Cage190: My cold turkey history

[Cage190]

By February 2017, after suffering an a intensive mobbing at my first year of university, I was suffering an a clinical picture of being unable to get concentrate and having headaches all the day. My doctor diagnosed me depression and prescribed me Zoloft. I took it about 45 days, 50 mg, and then I stopped abruptly due to an a side effect that I didn't like (I don't remember which one, it was something completely banal). I've to say that I experienced an a improvement, the headaches disappeared, my brain began to work fluenty, being able to concentrate and read perfectly. After 45 days, I stopped "cold turkey". That's when the catastrophe appeared. 

 

I've been really bad for about this 4 years, suffering an a extreme clinical picture - that I was not suffering from before taking the drug, only after the interruption, and achieved his peak after a month, maybe two from interruption - of cognitive deficits (to the point of not being able to read or speak correctly), akathisia, suicidal thoughts, anger episodes etc. I've been avoiding any kind of psychiatric drug, cause I thought I was still suffering from the withdrawal. I visited different doctors that tried to prescribe me an anticonvulsive (not being able to remember name) an a antipsychotic (Abilify). Refused both medications. In the middle (3rd year), I started mindfulness to try to heal my brain, and partially succeded. My suicidal thoughts disappeared after one month of mindfulness, my brain partially improved with more wellness and better functional performance. Despite that, I didn't notice an a better improvement superior to 15% about the cognitive deficits issue. After this 4 years, I've been unable to continue my studies (I was at university, I was 20 years old by then). The last year, I visited a psychiatrist who told me that clearly my problem was the cold turkey interruption (first time aware the problem was the cold turkey, I was thinking that I was still suffering from withdrawal symptoms). I used to play the piano, and it was though that my brain was not unable to send correctly the orders to my fingers, and I was failing to play correctly. 

For about 6 months, I was wondering that he was correct, that probably my problem was the cold turkey interruption. Thus, we started zoloft again three months ago, I started 6.25 and then increased after 15 days to 12.5 mg. Now I've been two months on 12.5 mg. I've been feeling an a improvement with my cognitive deficits (the problem with the piano has evolved to moderate to mild) an a improvement related with anger but akathisia and brain impairment still persists. I've come here to ask for follow up and advice. My aim is the following: in one month increase the dosage to 18.75 mg for three months, and then, increase to 25 mg again, and remain there for about 6 months, hoping to get healed and cure my brain from this clinical picture. And then, reducing following the 10% rule. I'm not considering getting into 50 mg. For me, 50 mg was too much, making me feel extremely well, extremely smart and focused, extremely creative, extremely capable, extremely everything, and I felt it was unreal and a hazard. And I don't want to feel the same anymore putting my brain in such a dose. 

 

I hope your veteran's wisdom and council are going to help me. 

Edited April 14, 2022 by Karma
Name update

[DataGuy]

Hi Cage190,

 

Welcome to SA. Sorry to hear about what happened to you. Generally reinstating the drug will only reduce or stabilize symptoms, and will not heal your brain. I'm glad the reinstatement has worked to help with symptoms. If I were you, I would be cautious in increasing the drug. Listen to your symptoms and don't just follow a plan of arbitrary increases. Just as tapers should be symptom-based, so should reinstatements. If you increase the dose again and it makes you feel worse, that is a sign to return to the lower dose and simply hold there. Once you feel your symptoms are stable enough, you can start a very slow taper. 

 

We'd recommend tapering by 10% to start (once you've stabilized), slowing if symptoms increase, which you can read about here. Tapering slowly helps minimize both symptoms and symptom severity, ensuring you can remain functional while you get off the drug. Reducing more quickly than 10% can be too fast for many people, and as you get to lower doses you may want to slow the reduction even further, since receptor occupancy of these drugs tends to decrease more rapidly at lower doses. Here are some tips on tapering zoloft (sertraline) specifically.

 

Is zoloft the only drug you are taking? Are you taking any supplements? Some other drugs can interfere with metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

In the meantime, you might find some of these non drug coping techniques helpful to ease your symptoms. Hope you start feeling better soon : )

[Cage190]

On 7/3/2021 at 6:23 AM, DataGuy said:

Hi @Cage190,

 

Welcome to SA. Sorry to hear about what happened to you. Generally reinstating the drug will only reduce or stabilize symptoms, and will not heal your brain. I'm glad the reinstatement has worked to help with symptoms. If I were you, I would be cautious in increasing the drug. Listen to your symptoms and don't just follow a plan of arbitrary increases. Just as tapers should be symptom-based, so should reinstatements. If you increase the dose again and it makes you feel worse, that is a sign to return to the lower dose and simply hold there. Once you feel your symptoms are stable enough, you can start a very slow taper. 

