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

[Altostrata]

13 hours ago, Maze said:

I tried taking it in the morning sometimes, but I couldn't work well in my day-to-day.

 

What was the dosage then, and what were the effects that interfered with your work?

[Maze]

Dear @Altostrata,

 

8 hours ago, Altostrata said:

What was the dosage then, and what were the effects that interfered with your work?

 

For the first two years, I was on 100mg without any adverse effects. I took the drug in the morning with breakfast. After 2,5 years, I quit the drug (cold turkey). However, after reinstalling 50mg four months later, I started having adverse effects. I also took the drug at breakfast. I began to experience adverse effects such as agitation, anxiety, arousal, brain fog, and grogginess. The psychiatrist then told me that the symptoms were side effects and moved the drug to the night. So, I started taking 50 mg every night and began to experience that when I woke up I had symptoms related to activation (anxiety-akathisia) and shortly after the mental fog began. But each time the adverse effects were increased. So I started taking the drug every other day. And the pattern has always been the same. Take the drug at night (50 mg). Waking up with anxiety-akathisia-restlessness and then brain fog-grogginess until 2-3 pm. I was like that for 8 years. Now it is similar but as I take the drug every day, the pattern is continuous (adverse symptoms every day) and more intense. The drowsiness-brain fog-grogginess is present almost until the evening. You can see it in the daily notes I wrote.

 

I hope this answer is helpful.

 

My questions previously were:

 

"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 daily notes, 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?"

 

Thanks Alto,

Maze

[Altostrata]

It does not appear that taking sertraline at night is helping your sleep. It may be causing insomnia. 

 

It's very possible the grogginess in the afternoon is from the prior night's sertraline wearing off. If I were you, I'd gradually move sertaline earlier by an hour each day until you are taking it at noon. 22.7mg is a lower dosage than the 50mg that caused problems before. 

 

This may help your sleep.

[Maze]

Dear @Altostrata and SA Community,

 

First of all, I hope you are well.

 

I am writing to request help in my withdrawal process.  I apologise in advance for my English.

 

This has been my process since November 2 (November 2: 22.7 mg; December 7: 21.4 mg; December 12; 20.2; December 17: 19.9 mg) and today I am seriously considering reducing a bit again. I am aware that it is a reduction faster than desirable (10% every month), but I have tried to reduce 10% every four weeks, and it is not possible in my case. I was able to stay on 22.7 mg from November 2 to December 7. In this time, I stabilized a lot, and I feel that stabilization until today. I feel better in my mood, my cognitive problems are fewer, and the feelings of derealization and blurred vision that I had have subsided. I feel like I have been accumulating repeated withdrawal processes, so I tried to stay the whole month on the same dose and I could did it. As November passed, I was feeling better, but from December 1 to 6, I became more agitated, hyperactive, nervous, with poor self-regulation. On December 1, I felt the level of hyperactivity was very high and it was challenging for me to control myself. Each day until December 6, I felt more hyperactivity, nervousness in the body, pressure on the head and neck, clenched teeth, gases, strange sensations in the head (such as internal tremors), and muscle stiffness in the hands (it was difficult for me to write). On the night of December 5, I even had insomnia. Since I had been on 22.7 mg for more than a month, I decided to reduce the dose to 21.4 mg on December 6 at night. I was able to sleep well and woke up the next day without all these symptoms. It emerged the symptoms that I have had more regularly each time I have reduced the drug; symptoms more associated with withdrawal (drowsiness, tiredness, teeth snapping, fatigue, milder mood). These symptoms felt much more tolerable than hyperactivity and I was happier.

