SeekingMeaning: tapered sertraline over 9mo and been free 1mo. Struggling tapering olanzapine.

[SeekingMeaning]

Hi all, just joined today.

 

In 2015 I had a major psychotic episode managed with lorazepam and olanzapine initially. In my zombie state they also started me on sertraline where I had previously resisted SSRI since a bad reaction to seroxat in 1995. 

 

For 5 years I tolerated side effects of long term combined sertraline 200mg and olanzapine 2.5mg having been browbeaten into the medical view that my lifelong depression required lifelong medication.

 

9 months ago I felt I was getting no benefit from sertraline and was sleeping my life away I was so sedated. I dropped to 150mg sertraline having been told by my psychiatrist that lots of people went up and down as their illness required.  I was not trying to stop at that stage and did not realise that the following 5 months of suicidal despair and vivid, obscenely violent nightmares that traumatised my days were probably withdrawal symptoms.

 

I am sorry, I have to pause there, I still get very tired writing this kind of thing. I will return.

[Erell]

Hello

 

And welcome on SA. 

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved.

 

Oh and thank you for your signature : it will help us give you the most accurate advice we can, and allow us to see your history at a glance.

 

On 2/23/2021 at 9:30 AM, SeekingMeaning said:

I am sorry, I have to pause there, I still get very tired writing this kind of thing. I will return.

 

It's ok, no pressure. I'm going to give you some links to help you understand what is happening : take your time to read them and feel free to ask questions if needeed

 

First, let me say that what you've been through while dropping Sertraline sounds like very common withdrawal symptoms : unfortunately, doctors don't seem to realise how powerful these drugs can be, and don't recognise withdrawal syndrome.
We usually advise our members to do very slow tapers, and to not drop more than 10% every 4 weeks.
This might help you understand : 

how-psychiatric-drugs-remodel-your-brain

 

-> About your Sertraline taper : 

- How did you drop Sertraline ? (pace, percentages)

- At which dose did you jump to 0 ?

 

-> Your signature says that you now take a quarter of a 2.5mg tablet of Olanzapine : are you holding since February 2020 or did you mean February 2021 ?

Your body went through a lot this year : I wouldn't drop Olanzapine for a while and give time to your Central Nervous System to stabilise (and recover from Sertraline withdrawal).

These threads might interest you : 

 

why-taper-by-10-of-my-dosage

 

and 

 

tips-for-tapering-off-zyprexa-olanzapine

 

Again, welcome  

 

[SeekingMeaning]

1 hour ago, Erell said:

 

 

 

-> About your Sertraline taper : 

- How did you drop Sertraline ? (pace, percentages)

- At which dose did you jump to 0 ?

Thank you for the warm and friendly welcome.  The internet is rife with a deluge of information and it's nice to find a calm site with genuinely useful guidance given that the medics seem to have so little grasp of the realities of these drugs and their side effects.

 

I recently filled in a side effect form for the site that collates them so will copy paste their report

 

 

Change	Year	Month	Day	Dose	Unit	Frequency
Started	2015	Feb	Select	200	mg	1 x per day

 

Suspect drug dose/frequency changes 

Change	Year	Month	Day	Dose	Unit	Frequency
Decreased dose	2020	Mar	14	150	mg	1 x per day
Decreased dose	2020	Oct	15	125	mg	1 x per day
Decreased dose	2020	Nov	10	100	mg	1 x per day
Decreased dose	2020	Dec	28	75	mg	1 x per day
Decreased dose	2021	Jan	4	50	mg	1 x per day
Decreased dose	2021	Jan	17	0	mg	1 x per day

 

I have to say that from that date in October where I dropped my dose to 125mg I have had exponential improvement in quality of life even though at first I had a monumental headache.  I have zest and energy for life for the first time since starting the drugs.  Since December I have been able to read a book for the first time in five years (I was always an avid reader right back to childhood, it is significant that the loss of this skill did not worry me more, because I really didn't care about anything much), this week I was able to listen to music for the first time since 2015.  Most significant of all in some ways though was to get a return  of genitourinary sensation for the first time in five years.  Like the reading, lack of feeling for sex didn't seem significant in a world where I wanted nothing and cared for nothing but there is something sinister about not even being able to feel yourself passing urine, especially if you're a middle-aged woman!

 

I see from reading more since I may have got off lightly with the speed of my decrease.  Also my husband is trying to come off his sertraline and has just had to go back up to original dose due to severity of his withdrawal symptoms.  It was actually his experience that led me to sign on here, I could see I needed to support him in tapering more effectively than I had done.

