Marcus/50mg sertraline since 2012

[Marcus]

Hey everyone, 

I want to share my story. Since november 2012 i am taking 50 mg of sertraline. 

 

Since 2010 i started to suffer from anxiety attacks in classrooms in University. But apart from that i was functioning without any major mental problems or physical problems. A psychiatrist prescriped me lexapro for the anxiety attacks.

 

I took one dose of lexapro in september 2012 but that gave me bad nausea. I got an prescription of primperan to help the nausea, but that gave me an extreme dystonic reaction. My neck was tilt over to my back and i couldnt move it back. So i stopped the lexapro and primperan and went to my gp. My gp adviced me to start sertraline 50 mg. This is around november 2012.

I must say the sertraline helpt the anxiety attacks. I graduated for my master in University. But after some time also the side affects became a problem. I suffered loose stools every day. I felt more and more tired and sleepy during the day. And i had an extreme appetite every day. Bloodtests and colonoscopy were fine and my gp said that she never heard of the side effects from sertraline. Together with my gp i decided to reduce the 50 mg to 25 mg. This is 2014. I got the brain zaps and felt even more lethargic. Also i got crying spells several times  On the advice of my gp i restarted 50 mg. She said i just needed the medication. 

 

Years went by and the tiredness became more and more a problem. I a was feeling zoned out and dizzy. And the extreme hunger. I visited many doctors and psychologists and they al said my problems were psychological. 

In 2018 i was reading about a pharmacist who makes special taperingstrips for tapering ssri medications. ( I live in the Netherlands) Around september 2018 a doctor ordered the strips for me. In two months i reduced my 50 mg sertraline to zero around november 2018. During tapering i felt good. After the last dose some brain zaps. But around january 2019 i crashed hard. My whole body felt in a state of flight or fight. My appetite went away completely. Extreme nausea. My gp said this couldnt be withdrawal because there were some weeks between the last dose and the start of symptoms. He prescriped me oxazepam and omeprazole. I think the anxiety went away from oxazepam but i was still really sick. No appetite and dry heaving all the time. I got an endoscopy of the stomach and an echography of my stomach. Results were all fine. They diagnosed me with functional dyspepsia. My gp started me om citalopram 10 mg. Still together with the oxazepam and omeprazole. No result. Then we restarted the sertraline. After weeks symptoms went away after building up to 50mg sertraline. This is may 2019 .Huge appetite came back. But also the tiredness and loose stools came back. In the next 1.5 years  the tiredness and zoned out feeling became more and more problematic.  I could not function.  Still all docs sayed it was psychological. So in october 2020 i wanted to give the taper sertaline 50mg a last try. With a scalpel i cutted a small piece of the tablet. Around 10 procent. I did this from october 2020 till the beginning of january 2021. The tiredness went away. I was awake during the day. Started running again The whole time i cutted the tablet the same every day,to stabilize. Unfortuanaly my appetite and thirst went away again beginning january 2021. And a feeling of nausea the whole day. I also feel extremely nervous without a reason. Crying.

I can t believe the taper went really well in the beginning weeks and now suddenly these symptoms start. I didnt went to my gp again. But iam afraid i will need this medication forever to have appetite. Or do I really have functional dyspepsia and I need sertraline for that. But in 2012 before the medication I never struggled with my stomach or appetite, it were anxiety attacks. So many questions. I hope anyone can relate to my story. Or give some advice. I also researched a lot about the role of serotonin in the gastrointenstinal tract. Does sertraline really have an impact on that?

 

all the best.

Marcus

 

 

 

[Shep]

Hi, Marcus.

 

Welcome to Surviving Antidepressants.

 

It sounds like you have had one adverse reaction after another with these drugs. This is not uncommon and you're correct - they do have a profound effect on the gastrointestinal tract. 

 

It sounds like you've been doing some reading on the site, so some of these links may be ones you've already read. But just in case, here they are:

 

Tips for tapering off sertraline (Zoloft)

 

Why taper by 10% of my dosage?

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

For stomach symptoms, please see:

 

Digestive problems: nausea, diarrhoea, bloating, GERD

 

On 1/21/2021 at 4:54 AM, Marcus said:

He prescriped me oxazepam and omeprazole.

 

 

Please add these drugs to your signature, along with the doses and the dates you were on them. 

 

Account Settings - Create or Update Your Signature

 

Once we have a complete drug history, we can help you with your taper.

 

Please continue to use this thread to document your taper and to ask questions. 

[Marcus]

Thank you so much Shep. Yes i will update my signature with all the medication and read the links you gave me. 

Wishing you all the best.

Marcus

[Shep]

Thanks for adding your signature.

 

Please note I added "November 2012: 50 mg of sertraline" to reflect when you started this drug. 