             

I kept taking 21.4. With each passing day, the symptoms most related to withdrawal disappeared and the symptoms of hyperactivity reappeared. 5 days later, the symptoms that are intolerable for me had returned. So, I went back to reducing the drug. The following day the hyperactivity pattern disappeared and the symptoms most associated with drowsiness reappeared. Since then, I have been trying to stabilize myself on a dose, keeping it longer, but the pattern always repeats itself. Therefore, as you can see in my signature, I have been tapering faster. On the evening of December 16, I did my last reduction to 19.9 mg from 20.2. Again the symptoms of hyperactivity and jitteriness subsided. But today, after five days, I feel hyperactive again. I feel agitated, restless legs, pressure in the head-neck-jaw, internal tremors in the head,  jitteriness, difficulty concentrating, hyper-reactivity, irritability. It lasts four to five days from the moment I reduce the dose until these symptoms return; they appear strongly every day, and I can't tolerate them on the fifth day (today). I can't control myself. These symptoms start about two hours after taking sertraline each night (see daily notes below). Around 6:30-7 am, I wake up with the whole set of symptoms. As the hours go by, they disappear. Generally, in the late evening, I am much calmer. I'd say in a normal state. Around 10-11 pm, before taking the sertraline, I feel completely calm and clear in mind and body. There are no symptoms of hyperactivity-agitation-jitteriness. So, I sincerely believe that I experiment an adverse reaction to sertraline every time I take it. My nervous system is sensitized to the drug and cannot tolerate it. I do not think this is abstinence. If it were abstinence, the daily symptoms would not have such a defined 24-hour pattern. The adverse reaction emerges one or two hours after taking the drug and lasts for part of the next day (generally the morning and noon). In the evening-night, the effects of the adverse reaction reduce until I take again the drug, What do you think of this Alto?.

 

Therefore, I feel trapped. I feel like I have to taper the drug faster due to its adverse effects on my system, but I'm scared to do so. If I listen to my body, there is no doubt that it should reduce faster, but I am afraid because then I will reduce too fast. I feel that taking a month the same dose I stabilized a lot, but now I feel that I have to reduce faster due to the effect of the sensitization to the drug. I would say that my nervous system has been sensitized to sertraline since I left the drug eight years ago, and on the withdrawal my psychiatrist reinstated me on 50 mg. Then, I couldn't tolerate 50 mg each day, but at the psychiatrist's insistence to take the drug, I started taking it every other day. Taking the drug inconsistently has probably sensitized my nervous system even more, and now my system does not tolerate sertraline. I have read several cases in the forum that suffer adverse reactions to sertraline daily, similar to me. So… here are my questions:

 

1) Since my nervous system does not tolerate sertraline, and I cannot be with these symptoms of agitation and hyperactivity, is it an option to reduce by listening to my body? Should I reduce a small dose (0.4 mg approx.) when I feel that the agitation is too high?. If at some point I can keep the same dose longer, I can stay on it, but otherwise, I guess I have to continue tapering. In the end, the goal is to get off the drug. How about this approach?

 

2) Can tapering the drug faster make me go into a more severe withdrawal when I finish the tapering process? That scares me, but I don't feel like I have a lot of choices as an adverse reaction to sertraline from sensitization I also think is quite dangerous.

 

3) Could I take a benzodiazepine at specific times where I feel that I have a lot of hyperactivity-akathisia-nervousness and I cannot control myself easily? If I don't reduce the dose, I feel that I could become suicidal. I am not saying it without awareness. I say it because I feel that. So perhaps a benzodiazepine at a difficult time can help to manage the state. I do not know. I never took benzodiazepines, except for two weeks when I started sertraline 11 years ago.

 

4) Is there any better drug tapering path or approach when the system is sensitized to the drug and the adverse effects are difficult to tolerate?.

 

Thank you very much for the help,

Warmly,

Maze

________

 

 

DAILY NOTES OF THE LAST THREE DAYS

 

December 18

 

8 to11 pm. Calm

*11:30 pm Sertraline 19.9 mg

 

December 19

 

12:30 am. Agitation. Stomachache. Restless legs. Head and jaw pressure.

8:00 am. Agitation. Stomachache.Restless legs.Head and jaw pressure. Head pressure. Muscle stiffness.

9:00 am. head and jaw pressure. Head pressure. Muscle  Muscle stiffness.

2:00 pm head and jaw pressure. Head pressure. Weird internal sensations after a nap. Clenched teeth.

7 pm Headaches. Tremors in the head. Head and jaw pressure. Rare internal sensations (internal tremors). Clenched teeth. Dizziness.

8:00 pm Calm. Fatigue. Clenched teeth

10:00 pm Calm. Normal state

*11:30 pm Sertraline 19.9 mg.

