mountaineer11: Beginning the tapering journey- Sertraline/Bupropion

[mountaineer11]

Hi everyone, 

 

I wanted to introduce myself and give a quick background about my experience with antidepressant medication. 

 

I was first prescribed Prozac in 2010 for persistent depression/anxiety and in subsequent years tried several others including Cymbalta, Lexapro, Symbyax, Viibryd, Xanax.. often prescribed with a sentiment much like "well, let's see if this works." The road was windy through these years. Some of them totally numbed my emotions or fogged my thinking, some heightened anxiety, others simply were not effective in reducing depressive symptoms. 

Since 2017 I have been on Sertraline (50mg) and Bupropion (300mg) daily. I will say that this combination has been most effective in reducing depressive episodes- I describe the feeling like being buoyed against the deepest lows and suicidal ideation that I felt previously- there is perhaps a numbness there against some of the more extreme distress. Unfortunately I’ve noticed this blunting effect in other areas as well- my emotional range seems to have narrowed in both directions. 

 

I’ve been back and forth about tapering off of medication- I’m afraid of relapse for sure, but I can’t shake the sense that I am missing some of the true experience of life. I miss having full  access to my brain. I miss being able to think clearly and express myself as I’d like. I have coping skills now and layers of support that I didn’t have when I started medication. 

 

I’ve tried cold turkey, I’ve tried the doctor prescribed tapering regimen- both with bad withdrawal symptoms. The few times I’ve tried to come off them I’ve had persistent brain zaps, bouts of deep hopelessness, recurrence of suicidal ideation. I am realizing that I was not set up for success during these trials as the tapering was way too quick. I’ve been reading about the 10% tapering plan and started tapering the sertraline this morning- (i got the liquid version of sertraline and took 45mg today- and plan to stick at 45mg for the next 4 weeks before the next 10% decrease. I’ve decided to stay on my current dose of Bupropion (300mg) while working on the sertraline taper- then hope to move on to tapering that med depending on how this goes. 

 

I’ll do my best to provide some updates along the way. I appreciate everyone’s experience- thanks for sharing.

Edited February 6, 2021 by manymoretodays

[Altostrata]

Welcome, @mountaineer11

 

Emotional anesthesia is a very, very common adverse effect of antidepressants. You've found our sertraline tapering topic? How did your first reduction go?

[mountaineer11]

Thank you!

 

I have found the sertraline tapering topic and have been reading through a lot of people's experiences. The first reduction is going well so far- I will reach the one week point tomorrow (2/11) on 45mg Sertraline while continuing on prescribed dose of 300mg Bupropion XL. 

 

I haven't noticed any withdrawal symptoms so far since the reduction. In past attempts it would take 10 days or so before I started experiencing withdrawal. With these past attempts at dose reduction, the first withdrawal symptom I'd get was nervousness/agitation and generally feeling like a raw nerve. I'm hoping the gradual reduction will help with this, as my other reductions have been much more drastic. 

 

I was reading some about receptor occupancy at different doses and it seems like the occupancy % is steadily at 80ish% until dosage drops below 25mg. I'm wondering if it would make sense to reduce 5mg weekly, or every two weeks until I reached 25mg dosage and begin 10%/month reductions. If the receptors are occupied at roughly the same % until the lower dosages, I'm wondering where the risk for withdrawal symptoms would come from at 30-45mg? I have also been on some form of SSRI/SNRI/NDRI for the past 10 years so maybe even small changes are jarring to my system. 

 

I'm also curious about timing for tapering off Bupropion. Is this something that can be done simultaneously with Sertraline? I may be getting ahead of myself, but wasn't sure if reducing one without the other would cause any problems.

 

Thanks!

