Embi: Trying to recover from dropping dose too fast

[Embi]

Hi, I have been back and forth on posting here but decided to go for it.

 

I was originally put on sertraline nearly 4 years ago due to extreme depression. I had a lot of traumatic events happen to me between the ages of 18 and 22 which I was still trying to cope with years later. I had been through many rounds of therapy and was still having a really hard time, especially after a bad breakup, so my doctor decided meds were the next option.

 

I had to taper up fairly slowly to 100mg and the side effects at the start were awful. I couldn’t eat, I was borderline manic, generally all over the place. After I settled at 100mg though I have had the most stable period of my life that I can remember. Although I have still had bad episodes (one of my oldest friends committed suicide, work stress etc.) I agreed with my doctor that these were understandable reactions to life events and we wouldn’t change my dose.

 

As I’ve been doing particularly well the past year my doctor wanted to decrease my dose. She suggested in late May that I alternate between 100mg and 50mg for a few weeks and then drop to 50. Alternating sent me all over the place so I just dropped directly to 50 and was fine throughout June and most of July. 
 

During July I had some big life decisions to make, and a lot of stress. After some triggers bringing up old trauma, realising I had made some bad choices etc. I started to have a lot of anxiety and breakdown. The anxiety was very intense, but I found that talking to people and making new plans eased it for a while. Then a week later, after a relatively stable week, I started having really bad panic that wouldn’t ease no matter what I did. This lead to a really bad episode of depersonalisation and derealisation that was the scariest I’ve ever had. My doctor wanted me to go back to alternating between 100mg and 50mg but instead I started taking 75, hoping that this might even me out. 
 

I have been on 75mg for just over 2 weeks now and I feel awful. For the first week I was entirely numb to everything, which was somewhat of a relief after the intense anxiety. However, since then I now wake up with intense dread and anxiety that lasts until at least noon if not all day. Waking up my heart is racing and I feel like everything is awful and always will be. I can’t eat until the evening. It exhausts me and I can’t do anything else afterwards. I’m going to work still but it is so difficult, I just want to crawl out of my skin. I’m trying to stay at 75mg and level out but I’m so scared that I never will. Before this I was so stable and having one of the best times of my life. Now I can barely function. 
 

I’m questioning whether I need to stay at 75mg, go back to 100 or drop back down to 50. It has only been a month since this all started and I can’t keep living like this.

[Go2zero]

Hi Embi,

 

Welcome to this support site.

 

I am so sorry what you are going through. There is a lot of information to be found on this website and the members here can offer a lot of support.

 

Reading you story, there are a few clear points to mention:

 

Your doctor made a big mistake by suggesting you should alternate dosages. This is really asking for trouble! It sensitizes the nervous system and destabilizes the (at that moment) existing brain chemistry. 

 

This link is about why we should not skip dosages. Alternating dosages does about the same (if not worse).

https://www.survivingantidepressants.org/topic/22958-never-skip-doses-to-taper/

 

By going up and down in dosages (after the alternating), your system probably got further sensitized. Also going down from 100 mg to 50 mg is a much too big step. We suggest tapering by maximum 10% of the last taken dosage per month!

 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

But please understand, we nearly all have made mistakes like this. Since doctors most often do not advise right about tapering or adjusting dosages.

 

The more often we change dosages up and down, the more our nervous system gets deregulated. This can and will stabilize again and finds a natural balance ! But this needs time. And most important a stable dose over time.

 

As we all react differently on dosage changes, I cannot give you the golden answer what dosage to take. But I read a few important things in your post. You say that you felt quite OK on 100mg (which is twice the standard dose). On 50 mg you went all over the place. Not so weird after a 50% drop in dosage and experiencing stressful life events.

 

Stress is nearly always a big trigger for anxiety and panic when in withdrawal! Keep that in mind. Changing dosages is not the best reaction then, since that can activate more stress. Better try to wait until stress levels drop again, instead changing dosage.

 

The problem with changing dosages over a relative short period of time, is that our system gets deregulated. When we would go back to a dosage where we felt good before (in your case 100mg), this does not automatically mean that you will feel good again with that dosage. The CNS is disturbed and going back to the old dosage may even create more disturbance.

 

The 2 magic words are: Stabilize and give it Time!

 

Taking all into account what you said, I would think that stabilizing on 75mg is the best thing to do right now. You may keep feeling bad for some time. Nobody can tell you how long. Again, we all react and heal differently. But you will find that WD symptoms will go. Others may come. That is how healing from WD from AD's works unfortunately. But symptoms will get less and less over time. This often happens in a wave and windows pattern.

 

https://www.survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/?tab=comments#comment-183

 

 

 

 

[Embi]

Hi Go2zero,

 

thankyou for your advice, I really appreciate it. I am going to try stick on 75mg for at least 3 months in the hope that things calm down. It’s just so hard to keep things the same when I want to change things and try everything to feel better. 
 

I also reduced my caffeine intake a lot over the last 2 weeks to try and ease the anxiety. I’ve started to get headaches but I can’t tell if it’s from the sertraline withdrawal, caffeine withdrawal or the fact that I’m barely eating and drinking. I guess I will just have to keep going. I have been getting windows in the evening where I feel more normal, but they’re not reliable. I’m hoping if I can stabilise and hold at 75mg then I can start a 10% taper next year. 
 