 

December 20

 

6:30 am Belly swollen and roaring. Restless legs. Hyperactivity. Clenched teeth. Weird internal sensations in the head. Gases. I feel intoxicated.

7:30 am. Heat in the head. Hyperactivity. Clenched teeth. Rare internal sensations in the head (tremors-waves in the head).

8:30 am. Heat in the head. Heat in the eyes. Clenched teeth. Weird internal sensations in the head. Inflammation in the head. Hyperactivity. Difficulties to self-regulate myself.

12:00 pm Clenched teeth. Weird internal sensations in the head. Severe head pressure. I feel inflammation in the head.

4 pm Weird internal sensations in the head. Muscle pain in hands-fingers-neck. Clenched teeth.

5 pm Weird internal sensations in the head. Internal tremors in the head when lying down. Mild constant body shaking if I stay still.

7–10 pm. I'm being calmer.

11 pm. Completely calm.

*11:30 pm Sertraline: 19.9 mg

 

December 21 (today)

 

7:30 am. Belly pain, nervousness, hyperactivity, jitteriness, restless legs, pressure in the head and strange sensations in head (internal waves-tremors). Internal heat in the head. Clenched teeth. Gases. Muscle grip (hands). I feel intoxicated. Nausea.

8:30 am. Over-activation. Hyperreactivity. Too much energy, hyperactivity, body discomfort, pressure on the head. Clenched teeth. Heat. Need to move. I can't be still. Walking around the house. I feel intoxicated.

10:00 am. Too much energy, hyperactivity, uncomfortable in the body, head with pressure. Clenched teeth. Over-activation. Need to walk.

11:00 am. Hyperactivity, Head with pressure. Clenched teeth Over-activation. Difficulty focusing and concentrating while sitting.

12:00 pm. Over-activation. Severe nervousness. Jitteriness. Head and jaw pressure. Clenched teeth. Nausea.

 

 

 

 

 

 

 

 

 

[Altostrata]

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.

 

Simple list format, please. I do not have time to read long narratives.

[Maze]

Dear @Altostrata, moderators and SA community,

 

First of all, I hope you are well.

 

I'm writing because I need help. I'm not feeling well at all and I need to make decisions. I hope you can help me. Sorry for my English. @Altostrata, I did not write before because I was recovering from the Covid.

 

As I have said several times I do not tolerate sertraline. I am pretty sure that my system are hypersensitized to sertraline. I have adverse effects to sertraline every time I take it.

 

The pattern is always the same, but the symptoms are becoming more severe last three-four days and I can no longer support them. The pattern is every day very similar:

1) I take the drug at night (11:30 pm) in a calm and clear-headed state.
2) I wake up around 6:30–7:00 am and have a lot of symptoms, which are extremely difficult to hold (internal agitation, internal tremors, Tension and burning sensation in the head, muscular rigidity, clenched teeth). They make me desperate. If I wake up around 2–3 am I already have these symptoms. Also at a cognitive level, it is impossible to concentrate and I have severe brain fog.
3) In the afternoon, the symptoms are reduced and at night I am calm and have mental clarity. I can think, I feel myself. When I take the drug at 11:30 pm the pattern repeats itself. 

 

In my signature it is possible to see how lately I have been reducing the drug "faster". I have been reducing small doses (0,3 mg) every five days. I did that because when I reduce the drug I feel better and after 4-5 days I have all the symptoms again (the effects of the drug become stronger). If I could stay stable on one dose I would, but honestly, I don't think it's possible. Therefore, I have to make decisions.

 

I wanted to ask if it would be convenient to taper the sertraline quicker since my system does not tolerate it. For example, to reduce to 17.5mg or some even lower doses. It scares me but I have to make decisions. If my body does not tolerate sertraline I guess I have to do something, even at risk of suffering more severe withdrawal symptoms. I feel that the my state in the mornings is dangerous; I try to control myself but it's like trying to control yourself when you've had ten drinks. Until the effect of the alcohol reduce, it is tough to control yourself. Therefore, I guess I have to listen to my body and reduce a little faster.

 

I appreciate any advice and guidance. I need it.