[manymoretodays]

On 2/10/2021 at 8:34 AM, mountaineer11 said:

I was reading some about receptor occupancy at different doses and it seems like the occupancy % is steadily at 80ish% until dosage drops below 25mg. I'm wondering if it would make sense to reduce 5mg weekly, or every two weeks until I reached 25mg dosage and begin 10%/month reductions. If the receptors are occupied at roughly the same % until the lower dosages, I'm wondering where the risk for withdrawal symptoms would come from at 30-45mg? I have also been on some form of SSRI/SNRI/NDRI for the past 10 years so maybe even small changes are jarring to my system. 

 

I'm also curious about timing for tapering off Bupropion. Is this something that can be done simultaneously with Sertraline? I may be getting ahead of myself, but wasn't sure if reducing one without the other would cause any problems.

 

Hi mountaineer11, and welcome aboard,

 

I know it does seem like that, one could go quicker up to a certain point with their taper. 

However, we don't recommend that at all.  If you have just begun your taper it's important to follow the 10% or less, from each proceeding dose.  And begin to get a feel for, how you do with each taper.  The risk of doing something like you describe is high, that it would result in a major WD crash at some point.

And then, your 10 years of SSRI/SSNRI/NDRI has most likely resulted in some changes, that are going to take some time to recover back to baseline factory settings, in your nervous system.

 

So.....if it was me, I would not think I might be the exception to what we have seen occur, over and over again here, with too fast tapers.  And I wouldn't proceed any less carefully or cautiously than our protocols suggest:

Why taper by 10% of my dose

Tips for tapering sertraline(Zoloft)

 

And then, see:

Taking multiple psych drugs? Which drug to taper first?

and as you are on, basically 2 accelerators, it's challenging....to know what to taper first

And then this for you to take in, as well:

Taper more than one drug at a time?

 

At some point it might make sense to begin to decrease your dosage of Wellbutrin, while you are pausing in your sertraline taper.

Please do an interactions check too:  Drugs.com

And then link us to the results, or copy and paste here

That should prove helpful.

 

And then, not knowing what you've read or taken in here yet, I feel obligated to give you some more of the basics:

 

Brain Remodelling

What is withdrawal syndrome.

The windows and waves pattern of withdrawal stabilization

 

Dr.Glenmullen’s withdrawal symptom list.

 

When we take 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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

And with all of this too, I really do believe that, for some, a judicious, and timely taper.......might really help to bypass WD syndrome, or some of the symptoms so familiar to some of us now.

 

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) 

 

 

You might be, yes, jumping ahead just a little bit, but good questions.  And do be patient with us too, on getting replies and such. 

 

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

 

And best.  Welcome.

 

L, P, H, and G,

mmt

 

 

Edited February 13, 2021 by manymoretodays
removed some text

[mountaineer11]

Thank you for your response, and the information. 

 

About 8 days since the decrease from 50mg Sertraline to 45mg I have had recurring depressive symptoms. This has been the time frame in the past- usually about 10 days- that I have had withdrawal symptoms (if indeed that's what this is). It's been 11 days since I made the initial dose reduction and the past three days have been very low for me. I've had extreme hopelessness, feeling easily overwhelmed, anhedonia, suicidal ideation- all the familiar symptoms that led me to seek meds in the first place. 

 

This morning I went back to 50mg and feeling defeated. I have a young child and lots of work responsibilities (like I'm sure many others do) but I am having a hard time imagining continuing the taper process if this is what it will be like, potentially for a long time. It would be impossible for me to be present with my son, wife, work, friends, etc. in this state. Feeling like I may be stuck on these meds forever- I don't foresee a time period where I could push through these feelings without being totally useless to those who depend on me. 

 

The adverse effects of being on the medication are minimal and nothing compared to the way I've felt the past few days. It feels ridiculous to throw in the towel at first sign of difficulty while so many manage to persist, but maybe another time will come when my life circumstances would allow me to give it a better shot, who knows. 

 

Just wanted to give the update that I am going back to original dosage to try and stabilize. I'll most likely still stick around to stay informed, but this is where I am today.

 

All the best to everyone giving it a go.