I’m hoping that my doctor will be reasonable and not push to continue the super fast taper or alternating. 

[Go2zero]

Headaches can come from caffeine withdrawal. But they are a very well known WD symptom for SSRI's as well. Eat healthy, drink a lot of water, some light exercise (do not overdo!), meditate or do yoga if these fit to you. All these things can help in stabilizing and healing.

 

In the end you should decide, not your doctor. If he/she does not respect your choice it may be time to find a doctor who does....

Edited August 4, 2021 by Go2zero

[Embi]

At the moment I’m just trying to put one foot in front of the other and eat whatever I am able to. Today was difficult. I just keep thinking that there’s no point in anything.

[Yersinia]

Hi @Embi 

52 minutes ago, Embi said:

Today was difficult. I just keep thinking that there’s no point in anything.

 

Just wanted to let you know that you are not alone in feeling this way - things feel pointless to me too.  From reading the Success Stories on this site, I've gathered that this feeling is common for people in WD (especially early WD).  I try to recognize it as a lie that my brain is telling me as it tries to heal from CNS destabilization (easier said than done!).  

[Embi]

Thankyou @Yersinia, I really appreciate your reassurance. It can be so hard to not give in to that feeling. My brain just keeps spiralling down really bad pathways about everything.

[Yersinia]

Oh yes @Embi I am familiar with that!  Check out the Symptoms and self-care forum for ideas on how to begin to distract your brain (meditation, etc.) 

 

Please be kind to yourself and try to remember that this temporary (even as I type that last statement, my brain is telling me that it's temporary for everybody except me - my poor broken brain).  Hang in there.

[Rusty1]

3 hours ago, Embi said:

Hi Go2zero,

 

thankyou for your advice, I really appreciate it. I am going to try stick on 75mg for at least 3 months in the hope that things calm down. It’s just so hard to keep things the same when I want to change things and try everything to feel better. 
 

I also reduced my caffeine intake a lot over the last 2 weeks to try and ease the anxiety. I’ve started to get headaches but I can’t tell if it’s from the sertraline withdrawal, caffeine withdrawal or the fact that I’m barely eating and drinking. I guess I will just have to keep going. I have been getting windows in the evening where I feel more normal, but they’re not reliable. I’m hoping if I can stabilise and hold at 75mg then I can start a 10% taper next year. 
 

I’m hoping that my doctor will be reasonable and not push to continue the super fast taper or alternating. 

You should decide what is best not your doctor. Just a quick peak around this board you should see how uneducated they can be regarding withdrawal.

IMO at best a doctor can be sympathetic and stay out of the way. I was fortunate to have this, they let me do my own thing knowing I didnt want their help.

If they put up resistance it is either time to look for another doctor who is willing to do what is best for the patient or if it comes to it and refilling a prescription is in question they dont need to know.  

[Embi]

Today things are really bleak. I have been wondering whether I can go on anymore. I started seeing someone about 5 months ago but now I feel like it’s pointless because it will inevitably end. I am waiting for a call back from my doctor but I don’t know what they can do. I don’t know whether it’s worth calling the crisis team. 

[Yersinia]

Hi - you need to get out of your head. Are you able to go out for a walk? 30 minutes or so in a nice part of town? Go outside and walk - focus on the natural world. When your mind starts to predict doom, gently acknowledge that you are “thinking”, let the thought go and return your attention to the natural world. You can do this. 

 

 

[Embi]

I’m at work so there’s nowhere I can really go. It is hard to challenge these thoughts when objectively it’s true - everything will end and there’s no point to it. I am considering taking some time off of work but I don’t know if it’s feasible. 

[Yersinia]

I agree with the idea that “everything will end” but disagree with “there’s no point to it”.  Even if experiences/events end, they change us. They have a lasting impact.
 

 

[Embi]

@Yersinia Thankyou for talking with me while I struggled this morning. This afternoon I’ve been a lot better, almost like I feel like a person again. It’s just so difficult getting through to the evening

[Yersinia]

You're welcome.  

[Greatful]

@Embi  I am glad that you found SA.    I am sorry that you are going through this.  I can hear the panic and despair in your voice. It pains me to read post after post of the panic, and desperate cry for help.  These doctors really need to learn more about the drugs they are prescribing and how much they affect your brain.  Most do not know how to correctly get off of them and send their patients into such mess.

 

.  You will need to take a deep breathe and know that you will heal.    Tell yourself I am okay right now,  I am breathing and my heart is beating. I know that is hard  do right now, but you can do it.

 

When your brain is not working right and the thoughts get all distorted you panic and spiral out of control.   When your dwelling on your thoughts you are fighting them.   Acknowledge the thought, do not engage in the thought, turn your attention on to something else. (something on your desk), go for a walk to the bathroom, refocus on what you are doing, really think about what you are doing.  Say the steps in your mind.  You will have to do this repeatedly over and over.  