 

 

1 hour ago, Erell said:

 

-> Your signature says that you now take a quarter of a 2.5mg tablet of Olanzapine : are you holding since February 2020 or did you mean February 2021 ?

My mistake, I have edited my signature, it's Feb 2021.

 

My olanzapine reduction has been ill-informed and crazy but inspired by my improved well being from getting off sertraline I went at it with a bit too much enthusiasm to be drug free completely.

 

2015 till 27.1.21 taking 2.5mg daily

6.2.21 4.5ml of 2.5mg/5ml suspension

7.2.21 4ml

8.2.21 3.5ml

9.2.21 3ml

10.2.21 2.5ml

12.2.21 2ml

18.2.21 1.5ml

19.2.21 1.25ml

 

The longer gaps in dropping were as I started to experience insomnia, extreme anxiety which I would more describe as an ingrained sense of dread.  Each time that passed I dropped a bit more.

 

As I say, lesson learned, now I'm at equivalent to quarter tablet and easy to get by just renewing my prescription and splitting tablets I shall sustain this dose for some time now.  Fingers crossed I do not get hit by any of the other delayed signs of withdrawal I've only heard of since visiting this site.  Ignorance was bliss!

 

1 hour ago, Erell said:

Your body went through a lot this year : I wouldn't drop Olanzapine for a while and give time to your Central Nervous System to stabilise (and recover from Sertraline withdrawal).

 

Thank you, I can't tell you how much it means to have someone acknowledge that what I have done is monumental and not just some 'here are some smarties for you to take as and when you need them' which was how I felt the GP and psychiatrist were treating them.

 

Apologies, it's a long time since I frequented bulletin boards/forums, my use of the editor system is very rusty.  I hope I got the quotations inserted in the right places.  I hate how the drugs have robbed me of so much of my natural intelligence and ease of use of technology... or is that my age creeping up on me... who knows.

[SeekingMeaning]

I had a bit of a shock yesterday after reading the article about correlation between drugs and severe covid.  Seeing Olanzapine listed as a culprit set me off on track to investigate why and whoa, suddenly a chronic symptom I didn't even realise was caused by my drugs made sense.  Since my psychotic episode in 2015 I have nightly woken up choking and coughing.  Same happens if I snooze in the day.  I didn't realise Olanzapine caused laryngeal and pharyngeal dystonia that can lead to difficulties swallowing and a tendency to aspirate.  I briefly wondered if this was worrying enough to spur me onto finish the withdrawal but on balance, as I've lived with this for five years I guess a few more months will not hugely affect me.  I do worry about the growing wheeze I have when I exercise and whuether there is any longterm respiratory damage from my nightly choking episodes.  A supplementary bit of info is that I've always been a drooler, especially at night but that I lately have found myself drooling in the daytime.  Quite an embarassing thing as I tend not to sense it till it runs right down my chin!

[Altostrata]

Hello, SeekingMeaning.

 

Is a quarter-tablet of olanzapine 2.5mg? Please let us know how you're doing on the reduced amount. (It's helpful for us if you refer to dosage in milligrams of active ingredient, rather than 1/4 tablet.)

[SeekingMeaning]

Hi Altostrata, great site you have created.

 

Sorry for confusing statement.  My tablets are 2.5 mg each so a quarter tablet is 1.25mg.  My initial focus of quarter tablet was borne of the thought I could just easily dose myself with a pill cutter but the tiny tablets refuse to break into equal quarters.  I have just ordered a set of 0.001g scales to help me used crushed tablet accurately.  

 

Having left my dose alone at 1.25mg for the last week I am more comfortable from the unpleasant withdrawal experiences I was having with Olanzapine.  I am also now well into the WD symtpoms of the sertraline.  However, there is a context to my experience such that I have had all these symptoms before in various forms for many years and compared to the horror of same sorts of symptoms while actually ON sertaline and it robbing me of most of my coping resources this is nowhere near as negative experience.

 

I am currently getting a lot of abdominal discomfort which is no huge surprise  I had IBS before I started Sertraline.  The Sertaline made it worse.  It's just par for the course that I now have GI disturbance from stopping the Sertaline too.  I'm finding my appetite changing too.  For such a long time the love of my life has been my own home made muesli but suddenly it just feels like cardboard in my mouth.

I'm getting bouts of severe fatigue but again, in context, I have had chronic fatigue since 1995 and have learned to manage my life and it's limited energy budget without having to give it a lot of thought.  The fact that for the first time in five years I can hold attention to read a book or listen to a meditation without falling asleep is a huge plus for me compared to my time on Sertraline.  Managing fatigue is much more interesting if I can engage in things that hold my attention whilst lying down.  That said, sometimes the fatigue leads me to just find any stimulation unbearable and then I have to put in ear plugs, wear an eyeguard and hope for sleep.