 

On 1/21/2021 at 4:54 AM, Marcus said:

So in october 2020 i wanted to give the taper sertaline 50mg a last try. With a scalpel i cutted a small piece of the tablet. Around 10 procent. I did this from october 2020 till the beginning of january 2021. The tiredness went away. I was awake during the day. Started running again The whole time i cutted the tablet the same every day,to stabilize. Unfortuanaly my appetite and thirst went away again beginning january 2021. And a feeling of nausea the whole day. I also feel extremely nervous without a reason. Crying.

I can t believe the taper went really well in the beginning weeks and now suddenly these symptoms start.

 

It's not uncommon for people to have milder symptoms at the beginning of the taper and then struggle on the lower doses. A lot of the medication is actually contained within these lower doses. Please see:

 

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

What dose of sertraline are you currently taking or are you completely off now? 

 

In your signature, you mention being off Omeprazole in 2019, but in the "October 2020 till now" section, you write you're on "Omeprazole 20mg in the morning." When did you re-start the Omeprazole? 

 

Please note that omeprazole will also need to be tapered. Going off and on this drug may have caused some of your symptoms. Also, please read the first post in the below link because it gives important information on how these drugs can block the absorption of key nutrients, such as B12. 

 

Tips for tapering off stomach acid blockers or PPIs...

 

It really looks like you're dealing with a lot of problems caused by these drugs, which is good because it means you can heal from the drug exposure and go onto have a great drug-free life. You'll just need to give your body time and space to heal. 

[Marcus]

Thank you for replying. Yes, i will add some more omeprazole information in my signature. I agree ppi s can cause problems. They reduce acid secretion. And acid is important to digest food.

 

About the SERT occupancy, I am really confused. I cut off approx. 10 percent of my tablet of 50mg. When i look in the SERT graph 45 mg sertraline gives still 80 percent sert occupancy. Alsmost the same as my 50 mg. Whats going on in my body.

 

So my setraline dose at the moment is that i cut 1/8 of my 50 mg sertraline tablet every day. ( So approx a 10 percent reduction) I know this is not the most accurate. But my two month expercience with taperingstrips also leaded to a disaster. 

 

I also tried a zoloft liquid prescription once. But when i took the liquid equil to 50mg of sertraline i suffered from constant heart palpitations. This was in June 2017. I will add this to my signature. Later i found out the body processes liquid drugs faster than tablets. But I hoped my gp had that knowledge;). 

 

 

[Shep]

Two thoughts, Marcus.

 

(1) Instead of cutting your pill, you may want to use a scale. Please see:

 

      Using a digital scale to measure doses - weighing

 

(2) If you opt for liquid sertraline again, please note it works best to gradually transfer over to liquid. This gives your nervous system time to adjust to the change. So you would, for example, take 25% in liquid and 75% in tablet for a few days. Then 50/50 split for a few days. Then 75% liquid and 25% tablet before transitioning completely to liquid after a few more days. 

 

Just some thoughts for going forward. 

[Marcus]

Thank you. I will think about those options. I can t update my signature, because it contains too many lines.

[Shep]

18 hours ago, Marcus said:

I can t update my signature, because it contains too many lines.

 

See if it will work now. I've removed some of the line spacing for 2019 and earlier. Not quite as readable for those earlier years, but at least you'll be able to squeeze in your more recent information and more information about the Omeprazole. 

[Marcus]

Thanks for all the help Shep. I added the date i started omeprazole in the signature. I think I am going to reduce the omeprazole by 25 percent. 

[Marcus]

In addition to my story in the opening post i have one more question. Does anyome recognize the excessive daytime sweating especially during exercise and summer days as a side effect of the ssri? (So not in wd but as a side effect). Its really hard to deal with this sometimes .

[Shep]

3 hours ago, Marcus said:

Thanks for all the help Shep. I added the date i started omeprazole in the signature. I think I am going to reduce the omeprazole by 25 percent. 

 

Please make sure you're being super mindful of your diet to help with any upticks in GI issues. Since you've only been on it for about 2 weeks, hopefully you haven't developed dependency. Please let us know how you do.

 

Also, while you're tapering the omeprazole, it's best to hold your antidepressant taper. One taper at a time. Please see:

 

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

 

50 minutes ago, Marcus said:

In addition to my story in the opening post i have one more question. Does anyome recognize the excessive daytime sweating especially during exercise and summer days as a side effect of the ssri? (So not in wd but as a side effect). Its really hard to deal with this sometimes .