 

We'd recommend tapering by 10% to start (once you've stabilized), slowing if symptoms increase, which you can read about here. Tapering slowly helps minimize both symptoms and symptom severity, ensuring you can remain functional while you get off the drug. Reducing more quickly than 10% can be too fast for many people, and as you get to lower doses you may want to slow the reduction even further, since receptor occupancy of these drugs tends to decrease more rapidly at lower doses. Here are some tips on tapering zoloft (sertraline) specifically.

 

Is zoloft the only drug you are taking? Are you taking any supplements? Some other drugs can interfere with metabolism and can also have psychotropic effects (antibiotics, steroids, some supplements, coffee, nicotine etc.). It would be very helpful if you could create a drug history in your signature like this one. This link will take you directly to the signature. Signatures generally look like this: 

 

Example:

2001–2002 paroxetine 
2003  citalopram 
2004  paroxetine
2008  paroxetine slow taper down to 2016 Aug off paroxetine
2016  citalopram May 20mg  Oct slow taper down
2018  citalopram 13 Feb 4.6mg 15 Mar 4.4mg 29 Apr 4.2mg

 

This will allow any moderator or member to quickly see your history and where you are in your taper, and thus be able to help more easily without too much reading (most people here are volunteers and have other jobs).

 

In the meantime, you might find some of these non drug coping techniques helpful to ease your symptoms. Hope you start feeling better soon : )

 

Thank for your fast reply. What do you mean when you say that I'm not going to heal my brain? That all this symptoms triggered by the cold turkey are never going to disappear? Even if I reinstate the drug? That's so descouraging. I expect that this horrible clinical picture is going to disappear with the restitution of the drug. I didn't have any of this symptoms before interrupting the drug, even when I was taking the drug.

 

Several weeks ago I read Peter's Breggin Withdrawal Guide, and I read the 10% reduction plan. I was going to do it following that rule. 

 

I'm not taking any other drug, or medicine. 

 

1000 thanks for your help.  

 

 

 

[Altostrata]

Welcome, @Cage190

 

On 7/2/2021 at 2:57 PM, DavidPT said:

I started 6.25 and then increased after 15 days to 12.5 mg. Now I've been two months on 12.5 mg. I've been feeling an a improvement with my cognitive deficits (the problem with the piano has evolved to moderate to mild) an a improvement related with anger but akathisia and brain impairment still persists.

 

This is a good sign, that this low dosage helped. Your nervous system will work on healing and this small amount of drug will be a crutch for it. It might be best for you to NOT increase the drug, don't get too aggressive at this point, give your nervous system time to get accustomed to the drug. More is not necessarily better.

 

Please let us know how you're doing.

 

What are your symptoms of akathisia? Do they worsen at any particular times of day? What time of day do you take Zoloft? Are you taking any other drugs?

 

It's a rare psychiatrist who recognizes protracted withdrawal syndrome, congratulations for finding one.

[Cage190]

On 7/3/2021 at 6:34 PM, Altostrata said:

Welcome, @Cage190

 

 

This is a good sign, that this low dosage helped. Your nervous system will work on healing and this small amount of drug will be a crutch for it. It might be best for you to NOT increase the drug, don't get too aggressive at this point, give your nervous system time to get accustomed to the drug. More is not necessarily better.

 

Please let us know how you're doing.

 

What are your symptoms of akathisia? Do they worsen at any particular times of day? What time of day do you take Zoloft? Are you taking any other drugs?

 

It's a rare psychiatrist who recognizes protracted withdrawal syndrome, congratulations for finding one.

 

Thank you for your interest, Altostrata. I have akathisia all the day, from 0:00 AM to 12:00 PM, always the same intensity. I feel the urge to walk and walk through my apartment. I take Zoloft when I wake up, before breakfast. I'm not taking any other drugs, the only thing I'm doing is meditation (2-3 hours per day), yoga and physical exercise. 

 

I have been only two months, but the improvement has been minimal. I was planning to get into 18.75 mg, but if both of you coincide on staying at 12.5 mg, I'm going to follow your advice. But.. why I cannot increase the dose? Which are the risks? Worse withdrawal? Possible brain damage?

 

Anyway, I'm extremely thankful for your help. Greetings from Spain

[Altostrata]

Taking too much sertraline can trigger a kindling reaction, which will be a large setback for you.