 

While cutting down the olanzapine actively my emotions were in a terrible state.  I felt very 'not me' and quite frightened by it.  That has stabilised again now though leaves me very fearful of restarting reductions in the future.  I shall try much smaller reductions and much more gently next time.

 

Something I read about withdrawal from olanzapine really clicked for me and I notice it very much now.  I clock watch avidly for my next dose.  When I was on 2.5mg a day I was the same but didn't really draw much conclusion from it.  I just knew that the peace of mind that magic tablet gave me was something I looked forward to with the same air I imagine someone who drinks wine would view a glass of wine of an evening.  Now I realise that it is actually more sinister than that, it is a real dependence I have formed and I get very edgy for a few hours leading up to the time of my next dose.  

 

I am getting really intense spells of cold.  I already have Reynauds syndrome but this is much more intense and even if I wrap myself up in bed with all my clothes on I am sometimes unable to generate any heat in my body.

 

While I was on the drugs I noticed my balance had deteriorated very badly so I am actively, each day, working on exercises to improve my balance and glad to say that this is being effective.  I have a wobble cushion and I go into a meditative state as it takes all my focus to be able to stand on one leg on my wobble cushion and then to make any movements sets the whole wobble off again.  When I was a child I took my nimblefootedness for granted and it is a quality I am determined not to let go of without a fight.

[SeekingMeaning]

I am notoriously bad at calculations, fortunately I know to check and recheck before I act. My dose is actually 0.6mg. After another night like the ones where I reduced dose I am ditching my liquid suspension in case it's losing potency.  Will be grinding pill tonight. With the animals we always mixed ground pill with a knob of butter. Everyone here seems to use liquid/water even for low solubility drugs. Does anyone mix with food?

[RusTW]

On 3/2/2021 at 11:31 PM, SeekingMeaning said:

I am notoriously bad at calculations, fortunately I know to check and recheck before I act. My dose is actually 0.6mg. After another night like the ones where I reduced dose I am ditching my liquid suspension in case it's losing potency.  Will be grinding pill tonight. With the animals we always mixed ground pill with a knob of butter. Everyone here seems to use liquid/water even for low solubility drugs. Does anyone mix with food?

Be careful tapering any anti-psychotic after dropping a drug previously. I did a dual taper with Seroquel and it was very grueling. I tapered off of Zoloft as well

[SeekingMeaning]

Thanks RusTW.  I think I am still only just starting to comprehend how big a deal it was to come off the Sertraline.  So little is made of it by the medics and the general public.  Going to try and be more respectful of my CNS now I've been absorbing some of the lessons from this site.

[SeekingMeaning]

Further to my post about choking since being on olanzapine (only just realised it WAS that as I had previously thought I had been choking since my psychosis in 2015 which of course was when I started olanzapine).  I've been on 0.6mg steady since the 19th Feb and I don't think I've choked once at night.  Progress!

 

I am still in a lot of GI pain and off most foods/poor appetite for the time being.  

 

I had a very bad night the night before last but last night I commissioned my new weighing scales, used a tablet rather than suspension and noticed a marked difference in how I felt.  I don't think the suspension ever agreed with me for some reason.  As soon as it got into my system I felt woozy and over drugged even at low doses.  

 

I did also make some conscious choices to do things that soothe the para sympathetic system pre bed, rather than the night before where I had been browsing this site in the evening.  It's a great site but it is heart-rending hearing how awfully so many are suffering.

[SeekingMeaning]

My agitation has been getting more and more unbearable, harder to stay in a wise and nurturing place with it.  Yesterday I was in such a bad state I took my 0.6mg olanzapine a little earlier and felt immediate relief.  Yet the agitation returned within only an hour and I could not bear it.  It felt like my brain had become inflamed and needed more help.  I took another 0.3mg and again a little more comfort for a few hours.  My worst time is as I drop off to sleep.  I startle awake and in that just woken state the full limbic terror response kicks in before my cognitive and meditative skills can kick in and I'm a mess.  I'd already decided before lying down that if this happened I'd take another 0.3mg, I'd saved my leftover suspension with that in mind.  I didn't have an awful night though not hugely restful compared to how I used to before starting WD.  