 

Thanks a lot

Maze

 

--------

 

EXAMPLE OF DAILY NOTES (*it is possible to see more examples in previous communications but the patterns is always very similar)

 

- January 15 (Sertraline 18.55 mg.) (yesterday)

 

9:00–11:30 pm. Calm and clarity of mind
*11:30 pm. Sertraline 18.55.

 

- January 16 (Sertraline 18.55 mg.) (today)

 

6:30 am (Wake up). Severe tension and pressure in the forehead and head. Burning sensation in the forehead. Clenched teeth. Restless legs. Muscle stiffness (eg, stiff hands). Swollen belly. I snap teeth.
8:30 am. Severe tension and pressure in the forehead and head. Burning sensation in the forehead. Akathisia. Agitation and internal tremors.  Dizziness.
10:00 am. Tension and severe pressure in the forehead and head. Severe grogginess. Agitation and internal tremors.Dizziness. Burning sensation in the forehead.
11:45 am. Tension and severe pressure in the forehead and head. Dizziness. Burning sensation in the forehead. Agitation and internal tremors. Inability to concentrate or make decisions. Severe grogginess.
2 pm. Severe head pressure. Dizziness. Burning sensation in the forehead. Agitation and internal tremors. Lack of concentration

 

 

[Altostrata]

When did you have covid? Are you fully recovered from it?

 

It appears you have been reducing sertraline since October, when you were taking 23.2mg. How do you feel now compared to how you felt in November?

[Maze]

Dear @Altostrata,

 

16 hours ago, Altostrata said:

When did you have covid? Are you fully recovered from it?

 

I tested positive for Covid on December 28 and negative on January 6. However, I am still recovering. I continue with exhaustion, tiredness, fatigue. Also, I have some cough but less and less. Therefore, I am not fully recovered and it has affected me in my sertraline withdrawal process. This situation complicated the withdrawal process since I could not listen my body's reactions to sertraline for almost 3 weeks.

 

16 hours ago, Altostrata said:

It appears you have been reducing sertraline since October, when you were taking 23.2mg. How do you feel now compared to how you felt in November?

 

I have been tapering progressively since September to today (from 30mg to 18 mg). I have been feeling better since I reduced sertraline from September until December 28, when I got Covid. Since then, I have felt worse. I have been feeling very tired with Covid and Covid has masked the adverse effects that sertraline has on me. As COVID has been improving, all the adverse effects of sertraline has appeared again every day after take the drug at night.

 

Yesterday I wrote here because I have been feeling terrible adverse effects last few days. Yesterday I felt that the adverse effects were so strong that I decided to reduce to 18 mg last night (from 18.6 to 18mg). This morning, when I woke up, the adverse effects were much less intense than yesterday (less tension and pressure in the head, less burning sensation in the head, milder nervousness, less akathisia). So I'm glad I reduced it even though now I'm experiencing increased withdrawal symptoms (e.g., tiredness-exhaustion-dizziness). These symptoms are very uncomfortable, but I feel they are less dangerous than the symptoms of akathisia-head pressure. I do not feel crazy.

 

For this reason, yesterday, I asked if perhaps I have to reduce faster when I have these severe adverse effects. I feel I have to do it because I can nt tolerate the adverse reactions. But I want to ask because in that case maybe the tapering process will be quicker. Unfortunately, it doesn't seem to be possible to settle on one dose for weeks in my tapering process. I have tried constantly, but I just could one time (November 2: 22,7 mg; December 7: 21,4). Since then, the adverse effects of akathisia-head pressure were stronger. As I said yesterday, I have been reducing small doses (0,3 mg) every five days because when I reduce the drug I feel better and after 4-5 days I have all the symptoms again (the effects of the drug become stronger). For me, there is no doubt that my system is hypersensitized to sertraline and I experience severe side effects each time I take it.

 

The diary pattern that I experiment is always very very similar:

 

1) I take the drug at night (11:30 pm) in a calm and clear-headed state.
2) I wake up around 6:30–7:00 am and have a lot of symptoms, which are extremely difficult to hold (internal agitation, internal tremors, tension and burning sensation in the head, muscular rigidity, clenched teeth). They make me desperate. If I wake up around 2–3 am I already have these symptoms. Also, it is impossible to concentrate at a cognitive level, and I have severe brain fog.
3) In the evening the symptoms reduced and at night I am calm and have mental clarity. I can think. I feel myself. When I take the drug at 11:30 pm the pattern repeats itself.  

