Maze: Lost in the maze of sertraline: trying to stabilize me.

[Maze]

Hi everyone. First of all, thank the founder and the SA moderators. I feel that creating the SA forum to help people who are in a complicated process with medication is a really compassionate act. Likewise, I would like to thank all the brave people who share their experiences here. Second, I apologize and request your patience with my English. I am Spanish and it is not my native language. I will try to express myself as best I can.

 

Here is my story. When I was 22 years old (2012) I began to experience tension headaches, probably due to academic pressure (I am a psychologist). Because of this, little by little I began to experience anxiety and low mood and at 6 months I was feeling pretty bad. For this reason, I started going to therapy and also went to a psychiatrist. The psychiatrist prescribed me sertraline and benzo to reduce the initial impact of the sertraline. After a month, I was taking 100 mg of sertraline in the morning and benzo was withdrawn. During the following months, with the help of medication and therapy, I began to improve. I was taking 100mg of sertraline without any side effects for about 2,5 years.

 

At two and a half years, I was traveling in India and I was interned in a hospital for gastroenteritis due to some bad food. I didn't have the pills with me, so I didn't take them for a week. When I realized that it had been two and a half years and my psychiatrist had told me that we would withdraw the medication when I felt better, I decided it was a good time. I retired 100 mg (cold turkey). At the time, I knew absolutely nothing about the withdrawal effects. No one had told me anything about it. When I took it off I didn't feel anything strange. I continued my life. However, three months later I began to experience bizarre symptoms that I had never had before, palpitations, very fast peaks of anxiety, crying etc. I held on for a couple of weeks, but I worried and called to the psychologist and psychiatrist again. The psychiatrist then told me it was a relapse. He prescribed me 50mg and told me it would be for life (like a person with diabetes take insulin, he told me). He assured me that it was safe, that it had no side effects, that science said that it could be taken without problem for life and that if one day I wanted to take it off it would not generate dependency. After a long conversation, I ended up trusting him and started retaking 50 mg. Now I think a protracted withdrawal syndrome can explain those symptoms, and the psychiatrist did not tell me the truth. Within days of reinstating sertraline, all symptoms subsided.

 

However, within a few months, I started having side effects from the medication for the first time. Basically, I felt akathisia, brain fog, difficulty to think, bloating and stomach pain, and diarrhea. Since I was doing a Master's, it disabled me a lot to study. Hold on for a while and I mentioned it to the psychiatrist, but he told me it was normal and nothing was wrong. I noticed that taking sertraline at night (11 pm), the secondary symptoms improved a little with sports and mindfulness, but they only got worse over time. Since then, sports and mindfulness have always helped me, but I always got up in the morning with the side effects, which subsided around noon (2-3 pm). One day I decided not to take the pill at night and I found that I woke up without the side effects and that I could work much better in my day. So I started to alternate the doses. I took the sertraline every other day. So at least half of my week, I had a better quality of life. I mentioned it to the psychiatrist, and he told me that it was fine if that regimen went well. So from sometime in 2013 until the end of July 2021, I have been taking 50mg sertraline like this. On Sunday, Tuesday and Thursday nights I took sertraline, and on Monday, Wednesday and Friday morning I had the side effects that I tried to mitigate with swimming and meditation. At noon (2-3 pm), the side effects subsided. I never had inter-dose withdrawal effects during all these years. I have read in this forum that it can happen, but I did not experience it. Now I know, thanks to this forum, that skipping doses seems like a non-recommended practice. I didn't know and I regret it. 

 

In July I finished my Ph.D. on Clinical and Health Psychology. My problems motivated me to do a Ph.D. about the use of mindfulness with children to prevent the early onset of anxiety and depression. When I finished, I was tired of the side effects and decided to start to taper the sertraline. I wanted to stabilize the drug on a stable daily dose and then taper it little by little. Once my psychiatrist told me that instead of taking sertraline three days a week (150 mg a week), I could take 25 mg every day at night (175 mg a week). I felt mentally strong, so I started to make this change on August 1 before going on vacation. I thought it was a good time. But it has gone wrong and I have been destabilized like never before in my life. On August 22 I discovered this forum (SA) and started reading. With the reduction to 25 mg every day I have been able to experience how the side effects of sertraline diminished (by 10 am I almost no longer had akathisia, mental fog, etc.). However, I have experienced many symptoms associated with increasingly difficult withdrawal symptoms. In the first days with 25 mg, the symptoms were tolerable, but on days 19-22 August I feel extreme weakness, drowsiness, motor slowness, weakness, blurred vision, extreme tiredness, no energy to talk, crying, no ability to think, introversion, jaw tension, inability to concentrate, derealization, etc. I have never had any of these symptoms before. So I thought about reinstalling. I read in SA that I was within the 4-week window to reinstall and that I could reinstall an mg or two, but I had no idea how to reinstall a mg or two of my 50mg sertraline pill. All I could do was cut it into roughly four equal parts and take 37.5 mg instead of 25 mg. So, I began the process on the night of August 22. On the morning of August 23, I woke up much better, but the typical side effects of akathisia, brain fog etc. had returned. So I continued taking 37.5 mg, but I felt that the drug had more and more power each day I took it, and after 4 days, my body could not tolerate it. I felt intoxicated. On days 27 and 28, I experienced insomnia, anxiety, desire to vomit, severe stomach aches, severe dizziness, severe mental fog, diarrhea, despair, difficulty walking, stunned, crying, severe stomach pain (cramps). I was in a hotel and could hardly get to the breakfast room. I've never felt this before either. Seeing how things were going, my partner convinced me to stop and not take the 37.5 mg dose on the 28th at night. It was really hurting me (I guess serotonin syndrome possibly). That night I was able to sleep, and on the 29th, when I woke up, although I was weak, I felt much better. I did not doubt that my body was not tolerating the 37.5 mg each day.

 

In the last three days, I have continued to alternate the doses to try to stabilize myself. On the 29th, I took 37.5 mg; on the 30th, I do not take it; today, the 31st, I will take it. This is a summary of how I have felt ever since.

- From 28 to 29 (not take 37,5 mg): I sleep somewhat better. My symptoms go away even though I'm still unsettled. I feel like the level of intoxication goes down. Weakness but a feeling of recovery.

- From 29 to 30 (take 37.5): I sleep better, although the classic side effects I had with 50mg returned—Akathisia, mental fog, etc. In the morning, the side effects lasted; in the afternoon, they diminished. At night I was fatigued. Possibly a beginning of withdrawal symptoms inter-doses?.

- From 30 to 31 (not take 37,5 mg): Today, I have slept well, but I did not rest. I feel the withdrawal symptoms again; they are similar to when I dropped to 25 mg, especially the drowsiness and extreme fatigue.

 

And here I am. Trying to stabilize me. And I really don't know what to do. I have made an appointment with a new psychiatrist who has been recommended to me. He has written scientific literature on reducing antidepressants and reviews said that he is empathetic and listens. I am hopeful that we can do something to stabilize myself. I feel in a maze. Trapped. With 25 mg every day, I have withdrawal symptoms, with 37.5 every day I cannot tolerate it, and taken 37.5 mg every other day it seems that withdrawal symptoms emerge (which I never happened with 50 mg in 7 years). I wonder, therefore, what I can do since I am suffering. I am a mindfulness instructor, clinical psychologist and researcher, and it is challenging for me to carry out my work under these conditions. Feeling that it will be a long process, I have reduced my the workload for the next few months. If I can't stabilize myself, I will have to stop working.

 

I hope you can help me in this process. Some questions that I have in my mind now are:

 

- What sertraline regimen should I take? Should I switch to another drug to stabilize myself and then try to reduce the dose once stabilized in amounts of 5% -10% with a liquid formulation?

- Could it be that my body and nervous system have adapted to taking the medication every other day and now it cannot tolerate taking the drug every day?

- How is it possible that taking sertraline (short-lived SSRI) has not had any withdrawal effects in alternate doses? Could it be because of how I metabolized sertraline and how my body adapted to it after 7 years?

- Should I reinstate 50 mg every other day, as usual, and see if I stabilize and then reduce by 5% -10% taking sertraline? (I am aware that the doses should never be skipped, but given my situation, I wonder if I have no other option if my body has adapted to that).

 

For now that. Sorry about the length of the story, but I feel it's better to write it accurately for the first time around so we can work from now on. If you don´t understand something because of my English just let me know and I will try to explain better. 

 

Thank you very much for your compassionate help.

 

Warmly,

Maze.

Edited August 31, 2021 by arbor

[arbor]

Hello @Maze,

Welcome to SA.

 

I'm so sorry you're having this difficult time in "the maze of sertraline" which it certainly is.  Hopefully, your strong training in Mindfulness will be of some support for you.  To be able to give you the best information, we ask members to summarize their medication history in a signature – just drugs, doses, dates, and discontinuations & reinstatements in a list format.     

 

Account Settings – Create or Edit a signature.

 

After you've completed this I can bring your situation to the attention of moderators who can help you stabilize and then eventually taper at a very low rate.  Here are some links to read that can help you understand what might be going on:

 

What is withdrawal syndrome?

Post WD Nervous System Hypersensitivity, hyper Reactivity and Kindling

Cold Turkey and Too Fast Tapers

Why taper by 10% of my dosage?

 

You may have noticed that we don't recommend skipping doses.  Here is a link that explains this view:

NEVER SKIP DOSES TO TAPER 

 

To address your questions, this link may be helpful: 

About reinstating and stabilizing to stop withdrawal symptoms

 

I also include these links to support you further:

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 3 that many of us find helpful are magnesium, omega-3, and melatonin. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

Melatonin

 

 

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

I'm glad you've found us. 

Arbor

[Maze]

Thank you very much @arbor for the quick reply.

I summarize my medication history in a signature as you request. Let me know if it is ok like that.

On the other hand, much of the information you have provided me I had already read. I will calmly re-read everything and read everything that I had not read. Especially the issue of supplements. I had already read the information about not skipping the dose. Also, about reinstating 1mg or 2 mg. But at this time I was out of Spain, and I did not know how did it, so I increased 12,5 mg (3/4 of a pill; from 25 mg to 37,5 mg).  Now I know I can do it with a liquid formulation, but I cannot change what I have already done.

Last night I took 37.5 mg dose. And I've had a tough night. I feel pretty destabilized, despite putting all my mindfulness skills into play. During the night, I have experienced insomnia, sweats, nightmares and agitation besides stomach pain. In the morning (in Spain), I am feeling akathisia, brain fog, and instability. I feel like my body has become sensitized to sertraline and I cannot tolerate it. The explanations about kindling make a lot of sense to me. It seems the principal problem now, isn't it?

In this situation, as I said yesterday, I feel lost and trapped. I am aware that skipping doses is not a good option. So, as I mentioned, I took 25 m to stabilize myself, but it did not work. I mistakenly thought (and so did the psychiatrist) that 25 mg every day would be the same as 50 mg three days a week. I did the alternating dose regimen for 7-8 years, and I regret it, but I can't go back. I did this to survive and manage the side effects that were very difficult for me. But now I have to focus on improving and look for a solution for the present and the future.

What can I do to stabilize myself? When I have taken 25 mg every day, it seems that withdrawal symptoms emerge (I did it from August 1 to 22). If I take 37.5 mg every day, my system will not tolerate it (I did it 5 days from 23 to 27 and the day 4 and 5 was hell). And if I take 37.5 mg every other day I experience side effects on the days I take the sertraline and a few withdrawal symptoms the days I do not take the dose. By the way this is similar to what I experienced when I was taking 50 every other day, but now side effects are more potent the day I take the dose, and withdrawal symptoms emerge the day I don't take it. Inter-doses withdrawal symptoms didn't exist before).

Before making any new medication changes, I want to ensure that what I do helps me stabilize. I don't know if it will be possible with sertraline or if my history with sertraline is over. Maybe I have to switch to another medication to take it every day, stabilize myself, and eventually begin to decrease very little by little in the future?

Thank you very much for the help. It is invaluable.