The thing is, I feel terrible this morning.  Still as if my brain is inflamed and I'm on the edge of unbearable all the time.  I'm so tempted to just give up the reduction in olanzapine for now and take the full 2.5mg again while I get used to no sertraline for a few months.  I'm torn between wanting to ease the 'inflamed mind' feeling I have now before it kindles into something more resistant and the advice in the reintatement topic to try reinstating a lower dose over a week to see if it's enough.

[BadMedicine]

Might be wise to try re-instatement of a small amount to see if that works first. You might need to give it a couple of weeks to see the benefit. When I re-instated 2.5mg from 1.8 (3/4 tablet) it took 3 days for my sleep to return and then it would periodically go bad again every so often for a few days at a time but I did start feeling more stable and sometimes good within a month. I dropped sertraline from 18.75 and olanzapine from 5 to 2.5 at the same time and periodically still have a few bad days here and there a year later. It gives the brain a lot to sort out. However in between I feel much better than I did on the higher dose of olanzapine and without the sertraline so it is worth it in the long run but it might be worth you updosing in the mean time to allow your brain to catch-up and stabilise a bit.

[SeekingMeaning]

Thank you BadMedicine, and for your response in your own thread (sorry not quite sure of etiquette about where to reply to things).  By 10am yesterday I was in such a mess I reasoned taking another 1.25 mg was just like having the other half of the night before's dose and returning to my original 2.5mg per day.  I took that and within an hour was stabilising noticeably.  During the course of the day I began to feel almost human and by the time I'd had my evening dose my appetite for my dinner was back to normal and my food was tasty rather than something I was forcing down like medicine.  My sleep was only slightly edgy once and I was able to recover from that panic using parasympathetic stimulation exercises and go back to sleep.  This morning I feel 'myself' for the first time in weeks and had not realised how bad I was feeling till I'm through it now.  Thankfully Olanzapine is the drug I don't mind sticking with.  It was the Sertraline I was having such negative side effects from so if I have to stay on this to stabilise I'm ok with that.  I can function normally (for me) at this level.  I will try again but not till I'm sure I'm through the WD process from the Sertraline and with a veeeeerrrry slow taper that I hope my mind will barely notice!

[Erell]

On 3/13/2021 at 9:58 AM, SeekingMeaning said:

  This morning I feel 'myself' for the first time in weeks and had not realised how bad I was feeling till I'm through it now.  

I'm so glad to read that you feel so much better.

Your body went through a lot this year, and you stopped Sertraline very recently. If you're feeling better with 2.5mg Olanzapine and feel like you can stabilise on it, it's ok.
Give time to your body to rest and heal, enjoy the relief, and if one day you decide to taper Olanzapine and feel ready for it, you know you'll find all infos and support here

Sending hugs (if you like them ! )

[SeekingMeaning]

The wise amongst you would probably have seen this coming from my first post but today I have decided to reinstate Sertraline.  The wellbeing from returning the olanzapine to full dose was shortlived and very fragile.  I'm obsessing about anxiety that I could be heading for really bad withdrawal if I don't act now to reverse the stupidly rapid final dose reduction I made.  Well, not stupid really.  I was acting without the knowledge I've gleaned since joining this site and based on how easily the medics implied these tablets could be just stopped when their job was done.

I've reinstated at 1/40th final dose (50mg) so 1.25mg based on the fact that my primary withdrawal symptom is agitation anxiety and insomnia.  Seemed best to start very low.  A few weeks ago I'd have seen this as failure but I've acclimatised to seeing this as a step in self=care I need to take.  Wish me luck. xx

[Gridley]

23 minutes ago, SeekingMeaning said:

've reinstated at 1/40th final dose (50mg) so 1.25mg based on the fact that my primary withdrawal symptom is agitation anxiety and insomnia.  Seemed best to start very low.  A few weeks ago I'd have seen this as failure but I've acclimatised to seeing this as a step in self=care I need to take.  Wish me luck. xx

It is wise of you not to judge yourself or view this as failure. You know your situation better than anyone and should do what you need to do to care for yourself.

 

It's very good that you reinstated at a very low dose, which is exactly what we recommend.  Too much can overwhelm your system, which is sensitized from dose changes of the two drugs.  You are well within the time frame (3 months after your last dose) when reinstatement most predictably works.  It takes four days for the reinstated dose to reach full strength in your blood dream and a few more days to register in the brain, so be patient and give the 1.25mg a chance to work.  In judging the effect of the reinstatement, please keep in mind that the purpose of reinstatement isn't to eliminate withdrawal symptoms completely (though it does for some) but rather to bring them down to a tolerable level.

 

This link will give you some information about reinstatement:

 

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

 

 

 

[Erell]

Hello @SeekingMeaning

 

How are you doing with your reinstatement?