 

Indeed it is. Please see: 

 

Is Your Medication Making You Sweat? 10 Drugs That Cause Excessive Sweating as a Side Effect

[Marcus]

An update from side. I am back on 50mg sertraline. Also i take omeprazol 20mg and a ginger supplement. My appetite went to zero and i also experienced bloating, gas and nausea. I am now at the point that i just need sertraline 50 mg for functional dyspepsia. Or maybe its what they call emetophobia. I will update the signature. Hope you guys doing well.

[Marcus]

I decided to begin tapering again. I restarted 50mg sertraline in february 2021. The fatique came back, the dizziness came back and the huge appetite came back. I couldnt handle this anymore. So my doctor prescriped the liquid version of sertraline for me, 20mg/ml. I take an 25mg pill of sertraline and 1ml of the liquid now for 1.5 weeks. The tirednss and dizziness improved a lot!. But i also feel very nervous and anxious and the the gagging/dry heaving is coming back also. Can this be withdrawal? I don t know what to do anymore! It s so confusing. 

 

Thank you!

Ps. I did al lot of reseach on withdrawal the past months. I want to thank Mark Horowitz, Altostrata, Peter Groot, Jim van Os and James Moore for there work and dedication regarding withdrawal of antidepressants. Maybe they will read this one day;).

 

[Marcus]

No one any input? 

Hope someone can read my opening post, can this nausea and dry heaving really be withdrawal?

 

Thank you.

[Mia1]

Hi Marcus,

 There are so many different w/d symptoms and nausea certainly can be one of them. Are you dry heaving because of the nausea? Have you been able to explore the sight, the different topics and forums? There is a wealth of information here and a lot of your answers can be found. It’s comforting to know that you’re not alone in this.

[Mia1]

Also, if you want to get someone’s attention you have to tag them if they’re not following your thread. So just type @ and the name of the person you wish to speak with and they will get a notification. 

[Marcus]

Hello @Mia1

Thanks for your message. Yes i did a lot of research on the forum and found soms similar stories. But my doctor thinks the nausea is psychosomatic and not related to the sertraline. Also for me its very hard to understand that i only had mild situational panic attacks before i got prescriped the drugs and now iam sick 24/7. Also the delayed onset of withdrawal the first time i tapered down is a mystery for me. I think thats why my doctor thinks its not related to sertraline or withdrawal. 

Ok i will keep in mind the tagging;)

 

[Shep]

21 hours ago, Marcus said:

Also the delayed onset of withdrawal the first time i tapered down is a mystery for me. I think thats why my doctor thinks its not related to sertraline or withdrawal. 

 

Yes, you are definitely correct that the delayed withdrawal creates confusion amongst the medical profession. If this is still causing confusion for you, please have a read of these threads, if you haven't already. These threads can help us find a way to articulate this rather confusing concept. 

 

Delayed onset of withdrawal symptoms 

 

 One theory of antidepressant withdrawal syndrome

 

 

In that second link, Alto writes:

 

On 5/24/2011 at 10:59 PM, Altostrata said:

My guess is: The first phase of withdrawal, the acute phase, is the initial shock of withdrawal, with the most defined symptoms, such as brain zaps and nausea and possibly waves of unusually intense "depression" and "anxiety" -- actually, emotions generated by the neurological upset. Later, glutamatergic hyper-reactivity and autonomic instability take over. Often the autonomic instability causes wide hypersensitivity to drugs, supplements, and even foods.

 

Many of us become hyper-reactive to certain supplements and even foods, creating more symptoms later on. All of this, if presented to the vast majority of medical professionals, will be seen as a "relapse of mental illness," and not the body's normal reaction to being exposed to a neurotoxic drug. 

 

 

 

22 hours ago, Mia1 said:

There are so many different w/d symptoms and nausea certainly can be one of them.

 

So true, Mia. 

 

@Marcus If you're having trouble communicating with your doctor, this thread may help:

 

How do you talk to a doctor about tapering and withdrawal?

 

While it would be nice to be able to educate doctors on withdrawal, at the end of the day, as long as your doctor is willing to prescribe the drug so you can taper, that's really all you need from him or her. 

 

You may want to slow your taper down and do a micro-taper. That may help with the symptoms. Please see:

 

Micro-taper instead of 10% or 5% decreases
Decreasing your dosage by very tiny amounts more often might be more tolerable than 5% or 10% decreases. Know your symptom pattern first so you can estimate how often you can reduce.

 

The Brassmonkey Slide Method of Micro-tapering

 

 

The Brassmonkey Slide allows you to tailor your taper to 4 small reductions instead of one larger monthly reductions. And you can set it up for a micro-taper at whatever rate you wish. 

 

Let us know if you need any help with the math along the way. 

[Marcus]

@Shep @Altostrata @Mia1Thanks for your message Shep. I will read the topics you wrote down in your post. Is it better to first fully transist to liquid? Because i'am now doing 25mg tablet and 1ml liquid. I must say i am very sensitive to brands and it happened in the past the pharmacy gave me sertraline from a different manufacturer/brand and i felt symptoms immediatly. 