 

I read that the elimination half-life of sertraline was approximately 24 hours, so maybe this is the reason because I always feel better in the evenings and at night (7 pm-11pm) before re-taking the sertraline at night (11:30 pm). I do not know...

 

So, my question is, what is the best tapering approach in my situation?. I'm trying to do my best, but it's hard. I hope you can help me.

 

Thanks again,
Maze

 

[Altostrata]

@Maze, your situation is a bit different because you had adverse effects from sertraline for such a long time and you were skipping doses for so long. The 30mg daily dose you settled on in September may have been too high, you continued to feel adverse effects of the drug.

 

It does seem possible you still have adverse effects of sertraline AND experience withdrawal when you reduce the dosage. If I were you, I'd micro-taper much as you're doing, by maybe 0.20mg every 3 days, until you get to 15mg, then hold.

[Maze]

Dear @Altostrata

 

It is 1:30 am in my city. I have took the drug (18 mg) at 11:15 pm. I woke up right now with the adverse effects. They are worst than yesterday. I am feeling akatisia and it is very difficult to manage. Maybe my body does not tolerate more the sertraline. I would like to do the micro taper up to 15 mg but maybe I have to do even faster. Maybe tomorrow I have to taper to 16,5 and in three days to 15. I do not know. I can not tolerate the adverse reaction. I feel fear of these symptoms. I am triying to maintain calm but with this adverse reactions is almost impossible. To be honest I feel lost. I feel I lost the control of the tapering since I got Covid. 

 

Thanks for the help,

Maze
 

 

[Altostrata]

I'm sorry, Maze, you'll have to do the best you can. If you are feeling adverse effects of sertraline even more intensely, a faster micro-taper might be a good idea.

[Maze]

Dear @Altostrata,

 

First of all, thank you for the suggestions you have given me and all the help you provide. Thank you.

 

Secondly, following your recommendation, I have tapered to 15.1 mg the best I could. It has not been easy. Probably I am experiencing symptoms from sertraline sensitization and withdrawal effects, like you said. It's hard to discriminate which corresponds to what, but I guess that's how it is. Anyway, the diary pattern I mentioned above continues. I attach here the pattern already explained just to remember.

 

On 1/16/2022 at 1:13 PM, Maze said:

The diary pattern that I experiment is always very very similar:

 

1) I take the drug at night (11:30 pm) in a calm and clear-headed state.
2) I wake up around 6:30–7:00 am and have a lot of symptoms, which are extremely difficult to hold (internal agitation, internal tremors, tension and burning sensation in the head, muscular rigidity, clenched teeth). They make me desperate. If I wake up around 2–3 am I already have these symptoms. Also, it is impossible to concentrate at a cognitive level, and I have severe brain fog.
3) In the evening the symptoms reduced and at night I am calm and have mental clarity. I can think. I feel myself. When I take the drug at 11:30 pm the pattern repeats itself.  

 

Therefore, my question is:

 

Suppose I do not tolerate the adverse effects of sertraline due to the sensitization to the drug, do you think it might be better to taper faster at the risk of suffering a possible more severe withdrawal at each reduction of the drug and at the end of the tapering process? I have been making an incredible effort for 6 months to taper as slowly as I could, considering how bad sertraline makes me feel every time I take it.

 

Sometimes I feel that the intolerance is such that it would be better to reduce faster and end this process. I try to hold it, but it is very hard as you guess. What do you think in my case? I would like to follow a 10% reduction every four weeks, but unfortunately it does not seem possible in my particular case maybe due to my history with sertraline.

 

Thank you,
Maze

 

 

 

[Altostrata]

Has the intensity of these symptoms changed as you've reduced your dosage?

[Maze]

Dear @Altostrata,

 

10 hours ago, Altostrata said:

Has the intensity of these symptoms changed as you've reduced your dosage?