 

Hoping you enjoy the sun today ☀️

[SeekingMeaning]

Thank you to Gridley for your prompt encouragement.  I was in quite a mess by the time I was trying to decide what to do so it was very heartening to hear you saying I probably hadn't left it too late to reinstate (which I was really afraid of).  I was unable to tell whether I was just creating massive health anxiety by having read the stories on this site of how bad things can get.  I kept wanting to believe I would be one of those people the medics are so quick to refer to as the normal ones who can just stop the meds without problems.  Sigh.  Anyway, looking back at my thought processes at the weekend it occurred to me that it doesn't matter if a person who casually plays chicken with traffic on the street scares themselves by reading stories of people who have survived car accidents.  If the end result is that the person stops playing chicken with the traffic it's neither here nor there if they  might have been lucky and missed an accident.  I am pleased I listened to the stories here and people have so generously shared their experiences so that I was able to avert my own accident (hopefully, still early days I know).

 

So far so good.  The reinstatement has regained me some balance.  I am at the point where I now recognise what my husband says sometimes 'I can feel the drugs working' as in I can sense how I would be without them and can tell they are muting that dark place that is just a missed dose away.  I particularly sense it as I'm coming up to each next dose.

 

I'm still having disrupted sleep but when it is not accompanied by blind terror and dread as it has been recently I find it quite tolerable.  So it was also useful to read that tolerable is what I'm aiming for rather than absence of side effect.  I'm perhaps in the lucky position at the moment to have the best of both worlds.  I am more able to function than when I was dosed to the eyeballs a year ago and more able to function than I was in the latter weeks when I had destabilised my system by coming off both drugs too fast.  

I'm using my time now to build resources, doing lots of training on the parasympathetic stimulating exercises and establishing some hitherto unsensed levels of autonomic regulation during meditation periods.  Up to now, autonomic regulation has always felt like a state of someone describing sight to someone blind.  I had so little experience of it I did not know what it felt like or how to attain it.  I feel like someone engaged in physical training ready for some big upcoming event...  still very much focussed on the end goal of getting off the meds entirely.

 

@Erellthank you so much for asking after me and I have indeed been out in the sunshine.  I hope you are also being blessed with sunny spells. xx

[SeekingMeaning]

Apart from one severe wobble when I ate something with sugar and set off insomnia and panic again I am relatively stable.  My sleep is disrupted but with my current regime of 1.25mg sertraline and 2.5mg of olanzapine I am not being kept awake in hyperalert terror states.

 

I'm using my stabilising time to read around as much as I can on here and trying to make sense of my experiences with both new vision and feeling permission to explore the spiritual emergence view of my experience I have always leaned towards but which was stamped on soundly by the orthodox medics.

I'd like to ask some questions but perhaps need some backstory too.

 

First question

 

Looking for a time frame for when to make more reductions to my meds.  I recognise I've given my CNS major trauma and having experienced that brief month of severe WD before I reinstated I very much do not want to go there again.  I can see that my current tolerable state is thanks to the drugs and am treating them with great respect.  So is the objective to wait until I have unbroken sleep for a few months?  Should I simply set myself a limit of at least 3 months?  At least 6 months? 

This is now where I need to put in back story.  My psychotic episode in 2015 made sense to me in terms of having been in the thrall of a yoga teacher who pursued her own goal of getting me to release chronic tension and ignored signs that I was not able to contain all that was being released.  When I started to question if I was approaching Kundalini psychosis she just shut me down and abandoned me.  But by then I was looping the loop.  I was barely sleeping and I was making series of moves that to my addled brain were keeping my energies held in as best I could.  The crisis got severe enough that the critical care team were called in who had no time for any Kundalini theories and just treated me as having insomnia and acute anxiety-induced psychosis.  Never mind that the anxiety was being brought on by my terror that I was coming apart at the seams due to the searing energies rushing through my system.  A month or so of Lorazepam and Olanzapine with some Zopiclone thrown in crashed me back to earth and made me sleep for forever.  I have lost six months of my life as the Lorazepam made my short term memory pack up.  2015 starts again for me around autumn having had the crisis in February.

 

While in this superdrugged state I was packed off to the outpatient psychiatrist who took the opportunity to treat my lifelong depression and anxiety with Sertraline.  I was not really in a fit state to give informed consent despite having refused SSRI's from the time they were first offered me in 1995.  Sertraline did not really help and the dose kept being increased.  I have the bizarre situation now of giving thanks for the severe social anxiety which made me stop going for any further psychiatric treatment and play the 'good patient' who was getting better.  Those traits are probably why I only have the two drugs to try to recover from rather than a whole gamut of things they tried if I'd owned up to the fact Sertraline was doing nothing for me.