Warmly,

Maze

 

 

[arbor]

Dear @Maze,

I sympathize with the challenge of your situation.  It is not unlike my own.  As you probably have read, reinstatement doesn't consistently fix w/d.  You write that you take sertraline at night.  Have you tried taking it in the morning instead?  It can be less agitating that way.  It's interesting that every other day use of sertraline has worked better for you.  I'm going to bring your post to the attention of the more knowledgeable moderators.  Again, I'm so very sorry that this is happening for you.

Best wishes,

Arbor

[Altostrata]

Welcome, @Maze

 

14 hours ago, Maze said:

When I have taken 25 mg every day, it seems that withdrawal symptoms emerge (I did it from August 1 to 22). If I take 37.5 mg every day, my system will not tolerate it (I did it 5 days from 23 to 27 and the day 4 and 5 was hell). And if I take 37.5 mg every other day I experience side effects on the days I take the sertraline and a few withdrawal symptoms the days I do not take the dose.

 

It is clear that 37.5mg is too much for you. As explained in Tips for tapering off sertraline (Zoloft), you can find an infinite number of dosages between 25mg and 37.5mg by supplementing 25mg with a liquid, either prescription or homemade.

 

If I were you, I would immediately reduce to 30mg and see what happens.

 

On 8/31/2021 at 8:24 AM, Maze said:

Once my psychiatrist told me that instead of taking sertraline three days a week (150 mg a week), I could take 25 mg every day at night (175 mg a week). I felt mentally strong, so I started to make this change on August 1 before going on vacation. I thought it was a good time. But it has gone wrong and I have been destabilized like never before in my life. On August 22 I discovered this forum (SA) and started reading. With the reduction to 25 mg every day I have been able to experience how the side effects of sertraline diminished (by 10 am I almost no longer had akathisia, mental fog, etc.). However, I have experienced many symptoms associated with increasingly difficult withdrawal symptoms. In the first days with 25 mg, the symptoms were tolerable, but on days 19-22 August I feel extreme weakness, drowsiness, motor slowness, weakness, blurred vision, extreme tiredness, no energy to talk, crying, no ability to think, introversion, jaw tension, inability to concentrate, derealization, etc.

 

What time o'clock did you take 25mg sertraline? What time o'clock do you take 37.5mg sertraline?

 

Withdrawal symptoms mean your nervous system is upset. When you skip doses and endure withdrawal effects on alternate days, you are progressively irritating your nervous system more. Suffering the symptoms of akathisia after taking a drug and withdrawal in between skipped doses is not a benign pattern. 

 

Most likely, your irregular dosing has sensitized your nervous system to sertraline and predisposed you to kindling (increased intensity of adverse effects).  With a sensitized nervous system, people often cannot tolerate the dosages of drugs they had taken before with no problems.

 

We see such problems all the time, when doctors attempt to aggressively treat withdrawal syndrome with larger doses of drugs or new drugs. There are many, many cases of drug-induced sensitization here and some cases of kindling.

 

I think it's very possible that the symptoms you have identified as withdrawal symptoms were adverse effects from 25mg sertaline instead, and 25mg sertraline was also too much for you.

 

Please reduce your dosage and let us know how you're doing.

[Maze]

Dear @Altostrata and @arbor, thank you very much for your help.

Alto, I always take the 25 mg and 37.5 mg doses of sertraline at night before sleeping. It was approximately 11 pm-12 am. I have done it like this for 8 years (before with 50 mg every other day), since if I take sertraline in the morning, I cannot tolerate the adverse effects throughout the day. However, if I take sertraline at night, I "only" experience adverse effects at night and during the following day (generally until 3 pm approx.). At night I never had insomnia. I only woke up earlier (i.e., around 6:30 - 7 am), until last week when I had insomnia.

Likewise, what you suggest about lowering the dose to 30 mg makes a lot of sense for me. Combining 25 mg of pill with 5 mg of liquid the first week and then gradually changing to only liquid in three weeks.
For example, first week: 25 mg tablet-5 mg liquid; second week: 12.5 mg tablet-17.5 mg liquid; third week: 30 liquid). Could this option be correct?

As I told you, yesterday I went to a private psychiatrist and told him about my case. I explained my whole story and everything I had learned in SA as well. He was very empathetic and listening to a lot. For 50 minutes between have considering options, and we agreed that the best option could be to switch to liquid sertraline and reduce to 30mg immediately—same plan as you suggest Alto. The psychiatrist commented that I clearly seem to be sensitized to sertraline and that it is necessary to taper and remove it from my body. However, the psychiatrist and I differed about what is the best option to taper sertraline (subsequently to the stabilization on 30 mg). He suggested that after a month at 30 mg, I would drop 5 mg every two weeks to be off sertraline in three months maximum. He thought that sertraline does not suit me and that I have to give it up quickly. Also, to help me during this period, he suggested using benzos and removed them after three to four months. I told him about the possibility of tapering with the 10% rule because I feel more confident after everything I have read. He told me that it is a very conservative rule, but he agreed to engage on this way if I feel better with this option.  He also said that while I am on 30 mg, I may need some short-acting benzo in the morning when I get up (where the alteration due to taking sertraline at night affects me) due to my sensitization to sertraline. I was a bit resistant, but I finally agreed to take some benzo some days if I need it. It seemed good to him too. So, I'd like to know your thoughts, Alto and Arbor, on this plan. What do you think?. Personally, it sounds like a good plan, but to be honest, I feel afraid that by reducing to 30 mg of sertraline each day, I will continue experiencing significant adverse effects (kindling), and also withdrawal effects would also emerge as happened at 25 mg. Anyway, I do not see better options.

Alto, you suggest that the symptoms I have been identifying as withdrawal symptoms when I was on 25 mg may actually be adverse effects from sensitization to sertraline. If you will allow me, in my case I feel that the adverse symptoms from sensitization are pretty different from withdrawal symptoms. I experience adverse effects from sensitization to sertraline after taking sertraline in the evening and the next morning. They have always been akathisia, agitation, brain fog, difficulty concentrating, etc. I have experienced them 1) the last 7-8 years every other day taking 50 mg, 2) with 25 mg every day, but much milder, 3) with 37.5 mg when I took it every day last week (intolerable the fourth and 5th day) and 4) now when I on 37.5 mg every other day, where after taking the dose in the nigh I experience symptoms on the night and the next morning (as I have experienced the last few days). However, the effects of withdrawal have been more associated with drowsiness, fatigue, tiredness, etc., instead of agitation. That is why I feel that taking a dose of 30 mg each day can be a good option to find a balance between the symptoms of sensitization to sertraline and the symptoms of withdrawal. Obviously, I feel afraid that the sensitization symptoms will still be very strong (which is why the psychiatrist suggested using benzos), and that the withdrawal symptoms of lethargy, severe fatigue, drowsiness, etc., will emerge with force, and they disable to me. What do you think about it?

Finally, I would like to share that by reading the material you provided, I realized that my story with sertraline might have been different from how I understood it. I said previously that possibly my "relapse" at three months was a protracted withdrawal syndrome. I have realized now that since the psychiatrist put me back on 50 mg 8 years ago, I have not tolerated sertraline, possibly due to a sensitizing effect. For the last 8 years, I have thought that the adverse effects I had after taking 50 mg of sertraline were side effects of the pill, but in reality, they seem to have been effects derived from my sensitization to sertraline. During the first two years, I did not have any adverse effects with 100 mg. Nevertheless, the re-administration of 50 mg after the withdrawal syndrome could bring a sensitizing effect, which I have been managing for 8 years. Possibly this is why I couldn't take sertraline every day, although I did try sometimes. It was impossible. It is just as impossible as when I took 37.5mg every day for 5 days one week ago and couldn't tolerate it at all. However, I was able to take 25 mg every day since the sensitization effects were the same but somewhat more manageable, less intense. So I hope I can tolerate the sensitizing effects on 30 mg... Hopefully. In case of not tolerating them, I guess I have two options: 1) reduce the doses, which could imply the risk of a more severe withdrawal syndrome, or 2) use benzos, as the psychiatrist suggested. What option do you think would be better?

As you say Alto, it is possible that the irregular dosing for so long has sensitized my system even more to the drug, but I don't feel like I had a choice, since taking it every day my system did not tolerate it, and when I dropped to 25 mg the withdrawal symptoms emerged. I did not know during all these years that I could have intermediate options such as the liquid formulation or other ways of handling it than skipping doses .... My lack of knowledge and the absence of help from my psychiatrist have meant that for 8 years I have been skipping doses. Like I said earlier, I'm sorry. I'm going to see now if my system tolerates taking sertraline every day and reducing it. I am putting all my efforts into taking the right road at the moment.

Thank you very much for the help. Sorry about the long text. I'm trying to find my way.

Maze

 

[Altostrata]

It's good you found a psychiatrist who is willing to work with you. Few know anything about tapering or withdrawal.

 

We recommend making a gradual change from tablet to liquid form, such as adding 5mg liquid to a 25mg tablet, rather than a sudden conversion, which is sometimes destabilizing. A week is only long enough to see if the dosage is correct, we recommend stabilizing for at least a month between changes.

 

My intuition is 30mg still will be too high a dose and you will want to take somewhat less than 25mg sertraline. But 30mg is a place to start for now.

 

My interpretation of your symptom pattern is that after a dose, initially you have symptoms of activation because the dosage is too high, which is a very common pattern with antidepressants. After it wears off some -- perhaps by half or more-- you experience other adverse effects such as drowsiness, fatigue, tiredness, etc. (typical of sertraline), which you have misinterpreted as withdrawal effects. Then you take the next dose in the evening and repeat the cycle.

 

Please let us know how you're doing after you've reduced to 30mg. As I said, the reduction will take about a week to have full effect. Please observe your symptom pattern each day and report here.

[Maze]

Hello @Altostrata,

Thank you so much. I already started last night with the 25 mg tablet and 5 mg liquid. The experiment did not start very well as I have had severe stomach pain, severe agitation, and insomnia during the night (I woke up four times from 12:30 am to 7 am). When I got up in the morning, I had a little less stomach pain, but the rest of the symptoms were the same. I also felt the tension in my jaw, shivering teeth, severe dizziness and brain fog. Also a lot of gases. I have gone swimming despite how exhausted I feel, and after 45 minutes of slow swimming the set of symptoms related to agitation have improved a bit, but severe brain fog, grogginess and severe dizziness continue until now (12 pm). I feel quite destabilized. I will write in a list format for hours and days all this as you have requested Alto.

So, just to clarify, if I can I will keep this 30 mg dose for a week, and if it works I will keep on it for a month, right? And during this month, I make a gradual change from tablet to liquid as I mentioned (i.e. first week: 25 mg tablet-5 mg liquid; second week: 12.5 mg tablet-17.5 mg liquid; third week: 30 liquid) or maybe it is better not to add more amount of liquid for a month?.

To be honest and seeing my body's reaction this night, I have doubts that I can tolerate the 30 mg every day this week, but I suppose I should try despite the symptoms, right? Or if it is very complicated because I cannot tolerate it due to sensitization (kindling), should it drop to 25 mg or less?.

Thanks for the support and help in difficult times,

Warmly,
Carlos

[Altostrata]

11 hours ago, Maze said:

The experiment did not start very well as I have had severe stomach pain, severe agitation, and insomnia during the night

 

What time o'clock did you take sertraline and when did these symptoms emerge?

 

Is this the usual time you have taken sertaline?

 

Please note that you have changed dosage form after a period of skipping 37.5mg sertaline doses, which can also cause bad symptoms. It will take some days before your dosage reaches steady-state at 30mg per day.

 

As noted earlier, my guess is you will find 30mg sertraline also to be too high a dose.

[Maze]

Hello @Altostrata,

Thanks for writing. I preferred to wait and be patient until Monday to answer to see how the situation evolved. I have some interesting news.