 

It is not easy to answer the question. It may be that the adverse effects associated with sensitization to sertraline have been reduced their intensity as I have been reducing the drug (15 Jan: 17.95; 17 Jan: 16.98; 21 Jan: 16.65; 24 Jan: 16.32; 28 Jan: 16 mg; Jan 31: 15.4 mg; Feb 7: 15.1 mg). The difficult symptoms I have had last ten days were likely due to withdrawal + still sensitization (even being less intense). In any case, it is sure that every time I take sertraline at night, I begin to have difficult symptoms within a few hours. These symptoms reach their peak at 4-10 hours and then decrease throughout the day. In the evening I feel better until I take the sertraline at night and the cycle is repeated.

 

For example, yesterday I took sertraline (15.1 mg) at 11:30 pm. I was calm and tired. I woke up at 6:45 am feeling agitation, restless legs, clenched teeth, heat and pressure in the head, muscular stiffness. This morning (9 am - 1 pm), I have had agitation, brain fog, nervous leg movements (as low akathisia), and head and jaw pressure (bruxism). Now, at 5 pm, the symptoms have reduced. Although I still feel this pattern of symptoms, it is much milder.

 

Therefore, sertraline sensitization effects + withdrawal effects from quick tapering may be mixed. Is it possible that I have sensitization effects every day, which decrease as I reduce the dose, and at the same time may I be in a wave and window pattern because of quick taper? Maybe when I'm on a wave and at the same time I am experiencing the sensitization effects, my suffer increases. It's hard to discern precisely but it might be a mix between the two processes. I do not know.

 

Generally, the next day after tapering I feel more tired and exhausted (sometimes stronger akathisia appears too), but the symptoms associated with sensitization are reduced. However, during the next 5-7 days adverse effects related to sensitization reappear strongly (day by day they are stronger) and the effects associated to the withdrawal are reduced. My taper process has almost always been characterized by something like this.

 

So I repeat the question hoping the info provided has been helpful.

 

On 2/7/2022 at 1:51 PM, Maze said:

Suppose I do not tolerate the adverse effects of sertraline due to the sensitization to the drug, do you think it might be better to taper faster at the risk of suffering a possible more severe withdrawal at each reduction of the drug and at the end of the tapering process? I have been making an incredible effort for 6 months to taper as slowly as I could, considering how bad sertraline makes me feel every time I take it.

 

Sometimes I feel that the intolerance is such that it would be better to reduce faster and end this process. I try to hold it, but it is very hard as you guess. What do you think in my case? I would like to follow a 10% reduction every four weeks, but unfortunately it does not seem possible in my particular case maybe due to my history with sertraline.

 

Thank you very much Alto,

Maze

 

[Erimus]

The symptoms you experience are almost identical to what I feel @Maze. 

29 minutes ago, Maze said:

feeling agitation, restless legs, clenched teeth, heat and pressure in the head, muscular stiffness. This morning (9 am - 1 pm), I have had agitation, brain fog, nervous leg movements (as low akathisia), and head and jaw pressure (bruxism)

I experience all of the above symptoms in varying intensity each day. Normally worse around 4-8 hours after taking sertraline (50mg) at 11am. The symptoms seem to cycle every few days.
 

It will be interesting for me to see how you respond to your taper approach. I am currently holding on 50mg in the hope I stabilise somewhat, I regularly have doubts I am doing the right thing in waiting.

 

Hopefully your symptoms improve as you taper further down. I bought a mouth guard to help with the bruxism in my sleep. 

[Altostrata]

5 hours ago, Maze said:

Generally, the next day after tapering I feel more tired and exhausted (sometimes stronger akathisia appears too), but the symptoms associated with sensitization are reduced. However, during the next 5-7 days adverse effects related to sensitization reappear strongly (day by day they are stronger) and the effects associated to the withdrawal are reduced. My taper process has almost always been characterized by something like this.

 

I am sorry you are having withdrawal symptoms with the adverse effects you feel after you take sertraline because the dosage is still too high.

 

It sounds like you're coping with this. All you can do is carefully proceed.

[Maze]

Thank you @Altostrata,

 

15 hours ago, Altostrata said:

I am sorry you are having withdrawal symptoms with the adverse effects you feel after you take sertraline because the dosage is still too high.

