alecost: slow taper

[alecost]

Hi all, first time writing on here. Im wondering why despite attempting a very slow taper, once a year ago and again recently i get hit at the third month with bad sxs and have to stop and hold despite basically cutting at 1% roughly a month. First two months seem to go fairly ok then both times on the third month all hell breaks lose again. Not sure its possible to go slower ? any help thanks so much 

Edited April 22, 2021 by Gridley

[Gridley]

Welcome to SA, alecost.

 

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.

 

Account Settings – Create or Edit a signature.

 

I've heard of others on the site who get hit with withdrawal symptoms around month 3 after a cut, so it's not uncommon.

Your system is obviously very sensitive to these drugs. 

 

Are you tapering at 1% of current dose or your original dose?  We recommend tapering by a percentage of your current dose.  1% per month is a slow taper but you might need to go even more slowly.  You're wise to hold when hit with these symptoms.  Do the symptoms eventually fade?

 

Here is a link about mice-tapering, which is the gentlest method of tapering.

 

Micro-taper instead of 10% or 5% decreases

 

So that you have a better idea of what you're experiencing here is some information on withdrawal and the healing process.

 

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 are 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.

Edited April 22, 2021 by Gridley

[alecost]

Thanks for the reply. I’ve just done the signature so you have an idea. 

Yes I was reducing at 1% of current dose 0.3mg, very slow and ok for first two months then severe symptoms reoccur at 3/12 mark, then symptoms do fade after about 4 weeks. But I’ve held at this point because its intolerable so I am fearful to drop again. 
Also I cannot change brand or the same happens. 

[Gridley]

1 hour ago, alecost said:

Thanks for the reply. I’ve just done the signature so you have an idea. 

Yes I was reducing at 1% of current dose 0.3mg, very slow and ok for first two months then severe symptoms reoccur at 3/12 mark, then symptoms do fade after about 4 weeks. But I’ve held at this point because its intolerable so I am fearful to drop again. 
Also I cannot change brand or the same happens. 

Yes, you are obviously very sensitive to the Sertraline.  You're doing the right thing, holding when necessary and going very slowly.

 

I have one suggestion that might help, at least a little.   When you say you are weighing and dry cutting, are you crushing the tablet into a powder?  If not, you might want to do this (I do it between two spoons).  There's no way to tell how well the manufacturer distributes the active ingredient in the pill.  If you crush the pill and stir the powder with a toothpick, that will ensure that the active ingredient is well distributed and that your doses are consistent.  I use a size 0 or 00 gelatin capsule for my powder.

[alecost]

Thanks so much I will start doing that. I can’t believe that May brain can’t cope with a 1% drop it’s crazy, would that be because of damaged my CNS on the gp’s advice to drop the dose to half ?

[alecost]

I just discovered my scales are malfunctioning & may explain the worsening symptoms I’ve been getting the last few weeks. I didn’t realise they were so ‘off’ till I weighed a tablet multiple times and got different readings (.110, .125, .150, .105). I usually just weigh it once and take it so I’ve probably been taking a variety of doses in recent weeks. 
Is there anything I can do to make this approach more reliable? Two sets of scales?? Anyone else had to deal with this? 

[getofflex]

Previous post moved to your intro to keep you history all in one place.  Please post all questions and discussion of your situation in this one thread, so the moderators can get the full story and know how to best advise.  Thank you.  

 

I'm thinking maybe your system could still be very fragile from getting off the Valium cold turkey back in 2019.  It looks like you have been doing your Sertraline taper extremely carefully and slowly, so I'm sorry you are still having trouble.  There is a way you can do a liquid, and this would allow for precise dosing and very small decreases using a syringe.  Here is the link for more info on how to taper sertraline. 

 

Tips for Tapering Sertraline

 

The other option would be to get a new scale.  

 

 

 

[alecost]

Thank you so much for replying. Can you recommend a reliable scale?

[getofflex]

Altostrata, the owner of this site, recommends the following:  

 

Gemini 20 scale

 

This thread may contain some other scale recommendations, and has lots of useful info: 

 

Using a Digital Scale to Measure Doses

Edited April 27, 2021 by getofflex

[alecost]

Hi can someone please help. I don’t think I can take these symptoms much longer it just goes on and on. 