 

How do you feel before and after you take Zoloft?

 

Two months reinstatement is not very long. It may take many more months, not weeks, for your nervous system to very, very gradually settle down. Withdrawal syndrome is not a trivial upset.

 

Many people find fish oil and magnesium supplements helpful, see

 

https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

You might try a little bit of one at a time to see how it affects you.

[Cage190]

Before taking Zoloft: feeling really agitated mentally, seeing the world in kind of dystopic way, moderate cognitive deficits. And anger, feeling really angry easily. 

 

After taking Zoloft again: I've been feeling more human. It's like the feeling of getting back to the reality before mobbing/depression. Feeling more hope, more wellness. Better cognitive performance. More mental strenght. 

 

I still suffer from cognitive deficits, maybe less, but still suffering from them. Still have akathisia, anger persists, and still suffering from intrusive thoughts like almost before. 

 

I have to say that meditation has helped me a lot (from the psychologic sight) along with yoga. I've been feeling a lot of improvement, in fact, if one day I forget meditation, I feel so uncomfortable that I suffer headaches, start being agitated, and nervous. Mindfulness helps me in a way that anything can replace. Without that, I believe I would be dead. They brought me hope when anything was able to give me relief. 

 

Sorry for my ignorance, but.. what exactly is a kindling reaction? I've searched the meaning but I don't understand it at all. It's an a worsening of the withdrawal syndrome when you try to come off the drug? Or a crazy feeling to start burning things?

 

I'm going to try these supplements, thanks for the reference. 

 

For this moment I'm going to stay with 12.5 mg for about 12 months. I believenthat this seems the correct treatment. 

 

Another question: it's obvious that antidepressants cause brain damage, as Gotzsche has dennounced along with another physicians. It's the same brain damage if you take for example 12.5 mg for 12 months instead of 25 mg for 6 months? Your brain suffers the same? 

 

Thanks Altostratanfor your follow-up, really thankful 

 

 

 

 

 

[Greatful]

@Cage190 I am sorry you are going through this. You have done a great job dealing with this for so long.  You are a very strong man.  It is really tuff to have some many things going through your mind on what went wrong and how do I fix it.  I have no answers for you. I am also struggling to understand my situation and get better.  It is sad to say there are so many of us that are affected by these drugs.  The brain adapts to make changes as quick as a month on them.

 Remember you are not alone.. Look around the site on Introductions and see if you can find some members in similar situations.  Corresponding with other members is very helpful.

 

Post as much as you need for support, questions, or just plain venting.  We all need support and encouragement.

 

If you want to talk to someone specific you hit the @ key and then start to type their name and them click on their name and it will highlight and turn blue like yours did.  This is tagging them and they will get notified of a tag.

Hang in there

[DataGuy]

@Cage190, this may help explain kindling for you. After withdrawal the nervous system can be hypersensitive to drugs, even the drug you came off of. Although you tolerated the drug well enough at higher dosages before, that may no longer be the case. Thus, you have to be very careful increasing the drug, as it can result in an adverse reaction, which is the setback that Altostrata was talking about. 

 

When I said the zoloft will not heal your brain, I only meant that the injury caused by the withdrawal reaction will not go away from taking the drug. However, it can help to stabilize your symptoms, allow you to feel better, then allow you to slowly taper off the drug once you feel more stable. But this will (hopefully) be many months down the road. In the meantime, it might be good to learn what you can from other SA members. Here is a list of important topics (including information on kindling, adverse drug reactions and hypersensitivity) if you feel like doing some reading.

 

Here is some information on updosing and reinstating. Generally you want to aim for stability. Since the dose you took made you more stable, that is great! A further increase may help stabilize you more, but it could also destabilize things and make you worse. Since you were off the drug for so long, you are pretty lucky that reinstating was successful for you. Trying to increase the dose would probably be pushing your luck, but you are welcome to read the resources and then decide what you think is best. Hope your symptoms continue to improve, David. 

 

I don't think much is known about brain damage. It seems like the greatest risk for injury is due to rapid withdrawal, which can cause brain injury-like symptoms, or toxicity events, such as overdose, serotonin syndrome, or adverse reactions, which can be a type of toxic event (for example, sexual dysfunction, which can end up being a long term problem for people, even after they stop the drug). All in all it is best to use only the lowest dose needed, since higher doses seem to be associated with more problems, and you have enough problems to deal with at the moment. 