 

Do you meditate?  I would recommend meditation.  This is a good tool to help you redirect your brain and not get caught up in thoughts. If you would like I can help you with that.

 

Yersinia has some really good ideas to help you cope. 

 

Something that is empowering is 

I made it through yesterday, I can make it through today, and tomorrow will take care of tomorrow.

 

Please know that you are not alone. 

Do not hesitate to post and  let your pain be heard.  This is a scary time for you, most of us have felt panic and overwhelmed several times. We are always there to give you support and encouragement.

Hang in there, you are doing great☺️

[Embi]

Hi everyone,

 

sorry that I didn’t reply to previous messages. I read them and appreciated the advice so much, I was just in too much of a bad place to be coherent.

 

I’ve now been on 75mg for three months. Most of my worst symptoms subsided after around a month and since then I’ve been up and down. The worst part for me is this occasional certainty that everything is pointless and meaningless. It makes everything feel hopeless and nothing brings me happiness. Even happiness itself seems pointless. I still have bad restless legs also. 
 

I am mostly stable now and wondering if I should start transferring over to a liquid dose so that I can taper. I’m cautious to do this because I still don’t really feel like myself a lot of the time. On the other hand, I really want to be on a lower dose and make some initial progress on my taper.

[Embi]

Today is too much. I started to try and move over to liquid from Monday. I could only start by dissolving 1/3 of my dose, not a quarter, because of how my dose is split between tablets.

 

Today I feel like I can’t do this. I have cried all day. I have such intense anxiety and derealisation. I don’t see a point in anything. I just want everything to end. Everything good ends, it’s just pointless.

 

I don’t know what to do. I feel like I’m going to be stuck on these meds forever. I can’t stick with it. I just want out.

[Embi]

Today I am still incredibly anxious. I am moving back to just taking solid doses until I level out. I don’t think I will try to change my dose again until next year. I can’t deal with the intensity of the anxiety and depression.

[Greatful]

@Embi

 

20 hours ago, Embi said:

Today I feel like I can’t do this. I have cried all day. I have such intense anxiety and derealisation. I don’t see a point in anything. I just want everything to end. Everything good ends, it’s just pointless.

I can relate to the ups and downs of WD.  I am glad to see that you are stabilizing to some degree.  Unfortunately that is the power the drugs have in our system and little changes generally shows up for a little while until your systems adjusts to it.

I can assure you that most of us have felt this way many times over.  All the scary WD symptoms and the panic really can be hard to take.

How are you doing with coping skills, meditation, tapping, breathing exercises, mindfulness, and it does help to let things out here on SA to feel validated and heard.

Reading success stories in the forums section, connecting with some of the members that are on the other side of this nightmare is very encouraging.  It is a bust in energy to know that you are healing everyday and that one day you too will be writing your own success story and helping the ones that are just starting out, in uncertainty, pain and panic. 

 

As the saying goes around here "One day at a time"

By the way you did a great job in the last several months, stabilizing. 

You can see that you are stronger then you probably ever thought💪😊  So just keep putting that one foot forward everyday.❤️ 

  

 

 

4 hours ago, Embi said:

I don’t think I will try to change my dose again until next year. I can’t deal with the intensity of the anxiety and depression.

It is a good idea to hold until you get to a point that you can handle the dip.  

I see in your signature that you are not taking any supplements.  You may want to try Magnesium and omega 3s here is some information on them both If you do try them start with one at a time and at a  low dose to see how your system tolerates them. Many here take them and find some benefit from them.

https://www.survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/?tab=comments#comment-11734

https://www.survivingantidepressants.org/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/?tab=comments#comment-44

[Embi]

Hi @Greatful! Thankyou for your kind response, I really appreciate it.

For coping skills I usually try to go for a walk and focus on that, but the nights are getting darker now which makes it more difficult. I have varying success with mindfulness, mostly because it’s hard to remember it when my brain goes into full panic mode. I’m finding it a challenge because I have methods to deal with more ‘normal’ levels of anxiety but these withdrawal symptoms are off the charts. Last night I contacted a helpline which was good just to have someone unrelated to talk to since I feel like this can put a lot of stress onto my relationships.
 

I have actually bought a magnesium spray and some fish oil tablets  I’m using the magnesium spray, but I haven’t started on the fish oil tablets yet. I think I might try to get into good habits with those and with my coping skills before I try to change anything with my dose again. 

[Embi]

Hi, I just thought I’d give a quick update. 
 

I finally started tapering this month after spending some time switching part of my dose over to liquid. I’m ten days into my new dose (67.5mg) and so far I feel okay. I have the usual anxiety and depression but none of the super intense symptoms I had when I crashed last year. 
 

Part of me wants to speed up my taper because I feel okay but whenever I get the urge to do that I think of how many people here would tell me not to. So instead I’m trying to just focus on my health in general.

[Blossom71]

Hi @Embi

Glad your latest drop is going well so far.  I'm also tapering Sertraline and I know the feeling of wanting to speed up very well!   😬

I've had a rough couple of weeks though so it's been a reminder to me of how quickly things can spiral when life gets a bit crazy.

Focussing on your general health sounds like a plan!