Zwerger: help with Zoloft taper for my non-vocal adult child

[Zwerger]

I have a 23 year old non-vocal child (autism, self-injury, mood disorder and agitated catatonia.) Since they cannot tell me about the withdrawal effects they are experiencing I'm reaching out for some help. 

 

They have been on 175mg of Zoloft for 3+ years, they have also been experiencing severe periodic limb movements of sleep which I've read can be a side effect of Zoloft. The doc recommended reducing Zoloft by 25mg every two weeks. Within 3 days of reducing the Zoloft my adult child starting have problems with falling asleep and staying asleep as well having short periods of unusual agitation during the day. The doc doesn't think the insomnia is related to the taper but it is clear to me that there is a direct correlation. 

 

My thoughts are reducing the daily zoloft in increments of 11.5mg per month (cutting a 25mg pill in half,) This taper would take us through mid-October of next year before we could discontinue. Does this sound reasonable?

 

Are there any other possible/likely discontinuation symptoms I should be on the watch for?  

 

Regards'

Zwerger

Parent of Adult non-vocal child with various mental health conditions

Zoloft 175 Taper Recommendations Needed

Venlafaxine 150MG

Trazodone 250MG

Depakote ER 500mg tabs, takes two pills each in AM and PM for a total of 2000mg

Edited November 13, 2020 by Gridley

[Gridley]

Welcome to SA, Zwerger.

 

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.  You can just copy the information in your post using the following link.

 

Account Settings – Create or Edit a signature.

 

Insomnia and agitation are common withdrawal symptoms.  Here are two links, the first to give you a background on withdrawal, the second listing typical withdrawal symptoms.  

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

We recommend tapering by 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

There are a couple of problems with the tapering method you suggest.  Pill cutting can work but often the doses are inconsistent and inexact with this method.  

 

The second problem is that as long as you're at a high enough dose, a straight drop of 12.5mg a month is fine.  But as you get lower in dose 12.5mg a month is going to be more than the recommended 10% per month.   Decreasing by a straight unvarying milligram drop also accelerates the amount that you  would be decreasing each time making it rougher and rougher with each drop. Decreasing by a percentage however decelerates the amount of each drop and makes things gentler on your system.  

 

This link is specifically about tapering Zoloft.  Zoloft comes in a prescription liquid in the U.S., and we recommend this method as being easy and accurate.  If you decide to switch from tablet to liquid, you should do a gradual crossover from tablet to liquid before continuing your taper.  This link is specifically about tapering Zoloft and includes information about the liquid as well as other tapering methods.

 

Tips for tapering off sertraline (Zoloft)

You're wise to wan to get your son off the Zoloft.  I've run your son's drugs trough a drug interaction site, and there are major interactions among Zoloft, Venlafaxine and Trazodone, as follows:

Interactions between your drugs

Major

traZODone  sertraline

Applies to: trazodone, Zoloft (sertraline)

Using traZODone together with sertraline can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Major

traZODone  venlafaxine

Applies to: trazodone, venlafaxine

Using traZODone together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Major

sertraline  venlafaxine

Applies to: Zoloft (sertraline), venlafaxine

Using sertraline together with venlafaxine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

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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 are single ingredient (not mixed with other types of supplements).

 

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

 

 

 

 

 

 

 

 

 

 

 

Edited November 13, 2020 by Gridley

[ChessieCat]

Hi and welcome to SA from me too.

 

Please post what specific times the drugs are taken.  Thank you. 

[Altostrata]

Welcome, @Zwerger

 

Sleeplessness is indeed a very common symptom of too-fast tapering of antidepressants. You might split the difference, go back to 162.5mg Zoloft, and see if that helps. The increase should take effect in about 4 days.

 

The easiest way to do this is to take the majority of the daily dose in tablet form and the rest in liquid for easy dosage adjustment. Zoloft comes in a liquid form for this purpose; see the link Gridley gave you.

 

As you can see from the drug interaction report, there are problems with your child's polypharmacy. Prescribing 3 antidepressants together -- Zoloft, venlafaxine, trazodone -- is not good medical practice. Adding Depakote to this is also questionable. If I were you, I would not take further advice about psychiatric drugs from this prescriber.

 

Please let us know how your child is doing.

[Zwerger]

Dear SA -

 

As a follow-up to this post I'm wondering if what we're seeing with our child could be a side effect of the zoloft taper. 

 

Our child, as we've continued the taper, is having symptoms of depression/fatigue. It's difficult to know since she is non-verbal. 

 

The symptom we're seeing is her wanting to be in bed all day. This is quite abnormal for her and doesn't necessarily appear to be fatigue. 

 

Any thoughts?

 

Thank you!

[Altostrata]

Yes, depression and fatigue can be withdrawal symptoms.

 

One of our Moderators Emeritus, @Glosmom, was in a similar situation. Perhaps she will return to talk with you.

 

Her daughter is now doing much better, see