[Cage190]

On 7/5/2021 at 6:06 PM, DataGuy said:

@Cage190, this may help explain kindling for you. After withdrawal the nervous system can be hypersensitive to drugs, even the drug you came off of. Although you tolerated the drug well enough at higher dosages before, that may no longer be the case. Thus, you have to be very careful increasing the drug, as it can result in an adverse reaction, which is the setback that Altostrata was talking about. 

 

When I said the zoloft will not heal your brain, I only meant that the injury caused by the withdrawal reaction will not go away from taking the drug. However, it can help to stabilize your symptoms, allow you to feel better, then allow you to slowly taper off the drug once you feel more stable. But this will (hopefully) be many months down the road. In the meantime, it might be good to learn what you can from other SA members. Here is a list of important topics (including information on kindling, adverse drug reactions and hypersensitivity) if you feel like doing some reading.

 

Here is some information on updosing and reinstating. Generally you want to aim for stability. Since the dose you took made you more stable, that is great! A further increase may help stabilize you more, but it could also destabilize things and make you worse. Since you were off the drug for so long, you are pretty lucky that reinstating was successful for you. Trying to increase the dose would probably be pushing your luck, but you are welcome to read the resources and then decide what you think is best. Hope your symptoms continue to improve, David. 

 

I don't think much is known about brain damage. It seems like the greatest risk for injury is due to rapid withdrawal, which can cause brain injury-like symptoms, or toxicity events, such as overdose, serotonin syndrome, or adverse reactions, which can be a type of toxic event (for example, sexual dysfunction, which can end up being a long term problem for people, even after they stop the drug). All in all it is best to use only the lowest dose needed, since higher doses seem to be associated with more problems, and you have enough problems to deal with at the moment. 

 

@Altostrata @DataGuy Okay thank you, now I understand. I suffered kindling for aproximately a week 10 days after increasing to 12.5 mg, and then disappeared, following an a strong improvement the next week. I haven't had suffered any class of kindling anymore in 40 days. 

 

I hope that my symptoms (akathisia, cognitive deficits, anger and so one) are going to vanish with the reinstantment. I really desire getting back to the old David. In this 2 months, I've been feeling an a improvement, but I've to keep in mind that I've been 50 months (4 ******* years) suffering this cold turkey withdrawal clinical picture. 

 

By now, I'm going to stay more months with 12.5 mg. 

[Altostrata]

Very gradual improvement is what we expect. It's never fast enough!

[Cage190]

On 7/5/2021 at 1:50 AM, Altostrata said:

Taking too much sertraline can trigger a kindling reaction, which will be a large setback for you.

 

How do you feel before and after you take Zoloft?

 

Two months reinstatement is not very long. It may take many more months, not weeks, for your nervous system to very, very gradually settle down. Withdrawal syndrome is not a trivial upset.

 

Many people find fish oil and magnesium supplements helpful, see

 

https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

You might try a little bit of one at a time to see how it affects you.

 

How long is going to take (in terms of months) to begin to feel notable improvements? 9? Maybe 12? 18? 

 

By the end of this one, (the third) I've been feeling an a moderate improvement, but I'm still suffering from many of the symptoms (akathisia, cognitive deficits) like almost the beggining. What I should do? Stay at 12.5 mg and wait to the 9th month and if I don't have improved the desirable, increase dosage to 18.75 mg? 

 

The improvement has take place, but I'm still suffering from cognitive deficits, akathisia and so on. Anger has improved, mental stability too, but I'm still suffering. Any ideas? Anyway, thanks

[Altostrata]

On 7/21/2021 at 11:13 AM, DavidPT said:

How do you feel before and after you take Zoloft?

 

Please read questions from the staff carefully and answer completely.

[Cage190]

11 hours ago, Altostrata said:

 

Please read questions from the staff carefully and answer completely.

 

Ouch. Sorry

[Altostrata]

So how do you feel before and after you take Zoloft? (3rd request)

[Cage190]

@Altostrata 

 

On 7/5/2021 at 3:46 AM, Cage190 said:

Before taking Zoloft: feeling really agitated mentally, seeing the world in kind of dystopic way, moderate cognitive deficits. And anger, feeling really angry easily. 

 

After taking Zoloft again: I've been feeling more human. It's like the feeling of getting back to the reality before mobbing/depression. Feeling more hope, more wellness. Better cognitive performance. More mental strenght. 

 

I still suffer from cognitive deficits, maybe less, but still suffering from them. Still have akathisia, anger persists, and still suffering from intrusive thoughts like almost before. 

