me. To acknowledge they are there and try to prevent them from taking over my headspace.

 

take care

[Jennings]

Hey gd,

 

Huge fan of horror movies here and I’m six months off Lexapro and I can’t watch them anymore, it’s terrible.  I used to also play horror games and I can’t do that either.  It’s like a shock to my system when I watch them.  
 

I’m not really watching anything tbh.  TV is on but there is no enjoyment.

[gdtrfb]

Hi all -

 

Is there any information on how to differentiate between symptoms caused by SSRI wd and general underlying issues? 
 

many of us were placed on these drugs for an initial diagnosis. My anxiety / ocd like obsessive thoughts were astronomical during my two too fast tapers. Lately I’ve been feeling pretty down and apathetic towards a lot of things while the intense symptoms have kind of flatlined.

 

Wondering if anyone has devised a way to differentiate. For example, I have had anxiety before drugs, while taking, after, before, during and after all over again. It’s fair to say that anxiety is a symptom hard to differentiate. On the other hand some of my general mood (depression?) hasn’t been experienced too much.

 

I feel as if my lower moods in the past have been caused by my underlying anxiety. Now I kind of just shrug and wonder why.

 

Anyways — for those that are browsing and wondering, SOME of my PSSD(-like) symptoms are IMPROVING. Libido is mostly still in the gutter. Some of the other effects noted in my OP have improved on a sliding scale of “good” to “almost back to normal.”

To the many of you also experiencing these effects please take a deep breath. Some of us are more devastated than others. There is a minority that appear to be damaged more permanently but many of us go on to make significant improvement, if not mostly a complete one. 
 

In the 4-ish months since my OP noticeable improvements have been made. Try to control what you can control: good sleep hygiene, exercise to your ability, eat well, try to limit caffeine/alcohol/ other mind altering substances, and do the best you can. Be patient. But don’t strive to be perfect. I suffer from days or even weeks of feeling the downs and the pits of despair. 
 

 

[Gridley]

18 minutes ago, gdtrfb said:

 

Is there any information on how to differentiate between symptoms caused by SSRI wd and general underlying issues? 
 

 

This link provides some general guidance, but there's no hard-and-fast rule.

 

How do I know it's withdrawal and not relapse?

 

I tend to look at the drug history.  If there are a lot of dosage changes, fast tapers and jumping off at a high dose, I would be inclined to attribute the symptoms more to withdrawal.