First of all, answering your questions, I have been taking sertraline for 8 years at night before sleeping. I usually have taken it was 11:30 pm-12 am. In the beginning, I took it in the morning, but as the adverse effects appeared every time I took it, I  started to take sertraline at night. The symptoms described (i.e. Akathisia, upset stomach, etc.) have always appeared shortly after taking the pill and continue in the morning (until 3 pm approx.). That has been the pattern and since it was intolerable I started to take the sertraline every other day. It was almost at the beginning of the reinstallation of the 50 mg sertraline eight years ago.

Regarding the interesting news, I have to share something that I am experimenting with surprise and anger. As I mentioned last Thursday night, I started taking sertraline every day (25 mg tablet, 5 mg liquid). On Friday, I wrote that the experiment did not begin well since I felt all the typical adverse symptoms that I feel when taking sertraline every day. Therefore, I was afraid to take it every day because maybe 30 mg was a very high dose (as you suggest Alto). Then, something remarkable has happened and it makes me feel confused. I will try to explain it. From Friday night to Saturday morning, I decided to take sertraline 25 mg tablet - 5 mg liquid, but I decided to take 25 mg from the brand Kern Pharma instead of Cinfa brand. To mention that when I started taking sertraline 11 years ago I started taking Kern Pharma, and I never had any side effects. After the CT, in the reinstatement of 50 mg (3 months later), the pharmacy gave me the Cinfa brand. I started to feel the adverse effects, but never associated that they were brand-related. I asked the pharmacist, my psychiatrist, and my mother (What is GP), and they all told me that all sertraline generics were the same. According to them, there was no difference, so I didn't care. However,  I decided to change a few days from Cinfa to Kern Pharma, and the symptoms of akathisia,  intense dizziness, etc. were much more minor or almost non-existent. But instead of these symptoms after a few days I began to feel withdrawal symptoms (i.e. Extreme weakness, dizziness). Therefore, I felts that taking Kern Pharma I was not taking the medication and something was wrong. I felt like it didn't have an effect. Cinfa was generating a lot of strength, but also all the adverse side effects described. So ... I went back to taking Cinfa, the side effects returned, and my withdrawal symptoms went away (weakness, drowsiness, sleepiness, fatigue, etc.). From that moment on, I have always continued with Cinfa, tolerating it as best I could (i.e., skipping doses). Until this Saturday, that moving by curiosity, I switched to Kern Pharma. And...I was able to sleep, not insomnia, I got up without akathisia, with less agitation. No typical adverse symptoms. I didn't understand it very well, so from Saturday night to Sunday morning I retook Kern Pharma and the same thing happened. Also today. Insomnia is gone, akathisia is gone. I can not believe it. However, instead of feeling agitation, etc., I feel weak, tired, with extreme fatigue. It looks more like a withdrawal symptom.

So I have asked myself, could it be that I have never tolerated Cinfa sertraline and I have been taking it for 8 years? Could it be that not all brands are the same? I can not believe it. I did a brief research and I have discovered that many people have experienced the same.

Examples:
-1) https://www.latimes.com/archives/la-xpm-2007-dec-17-oe-wax17-story.html
-2) https://www.google.com/search?q=can+different+brands+of+sertraline+cause+different+side+effects+site:patient.info&rlz=1CDGOYI_enES847ES847&hl=es&prmd=isnxv&sxsrf=AOaemvIMk-2bdD2zu5gTKqEas-tYUATqRQ:1630740516134&sa=X&ved=2ahUKEwi_8bzp5eTyAhX0BWMBHeo4BSAQrQIoBHoECAMQBQ&biw=414&bih=720&dpr=2
-3) https://www.peoplespharmacy.com/articles/generic-sertraline-zoloft-problems-lead-to-anxiety-and-panic

So from Friday until now, I have been feeling less adverse effects from sertraline Kern Pharma. Instead, I am feeling more effects of drowsiness, fatigue, weakness, which had already appeared at some point in the last few years when I have tried to reduce quickly from 50 mg to 25 mg. But they are very different from akathisia, agitation, etc., very different from the classic symptoms after taking Cinfa every two days or every day.

So ... I am surprised. Now I guess I have to stabilize at 30 mg with Kern Pharma (i.e., 25 mg tablet Kern Pharma-generic and 5 mg liquid Besitran-Pfizer-original brand). I feel it may be a good option to hold on in this regime to see what happens in the next few weeks. I suppose it is better not to increase the dose and tolerate this fatigue, weakness, etc., isn't it?

On the other hand, as you requested Alto, below you can find the schedules of the last days since I started taking 30 mg.

Thank you very much for the help. I feel much more secure with your help.

Warmly,

Maze.

__________________

 

Daily log

 

September 4

 

12 am. 25mg tablet (Cinfa brand) and 5mg liquid (Besitran) = 30 mg

1:00 am. stomach pain, swollen belly

3 am. Insomnia. Difficulty sleeping. Agitation. Stomachache

5:30 am. Insomnia. Difficulty sleeping. Agitation. Stomachache

7:45 am. Wake up. Akathisia). Hot. Stomach pain and bloating. Dizziness. Tension. Shivering in the teeth.

Generalized feeling of significant discomfort, restlessness, agitation and dizziness. Tough night.

8:00 am. breakfast

8:15 am. diarrhea

8:30. Swimming. I can swim, but I don't have much energy. By swimming 45 minutes slow, I feel less agitated, less Akathisia. However, the general grogginess, dizziness, and malaise persist. I don't feel like myself.

11:00 am. Dizziness and malaise continue—less agitation, but stunning.

1 pm. Dizziness and malaise continue. Drowsiness and difficulty holding attention. Lack of energy. Depersonalization.

2:30 pm. I feel a little better. I'm still dizzy but more tolerable—lack of energy.

2:40 pm. Lunch.

3:15 pm. Nap. I notice my body agitated and with difficulty sleeping—restless body.

4:00 am. The dizziness continues.

5:00 am. Continuous dizziness.

8:00 am - 12 am: dizziness dissipates and I feel better

12 am. 25mg tablet (Kern Pharma brand) and 5mg liquid (Besitran) = 30 mg

 

September 5

 

12 am - 7 am. Better sleep throughout the night. Somewhat stirring but gentle.

7:30 am. I wake up with less Akathisia and less brain fog. No diarrhea. However, I feel more weak, tired. Fewer classic symptoms of effect with Cinfa (i.e., less akathisia, agitation, dizziness, tension, grogginess, malaise, diarrhea, stomach pain)

7:30 - 11 am. Weakness, fatigue persists. Less hyperactive

11:00 am - 9:00 pm. I go out with friends and we are sitting in a bar. We sit around during the day. A feeling of weakness and fatigue increases. Also certain anhedonia.

11:00 pm. 25mg tablet (Kern pharma brand) and 5mg liquid (Besitran) = 30 mg

 

September 6

 

12 am - 7 am. Sleep without waking up. No insomnia.

7:30 am. Some nervousness, agitation and heat when waking up but much less than with Cinfa. In contrast, I notice more fatigue.

8:00 am - 1:00 pm. Fatigue, weakness, extreme fatigue, anhedonia progresses throughout the hours (they are increasing). * I feel as if with Kern Pharma I have no dose in the body of sertraline. I feel as if with Cinfa my energy was very hyperactive and agitated and with Kern Pharma I was more depressed.

* They resemble the symptoms of when you lower to 25 mg with Cinfa after 19 days of withdrawal (before doing the reinstallation). It is felt like a depressed mood.

2:30 pm. Intense dizziness and weakness.

6 pm. severe dizziness and weakness

8 pm. dizziness but more manageable

9 pm. stability

11:30 pm. 25 mg tablet (Kern pharma brand) and 5 mg liquid (Besitran) = 30 mg

 

September 7

 

7:30 am. Wake up. No akathisia and very little dizziness. Tiredness, strange bodily sensations like weakness, some tingling in the body, not strength. I sleep well but do not regain energy—difficulty breathing. I am feeling that I could continue sleeping.

Central symptom: tiredness, weakness and feel a strange body. Certain anhedonia.

8:30 am. swim

9:30 am. Feeling of drowsiness and slight dizziness continues. Not Akathisia. More weakness.

11:30 am.  Feeling of tiredness and weakness continues, but something better. Some anxiety too. More manageable.

[Altostrata]

9 hours ago, Maze said:

The symptoms described (i.e. Akathisia, upset stomach, etc.) have always appeared shortly after taking the pill and continue in the morning (until 3 pm approx.).

 

This indicates you have always been taking a dosage that's too high, and that sertraline is activating for you.

 

9 hours ago, Maze said:

But instead of these symptoms after a few days I began to feel withdrawal symptoms (i.e. Extreme weakness, dizziness).

 

These are not withdrawal symptoms. These symptoms are the effect of the drug on you. You feel them throughout the day. They also may indicate too-high a dose. 

 

You have been misinterpreting your symptoms for 11 years.

 

It is impossible to identify a brand effect from your experiment. The variations might be ups and downs from reinstatement. However, if you feel more comfortable with a certain brand, by all means, take it if you can get it.

 

If the drug causes activation when you're trying to sleep, you might move it earlier by an hour each day until it does not affect your sleep.

[Maze]

Dear @Altostrata,

 

Thanks for your answer. I have waited a week to answer. I wanted to figure out how I felt on 30 mg.

 

I've been with 30 mg for 9 days (25 mg tablet + 5 mg liquid). During this week, I have felt that the drug was becoming more and more powerful. I've been thinking about your interpretation of my symptom pattern and I feel like it makes sense. It is possible that I have been taking a very high dose for me many years (50 mg sertraline at night) and that is why I woke up with akathisia, brain fog, stomach pain, which lasted until about 3 pm. approx., and then I was tired, sleepy, and lethargic. During the last 9 days with 30 mg, my pattern of symptoms has been a little different. Akathisia has been less strong, although it is a bit present in the mornings. However,  I feel much more lazy, sleepy, drowsy, weak, dizzy, emotionally labile, and mentally foggy throughout the day. In general, throughout the day, a pattern of low energy, more drowsiness and dizziness, and more depression has been established. I am having a hard time working in this state as I feel drained of energy and cognitively poor.

At this point, I wonder how to continue. So I have several questions if you can help me.

First of all, Alto, if I understood you correctly, you suggested that my symptoms may be caused by a too high-dose and that perhaps I would have to stabilize at 25 mg or even below 25 mg. Do you still consider that this is an interesting option? I am afraid to go down to 25 mg and feeling disabled for my daily activities. What do you think?. Perhaps a dose of 30 mg could it causing all the weakness-related symptoms and diminishing this amount would decrease these symptoms?. On previous occasions, when I quick taper from 50 mg to 25 mg a pattern of symptoms related to the weakness appeared. However, If I understood you, you don't think they are withdrawal symptoms ...

Second, I am figuring out how to stop taking tablet and liquid and take all in a liquid form. Currently, I have a 50 mg tablet that I break in half (25 mg), plus five of liquid. What is the best way to turn everything into liquid? In a previous publication, I suggested this formula: first week: 25 mg tablet-5 mg liquid; second week: 12.5 mg tablet-17.5 mg liquid; third week: 30 liquid. However, it seems that cutting 1/4 of the tablet with precision may be difficult.  Probably I will not be accurate. I can easily split it in half, but splitting 1/4 of the pill seems more difficult. Therefore, any suggestions on how to change entirely to liquid form? Could  I destabilize myself by a change directly to liquid form from my actual regime?

Thank you very much for your support.

Warmly,

Maze

 

[Altostrata]

Many people feel drowsy and enervated from sertraline.

 

Adverse effects tend to be dosage-related. Taking a lower dose of sertraline will decrease the activation you feel from it after you take it and the fatigue effect during the day. You may wish to reduce to 25mg and see if you feel better.

 

As you are taking 25mg tablet and 5mg liquid, there is no reason to switch to all-liquid now, you'd decrease by the 5mg you're taking in liquid to 25mg.