 

I have to say that meditation has helped me a lot (from the psychologic sight) along with yoga. I've been feeling a lot of improvement, in fact, if one day I forget meditation, I feel so uncomfortable that I suffer headaches, start being agitated, and nervous. Mindfulness helps me in a way that anything can replace. Without that, I believe I would be dead. They brought me hope when anything was able to give me relief. 

 

Sorry for my ignorance, but.. what exactly is a kindling reaction? I've searched the meaning but I don't understand it at all. It's an a worsening of the withdrawal syndrome when you try to come off the drug? Or a crazy feeling to start burning things?

 

I'm going to try these supplements, thanks for the reference. 

 

For this moment I'm going to stay with 12.5 mg for about 12 months. I believenthat this seems the correct treatment. 

 

Another question: it's obvious that antidepressants cause brain damage, as Gotzsche has dennounced along with another physicians. It's the same brain damage if you take for example 12.5 mg for 12 months instead of 25 mg for 6 months? Your brain suffers the same? 

 

Thanks Altostratanfor your follow-up, really thankful 

 

 

 

 

 

 

[Altostrata]

I meant "how do you feel before and after taking Zoloft each day lately?"

[Cage190]

On 7/24/2021 at 1:55 AM, Altostrata said:

I meant "how do you feel before and after taking Zoloft each day lately?"

 

I have been feeling an a improvement, moderate the best days to mild/non existent the worse ones. 

It really depends of the amount of hours of mindfulness/yoga that I practice. If I practice more hours this two practices, the improvement that follows is stronger. Since I began taking the pill (12.5 mg) 2 months and 3 weeks ago, the improvement has been patent, but not as good as I wanted. There are some symptoms that have not improved like akathisia. And that makes me think about increasing the dose. 

 

I sincerely believe that it's not necessary to increase the dose to 18.75 mg or 25 mg. First of all, for the possible side effects: kindling reactions, more brain damage etc and because I prefer being patient and wait more time as you advised me, @Altostrata rather than chasing an a faster relief. 

 

For example: I prefer an a improvement of the 40% following a treatment of 12.5 mg for 18 months, rather than taking 25 mg for 9 months. 

 

By now, I'm going to stay at least 9/12 months at this dose, or even 18 if its necessary. Thanks for your follow-up, Altostrata

[Altostrata]

A slight or moderate improvement is a good sign. We do not expect instant results. Please let us know how you're doing.

[Cage190]

@Go2zero 

 

Now I've been 4 months, experiencing certain relief, but still suffering. How many receptors are blocked with 12.5 mg (the minimum therapeutic dosage of Zoloft is 50 mg)?

[Go2zero]

 

As you can see in this chart, the SERT with 12,5mg is around 48%. It is not exact, since everybody reacts different on these meds. And the speed of metabolism also counts. But it is a very good average.

 

 

% of 1 pill(20 mg)	Dosage in mg Zoloft/sertraline	% blockage serotonin receptor (SERT)
100	50	78
50	25	72
25	12,5	62
12,5	6,3	48
10	5	44
7,5	3,75	37
5	2,5	29
4	2	25
3	1,5	20
2	1	14,5
1,5	0,75	11
1	0,5	8
0,5	0,25	4
0,25	0,12	2
0,1	0,05	0,9
0,05	0,03	0,5

 

 

 

 

[Cage190]

11 minutes ago, Go2zero said:

 

 

As you can see in this chart, the SERT with 12,5mg is around 48%. It is not exact, since everybody reacts different on these meds. And the speed of metabolism also counts. But it is a very good average.

 

 

 

% of 1 pill(20 mg)	Dosage in mg Zoloft/sertraline	% blockage serotonin receptor (SERT)
100	50	78
50	25	72
25	12,5	62
12,5	6,3	48
10	5	44
7,5	3,75	37
5	2,5	29
4	2	25
3	1,5	20
2	1	14,5
1,5	0,75	11
1	0,5	8
0,5	0,25	4
0,25	0,12	2
0,1	0,05	0,9
0,05	0,03	0,5

 

 

 

 

So If you were me, you would stay at 12.5 mg? 

 

Thanks for this godsend table

@Go2zero

[DataGuy]

@Cage190 I would stay on that dose until you feel you are as stable as you are going to get. Then if you want you can start a very slow taper. What are your current symptoms? How do they compare to your initial symptoms before you reinstated?

[Cage190]

On 7/5/2021 at 3:46 AM, Cage190 said:

Before taking Zoloft: feeling really agitated mentally, seeing the world in kind of dystopic way, moderate cognitive deficits. And anger, feeling really angry easily. 