I have been fine for over 12mths stable holding at the dose after an initial rocky attempt at tapering. Started tapering again in jan 21 very very slowly (0.3mg a month) but the past month the full WD symptoms are back. I increased dose by 0.3mg the past 4 days not really improved any, should I increase again? Coming up to a month now since decreased dose. 

[getofflex]

48 minutes ago, alecost said:

I increased dose by 0.3mg the past 4 days not really improved any, should I increase again? Coming up to a month now since decreased dose. 

Can you please update your drug sig with your recent changes to your drugs?  Please list each date with the amount of the drug you are taking, not the amount of the drug change.  That way we can give you the proper advice for tapering.  Thank you.  

Account Settings – Create or Edit a signature.

 

Can you please briefly describe your symptoms?  

 

I do not suggest that you change your dose again, after having just increased it by 0.3.  Since I don't know what your actual dose is, only the amount you increased it by, it's hard for me to see what percent you have tapered.  

 

At any rate, it takes 7 days on average for a person to feel the effects of a dose change.  Please give it at least 7 days, and then see how you feel.  We will take it from there.  

 

Here is a link with information about reinstatement:  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

In the meantime, there are many non drug coping techniques that can really help. 

 

Non Drug. Coping Techniques

 

 

 

 

 

[alecost]

Thank you, I’m taking 35mg sertraline. I’ve been taking that same dose for over 12mths. I started tapering 3mths ago by 0.3mg per month. 
Ok for first 2 months, third month all hell broke lose again as per 2 years ago. Symptoms- dizziness, vertigo, very low mood, akathisia, bloating, anxiety, sadness, burning skin, derealisation, depersonalisation. 
 

 

[getofflex]

Great, thanks.  Can you please put it in your drug signature via the link I gave you above?  Please list each and every time you made a dose change.  For example:  

Sertraline   April 15 35 mg. May 15 34.7. June 15 34.4.  

[alecost]

Updated signature 

[getofflex]

Thank you, this helps a lot. Was it early, middle or late in the months when you reduced?  Can you please add that to the drug sig?   Can you please add also where you increased the dose by 0.3 mg 4 days ago?  I assume right now you are on 34.8 mg?  Let us know in about 3-4 days if you feel any changes in your symptoms for better or worse.  

 

Symptoms sound like withdrawal.  Have you checked out any of the non drug coping techniques?  

 

Non Drug Coping Skills

 

Akathisia, Restlessness, Anxiety

 

Derealization/Depersonalization

 

Audio:  First Aid for Panic (4 minutes)
 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy
 

Audio:  How to Recover from Anxiety - Dr Claire Weekes
 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

Edited April 29, 2021 by getofflex

[alecost]

Still same a week after updosing. I always take dose at night and pattern seems to be I get hit first thing in morning by a huge wave, comes on very fast- DR DP dizziness vertigo, extreme fear, burning skin, very black mood & suicidal thoughts, air hunger, nausea and diarrhoea. Then after about 1 - 2 hours it starts to ease and become bearable and I can ‘function’ to care for my children. Then the same happens again mid afternoon.  It’s not possible to function at all during those times.

Not had this for over a year I was sailing along ok at my held dose and can’t believe just from decreasing 1% per month the last 3 months. Only other thought is I now know the scales have been malfunctioning and have been giving wrong readings for I don’t know how long and this has destabilised me.
I now have new scales this past week. Any help to get things stable again? 

[alecost]

Can anyone help. I increased my dose as per signature but not improvement after 10 days in fact seems to be worsening. Not in an adverse reaction just wd symptoms. Very difficult to look after my children like this. 
should I increase another 0.3mg as that’s the lowest my scales will allow??