[Maze]

Dear @Altostrata,

an update of my state after 9 intense days. Following your recommendation on September 13, I reduced my dose last (30 mg). However, I preferred to be a bit more conservative and taper to 27.5mg. As I told you, I am afraid to go down to 25 mg since the last time I taper to 25 mg from 50 mg (where I had been skipping doses for eight years as I mentioned above) I began to have symptoms that were very difficult to tolerate and very disabling. So I tapered slowly to 27.5mg.

Previous adverse effects were reduced. Akathisia and palpitations were reduced. Dizziness as well and extreme fatigue was also somewhat reduced. However, from September 13 in night (taper from 30 mg to 27.5 mg) until yesterday (September 21 at night), I felt how the effect of sertraline increases in power and other adverse effects appeared. I was better on September 17 and 18, but since September 19 I began to feel a high pressure in my head. Also a lot of heat in my head (frontal zone and right ear). And yesterday I had extreme pressure in my head all day. So, I felt again that I could not tolerate that amount (27.5 mg). Although the dizziness and akathisia had improved, this increasing pressure in my head together with extreme fatigue around 1 p.m. (an example day attached below: September 21) has made me think that I was again experimenting the sertraline sensitization effects. So, being brave last night I decided to taper from 27.5 mg to 26.2 mg. I have woke up with a different symptom pattern. A milder head pressure, mild akathisia, increase dizziness (similar dizziness I had felt when I taper from 30 mg to 27.5), a feeling of unreality, and brain fog. I also feel like I have cognitive problems as if my processing is slower. I cannot think clearly and I feel fragile.

The reason for not tapering to 25mg directly is that it scares me. My current feeling is that I clearly cannot tolerate sertraline, my system is sensitized to it, but if I taper too much I guess withdrawal symptoms may appear and I may not be not functional at all on a day-to-day basis. Looking at my story with perspective, I feel that I have been sensitized to the drug since I reinstalled 50 mg eight and a half years ago (and that is why I had to skip doses to tolerate it). Also, I have become even more sensitized when I taper to 25 mg from 50 mg. And I felt withdrawal during 20 days, I scared and increased to 37.5 mg. Since then I have been destabilized, I had all the symptoms describe and cognitive problems. So, I am trying to reduce to tolerate sertraline every day (not skipping dosis) and stabilize on a stable dose. But every time I try to stabilize on a new dose, as the days go by (approximately 5 days), I find that my nervous system does not tolerate that dose well. I'm feeling afraid that I won't be able to stabilize on an amount and may stablish there because of the sensitization problem, and at the same time, I have to keep taper and entering probably in a withdrawal process.

What do you think?. Any suggestions?.

I have started to do sports every day in the morning and I feel that it helps me (i.e., 3 days swimming and 4 days exercise bike). After doing so I feel better and the adverse effects are slightly more tolerable.

I appreciated a lot the help that you and the rest of the moderators and people provided in SA,
Warmly,
Maze
_________

September 21 (yesterday)

General condition: tiredness, cognitive difficulties, high pressure in my head

8:00: pressure in the head. Feeling hot head and pressure behind the eyes. It's not brain fog; it's more pressure. It is not akathisia. It's more like pressure and burning.
8:15: breakfast
9:00: exercise bike.
10:00: same pressure on the head.
10:00 - 13:00: head pressure
13:00-14: 00: exhausted. Sleep, need to sleep. Drowsiness, lethargy. Dizziness. Less pressure on the head than during the morning. Pressure on the jaw, fatigue and tiredness.
14:00: lunch
14:30: nap
15:30: diarrhea. Tiredness. Dizziness. Head pressure
15: 30- 21: 00: Head pressure and burning in the forehead and right ear.
10pm: Flu-feeling. Shaking chills.
23:00: taper to 36.2 mg 

 

 

 

 

 

[Altostrata]

Since you've been erratically dosing since 2012, it's likely your nervous system will be sensitive to any kind of drug change. Those effects from a small dosage reduction may last a few days. They should settle out over a week or so. What can you do to cope with them?

[Maze]

Dear @Altostrata,

Thanks for your quick response. Answering your question, I am coping with the process with mindfulness, cardiovascular exercise (swimming and cycling), social support, and trying to continue with my diary work. I also started a psychotherapeutic process.

I understand that due to my erratic dose since 2012 I have sensitized my nervous system and now I am sensitive to every change. My fear is that I feel trapped. I will try to explain myself better. On the one hand, every day that I take sertraline I have adverse effects and I am afraid that I may be damaging my nervous system every time I take it. On the other hand, if I continue tapering the dose further to minimize the adverse effects of sensitization, I may feel a withdrawal process (as I experienced when I taper from 50 to 25 mg a month and a half ago). Since I started taking sertraline every day instead of every other day, I have not been able to tolerate it well. Neither 37.5 mg, nor 30mg, nor 27.5 mg. I felt sertraline is toxic for me. Now I'm on 26.2mg and I feel a little better, but it's only been three days. Usually, the previous doses have started to hurt me after 5-8 days. That is why I am trying to get to 25mg, trusting that I will tolerate the adverse effects of sensitization and settle down to this amount for a few months before tapering off. I fear that I may not be able to tolerate the adverse effects due to sensitization at any dose close to 25 mg and have to taper too fast, thus starting to suffer from withdrawal symptoms. Do you understand what I mean? Hopefully, I am explaining well.  I would like to know how to proceed in the best possible way to minimize my daily suffering and reduce the damage to my nervous system. Repeating a pattern of adverse effects every time I take sertraline is quite exasperating and I do not know if my nervous sistem could have a long-term damage because sertraline.

As I said, I am now on 26.2mg (last three days) and feel better than 27.5mg. I have similar adverse symptoms but less intense than with 30mg and 27.5mg. When I wake up, the symptoms related to agitation, dizziness and brain fog are more intense; at noon and in the afternoon, the symptoms related to fatigue are more intense, and at night all the symptoms generally subside. Cognitive symptoms improve as the day progresses (ex., fewer problems concentrating).

Thanks again and sorry for the inconvenience,
Warmly,
Maze

 

 

 

 

 

 

 

[Altostrata]

8 hours ago, Maze said:

My fear is that I feel trapped. I will try to explain myself better. On the one hand, every day that I take sertraline I have adverse effects and I am afraid that I may be damaging my nervous system every time I take it. On the other hand, if I continue tapering the dose further to minimize the adverse effects of sensitization, I may feel a withdrawal process

 

You are adding worry to your drug-related problems. This is not a withdrawal symptom but a habit of mind. Only you can manage this, we can't make this go away.

 

Most likely, your withdrawal from sertraline will be a long process, potentially with setbacks along the way. You're going to need to accept that there will be difficulties. But we will assist as much as we can, to avoid difficulties.

 

 

[Maze]

Dear @Altostrata,

 

I appreciate your assertiveness, sincerity and willingness to help. I will work on my mental habits and the acceptance process.

 

Thank you,
Maze.

[Altostrata]

You're welcome, @Maze Just about everyone goes through this phase to some extent. Unfortunately, going off these drugs is difficult in ways we don't expect.

[Maze]

Dear @Altostrata,

An update of my situation. Also, one question.

Last night I decided to taper to 25mg. I've felt better at 26.2mg from September 22 to October 1, but again the drug gained more strength as the days passed. I had pretty adverse effects last four days. On Saturday, Sunday and Monday I felt pretty bad. I felt cognitive problems in addition to fatigue, dizziness, and drowsiness. I found it difficult to read and match some ideas in the text with others and had difficulties retaining information in my mind. Therefore, given the adverse effects, last night I decreased to 25 mg tablet and today my mind is somewhat more lucid. I feel destabilized, but it's normal. I'm getting used to the constant difficulties. I have to wait a few days as in the last reductions.

My question is ... now that I am taking 25mg tablet, if I really can't stabilize at this dose and I still have adverse effects because of my sensitization reaction to sertraline, I guess I will have to taper a bit more. However, I am not sure how to reduce further.

One option is to switch to liquid form, but I have read that perhaps it is not positive to change straight. So it is difficult for me to split the 50 mg tablet into four same portions (in my country, there are no 25 mg tablets and my 50 mg tablet is not circular). I guess that a good option would be to take 12.5 mg of tablet and 12.5 mg of liquid, but it is challenging to cut 12.5 mg of tablet precisely. I bought a Gemini-20 from the United States but still feel unsure how to accurately measure 12.5 mg tablet, even check-in that the weighing machine is quite precise. Any suggestions on which may be the best option for the subsequent reduction?

Thankful for the help,
Maze

 

 

[Altostrata]

You are splitting a 50mg tablet? How have you been measuring your decreases so far?

 

See Tips for tapering off sertraline (Zoloft)

[Maze]

Hi @Altostrata

I have been cutting a 50 mg tablet in half (i.e., 25 mg) and supplementing it with a liquid formulation. For example, 25 mg tablet + 1.2 mg liquid. However, I have reached 25 mg and am only taking the tablet without liquid. In this way, I have reduced from 30 mg to 25 mg, going through 27.5 mg and 26.2 mg. But now, to continue reducing from 25 mg, I do not know which is the best method.

I have read the tips to reduce Zoloft that you have sent me. It is difficult for me to understand how to reduce by making the liquid itself or turning the tablets into powder and making the gelatin capsules themselves. So, I still have the same doubt, to know if it is possible to change to a liquid form (liquid manufacturer form). I guess that changing to a liquid form will be the easier form. As I put above, this is my question:

"One option is to switch to liquid form, but I have read that perhaps it is not positive to change directly from tablet to liquid (i.e. 25 mg tablet to 25 mg liquid). I guess that a good option would be to take 12.5 mg of tablet and 12.5 mg of liquid at a first step, but it is challenging to cut 12.5 mg of a tablet precisely. I bought a Gemini-20 from the United States but still feel unsure how to accurately measure 12.5 mg tablet, even checking that the weighing machine is quite precise. Any suggestions on which may be the best option for the subsequent reduction? ".

Sorry for the inconvenience,
Maze

[Altostrata]

Can you quarter your 50mg tablet and top up the 12.5mg with 12.5mg in liquid form?

[Maze]

@Altostrata,

 

As you can see in the photo uploaded (50 mg tablet), I can easily split the 50 mg tablet into 25 mg (split half).

But how can I accurately split 12.5 mg?

If I take 1/4 of the pill, does the active component (i.e., molecule) in that quarter of a tablet have 12.5 mg? The sertraline molecule is evenly distributed throughout the tablet, and then if I cut 1/4 it corresponds to 12.5 mg?. In that case, I could split 12,5 mg and top up with 12,5 mg liquid.

How long would you recommend I have to take 12.5 mg tablet and 12.5 liquid before switching to all liquid?

I keep taking 25 mg at night every day and I still have quite a few adverse effects overnight and the next morning-afternoon. Among other difficulties, I experience cognitive difficulties and cannot easily organize, plan, perform complex tasks or write as I used to do. I feel a damage concerning executive function. I feel blocked. At night, I feel better, less blocked, and more agile mentally, but then I take the tablet before I go to sleep and the cycle repeats during night and the next day...Maybe the dose is still high...

Anyway, I am working on accepting this situation, but it is very difficult. Recurrently, I have thoughts about whether my brain has been damaged, and I'm not going to regain cognitive function like it used to be. Maybe it is just a terrible thought and it is not true, but I am not sure. Normally I have not felt insecure about my abilities but this situation is making me doubt. I feel my cognitive ability is totally different from how it has usually been. When I was skipping doses of sertraline in the past during the las 8 years, the days that I took it at night I found that the next day I had some cognitive problems, but they were not so disabling, and approximately at 2-3 pm they decreased. Now they are more severe and stable throughout the day. It feels very strange because 4 months ago I was able to write a doctoral thesis and defend it in court for 3 hours and now I have a hard time planning, writing ... never before in my life have I felt so cognitively slow and blocked. I feel that the adverse effect of sertraline, especially brain fog, makes me unable to do these types of tasks and now it is stronger than when I was skipping doses. Does it usually recover over time?. I guess it is like that, but a little bit of knowledge and hope could help to manage my thoughts relating to "the brain-cognitive permanent damage".  Also, I guess that I need to totally reduced sertraline because this cognitive damage every day seems to be an adverse reaction to the drug. Is it makes sense? Who knows...