 

After taking Zoloft again: I've been feeling more human. It's like the feeling of getting back to the reality before mobbing/depression. Feeling more hope, more wellness. Better cognitive performance. More mental strenght. 

 

I still suffer from cognitive deficits, maybe less, but still suffering from them. Still have akathisia, anger persists, and still suffering from intrusive thoughts like almost before. 

 

I have to say that meditation has helped me a lot (from the psychologic sight) along with yoga. I've been feeling a lot of improvement, in fact, if one day I forget meditation, I feel so uncomfortable that I suffer headaches, start being agitated, and nervous. Mindfulness helps me in a way that anything can replace. Without that, I believe I would be dead. They brought me hope when anything was able to give me relief. 

 

Sorry for my ignorance, but.. what exactly is a kindling reaction? I've searched the meaning but I don't understand it at all. It's an a worsening of the withdrawal syndrome when you try to come off the drug? Or a crazy feeling to start burning things?

 

I'm going to try these supplements, thanks for the reference. 

 

For this moment I'm going to stay with 12.5 mg for about 12 months. I believenthat this seems the correct treatment. 

 

Another question: it's obvious that antidepressants cause brain damage, as Gotzsche has dennounced along with another physicians. It's the same brain damage if you take for example 12.5 mg for 12 months instead of 25 mg for 6 months? Your brain suffers the same? 

 

Thanks Altostratanfor your follow-up, really thankful 

 

 

 

 

 

 

Everyday I'm getting better, but the differences are a copy paste of this post. I'm kind of the same point, but I feel less everything. Less anger, less akathisia, less cognitive deficits. I'm getting better every week/day, in a very, very gradual way. Despite that, sometimes I do not notice any difference.

 

I repeat myself that I've only been 4 months on 12.5 mg. We can consider that an a short interval right?

 

I believe that doing cold turkey I injured myself heavily. When I thought about this mistake, I began to believe that reinstantment was going to heal my brain completely in a year, perhaps two. I was not aware of possible kindlings, or that I was incorrect. 

 

I've been thinking a lot about your argument, the one that you said that the injury was not going to disappear after reinstantment. From which evidencies do you hold this statement? Why? Your experiences in the past? Why reinstantment can reduce symptoms but not erase them in a, let's say, 90%? Which are your ultimate arguments?

 

I'm not doubting about your knowledge level, @DataGuy. It's just that I need to know why, exactly. 

 

Thank you for you check-in, @DataGuy. 

[DataGuy]

Hi @Cage190,

 

Yes, 4 months is a short period. You are doing great if you are improving every day. It is also normal to have periods where you don't notice improvement or feel worse. Some people go weeks or months without noticing much improvement. It is the general pattern of gradual improvement that matters. 

 

Given the benefits you've experienced, I would not increase the dose. In fact, there is likely no need to ever increase the dose if you are currently stable after 4 months on 12.5mg.  

 

This is just a hypothesis, but likely there are a couple components to PAWS (post-acute withdrawal syndromes). One part would be that the brain needs to adapt back from the receptor changes caused by taking the medication. In the case of sertraline, 5-HT receptors would need to upregulate. 

 

The other component of a withdrawal syndrome likely results from damage or toxicity from overly rapid withdrawal. This can happen with benzodiazepine withdrawal, which can result in seizures and/or death. In rapid withdrawal from antidepressants, some people will experience extreme symptoms like brain zaps, akathisia, even seizures, as well as many other symptoms that are typical of someone who has suffered a brain injury, such as light and sound sensitivity, impaired cognitive function, sleep problems, depression, aggression, anxiety, vision problems, headaches, lack of impulse control etc as seen in the diagram below:

 

 

I think it is reasonable to hypothesize that the rapid withdrawal has caused some damage via a shock to the nervous system, which then gets stuck in a hyperaroused state because it cannot adapt quickly to life without the drug. What the exact cause of the damage is would likely depend on the drug. Damage also may occur from taking the drug, such as if you experience serotonin toxicity (serotonin syndrome), or develop akathisia or a movement disorder. But in your case it was likely the rapid withdrawal. I'm not a neuroscientist, so I can't explain how the injury occurs, but I do know that hyperexcitability of the nervous system is associated with injury and excitotoxicity. So it could be that the nervous system becomes dysfunctional and loses control, and the state of excess excitability results in damage and death of neurons.