 

So my reason for covering that part of my history in detail is that clearly, insomnia is a worry for me.  That my sleep is now disrupted scares me from ending up where I was in 2015.  On the other hand, I am way wiser than I was then.  I would not hand over control to any body therapist now and the only exercise regimes I follow are fully grounded, ordinary things like HIIT and weight training.  I treat my subtle energies with profound respect and if I'm tightly holding stuff in my body I know it's because of PTSD from childhood and shouldn't be messed with lightly by ignorant, however well-intentioned body workers.

 

Second question is what order to tackle coming off my drugs?  I read threads about SSRI's being activating and antipsychotics calming.  However my 200mg of Sertraline was heavily sedating rather than activating.  Having now read about pooping out I think that whatever benefit I may have had with Sertraline for the first two years the following three were in full tachyphylaxis mode.  Though it alarms me that Olanzapine is so toxic it actually has been the most 'useful' of the two drugs all along and once I dropped from 20 to 2.5 mg daily the metabolic disruption causing ravenous mind-bending hunger ceased.  When the time comes to go off Olanzapine I intend doing an incredibly slow, gentle taper with the hopes of not getting too deranged.  The last thing I want to risk is getting into the hands of the psychiatrists again and being started on anything else.  

  

[Erell]

Hello @SeekingMeaning

 

How are you doing these days ?

Still feeling more stable with the reinstatements ?

 

I'm a bit foggy so please excuse me if my sentences are not very clear, but I'll try to suggest possible answers to your questions:

 

- I don't think there is a specific timeframe. Considering that you've been through a lot this year and are feeling some relief, what do you think about enjoying the relief and wait some months to give some rest to your cns and see if some symptoms can improve with the hold, like sleep ?

The thing is, you don't have to make a decision now : you can let 3 months pass and then reassess and see how you do.

And as insomnia is a worry, I would say it might be best to take the time to see if you can streghten your sleep and start a taper when you'll feel stronger.

If you feel like reinstatements are helping, i would give a chance to your CNS to stabilise and wait several months before making a change. 

 

I would also add that you have the right to decide what is best for you, and that's not necessarily tapering to 0. I know some people decide to stay on a low dose of the drug because they fear tje return of insomnia, or voices, and nobody can judge that.

There are also people who decide to stop thinking about tapering to 0 because it is too stressfull, and just celebrate every little reduction in their dose (and actually I think it is the best way to do a taper).

 

So, really, no pressure here : you have suffered a great deal this past years, take your time, no need to take decisions or set limit now ☺

 

- About which drug to taper first : again, no pressure to make a definitive decision.

Usually on SA we recommend to taper the most activating drug first.

If you feel like Olanzapine is helping more than Sertraline, then perhaps you'll decide to taper Sertraline first (after several months 😉).

There are people who lower the dose of one drug, then hold and start lowering another drug (be carefull of not tapering two drugs at the same time).

I really do think that there's no need to make definitive decision or put a timeframe : our bodies lead the game here and it's always time to reassess.

 

Don't know if it will help you, in any case I'm sending hugs 🤗

 

Ps : thank you, a lot, for the tips you shared on my thread. It really does help ❤

[SeekingMeaning]

Thanks Erell, I appreciate your thoughts, especially knowing how hard a time you are having just now (((hugs))).

The reinstatement has largely been a success for me and I think overall you are right, it's important to relish the relative stability for a good while.  I still feel ill when I remember what it felt like in February and can't bear the thought of retriggering that state.  I had a very nasty nightmare yesterday and immediately had the panic of 'what if the vile nightmares are back, I could not bear that'.  But one step at a time eh.  I have had a month or so of quite severe fatigue which was not helped by receiving my first covid vaccination (though super grateful to have been given some immunity for sure so very worthwhile).  I can bear fatigue far better than the insomnia and nightmares though so don't make a big deal of that as a symptom.

I still haven't made up my mind which taper to do and when but as long as the answer is 'not now' I guess I can just let that question rest.  

[SeekingMeaning]

Just made another small reduction in sertraline dose and thought I'd pop in to update my info.  I've been holding pretty steady since the big crisis in March this year.  I feel so thankful I found this forum in time to reinstate to a safe dose and allow myself to recover functionality.

 

Overall life has been pleasant for the last few months, some waves and windows but the most significant improvements for me were the return of my ability to read books and the return of my enthusiasm for my spiritual life such that I've been able to be very active in participation with an online Sangha (Buddhist community).  I couldn't even have dreamt of those things while on high sertraline.