 

[getofflex]

Hello, I'm sorry to hear that you are feeling worse.  Here is a quote from our founder and owner of this forum altostrata: 

 

"When to discontinue reinstatement

• If, upon reinstatement, you very soon feel significantly worse, most likely you are sensitized to the drug and need to take a smaller dosage or, possibly, none at all. You will need to track your daily symptom pattern to see if it's the drug causing your symptoms. If so, they generally will be worse shortly after you take the drug.
• Sometimes reinstatement does not work. The nervous system has taken such a hard hit from withdrawal, it's destabilized beyond whatever effect the drug might have had.
• You get an adverse reaction from the drug. Look up your drug at drugs.com to identify known adverse reactions. A rash is always a bad sign. Sometimes an adverse reaction can be eliminated by taking a lower dosage. Do not mistake an adverse reaction for your existing withdrawal symptoms!"

Think carefully about this. 

 

1) How long after the reinstatement did you start to feel worse? 

 

2) On a scale of 1 - 10, how bad are your symptoms overall?  

 

It sounds like, from reading your previous posts, that your WD symptoms tend to be pretty delayed after you make any changes in your dose.  So that, combined with the fact that you are very sensitive to any changes in your drugs, means it would be prudent for you to go extremely slowly and carefully with this.   Your symptoms now could very well be from the 4 changes in drug doses that you made since January 1.  It doesn't sound like the reinstatement has helped, so I would not do another reinstatement if I were you.  

On 5/3/2021 at 3:10 AM, alecost said:

Still same a week after updosing.

The above indicates to me that your symptoms are not from the reinstatement, but probably a wave from the cumulative effect of the drug changes you made over the first 4 months of this year.  

 

If it were me, I would stay on the current dose, and use non drug coping techniques.  Unfortunately, there is often no quick and easy fix for this situation.  In our modern culture we've been mistakenly lead to believe that there is a pill to fix our problems, but often this isn't so.  I've seen too many people here make changes to their drug dosages to fix their WD, and it ends up just getting worse.  Please refer to my post on Thursday with links to info about reinstatement and non drug coping techniques.  In my personal opinion, and that of many other mods here, the best healer is time, and patience.  

[alecost]

I decided to clean up my diet and stopped all aspartame cold turkey (I drink quite a few diet sodas a day). This has increased symptoms a lot the last week, assume this will settle down ?? 

[alecost]

Hi looking for some advice. I decided to updose (0.3mg) on my sertraline which instantly improved my wd symptoms, physically and mentally for the first 4 days, felt much better than I have in a long time. Then day 5 onwards I’ve had huge increase in symptoms akathesia, nausea, lower mood confusion etc, which is worse than previous wd symptoms. I know I’ll be at steady state dose now, but am I best continuing on or reverting back to the previously dose being it only 5 days on. Thanks 

[getofflex]

3 hours ago, alecost said:

but am I best continuing on or reverting back to the previously dose being it only 5 days on. Thanks 

I would revert back to the previous dose if it were me.  Please put recent drug changes in your signature.  

[alecost]

Thank you so much for replying. I’ve updated signature.
I had a great improvement for 4 days after the increase but now at days 5/6 feeling a lot of negative symptoms as mentioned. I will go back to previous dose if that’s what you’d recommend. 

[getofflex]

That is what I would do if it were me.  Thanks for updating signature.  Once you revert to your previous dose, I would stay at that for a while, until I stabilized. 

[alecost]

Can someone help, I completely forget to take my dose 4 days ago, usually take around 8pm, I took the late dose at 6pm the next day then my usual dose a few hours later (this was probably wrong as I had almost double dose that evening.) Took usually dose the next two days no problems but today feel awful with strange symptoms (I've been holding for over 12mths and been fine). 
Is with withdrawl symptoms from the high dose or missed dose or what?? 

[manymoretodays]

Here you are @alecostback on your Introduction.  Best place to post your concerns around your tapering.

 

It's not unusual that you might feel some bumps after a missed dose and then altered timing of doses.

I expect your strange symptoms should pass as you keep your dosing regular now.  Same dose.  Same time of day.

Not to worry.

Tips to remember to take your dose-reminder ideas

 

Updates on your taper or non-taper to report?  I do see it has been a year since you've posted here.  And last here you were increasing doses to try to get symptoms under control.  We'd love to know.

 

Best.  L, P, H, and G,

mmt