 

This could explain why the withdrawal syndrome can last so long in some people (years in some cases, as documented in this study and others like it). You can still recover, it just takes a long time, with only slow improvement expected, since your body can only produce a relatively small number of neurons per day via neurogenesis. There is an academic debate about the possibility and extent of it neurogenesis, which you can read a bit about here, but needless to say, plenty of people have recovered from withdrawals like yours. It's great that you continue to improve. There is no reason you cannot heal the 'damage' part of the injury when you are taking the sertraline. The receptor adaptations will likely only happen once you withdraw from the drug, though. I believe I originally said that "reinstatement will not heal your brain". By that I only meant that reinstatement will not itself make you 100% better. It will only - at best - reduce symptoms and make them more tolerable. I did not mean that you cannot heal or improve after reinstatement. 

 

Did that answer make sense?

[Cage190]

On 9/3/2021 at 1:18 PM, DataGuy said:

Hi @Cage190,

 

Yes, 4 months is a short period. You are doing great if you are improving every day. It is also normal to have periods where you don't notice improvement or feel worse. Some people go weeks or months without noticing much improvement. It is the general pattern of gradual improvement that matters. 

 

Given the benefits you've experienced, I would not increase the dose. In fact, there is likely no need to ever increase the dose if you are currently stable after 4 months on 12.5mg.  

 

This is just a hypothesis, but likely there are a couple components to PAWS (post-acute withdrawal syndromes). One part would be that the brain needs to adapt back from the receptor changes caused by taking the medication. In the case of sertraline, 5-HT receptors would need to upregulate. 

 

The other component of a withdrawal syndrome likely results from damage or toxicity from overly rapid withdrawal. This can happen with benzodiazepine withdrawal, which can result in seizures and/or death. In rapid withdrawal from antidepressants, some people will experience extreme symptoms like brain zaps, akathisia, even seizures, as well as many other symptoms that are typical of someone who has suffered a brain injury, such as light and sound sensitivity, impaired cognitive function, sleep problems, depression, aggression, anxiety, vision problems, headaches, lack of impulse control etc as seen in the diagram below:

 

 

I think it is reasonable to hypothesize that the rapid withdrawal has caused some damage via a shock to the nervous system, which then gets stuck in a hyperaroused state because it cannot adapt quickly to life without the drug. What the exact cause of the damage is would likely depend on the drug. Damage also may occur from taking the drug, such as if you experience serotonin toxicity (serotonin syndrome), or develop akathisia or a movement disorder. But in your case it was likely the rapid withdrawal. I'm not a neuroscientist, so I can't explain how the injury occurs, but I do know that hyperexcitability of the nervous system is associated with injury and excitotoxicity. So it could be that the nervous system becomes dysfunctional and loses control, and the state of excess excitability results in damage and death of neurons.

 

This could explain why the withdrawal syndrome can last so long in some people (years in some cases, as documented in this study and others like it). You can still recover, it just takes a long time, with only slow improvement expected, since your body can only produce a relatively small number of neurons per day via neurogenesis. There is an academic debate about the possibility and extent of it neurogenesis, which you can read a bit about here, but needless to say, plenty of people have recovered from withdrawals like yours. It's great that you continue to improve. There is no reason you cannot heal the 'damage' part of the injury when you are taking the sertraline. The receptor adaptations will likely only happen once you withdraw from the drug, though. I believe I originally said that "reinstatement will not heal your brain". By that I only meant that reinstatement will not itself make you 100% better. It will only - at best - reduce symptoms and make them more tolerable. I did not mean that you cannot heal or improve after reinstatement. 

 

Did that answer make sense?

 

Wow, one trillion times thank you for this insightful explanation. Now I understand perfectly what you said.

Thanks 

@DataGuy

[Cage190]

Can kindling be mortal?

 

A few weeks ago I took diazepam, to alleviate part of some mental agitation. The next morning, I spent all the day feeling hopelessness, seeing the world in a very sad way and began suffering suicidal thoughts. 

 

Everything disappeared within 2 days. But I remember thinking about suicide for about all the day, in a very intense manner. 

 

It was only diazepam 2.5 mg. 

 

It's obvious that kindling is something dangerous, but, what are your opinions about this? 

 

I talked about this to my psychiatrist, saying she never heard of this before. How can be possible thay psychiatrista are unaware of this horrible/tragic phenomenon?

 

Edited September 22, 2021 by ChessieCat
added topic title before merging with intro topic

[Alternative7]

If your psychiatrist has never heard of kindling you need a new psychiatrist.