 

I long to get off the olanzapine but I feel almost PTSD type responses to how awful things got when I tried that in March even though I know now I did it far too fast and on top of the changes I'd made in sertraline.  Still, it is my objective to be off sertraline by spring 2022 and starting veeeeery slow taper of olanzapine probably no more than 2.5% per six weeks.

 

The method that's worked well for me with sertaline was to crush half a 50mg tablet each day, suspend it in water and quickly take my dose, disposing of remainder of fluid.  Then when I wanted to decrease dose by 10% I would suspend the tablet in 10%  more water but still take the same volume of suspension.  It made sense to my mathematically challenged brain anyway.  So I'm planning to do that with olanzapine too unless anyone has any warnings for me.

 

Thanks again for being here when my need of  you was so urgent.  As a side note, our GP advised a family member to reduce dose by going from 50mg sertraline to 25 mg alternate days.  Holds head in hands and determines not to seek any medical advice myself.

[BadMedicine]

Hi @SeekingMeaning. Really good news that you have stabilised and on a really low dose of sertraline. And great that you are noticing some of your old personality traits coming back now you are at lower doses.

 

With regards to the olanzapine. I tried to reduce too quickly initially and hit trouble. Insomnia, nausea, anxiety and anxiety eventually a return of some psychotic symptoms. I re- instated to 2.5mg and stabilised for 9 months. I have since been tapering at 5% of previous dose every 4 weeks. This has been relatively trouble free. I have not been completely free of withdrawal symptoms. I have some periods of elevated mood (I have never been bipolar so this is definitely a withdrawal symptom) and more recently some depression but sleep has remained good throughout. I am now at 1.875mg which is where I had problems before after dropping to this dose directly from 2.5mg. This time though I am stable, sleeping and absolutely no sign of any return of psychosis. In fact I feel better than I have done for years. What I am trying to say is that it is possible to reduce olanzapine comfortably. It just needs to be really slow. You will be able to do it when the time comes I am sure. 

Good luck with your continued sertraline tapering. I too was on sertraline and it was awful. I am so glad to be free of it. I’m sure you will get better and better the lower you go.

[SeekingMeaning]

Thank you @BadMedicine your words of reassurance and encouragement are very precious to me.  If my first drop of 2.5% olanzapine goes without hitch I might be bold enough to try the 5% you managed, balancing risk of symptoms with wanting to get off as fast as I can as usual.  

I noticed from your signature that you stopped Sertraline at 18.75mg?  I'm guessing that was because you have mirtazapine acting as a cushion?  Still trying to figure out how low to take my sertraline before stopping completely as it's that stop which is making me delay the olanzapine taper.

[BadMedicine]

I did stop sertraline at 18.75mg. I had to because I was an awful person on it. I also dropped the olanzapine from 5-2.5mg at the same time so I can’t differentiate which withdrawal symptoms were which. It wasn’t easy. I had an acute withdrawal reaction initially with crying, severe depression and suicidal thoughts. This did stop relatively quickly but I remained very flat for quite a long time although I didn’t have some of the severe symptoms that other people have. It was only when 3 months after dropping the sertraline and halving the olanzapine I tried to reduce olanzapine to 1.875mg I ran into trouble. The proverbial hit the fan with insomnia, nausea, anxiety and a labile  mood and eventually psychosis. I do think it was the cumulative effect of dropping the sertraline and significantly reducing olanzapine that led to the problem and I had to stabilise for 9 months. During this time once my sleep got better I felt OK most of the time but still had sporadic crying spells with depression and suicidal thoughts. They usually only lasted a couple of days and then I would be back to feeling OK for a week or two. The main problem I had was that sertraline had turned me into a very anxious and jealous person even of my sister who I have never been jealous of in my life. In fact I had always had a great relationship with her. It made it really difficult to talk to other people too. This has taken awhile to go and still hasn’t disappeared completely but is heaps better. My sister and her other half came to visit us recently and we had a fabulous time. Still some improvements needed in other parts of my life but it is so much better than when I was on high doses of the drug. 
 

As for when you can drop the sertraline I’m afraid I don’t have the answer for you. I just wanted to share my experience. Do you notice withdrawal symptoms when you make reductions? If not then you may be able to stop at a higher dose than recommended. I think on here they suggest going down to fractions of a mg. 

[SeekingMeaning]

On 10/31/2021 at 6:23 PM, BadMedicine said:

 

As for when you can drop the sertraline I’m afraid I don’t have the answer for you. I just wanted to share my experience. Do you notice withdrawal symptoms when you make reductions? If not then you may be able to stop at a higher dose than recommended. I think on here they suggest going down to fractions of a mg. 