Also i wanna mention a Dutch tv program called 'Zembla' made an television broadcast in April 2021 about people struggling with antidepressant withdrawal and insurance companies do not reimburse taperingstrips that are avalaible in The Netherlands. So hopefully one day doctors will believe patients and we will get help. Thank you,

Marcus

[Shep]

24 minutes ago, Marcus said:

Is it better to first fully transist to liquid? Because i'am now doing 25mg tablet and 1ml liquid. I must say i am very sensitive to brands and it happened in the past the pharmacy gave me sertraline from a different manufacturer/brand and i felt symptoms immediatly. 

 

No, it's not necessary. Many people like to take part of their dose in tablet and take part in liquid. You'll taper off the liquid first and then gradually transition the part in pill form to liquid. The gradual transition will allow your nervous system to adjust to the change. Also, you'll want to do this transition without making any reductions at that time. That way, the only thing your nervous system will have to process is the change in formula, not a change in dose. 

 

26 minutes ago, Marcus said:

Also i wanna mention a Dutch tv program called 'Zembla' made an television broadcast in April 2021 about people struggling with antidepressant withdrawal and insurance companies do not reimburse taperingstrips that are avalaible in The Netherlands. So hopefully one day doctors will believe patients and we will get help.

 

Thanks for posting about this, as it is a problem. It will be nice to have insurance reimbursements for taper strips. Hopefully, one day. 

[Marcus]

To update my situation. I'am back on 50mg sertraline, 1 tablet. The combination liquid and tablet didnt work. I lost my appetite and thirst unfortunely. I don t think i ever will be able live without sertraline 50mg. 

[Shep]

You may want to work with a scale instead of a liquid. Many people do great tapering using a scale. 

 

Using a scale to weigh and measure doses

 

 

[Marcus]

@Shep @AltostrataThanks for your response. Ok, i will keep that in mind. The weird thing is that the moment I stopped the liquid and changed fully to tablet again my appetite increased after some days. Maybe liquid drugs are absorbed differently in the body? I read in a official Dutch document about stopping antidepresants from 2018 that liquids are differently processed by the human body in comparison to medicine in tablets. 

[Shep]

30 minutes ago, Marcus said:

The weird thing is that the moment I stopped the liquid and changed fully to tablet again my appetite increased after some days.

 

When you switched to liquid, did you also reduce your dose or did you keep the dose the same? If you kept the dose the same, yes, it's possible that your system didn't agree with the liquid and you may do very well using a scale so you can stick with the tablet. 

[Marcus]

I combined the liquid and tablet.  i did half a tablet (25mg sertraline) and 1ml liquid which contains 20mg sertraline. I am very sad such a small dose reduction gave me  problems with my appetite and thirst. It also confuses me, is this withdrawal or is it all in my mind. 

[Shep]

13 hours ago, Marcus said:

I combined the liquid and tablet.  i did half a tablet (25mg sertraline) and 1ml liquid which contains 20mg sertraline. I am very sad such a small dose reduction gave me  problems with my appetite and thirst. It also confuses me, is this withdrawal or is it all in my mind. 

 

What dose were you on when you were only using a tablet? Were you on 50 mg or 45 mg? 

 

If you were on 50 mg and you switched over to liquid and tablet with a total dose of 45 mg, it may have been the reduction and not the liquid. 

[Marcus]

With tablets only i was on 50mg. With the combination liquid and half a tablet it was 45mg. 

[Shep]

1 minute ago, Marcus said:

With tablets only i was on 50mg. With the combination liquid and half a tablet it was 45mg. 

 

If liquid is what you feel is the best method for you to taper, you may want to try it again. Only this time, keep the total dose at 50 mg. It may have been the reduction in dose that created the symptoms, not the method of using liquid. 

 

Please see this part of the How to make a liquid from tablets or capsules thread:

 

On 7/26/2012 at 9:44 PM, Altostrata said:

When and how to substitute a liquid for a tablet

A liquid form of a drug will get into your system faster than a tablet. Some people can feel this difference.

 

The easiest way to substitute a liquid for a tablet is to ease into it -- take part of your dose in tablet form and part in liquid. After you get used to this for 4 days or more, substitute the liquid for the rest of the dose.

 

While you're making the substitution, do not make a decrease in your total daily dose. You need to see how you do with the substitution of the liquid before you continue to taper. If, over 4 days or more, the liquid dose seems too strong for you, you may want to reduce it slightly and continue your taper after you stabilize.
 

If it's more convenient for you, it's fine to continue to take part of your dose in tablet form and part in liquid form.