[Cage190]

I've been wrong all this time. 

 

I started at 6.25 mg the April's 15, remained there for 15 days. Then, I increased to 9/10 mg (let's say 9.5 mg), and stayed May, June, July. 

 

I believed that it was 12.5 mg, but it was less. I was calculating based on my "eye's insight". Then I bought an a scale to calculate the proper dose, and I increased without noticing it to 12.5 mg. 

 

I suffered kindling, 10 days later, including more anger, obsessions and finally, suicidal thoughts. Lasted 3 days. 

 

Now I've been August and September on 12.5 mg, and everyday I'm getting better. I haven't suffered any more kindlings. 

 

I just wanted to correct this error. Sorry to the staff

[DataGuy]

Thanks@Cage190. Do you mean you went back to 9.5mg? I am assuming that is what you meant. Sorry you suffered an adverse reaction. Hope you are feeling better now. 

[Cage190]

On 9/24/2021 at 9:39 AM, DataGuy said:

Thanks@Cage190. Do you mean you went back to 9.5mg? I am assuming that is what you meant. Sorry you suffered an adverse reaction. Hope you are feeling better now. 

 

Nono, despite the kindling at the beggining of August, I have been staying at 12.5 mg for august and september. 

[DataGuy]

Ok, I wasn't sure I understood, @Cage190. So you had been taking less than 12.5mg the entire time, went up to 12.5mg once you got the scale, then suffered some adverse effects that wore off about 13 days after the increase, and stayed at 12.5mg? This is what I am reading your post as. Sorry. Just a bit confused. 

[Cage190]

On 9/24/2021 at 5:56 PM, DataGuy said:

Ok, I wasn't sure I understood, @Cage190. So you had been taking less than 12.5mg the entire time, went up to 12.5mg once you got the scale, then suffered some adverse effects that wore off about 13 days after the increase, and stayed at 12.5mg? This is what I am reading your post as. Sorry. Just a bit confused. 

Yes, exactly. 

[Cage190]

Update: After 2 months, the improvement has been being more and more notable. I believe that in 2 years I'm going to be able to return to my studies. 

 

I still have waves - and for some days they hit really hard - but the windows always compensate that. I have both in a 50-50% relation. As you said, @DataGuy, they are some weeks that the improvement is so mild that I cannot feel any improvement. But soon or later, the improvement follows. 

 

By now, my brain is still - in some ways - disabled. I still have intrusive thoughts (but less than 2 months ago), my anger is getting vanished but I'm still suffering from anger outbursts (always mental/non physical). I can feel how, every month, I can reconnect myself with reality (I live in a little town, in a mountain environment) and feel the nature. I feel more human, more alive, more calm. My akathisia is getting mild everyday, in a very, very gradual way. But I'm afraid that the improvement is going to eventually stop (Murphy's law) and my improvement is going to get stucked. Hope not..

 

Despite the cognitive difficulties, I can feel hopeful. I feel more optimism, more enthusiasm, I can see the world with much more strength. I thank god that everyday I'm getting better. 

 

Thanks to all of us. I can see the light at the end of the tunnel

[Lilly998]

@Cage190congratulations !! This gives me so much hope I needed it a lot 🌸

But I wanna ask u from 2017 till 2021 was u experiencing WD non stop along this period ? I ask Bec I am having WD since 8 months and I only had meds for a year and half and I wondered if I it would be a good idea to reinstate again as I am losing patience .. so is reinstating is the Only way ?? 

Can u give advice to me plz 

[Cage190]

On 11/24/2021 at 5:46 PM, Lilly998 said:

@Cage190congratulations !! This gives me so much hope I needed it a lot 🌸

But I wanna ask u from 2017 till 2021 was u experiencing WD non stop along this period ? I ask Bec I am having WD since 8 months and I only had meds for a year and half and I wondered if I it would be a good idea to reinstate again as I am losing patience .. so is reinstating is the Only way ?? 

Can u give advice to me plz 

 

Hey, I thank that this has helped you. Yes, I became completely disabled and the collapse was all the time, with the same intensity (seemed almost permanent). 

 

If I were you, I would try reinstantment. After reading your signature, I can see clearly that your mistake was wearing off so fast from clompiramine. Just try it with a little bit, maybe 3 mg * (see quoted post below) and wait. Please, if I were you, I would be really cautious due to the possible condition of being super sensible to drugs because of coming off too quickly, and in consequence, suffer kindling. That's why I advocate for such a low dose. 

 

Hope it helps, 

 

David

 

*