 

Wishing everyone a good day.

Warmly,
Maze

[Altostrata]

16 hours ago, Maze said:

I keep taking 25 mg at night every day and I still have quite a few adverse effects overnight and the next morning-afternoon.

 

Do you feel dopey in the morning after taking sertraline? Does it make you sleepy after you take it?

 

You can cut your tablet in half at the score across its waist. Then you can the half lengthwise or through the side. That will give you 1/4 tablet.

 

You cannot make gelatin capsules, you purchase them at an herbal store or a vitamin store. 

 

I would take the 1/4 tablet with the rest in liquid for at least a week. Please let us know how you're doing.
 

 

[Maze]

@Altostrata,
 

13 hours ago, Altostrata said:

I would take the 1/4 tablet with the rest in liquid for at least a week.

Okay, I'll keep the 25 mg tablet a little longer. After this, I will follow the plan you suggest. Thanks.
 

13 hours ago, Altostrata said:

Do you feel dopey in the morning after taking sertraline? Does it make you sleepy after you take it?

I am currently on 25 mg and I take it at night every day (11 pm approx.). I began to take it on Monday night because I switched from 26.2mg to 25mg. The cycle of symptoms after taking 25mg is as follows. I take the tablet at night, and in the morning when I wake up, I feel more agitation, heat in my head and pressure in my head and jaw. I also feel severe brain fog and cognitive problems (as you say, I feel dopey). I feel that I am not able to concentrate easily, and to think and read correctly. I need to make an extreme effort to do that. As the day goes by, the difficulties diminish but do not stop totally until the night (around 9-10 pm I feel more mentally agile and less blocked). Also, from about 2 pm to 9 pm, I feel more fatigue and drowsiness emerges (I yawn a lot). Being active daily costs me much more than usual when I was taking 50 mg every other day. Also, when I try to do a complex task my head and ears get hot as if I was making an extra effort. It is strange.

I am sleeping ok (6-8 hours), although I have a lighter sleep than before. As I am more agitated, if there is any noise during the night, I wake up more quickly (sometimes I experience restless legs when I wake up at 2-3-4 am).

To put my symptoms in context, when I took 50 mg sertraline every other day (8 years), I always took it at night. The following mornings I always felt agitation (akathisia), brain fog and cognitive problems. The agitation I am experimenting now on 25mg each day is less severe, but the brain fog and cognitive issues are more severe. I have never had difficulties reading, understanding, planning etc. I was normally very lucid. Since I dropped to 25 mg, and mainly since I reinstalled 37.5 mg (kindling), I began to feel these more severe cognitive problems, brain fog, dizziness and drowsiness throughout the day. Last month I tapered from 37.5 to 30mg, from 30 to 27.5mg, from 27.5 to 26.2mg, and from 26.2 to 25mg to try to stabilize in some doses, but it is not totally happening. I feel that the agitation is less and less, but the cognitive problems, drowsiness, dizziness, change subtly but remain in the pattern that I mentioned above. Also, sometimes I have a strange vision (derealization), mainly the days after reducing the dose. As you can feel, the cognitive problems worried to me a lot since I never felt so blocked, groggy and slow as I explained in the previous message. I copy and paste here:

 

On 10/7/2021 at 1:00 PM, Maze said:

Anyway, I am working on accepting this situation, but it is very difficult. Recurrently, I have thoughts about whether my brain has been damaged, and I'm not going to regain cognitive function like it used to be. Maybe it is just a terrible thought and it is not true, but I am not sure. Normally I have not felt insecure about my abilities but this situation is making me doubt. I feel my cognitive ability is totally different from how it has usually been. When I was skipping doses of sertraline in the past during the las 8 years, the days that I took it at night I found that the next day I had some cognitive problems, but they were not so disabling, and approximately at 2-3 pm they decreased. Now they are more severe and stable throughout the day. It feels very strange because 4 months ago I was able to write a doctoral thesis and defend it in court for 3 hours and now I have a hard time planning, writing ... never before in my life have I felt so cognitively slow and blocked. I feel that the adverse effect of sertraline, especially brain fog, makes me unable to do these types of tasks and now it is stronger than when I was skipping doses. Does it usually recover over time?. I guess it is like that, but a little bit of knowledge and hope could help to manage my thoughts relating to "the brain-cognitive permanent damage".  Also, I guess that I need to totally reduced sertraline because this cognitive damage every day seems to be an adverse reaction to the drug. Is it makes sense? Who knows...

 

So... I don't know if these adverse effects could explain because my body is very sensitized to sertraline and 25 mg is still too high. My feeling is that since I reinstated to 37,5 mg, increasing up from 25mg when I was experiencing withdrawal, the adverse effects that I experienced for 8 years taking 50mg sertraline have increased their power. They are similar, but they are more powerful and disabling now.

 

By the way, I didn't know the meaning of dopey, I had to translate it into Spanish, but it fits my state quite a bit.

 

Thanks,
Maze

[Altostrata]

Yes, it's possible 25mg is still too much for you. As you have seen, adverse effects reduced as the dosage reduced. This probably will continue to happen, but you have to reduce very carefully.

 

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. Magnesium in particular can be good for so-called restless legs -- also stretching before bed.

[Maze]

Thanks @Altostrata, 

 

16 hours ago, Altostrata said:

Many people find fish oil and magnesium supplements helpful,

 

I will read the info about omega 3 and magnesium carefully. I have never taken supplements throughout my life. Thanks for the suggestion.
 

16 hours ago, Altostrata said:

Yes, it's possible 25mg is still too much for you. As you have seen, adverse effects reduced as the dosage reduced. This probably will continue to happen, but you have to reduce very carefully.

Yes, it seems that the adverse effects are progressively reduced as I reduce (except for the cognitive problems). So I would like to find a tolerable dose to settle down on it and let my nervous system rests (if it is possible). I would like to know what exactly you are thinking about when you say: "but you have to reduce very carefully". Reduce more slowly than 10% every four weeks? 5%?. Listening to the body carefully and trusting it?. Just to clarify.
 

Wishing you a happy weekend,
Maze

[Altostrata]

Most people can tolerate 10% reductions per month, with reductions calculated on the last dosage -- the amount of reduction keeps getting smaller.

 

You have to see if this causes withdrawal symptoms over the month. If it does, you need a smaller amount of reduction.

 

You are taking sertraline at night. At higher dosages, it caused symptoms of activation, which may have affected your sleep:

On 9/6/2021 at 3:44 AM, Maze said:

The symptoms described (i.e. Akathisia, upset stomach, etc.) have always appeared shortly after taking the pill and continue in the morning (until 3 pm approx.)

 

You are now taking a lower dose. You may have less activation and adverse effects the next day, but it still could be affecting your sleep. If I were you, I would gradually move your sertraline dose earlier by 1 hour each day until you are taking it at 5 p.m., and see if that helps you sleep.

 

Make this change after you've settled on a new tablet-liquid combination. It's best to make only one change at a time.

[Maze]

Dear @Altostrata and SA community,

 

I haven't posted around here for about 20 days. I would like to do an update.

 

I am currently on 23.10 mg of Sertraline (when I weigh the tablet in a Gemini-20, it indicates 0.073 g or 73 mg). From October 5 to October 19 I was on 25 mg tablet and from October 19 until today (October 31) I have been on 23.1mg. I have been trying to maintain stability on a dose for more than 10-14 days, but I start to think that it is not possible. I would like to stabilize on a dose for a month and then continue reducing according to the 10% rule but it is not possible.

 

The reason is that I always experiment the same pattern. I reduce to one dose, I have two or three days of destabilization symptoms (withdrawal symptoms such as crying, dizziness, derealization, some akathisia, snapping teeth, breathing difficulties, muscle pain) and then I begin to be somewhat more "stable". However, around the tenth or eleventh day, I begin to feel more tired, dopey and increased pressure on my head and jaw, brain fog, and I perceive that I have more cognitive problems (less attention, cannot think clearly, difficulties for me to maintain ideas in the head, etc.). I feel less troubled for conversation activities, but I feel cognitively impaired for reading, writing, and relating ideas (e.g., working on the computer). These symptoms grow from days 10 to 14 and I begin to feel that they are intolerable. So, listening to my body to this adverse reaction, I reduce the dose. And when I reduce the dose I have two or three days of destabilization symptoms (withdrawal symptoms such as crying, dizziness, derealization, some akathisia, snapping teeth) and then I start to be somewhat more "stable". The cognitive problems improve a lot and I feel more stable and capable on a day-to-day basis. Until the same pattern happens to me again 10-14 days later. So this has been the pattern from 30 mg to 23.1 mg, as you can read in my signature. Now at 23.1 I have been 12 days and for 2 days I have started to feel the most substantial adverse effects. I am thinking of reducing to 22 mg (69.5 mg approx the weight in the Gemini-20).

 

I begin to think that I will not be able to stabilize in any dose and have to listen to my body and reduce when the adverse effects are already strong. My system does not tolerate sertraline well anymore, it is very sensitized to it. It is true that the diary adverse effects have been reduced as I have been reducing it. At 30 mg they were stronger than at 27.5, at 27.5 than at 26.2, at 26.2 than at 25, and at 25 than at 23.1 mg. I was hoping to stabilize longer at 23.1 but I'm afraid it won't be possible.

 

On the other hand, I am calmer, less desperate. I am accepting the process much better. I support myself with social support, therapy, sports, and working as much as possible. Sometimes I feel hopeless, but in general I try not to get hooked and keep going as best as possible. I have also learned to handle all forms of tapering, just in case, it is better to use one or the other in the process (i.e., reduction with liquid and reduction by crushing the tablets, weighing and using gelatin capsules).

 

I have a pending account that is trying to switch to liquid, but it scares me. In particular, I am afraid of being destabilized by the change. My next step will be to reduce to 22 mg (66.5 mg approx. weight in the Gemini-20) and mix 12.5 mg of tablet and 9.5 mg of liquid in this dose. I wanted to stabilize myself first with a tablet before switching to liquid, but I don't think it will be possible. I guess I'll change to liquid on my following reduction taking the risk. I don't know why the switch to liquid scares me, but I think taper using liquid is better since the method I'm using now of filing the tablet is not the most accurate. I am splitting the 50mg tablet in half, and then with 25mg tablet (80mg on the Gemini-20), I file the tablet until the dose I want to take it. I use a file and it works, but it is not very accurate. It is more accurate with liquid or by crushing the tablet and using gelatin capsules. But as I say, this change gives me respect.

 

That is all for now. I am trying to keep my job, keep busy, be more self-compassionate and less self-demanding and learn to manage all the sensations as best as possible and survive the day-to-day. I am learning to survive with this condition and remain hopeful that there will be a better future by doing things right.

 

Thank you very much for all the help,

 

Warmly,
Maze

[Altostrata]

It sounds to me like you are reducing too fast and getting waves of withdrawal symptoms that build on each other every time you reduce and get progressively worse. 

 

It might be a good idea for you to stop changing your dose and simply stay at one accurately measured dose, such as 23mg, for some months, maybe 6 months or more. You have been beating up your nervous system with almost continual dosage changes, including long periods of skipping doses, for 8 years. This can be wearing on your poor nervous system. It's not made of rubber.

[Maze]

Dear @Altostrata,

 

Thanks for your quick response.

 

I'd like to do exactly what you say. However, my body continues to suffer from adverse reactions to sertraline. Every day that I take sertraline at night, I soon start to have adverse symptoms. It has been like this for the last 8 years (i.e., since the psychiatrist decided to reinstate to me 50 mg), and I manage the symptoms as I could during that time (i.e. taking an inconsistent dosing since the psychiatrist said I had to take sertraline for life even if it had secondary effects). Also, the adverse reaction worsened when I reduced to 25 mg, the abstinence began, and after 20 days, I decided to reinstate 37.5. At four days on 37.5mg, I could not tolerate sertraline in any way. It seems my system got even more sensitized by reinstalling 37 in the midst of withdrawal. This is when I decided to write in SA. You recommended that I start by reducing to 30, suggesting that I most likely needed a little less than 25 mg. And I think you were right. Since I reduced to something less than 25 mg, I have felt better. My cognitive problems and derealization were reduced, among other symptoms.

