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jiggityJog: Sertraline (Zoloft) & BFRB (Body-Focused Repetitive Behaviors)?


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Hi there,


I'm growing quite concerned that this high dose of sertraline that I'm on may be causing great difficulty in stopping myself from engaging in BFRBs (Body-Focused Repetitive Behavior), particular picking & biting my nails & the skin on my fingers. To be honest, I didn't even know these behaviors had an umbrella title until looking it up, just now. The reason I think it might be associated with sertraline is this behavior seemed to start shortly after dosage increases that went beyond prescribing guidelines for this medication. I used to have a problem with BFRBs but I haven't engaged in that behavior for 15-20 years, if I had to guess, & I don't remember it ever being this compulsive & automatic.


Another reason I suspect sertraline might be the cause of this these BFRBs is the very high dose that my doctor has me on. In U.S. prescribing guidelines, it appears the maximum recommended dosage is 200 mg QD & my doctor has me at 300 mg QD. His rationale for exceeding the recommended maximum daily dose was that we were seeing no symptom improvement at 200 mg & he believes he can govern what dosage that I can tolerate by monitoring the medication & subsequent concentrations in my urine. I didn't & still don't buy that hypothesis fully, but I've gone along with it until now because I've been desperate for relief from the debilitating symptoms of my depression.


I went to get the pertinent lab work done a week ago & the results have yet to return but considering how problematic this BFRB is getting, those lab values seem comparatively unimportant. My fingers are becoming quite painful & it's requiring a great deal of constant mindfulness to keep the damage to my fingers from getting into the range of what I would consider quite significant & would take a long time to heal. I also appear to be picking at my fingers in my sleep as well so there's no amount of mindfulness that's going to stop that from happening, as far as I know.


Ultimately, it is my intent to titrate off sertraline altogether with the aid of my psychiatrist and I am going to make sure that is done safely, which probably is going to entail a long titration period. I'm looking for answers to help me in the here & now, like, is this something that other people here have experienced & possibly some tips for managing these BFRBs in the interim until I the root cause can be addressed. If it weren't summer here, I would consider wearing something like thin cotton gloves to keep me from destroying my fingers, as much as possible, for the time being. Even if it weren't summer here, I don't think that solution would be very practical + I'd rather not have people ask why I'm wearing gloves all the time.


Any help or feedback would be greatly appreciated. Thanks for taking the time to read this.

Edited by arbor
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  • arbor changed the title to jiggityJog: Sertraline (Zoloft) & BFRB (Body-Focused Repetitive Behaviors)?
  • Moderator Emeritus

Hello @jiggityJOG,


Welcome to SA.


I'm sorry to hear that you're experiencing Body-Focused Repetitive Behavior.  This can be very distressing.  Since you're on a really high does of sertraline, I agree with you in questioning whether the drug  is worsening the situation.  High doses of the AD's can sometimes cause mild cases of Serotonin Syndrome.  This can be a dangerous condition.  I wouldn't delay in addressing the possibility which would entail planning and beginning a careful taper.  


To get you started, and to be able give you pertinent information, we ask members to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements in a list format.  


Account Settings – Create or Edit a signature.


[17 hours ago, jiggityJOG said:

Ultimately, it is my intent to titrate off sertraline altogether with the aid of my psychiatrist]


Here are some sites you might find useful:

Why taper by 10% of my dosage?  (The general philosophy of gradual tapering)

Tips for tapering Zoloft (sertraline) 

Important Topics in Tapering


[17 hours ago, jiggityJOG said:

I would consider wearing something like thin cotton gloves]


I understand the discomfort of explaining to others your situation, but wherever you can wear them, it would help you to not make the picking worse.  Especially, it might help at night when you're sleeping.


[17 hours ago, jiggityJOG said:

is this something that other people here have experienced]


I personally have known 2 others on high doses of sertraline to experience this.  I suggest avoiding those things that set of symptoms when you can, and getting your dosage straightened out as soon as possible.  This site can be useful:

symptoms and self care 


We don't suggest many supplements, but here are the links for info about 2 that we do recommend. It is suggested to add one at a time, and start with a low dose to see how it affects you. 



Omega 3 Fish Oil


This is your Introduction site where you can ask questions and connect with other members.

I'm glad you've found us, and hope the BFRBs will resolve soon,


Zoloft: 1995 - 2015

Prozac: 2015 - 2018 (tapered from 40mg x day on July 31 to 30mg on August 31 to 20mg on September 31 to 10mg October 31 to 0mg on  December 15, 2018

Gabapentin: 2016 to 2019  (tapered from 300mg x day to 150mg on August 31, 2019 to 75mg on September 15 to 50mg on September 31 to 25ishmg on October 15 to 0mg on December 1, 2019

Enalapril: 2010 - 2019

Lipitor: 2017 -2017

Metformin: 2000 - 2020

Liothyronine: 2007 - 2019

Levothyroxine: 2000 - 2022

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