 

In that case, do you think that the sertraline dose at some point will not be too high for my system? My intuition is that my body stopped tolerating sertraline and it will never find an adequate dose.

 

Hypothetically, if I reached a not too high dose I could stabilize myself on it. Hopefully, at some point, it will happen but I don't have much hope. However, I will not lose hope.

 

I will continue to proceed carefully and handle the tapering process as best as possible. Of course, I am suffering but also learning a lot. I'm sorry to learn in such a so cruel way. 

 

Warmly,

Maze

 

[Altostrata]

9 hours ago, Maze said:

do you think that the sertraline dose at some point will not be too high for my system?

 

I hope to see you reach this point soon, @Maze Then you can rest for a while.

[Maze]

Dear @Maze,

 

I am writing to update my status and ask for advice on the next steps in my tapering process.

 

I have been on 14.8 mg since March 3. On the reduction from 15.1 mg to 14.8 I felt well (no withdrawal symptoms). I have managed the situation to maintain the drug on 15,1 mg almost a month. I am happy with that. However, although I have been stabilized at 15.1 throughout the month, I continued to feel severe sensitizing effects of the drug every time I take it at night. It seems that the dose is still too high for my body. The pattern for each day is very similar.

 

9:00 - 11:30 pm: Tired but calm and clear-headed.
11:30 p.m. Sertraline 14.8 mg sleep.
6:30 am: insomnia (I cannot sleep anymore because of the effect of the sertraline). Wake up: hyperactive, restless legs, muscle stiffness, brain fog, bruxism. Also a bit lethargic.
6:30 am - 12:30 pm approx: hyperactivity, brain fog, muscle rigidity, bruxism remains (although they gradually decrease with the hours).
1:00 - 7 pm approx: grogginess, lethargy, fatigue, sleep. (symptoms of hyperactivity-bruxism reduced and almost disappeared)
7:00 - 11:30 pm: I feel tired but have more mental clarity.
11:30 p.m. Sertraline 14.8 mg and sleep.

 

This pattern is repeated every day. I feel that I am almost all day under the effect of the drug feeling this pattern of symptoms, except at night when I feel somewhat better. I assume this is due to the sensitizing effect of sertraline. It's hard to get the morning brain foggy symptom and feel like I'm groggy and numb most of the day. I have always been a very energic person, but taking the drug every day, I feel numb, fatigued, and groggy.

 

The other day I took the drug at 11:30 pm while I was calm in a restaurant. Instead of going to sleep, I stayed awake with friends. It was interesting. After an hour and a half, bruxism and hyperactivity had already appeared. So, I took the drug and the adverse effects started. It is like an equation...

 

My question is:

 

I guess it would be advisable to keep going down a little faster, right? A careful but faster reduction?. Maybe 0.6 mg every two weeks? I also need to feel like I am making progress in tapering to stay motivated...the sensitization symptoms affect my life a lot. I feel high. I feel as if I drink two shots at the beginning of the day and feel the effects associated throughout the day. I need to get out this drug of my body to begin the real recovery process. I need it. Too much time taking this drug with many adverse effects every day...

 

Thank you very much,

Warmly,

Maze

 

 

 

 

[ChessieCat]

Q:  Have you ever taken sertraline in the morning?

[Maze]

Dear @Altostrata,

 

Yesterday I wrote but I tag myself in the post. Haha! I attach here the yesterday's post. Thank you.

 

____________

 

Dear Alto,

 

I am writing to update my status and ask for advice on the next steps in my tapering process.

 

I have been on 14.8 mg since March 3. On the reduction from 15.1 mg to 14.8 I felt well (no withdrawal symptoms). I have managed the situation to maintain the drug on 15,1 mg almost a month. I am happy with that. However, although I have been stabilized at 15.1 throughout the month, I continued to feel severe sensitizing effects of the drug every time I take it at night. It seems that the dose is still too high for my body. The pattern for each day is very similar.