 

In fact, I have tried to be conservative in my reductions. I have reduced bit by bit from 30, instead of jumping straight from 30 to 25 or just under 25. I was reducing to 27.5, 26.2, 25 and 23.1 over the last two months. Even when the pattern I describe above has occurred, the overall adverse effects of sertraline have improved. From the point of view of abstinence, I am aware that the reduction has been rapid, but as you explained, it is evident that my system is sensitized to sertraline and does not tolerate it well. I don't think my nervous system can "breathe" taking sertraline every day. Instead, my nervous system takes the hit every time I take a dose at night. This can be seen by the activation symptoms that I have one or two hours after taking it, by the decreasing of these symptoms when I do cardiovascular sports in the morning, and by the symptoms remission throughout the day until reaching the night when I feel calmer, with a clearer mind and less brain fog. That is why, although doing it in the best possible way, but I need to taper sertraline. If I find a dose where the adverse effects allow me to stay longer, I will. I feel like I have to find a balance between the adverse effects of sensitization and the withdrawal effects. I understand what you say Alto, but hopefully, I will be able to explain myself correctly when writing (in a language that is not my native one).

 

10 hours ago, Altostrata said:

It sounds to me like you are reducing too fast and getting waves of withdrawal symptoms that build on each other every time you reduce and get progressively worse.

 

You suggest that I am reducing too fast and getting waves of withdrawal symptoms that build on each other every time I reduce and get progressively worse.  However, I have not worsened gradually in the last two months. I have been gradually improving as I have decreased from 30 to 23. Significantly I improved a lot when reducing to 25mg and from 25 to 23.1mg. The adverse effects became somewhat more manageable and my cognition was better. If I follow the same pattern, I understand that the adverse effects will improve even more by reducing doses. I'm not sure they are waves of withdrawal, I feel that they are adverse effects of the drug. Every time I reduce an amount, the drug's potency progressively increases as the days go by. It emerges the pattern I described above in detail. As I have been reducing from 30 to 23, the adverse effects have been better each time, and I have managed to stay longer in each dose without suffering so much. Above all, as I say, from 25 mg. So I think I have to continue reducing, even if it is a little faster for now than 10% per month.

 

If I manage to stabilize with less adverse effect at any dose, I will stay on it longer, as you suggest. This is what I wanted to do from the beginning because, as you recommend, it seems to be the best approach, but my intolerance to sertraline does not make it easy. I was taking sertraline for 8 years when I was feeling terrible. Believe me, if I could stay with a dose, I would.

 

I hope you understand what I am writing. If I can do anything to explain myself better, please let me know. For me, your help and the help of this forum have been invaluable, and I hope to continue having your support throughout this complicated process of withdrawal, which I would never wish even for my worst enemy.

 

After my answer, do you still think the same thing that you proposed in the last message?.

 

Thanks Alto for all your effort and your understanding,

 

Warmly,

Maze

 

[Altostrata]

Sorry, I may have misunderstood the symptoms you've reported.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

[Maze]

 

Dear @Altostrata,

 

Following your recommendation from the last message, I decided to take daily notes from November 1 at night until today. I have done it this way to have a broad view of how the process occurs from when I start a reduction until I begin to think to reduce again due to the complicated adverse effects of sertraline.

 

To provide a general context, the pattern that I experimented with sertraline has always been the same during the 8 years of intermittent dosing. I took the sertraline at night every other day. On the days that I took sertraline at night, I experienced severe akathisia and mental fog the following day, which approximately subsided around 3-4 pm if I had been practicing some sport in the morning (if not symptoms, could extend throughout the day). I was taking sertraline inconsistently to control these adverse effects, which started when the psychiatrist reinstated me four months after stopping sertraline (you can see this in my signature). Also, in this recent reduction attempt in which I am, I carried out a reinstallation from 25mg to 37.5mg after 19 days of withdrawal symptoms. That reinstallation caused a kindling reaction after 4-5 days. At that time, following your recommendation, I reduced it to 30 mg.

 

Since then, I have been managing the adverse effects as best I could, but I have never been able to stay on the same dose for more than 14 days (two weeks), so I have progressively reduced, as you can see in my signature. Now, I have been on 22.7 mg for precisely 14 days and it is the first time that I feel that my nervous system can tolerate the dose, even with a lot of adverse effects. In these progressive reductions from 30 mg to 22.7 mg the pattern has always been the same, but I feel better concerning the intensity of adverse effects. Adverse effects seem dosage-related; they reduced to the extent that I was reducing the dose. The first days after the reduction, withdrawal symptoms appear. I stabilize after 4-5 days (i.e., withdrawal symptoms seem to improve). Then the adverse effects remain due to my sensitization to sertraline. The first days after reduction are challenging since withdrawal symptoms are mixed with adverse effects. During the last decrease from 23.2 mg to 22.7 mg the pattern has been the same. I have registered it day by day, so it may be seen more clearly (see below daily notes).

 

Each time I reduce the dose, it emerges insomnia, severe akathisia, nerves, internal waves running through the body, heat, derealization, blurred vision, snapping of teeth and breathing difficulties. I feel pretty destabilized. These symptoms appear during the night after taking sertraline and last until about 10 am. Later, a pattern related to brain fog, fatigue, drowsiness, dopey-groggy, and dizziness begins. And these symptoms last most of the day. Specifically, the brain fog is reduced, and the drowsiness and tiredness remain. These symptoms generate cognitive problems with concentration, attention, retention of information, etc. At night, around 9-10 pm, I feel better, with more clarity and tranquility. I feel more normal. It feels like the side effect of the drug is not as strong or has even passed.

 

This pattern repeats itself consistently every day. However, approximately five days after the reduction begins, the activation symptoms pattern, which emerges after taking sertraline at night and is present when waking up in the morning, becomes less severe. The symptoms most related to brain fog-drowsiness-tiredness remain throughout the rest of the day until the night. The intensity of the symptoms can fluctuate, but in general, they are present and are pretty uncomfortable. I feel like I'm always sleepy and tired. It is difficult to work like this, although I try to accept it, not get frustrated and do what I can.

 

Since it is the first time I have been able to stay 14 days on the same dose (22.7 mg) despite the adverse effects, I think it would be positive to switch to liquid form to measure the dose more precisely. I am thinking of doing it now. I guess it is better to switch to liquid form before making the following reduction.

 

I am aware that I have been reducing faster than desirable, but honestly, the adverse effect I feel is very unpleasant. My system is sensitized to sertraline and does not tolerate it well. Doesn't it seem that this is what is happening? The pattern looks pretty consistent looking at the logs, doesn't it?

 

Therefore, should I last longer with each dose or taper a little faster due to drug sensitization? 5% every fourteen days? Do you think that I will be able to stay on a dose of sertraline with fewer adverse effects at some point so that I do not have to reduce it so quickly?

 

I hope I have explained myself better than on previous occasions.  Above all, I hope the daily notes help for a better understanding.

 

Thanks,

Warmly,

Maze

 

________________________

 

November 1

 

*11am. Sertraline: reduction from 23.2 mg to 22.7 mg.

 

November 2 (first day on 22.7 mg)

 

4:30 am. Insomnia. Akathisia. Nerves. Internal waves run through the body. Heat.

7 am. Akathisia. Nerves. Internal waves run through the body. Muscle pain and stomach pain. Snapping of teeth. Heat.

8 am. Breakfast

8:15. Go out into the street. Derealization. Blurry vision. Snapping of teeth. Mental fog.

8:30. Akathisia. Electric flow.

9:30. Breathing difficulties. Diarrhea.

10.00. Tiredness. Mental fog.

12:30 pm. Tired. A little groggy and head pressure. It remains but greatly diminishes nerves, akathisia, teeth snapping, and heat.

2:30 pm. A little groggy and pressure on the head. Dizziness. I feel better than in the morning.

3 pm. Nap.

4 pm. After the nap, the dizziness and tremors return a little. Dizziness. Mild tooth snapping. Mild motor difficulty writing.

5 pm. Heat. Nerves. Drowsiness. Heat in the front of the head (forehead)

6 pm. Tiredness. Drowsiness

7:30 pm. Drowsiness. A bit of heat in the head.

9 pm. I feel better. More stable.

10 pm. I feel better. More stable.

* 11:30 pm. Sertraline

 

November 3

 

5 am. Insomnia. Akathisia. Heat. Nerves. Snapping teeth. Stomach pain. Gases

7:30. Akathisia, heat. Nerves. Stomach pain. Gases. Snapping teeth.

8:00. Breath difficulties.

9:45 After swimming, akathisia improves. Shortness of breath, brain fog remains. A little derealization. Dopey.

10.00. Diarrhea.

10.30. Dopey. Mental fog. Derealization.

12:00 pm. Decreasing brain fog and derealization. They are still but they are decreasing. More tiredness and drowsiness emerge.

2 pm. Drowsiness, tiredness, grogginess.

4 pm to 7 pm. Drowsiness, tiredness, grogginess. It progressively decreases as the afternoon progresses.

9 pm. I feel better. More stable.

10 pm. Peace and clarity of mind.

* 11:30 pm. Sertraline

 

November 4

 

5 am. Insomnia, stomach pain, gas, akathisia.

7:30 am. Akathisia, Nerves. Internal waves run through the body. Snapping teeth. Dizziness. Gases

8:00. Breathing difficulties. Diarrhea.

9:15. Breathing difficulties. Mental fog. Dopey. Slight nausea

11:00. Brain fog, Dopey. Fewer nerves. A little tension in the jaw. Attentional difficulties.

12:30 pm. Dopey. Mental fog. Struggling to focus. Tiredness emerges.

2 pm. Tiredness. Drowsiness. Dizziness.

4 pm. Tiredness. Drowsiness.

5 pm. Drowsiness.

6:30 pm. Drowsiness.

9 pm. Calm, stable, mental clarity.

11:00 pm. Calm, stable, mental clarity.

* 11:30 pm. Sertraline

 

November 5

 

* Note: I feel that here the reduction begins to stabilize. However, I still have the adverse effects of drug sensitization. The first days after the reduction, it seems that both processes come together.

 

6:30 a.m. Insomnia. Akathisia, nerves, gas (all the symptoms when I wake up are a little milder than the previous three days. They are strong but are somewhat milder and progressively decrease).

8:00 am. Nerves. Mild internal agitation. Gases. Very slight pressure on the head. Some dizziness.

8:30. Swimming.

9:30. Mental fog. Slight derealization. Groggy. Dopey. Difficulty thinking. Akathisia and internal agitation disappear.

11:00. Mental fog.

13.00. Drowsiness and fatigue but better than previous days. Less intense symptoms.

3 pm. Drowsiness and fatigue but better than previous days. Less intense symptoms.

5 pm. Tired but more stable. Calm

6 pm. Tired but more stable. Calm.

6 pm - 11 pm. Calm.

*11:45 am. Sertraline.

 

November 6

 

6:45 am. Insomnia. Akathisia and nerves (milder than previous days). Gas and stomach pain. Slight pressure on the head.

9:00 am. Mental fog. Slight pressure on the head. Muscle tension, especially the neck, jaw and head. Slight snapping of teeth. (If I close my eyes tightly, it's like the muscles in my head relax and if I yawn, the muscles in my body shake).

9:30. Breathing difficulties.

10 am. Static bike

11 am. Mental fog, drowsiness. Groggy. Dopey. Akathisia and internal agitation disappear.

1 pm. Mental fog, drowsiness.  Groggy. Dopey. Head pressure (forehead, jaw, neck). Muscle pain.

3 pm. Drowsiness. Dizziness. The mental fog disappears.

4 pm. Drowsiness. Dizziness. Groggy.

6 pm. Calm. Drowsiness and grogginess disappear.