I'm so glad you found improvements off the Sertraline too.  It's got such deep rooted invasive effects that I doubt the docs would ever believe in.  I was listening to music yesterday and suddenly remembered that I'd been triggered to panic attacks by music for the whole five years on Sertraline.

So my miniscule taper of two weeks ago is affecting me more than I expected.  Getting some insomnia,  quite bad senses of dread and anxiety that I wasn't having while stable prior to the taper.  Also a return of some suicidal ideation but only in the sense of intrusive thoughts rather than as a feeling of despair so they're quite easy to ignore.  But I'd been kind of hoping I'd be able to see no impact of dropping a small dose and look forward to getting free of it sooner rather than later.  Hey ho, it'll come in time.

[SeekingMeaning]

I'm looking for advice about going for major abdominal surgery this week.  I've told my surgeon and anaesthetist about my sensitivity and discontinuation syndrome but I had the impression neither had heard of it nor took it terribly seriously.  Maybe it's because I'm self-diagnosed as my GP has a terrible attitude to withdrawal and I don't discuss it with her in case I get my prescription stopped CT.

 

Anyway, I know for sure I will get premed, probably fentanyl, anaesthetic and then will be on pain meds and anti emetics for the day post surgery.  It's the antiemetics that worry me most as I know they can be pretty psychotropic.  Anyone with any experience of this got any advice?  I obviously want the drugs as I think the risk of sickness following abdo surgery is significant.  It's just whether I should request something or not to have anything specific.

[ChessieCat]

surgery-and-anesthesia

 

[Blossom71]

Hi @SeekingMeaning

 

Wishing you all the best for your surgery and healing x

[SeekingMeaning]

It's been a long while since I updated.  I had the surgery I mentioned in the last message.  It went well though I did end up in ICU due to problems intubating me.  That meant I had a longer break between my psych meds than I liked and between that and the opiate medicines I did feel quite unwell for a while.  However, things stabilised and ultimately in May I decided that I was feeling so grim ON the Sertraline I might as well try stopping it completely.  By then I had tapered to 0.8mg.  At first I was very troubled by the panicky cortisol spikes during the night but gradually as the months went by I spent more time asleep before being woken in a panic and as it stands I am usually asleep for around five hours before the panic hits.  It feels bearable at least and I'm much better at calming myself, putting on a podcast and going back to sleep.

 

But my mood is still grim.  I am unable to feel pleasure from anything and my ability to be creative has dropped to zero.  I'm just plodding on, focussing on doing the essentials but it feels a joyless existence.  I'm increasingly wondering (hoping even) that this level of anhedonia is due to Olanzapine affecting my dopamine pathways.  In many ways I'd hoped to have complete nights asleep without panics before messing with my Olanzapine dosage but I'm starting to feel I cannot tolerate the status quo drifting on for many more months before eventually starting a taper.  I've been checking around and as I've read I seem to have made up my mind to start the process of a slow taper perhaps Brass Monkey style.

 

Tonight I plan to crush my 2.5mg tablet, suspend in water and take it all, just to check that the method of ingestion is not responsible for side effects before I reduce.  Then I'll do 2.5% reduction per week for four weeks and two weeks hold as suggested though open to change if the insomnia becomes unbearable.  How lovely it would be if actually I find a gentle reduction schedule doesn't bring on side effects and I find release from the miserable joylessness I now experience.  Nothing like hoping for the best eh.  I am very scared though.  And as with the Sertraline taper, it's only because the present experience is so grim that making a change feels the lesser of two evils, staying the same feels non-viable.

[SeekingMeaning]

In January I was experiencing such awful depression and got a fixation in my head that the olanzapine was causing it by messing with my dopamine and oxytocin pathways.  Despite feeling so bad I decided to go ahead and start my olanzapine taper.  I used the water taper method to drop by 10%.  I have had some weeks with night time dread/terror causing insomnia and a lot of nausea.  This week I'm getting some nights where I sleep with just a couple of interruptions that I can drop back off from till about 5am so that feels an improvement.  The nausea is not so extreme either. 

 

Although I may be stabilising to the new dose I'm inclined not to drop again for a bit, partly because it's felt such a harrowing few weeks and partly because I need to be robust for some events in April and May and can't afford to be that sick again for those.  

 

It's in my mind that I could still be mainly experiencing effects of having stopped the Sertraline last May, it might not even be the olanzapine, who knows.  Just got to keep on doing the best I can with what I can bear.