8 pm.  Calm.

10 pm. Calm.

11 pm. Tired but calm.

*12:30 am: Sertraline

 

November 7

 

7:45 am. Wake up. Nerves. Gases. Trouble to breathe. Stomach pain. Mild teeth snapping. Need to move legs, akathisia. Body (muscle) pain.

8 am. Diarrhea.

9:30. Dizziness, dizziness. Body (muscle) pain.

11:00. Drowsiness, tiredness. Dopey. Mild pressure on the jaw, neck, and head.

12:00. Fatigue, dopey, grogginess, tiredness, drowsiness. Pressure on the jaw, neck and head. Cognitive difficulties when trying to concentrate and write.

12:15 pm. Diarrhea

1:30 am. Pressure on the jaw, neck and head. Fatigue, dopey, grogginess, tiredness, drowsiness. Cognitive difficulties when trying to concentrate and write.

1:30 am. Pressure on the jaw, neck and head. Muscle pains. Fatigue, dopey, grogginess, tiredness, drowsiness. Cognitive difficulties when trying to concentrate and write.

2:30. Really tired. Breathing difficulties. Some throbbing. The general condition is very groggy.

3:30 pm. Severe tiredness. Sleepy.

4:30 pm. Severe tiredness. Sleepy.

5:30. Nap with internal waves that run through the body. Heat in the head.

7 pm. Muscle pain. Severe tiredness. Drowsiness.

9 pm. Quiet. Mental clarity.

11 pm. Quiet. Mental clarity.

* 12 pm. Sertraline.

 

November 8

 

6:45 am. Insomnia. Nerves, akathisia. Muscle pain. Mild teeth snapping. Mild stomach pain.

8:00. Agitation. Akathisia. Internal tremors. Shortness of breath. Pressure on the jaw, neck and head. Heat in the neck.

8:30. Swimming.

9:30 am. Mental fog. Groggy. Difficulty reading

11 am. Mental fog. Groggy.

12:30 pm. Muscle pain in the body. Drowsiness. The mental fog gradually diminishes. Heat in the head.

14 pm. Drowsiness. Muscle pain in the body. Tired. Fatigue. Lack of energy. Jaw pressure.

3 pm. Nap.

4:30 pm. Drowsiness. Tired. Lack of energy. Heat in the ears.

5 pm. Diarrhea.

6 pm. Muscle pain in the body. Pressure in the jaw. Neck and head pain. Tired. Lack of energy. Heat in forehead and ears.

7 pm. Tiredness and heat in the forehead and ears.

8 pm. Caml. Tiredness.

9 pm. Calm. Tiredness.

10 pm. Calm and clear mind. Very tired.

11 pm. Exhausted.

* 11 pm. Sertraline

 

November 9

 

6 am. Insomnia. Snapping of teeth Leg movement. Muscle pain. Feeling of exhaustion

7:45 am. Breathing difficulties. Jaw pressure. Mental fog.

9:30. Breathing difficulties. Mental fog. Dizziness.

12:30 pm. Tiredness, drowsiness (somewhat less than other days)

2:30 pm. Muscle pain. Tiredness and mild drowsiness. Brain fog disappears.

3:30 pm. I feel normal (for the first time in 3 months). Calm.

5 pm. Mild dizziness. Calm.

6:15 pm. Calm. Jaw pressure.

7 pm - 10 pm. Calm.

* 11 pm. Sertraline

 

November 10

 

5:45 am. Insomnia. Leg movement. Nerves. Snapping of teeth Muscle pain. Gases

8:00. Body-muscle pain. Palpitations. Diarrhea. Heat. Internal tremors.

9:45 am. Mental fog. Tiredness. Fatigue. Groggy.

12:00 pm. Groggy. dopey. Mild mental fog

2 pm. Drowsiness. Groggy. Dopey. Mental fog. Mild dizziness

6 pm. Severe drowsiness. Groggy. Dopey. Lack of energy.

9 pm. Stable, calm, mental clarity.

10:30 pm. Stable, calm, mental clarity,

* 11 pm. Sertraline.

 

November 11

 

6:45 am. Insomnia. Muscle pain. Leg movements. Mild nerves Mild tooth snapping.

9 am. Diarrhea. Groggy. Mental fog. Body heat. Mild dizziness

11 am. Groggy.  Mental fog.

12 pm. Drowsiness. Groggy. Cognitive difficulties when working (grogginess). Lack of energy.

1 pm. Drowsiness. Groggy. Cognitive difficulties when working (grogginess). Lack of energy.

2 pm. Drowsiness. Groggy. Lack of energy.

4 pm. Calm. Slight tiredness. Less grogginess and drowsiness.

7:30. Tiredness, drowsiness. Mild jaw pressure.

9:30. Calm.

* 11:15 pm. Sertraline

 

November 12

 

6:45 am. Insomnia. Gases. Slight leg movements. Mild nerves Mild tooth snapping.

8:15 am. Mental fog. Groggy. Emotional numb.

8:30. Swimming

10 am. Mental fog. Groggy.  Emotional numb.

12 pm Groggy. 

1 pm. Dizziness. Tiredness and Drowsiness. Light pressure on the head.

2 pm. Dizziness. Tiredness and Drowsiness. Light pressure on the head.

7 pm. Tiredness, drowsiness

9:30. Calm. Tiredness.

10:30. Calm.

* 11:15 pm. Sertraline

 

November 13

 

5:30 am. Insomnia. Restless legs. Nerves. Gases Mild tooth snapping. Bodily restlessness. Throat pain.

8:30 am. Body ache. Mild dizziness

4 pm. Tiredness. Drowsiness.

7 pm. Tiredness. Drowsiness.

9 pm. Calm. Stable.

* 11 pm. Sertraline.

 

November 14

 

6:45 am. Insomnia. Gases Restless legs. Nerves. Bodily restlessness. Throat pain.

11am. Mental fog. Emotional numb. Slight pressure on the head and jaw (teeth).

13 am. Drowsiness. Mental fog. Groggy. Dizziness. Slight pressure on the head and jaw (teeth).

15:30 am. Drowsiness. Tiredness. Groggy. Dizziness. Slight pressure on the head.

17:15. Drowsiness. Slight pressure on the head. Tiredness

18:30. Drowsiness. Slight pressure on the head. Tiredness

19:30. Drowsiness. Tiredness. Heat in the head.

10 pm. Quiet. Stable.

* 11 pm. Sertraline.

 

November 15

 

7:00 am. Wake up. Nerves, restless legs, shortness of breath. Snapping of teeth Muscle pain. Internal waves run through the body.

8:15. Breathing difficulties. Body ache. Slight pressure on the head. Emotional numb.

8:30 Swimming

9; 45 Mental fog. Emotional numb. Dopey. Groggy.

1 pm. Dopey. Groggy. Dizziness. Head and jaw pressure.

2:30 pm. Drowsiness. Groggy. Dizziness. Head and jaw pressure.

4:30 pm. Drowsiness. Groggy. Jaw pressure.

5:30 pm. Drowsiness. Severe tiredness. Groggy.

6:30 pm. 5:30 pm. Drowsiness. Severe tiredness. Groggy.

10:30 pm. Calm. Clarity of Mind.

*11:30 pm. Sertraline

 

November 16

 

6:15 am. Insomnia. Mild restless legs. Gases Nerves. Body heat.

9 am. Brain fog.  Dopey. Groggy. Head pressure, jaw pressure.

10 am. Brain fog.  Dopey. Groggy. Cognitive difficulties.

13:00. Emotional numb. Tiredness. Drowsiness. Dizziness. Jaw pressure.

 

 

[Altostrata]

Thanks for the notes.

 

5 hours ago, Maze said:

*11am. Sertraline: reduction from 23.2 mg to 22.7 mg.

 

Do you mean 11 p.m. reduction of sertraline from 23.2 mg to 22.7 mg on November 1?

 

Yes, it appears it took a few days for stabilization from the dosage reduction.

 

I am not looking for a global or average impression of symptoms, I want to know symptoms from day to day. Please include the drug dosage in all daily notes.

 

How do you feel AFTER you take sertraline at night? Have you ever taken it earlier in the day?

[Maze]

Dear @Altostrata,

 

17 hours ago, Altostrata said:

Do you mean 11 p.m. reduction of sertraline from 23.2 mg to 22.7 mg on November 1?

 

I wanted to write 11 pm, not am. Sorry. I reduced on November 1 at 11 pm.

 

17 hours ago, Altostrata said:

Please include the drug dosage in all daily notes.

 

I enclose below again the notes with the doses. The dose is always the same in any case. 22.7 mg.

 

17 hours ago, Altostrata said:

How do you feel AFTER you take sertraline at night? Have you ever taken it earlier in the day?

 

After taking sertraline every night, I go to sleep. Before bed, the last thing I do is to take sertraline—every day between 11 pm and 12 pm. So I'm not sure exactly what happens after taking sertraline, but I have a pretty good idea. First, taking the sertraline makes me wake up earlier (6:30 am). I can't sleep anymore on the sertraline. Before, when I took doses every other day, I could sleep more on the days that I did not take. In general, I have always slept well and that is why I can sleep despite the adverse effects of the drug, although it affects me. Second, after taking sertraline at night, as the hours go by, adverse effects will appear. I take the sertraline, go to bed calmly and mentally clear. Then, a set of anxiety-related activation symptoms appear (restless legs, akathisia, snapping of teeth, etc.) throughout the night. If I wake up during the night (e.g., 4 am), I am already experiencing these symptoms. When I get up around 7 am, adverse effects continue. I take breakfast and go swimming or biking. Then, the symptoms subside a little thanks to cardiovascular activity, and I can clearly notice brain fog and grogginess symptoms after. Throughout the day these symptoms persist (i.e., brain fog, drowsiness, grogginess, dizziness, head and jaw pressure). And towards the end of the evening, they disappear and I feel better. Until I take sertraline at night and the cycle repeats.

 

When I started sertraline treatment 11 years ago, I took the drug in the morning and it had no adverse effects. After removing and reinstalling it, I began to have adverse effects. I tried taking it in the morning sometimes, but I couldn't work well in my day-to-day. So the psychiatrist proposed to change at night. And since then, I have taken it at night. During the last 8 years, before starting the tapering, I have ever tried to take it in the morning sometimes.  Two or three hours after taking sertraline, the activation-anxiety-akathisia pattern emerged, similar to the pattern I usually experiment when I take the drug at night. With the akathisia, the anxiety, and the brain fog it was hard for me to work and function, so I retook it at night, so that while I am asleep, the activation symptoms appear, and then in the morning with sports they are remitting.

 

I attached here the daily notes again (including today).

 

Thanks.

_________

 

November 1

 

*11pm. Sertraline: reduction from 23.2 mg to 22.7 mg.

 

November 2 (first day on 22.7 mg)

 

4:30 am. Insomnia. Akathisia. Nerves. Internal waves run through the body. Heat.

7 am. Akathisia. Nerves. Internal waves run through the body. Muscle pain and stomach pain. Snapping of teeth. Heat.

8 am. Breakfast

8:15. Go out into the street. Derealization. Blurry vision. Snapping of teeth. Mental fog.

8:30. Akathisia. Electric flow.

9:30. Breathing difficulties. Diarrhea.

10.00. Tiredness. Mental fog.

12:30 pm. Tired. A little groggy and head pressure. It remains but greatly diminishes nerves, akathisia, teeth snapping, and heat.

2:30 pm. A little groggy and pressure on the head. Dizziness. I feel better than in the morning.

3 pm. Nap.

4 pm. After the nap, the dizziness and tremors return a little. Dizziness. Mild tooth snapping. Mild motor difficulty writing.

5 pm. Heat. Nerves. Drowsiness. Heat in the front of the head (forehead)

6 pm. Tiredness. Drowsiness

7:30 pm. Drowsiness. A bit of heat in the head.

9 pm. I feel better. More stable.

10 pm. I feel better. More stable.

* 11:30 pm. Sertraline: 22.7 mg.

 

November 3

 

5 am. Insomnia. Akathisia. Heat. Nerves. Snapping teeth. Stomach pain. Gases

7:30. Akathisia, heat. Nerves. Stomach pain. Gases. Snapping teeth.

8:00. Breath difficulties.

9:45 After swimming, akathisia improves. Shortness of breath, brain fog remains. A little derealization. Dopey.

10.00. Diarrhea.

10.30. Dopey. Mental fog. Derealization.

12:00 pm. Decreasing brain fog and derealization. They are still but they are decreasing. More tiredness and drowsiness emerge.

2 pm. Drowsiness, tiredness, grogginess.

4 pm to 7 pm. Drowsiness, tiredness, grogginess. It progressively decreases as the afternoon progresses.

9 pm. I feel better. More stable.

10 pm. Peace and clarity of mind.

* 11:30 pm. Sertraline: 22.7 mg.

 

November 4

 

5 am. Insomnia, stomach pain, gas, akathisia.

7:30 am. Akathisia, Nerves. Internal waves run through the body. Snapping teeth. Dizziness. Gases

8:00. Breathing difficulties. Diarrhea.

9:15. Breathing difficulties. Mental fog. Dopey. Slight nausea

11:00. Brain fog, Dopey. Fewer nerves. A little tension in the jaw. Attentional difficulties.

12:30 pm. Dopey. Mental fog. Struggling to focus. Tiredness emerges.

2 pm. Tiredness. Drowsiness. Dizziness.

4 pm. Tiredness. Drowsiness.

5 pm. Drowsiness.

6:30 pm. Drowsiness.

9 pm. Calm, stable, mental clarity.

11:00 pm. Calm, stable, mental clarity.

* 11:30 pm. Sertraline: 22.7 mg.

 

November 5

 

* Note: I feel that here the reduction begins to stabilize. However, I still have the adverse effects of drug sensitization. The first days after the reduction, it seems that both processes come together.

 

6:30 a.m. Insomnia. Akathisia, nerves, gas (all the symptoms when I wake up are a little milder than the previous three days. They are strong but are somewhat milder and progressively decrease).

8:00 am. Nerves. Mild internal agitation. Gases. Very slight pressure on the head. Some dizziness.

8:30. Swimming.

9:30. Mental fog. Slight derealization. Groggy. Dopey. Difficulty thinking. Akathisia and internal agitation disappear.

11:00. Mental fog.

13.00. Drowsiness and fatigue but better than previous days. Less intense symptoms.

3 pm. Drowsiness and fatigue but better than previous days. Less intense symptoms.

5 pm. Tired but more stable. Calm

6 pm. Tired but more stable. Calm.

6 pm - 11 pm. Calm.

*11:45 am. Sertraline: 22.7 mg.

 

November 6

 

6:45 am. Insomnia. Akathisia and nerves (milder than previous days). Gas and stomach pain. Slight pressure on the head.

9:00 am. Mental fog. Slight pressure on the head. Muscle tension, especially the neck, jaw and head. Slight snapping of teeth. (If I close my eyes tightly, it's like the muscles in my head relax and if I yawn, the muscles in my body shake).

9:30. Breathing difficulties.

10 am. Static bike

11 am. Mental fog, drowsiness. Groggy. Dopey. Akathisia and internal agitation disappear.

1 pm. Mental fog, drowsiness.  Groggy. Dopey. Head pressure (forehead, jaw, neck). Muscle pain.

3 pm. Drowsiness. Dizziness. The mental fog disappears.

4 pm. Drowsiness. Dizziness. Groggy.

6 pm. Calm. Drowsiness and grogginess disappear.

8 pm.  Calm.

10 pm. Calm.

11 pm. Tired but calm.

*12:30 am: Sertraline: 22.7 mg.

 

November 7

 

7:45 am. Wake up. Nerves. Gases. Trouble to breathe. Stomach pain. Mild teeth snapping. Need to move legs, akathisia. Body (muscle) pain.

8 am. Diarrhea.

9:30. Dizziness, dizziness. Body (muscle) pain.

11:00. Drowsiness, tiredness. Dopey. Mild pressure on the jaw, neck, and head.

12:00. Fatigue, dopey, grogginess, tiredness, drowsiness. Pressure on the jaw, neck and head. Cognitive difficulties when trying to concentrate and write.

12:15 pm. Diarrhea

1:30 am. Pressure on the jaw, neck and head. Fatigue, dopey, grogginess, tiredness, drowsiness. Cognitive difficulties when trying to concentrate and write.

1:30 am. Pressure on the jaw, neck and head. Muscle pains. Fatigue, dopey, grogginess, tiredness, drowsiness. Cognitive difficulties when trying to concentrate and write.

2:30. Really tired. Breathing difficulties. Some throbbing. The general condition is very groggy.

3:30 pm. Severe tiredness. Sleepy.

4:30 pm. Severe tiredness. Sleepy.

5:30. Nap with internal waves that run through the body. Heat in the head.

7 pm. Muscle pain. Severe tiredness. Drowsiness.

9 pm. Quiet. Mental clarity.

11 pm. Quiet. Mental clarity.

* 12 am. Sertraline: 22.7 mg.

 

November 8

 

6:45 am. Insomnia. Nerves, akathisia. Muscle pain. Mild teeth snapping. Mild stomach pain.

8:00. Agitation. Akathisia. Internal tremors. Shortness of breath. Pressure on the jaw, neck and head. Heat in the neck.

8:30. Swimming.

9:30 am. Mental fog. Groggy. Difficulty reading

11 am. Mental fog. Groggy.

12:30 pm. Muscle pain in the body. Drowsiness. The mental fog gradually diminishes. Heat in the head.

14 pm. Drowsiness. Muscle pain in the body. Tired. Fatigue. Lack of energy. Jaw pressure.

3 pm. Nap.

4:30 pm. Drowsiness. Tired. Lack of energy. Heat in the ears.

5 pm. Diarrhea.

6 pm. Muscle pain in the body. Pressure in the jaw. Neck and head pain. Tired. Lack of energy. Heat in forehead and ears.

7 pm. Tiredness and heat in the forehead and ears.

8 pm. Caml. Tiredness.

9 pm. Calm. Tiredness.

10 pm. Calm and clear mind. Very tired.

11 pm. Exhausted.

* 11 pm. Sertraline: 22.7 mg.

 

November 9

 

6 am. Insomnia. Snapping of teeth Leg movement. Muscle pain. Feeling of exhaustion

7:45 am. Breathing difficulties. Jaw pressure. Mental fog.

9:30. Breathing difficulties. Mental fog. Dizziness.

12:30 pm. Tiredness, drowsiness (somewhat less than other days)

2:30 pm. Muscle pain. Tiredness and mild drowsiness. Brain fog disappears.

3:30 pm. I feel normal (for the first time in 3 months). Calm.

5 pm. Mild dizziness. Calm.

6:15 pm. Calm. Jaw pressure.

7 pm - 10 pm. Calm.

* 11 pm. Sertraline: 22.7 mg.

 

November 10

 

5:45 am. Insomnia. Leg movement. Nerves. Snapping of teeth Muscle pain. Gases

8:00. Body-muscle pain. Palpitations. Diarrhea. Heat. Internal tremors.

9:45 am. Mental fog. Tiredness. Fatigue. Groggy.

12:00 pm. Groggy. dopey. Mild mental fog

2 pm. Drowsiness. Groggy. Dopey. Mental fog. Mild dizziness

6 pm. Severe drowsiness. Groggy. Dopey. Lack of energy.

9 pm. Stable, calm, mental clarity.

10:30 pm. Stable, calm, mental clarity,

* 11 pm. Sertraline: 22.7 mg.

 

November 11

 

6:45 am. Insomnia. Muscle pain. Leg movements. Mild nerves Mild tooth snapping.

9 am. Diarrhea. Groggy. Mental fog. Body heat. Mild dizziness

11 am. Groggy.  Mental fog.

12 pm. Drowsiness. Groggy. Cognitive difficulties when working (grogginess). Lack of energy.

1 pm. Drowsiness. Groggy. Cognitive difficulties when working (grogginess). Lack of energy.

2 pm. Drowsiness. Groggy. Lack of energy.

4 pm. Calm. Slight tiredness. Less grogginess and drowsiness.

7:30. Tiredness, drowsiness. Mild jaw pressure.

9:30. Calm.

* 11:15 pm. Sertraline: 22.7 mg.

 

November 12

 

6:45 am. Insomnia. Gases. Slight leg movements. Mild nerves Mild tooth snapping.

8:15 am. Mental fog. Groggy. Emotional numb.

8:30. Swimming

10 am. Mental fog. Groggy.  Emotional numb.

12 pm Groggy. 

1 pm. Dizziness. Tiredness and Drowsiness. Light pressure on the head.

2 pm. Dizziness. Tiredness and Drowsiness. Light pressure on the head.

7 pm. Tiredness, drowsiness

9:30. Calm. Tiredness.

10:30. Calm.

* 11:15 pm. Sertraline: 22.7 mg.

 

November 13

 

5:30 am. Insomnia. Restless legs. Nerves. Gases Mild tooth snapping. Bodily restlessness. Throat pain.

8:30 am. Body ache. Mild dizziness

4 pm. Tiredness. Drowsiness.

7 pm. Tiredness. Drowsiness.

9 pm. Calm. Stable.

* 11 pm. Sertraline: 22.7 mg.

 

November 14

 

6:45 am. Insomnia. Gases Restless legs. Nerves. Bodily restlessness. Throat pain.

11am. Mental fog. Emotional numb. Slight pressure on the head and jaw (teeth).

13 am. Drowsiness. Mental fog. Groggy. Dizziness. Slight pressure on the head and jaw (teeth).

15:30 am. Drowsiness. Tiredness. Groggy. Dizziness. Slight pressure on the head.

17:15. Drowsiness. Slight pressure on the head. Tiredness

18:30. Drowsiness. Slight pressure on the head. Tiredness

19:30. Drowsiness. Tiredness. Heat in the head.

10 pm. Quiet. Stable.

* 11 pm. Sertraline: 22.7 mg.

 

November 15

 

7:00 am. Wake up. Nerves, restless legs, shortness of breath. Snapping of teeth Muscle pain. Internal waves run through the body.

8:15. Breathing difficulties. Body ache. Slight pressure on the head. Emotional numb.

8:30 Swimming

9; 45 Mental fog. Emotional numb. Dopey. Groggy.

1 pm. Dopey. Groggy. Dizziness. Head and jaw pressure.

2:30 pm. Drowsiness. Groggy. Dizziness. Head and jaw pressure.

4:30 pm. Drowsiness. Groggy. Jaw pressure.

5:30 pm. Drowsiness. Severe tiredness. Groggy.

6:30 pm. 5:30 pm. Drowsiness. Severe tiredness. Groggy.

10:30 pm. Calm. Clarity of Mind.

*11:30 pm. Sertraline: 22.7 mg.

 

November 16

 

6:15 am. Insomnia. Mild restless legs. Gases Nerves. Body heat.

9 am. Brain fog.  Dopey. Groggy. Head pressure, jaw pressure.

10 am. Brain fog.  Dopey. Groggy. Cognitive difficulties.

13:00. Emotional numb. Tiredness. Drowsiness. Dizziness. Jaw pressure.

2 pm. Dizziness.

5 pm. Emotional numb. Tiredness. Drowsiness. Dizziness. Head pressure.

9 pm. Calm. Clarity of Mind.

10 pm. Calm. Clarity of Mind.

*11:30 pm. Sertraline: 22.7 mg.

 

November 17

 

7:00 am. Akatisia, teeth snapping, internal restlessness, pressure on the head, restless legs, gases.

Internal waves running through the body.

8:00 am. Pressure in the head. Snapping of teeth, Internal restlessness. Heat in the head.

10:00 am. Brain fog. Emotional numb. Groggy. Dopey. Dizziness. Jaw and head pressure. Heat.

12:00 am. Brain fog. Emotional numb. Groggy. Dopey. Dizziness.