 

9:00 - 11:30 pm: Tired but calm and clear-headed.
11:30 p.m. Sertraline 14.8 mg sleep.
6:30 am: insomnia (I cannot sleep anymore because of the effect of the sertraline). Wake up: hyperactive, restless legs, muscle stiffness, brain fog, bruxism. Also a bit lethargic.
6:30 am - 12:30 pm approx: hyperactivity, brain fog, muscle rigidity, bruxism remains (although they gradually decrease with the hours).
1:00 - 7 pm approx: grogginess, lethargy, fatigue, sleep. (symptoms of hyperactivity-bruxism reduced and almost disappeared)
7:00 - 11:30 pm: I feel tired but have more mental clarity.
11:30 p.m. Sertraline 14.8 mg and sleep.

 

This pattern is repeated every day. I feel that I am almost all day under the effect of the drug feeling this pattern of symptoms, except at night when I feel somewhat better. I assume this is due to the sensitizing effect of sertraline. It's hard to get the morning brain foggy symptom and feel like I'm groggy and numb most of the day. I have always been a very energic person, but taking the drug every day, I feel numb, fatigued, and groggy.

 

The other day I took the drug at 11:30 pm while I was calm in a restaurant. Instead of going to sleep, I stayed awake with friends. It was interesting. After an hour and a half, bruxism and hyperactivity had already appeared. So, I took the drug and the adverse effects started. It is like an equation...

 

My question is:

 

I guess it would be advisable to keep going down a little faster, right? A careful but faster reduction?. Maybe 0.6 mg every two weeks? I also need to feel like I am making progress in tapering to stay motivated...the sensitization symptoms affect my life a lot. I feel high. I feel as if I drink two shots at the beginning of the day and feel the effects associated throughout the day. I need to get out this drug of my body to begin the real recovery process. I need it. Too much time taking this drug with many adverse effects every day...

 

Thank you very much,

Warmly,

Maze

 

 

[Maze]

Dear @ChessieCat,

 

thanks for writing. This is my answer to your suggestion: "Have you ever taken sertraline in the morning?"

 

Yes. I took sertraline in the morning for the first two years (100 mg). Everything was good. However, I began to feel drug sensitization problems when I stopped sertraline and then reinstated it due to withdrawal symptoms. Since then, I have never been able to take it in the morning because it generates adverse effects, as you can see in my pattern of symptoms. Luckily, I can sleep through the worst side effects. For eight years, I have been taking sertraline before going to bed. I prefer to continue taking sertraline at night so that the worst side effects happen at night. If I were to take it in the morning, as I did the first few months after reinstallation eight years ago, the side effects would be more severe during the day rather than at night.

 

I hope I am explaining myself.

 

Warmly,

Maze

[Altostrata]

If you've been reducing every 28 days with no withdrawal symptoms, you might try reducing every 24 days and see if that's okay.

[Maze]

Dear @Altostrata and SA community,

 

I hope you are well. I want to do an update on my status. I need to make decisions and I seek help. I will try to explain myself. I am sorry for the length of the text but I think it is essential to understand the situation. It is not simple.

 

First, a brief summary of my story to understand what I will say next:

 

1. 2010: Sertraline 100 mg. (I had no adverse effects except for the first few days) (one month of benzos for the first month to manage adverse effects)
2. July 2012: Cold turkey (100mg-0). Not acute withdrawal.
3. November 2012: Late hitting withdrawal. (Symptoms were very different from my initial problem. I felt akathisia and strong anxiety)
4. November 2012: Reinstatement of sertraline 50 mg. Withdrawal ceases. It got better immediately upon reinstall.
5. December 2012 - January 2013: However, adverse effects appear every time I take sertraline after reinstatement. The psychiatrist tells me that it doesn't matter, I have to take it "for life" 🤦‍♂️
6. I continue taking sertraline every day but I cannot sustain the adverse-toxic effects. In order to sustain them, I start skipping doses. I take the sertraline every other day (at night, before I go to sleep, I take the sertraline). I continue experiencing adverse effects on days I take sertraline at night but they go away by 3 pm the next day and I feel fine. I do not have inter-dose withdrawal at any time. I have never suffered inter-dose withdrawal. I was on this regimen for 8 years.
7. July 2021: I decide that I want to stop sertraline due to the adverse effects I experience every time I take it (only the days I take it, the rest I am fine). The psychiatrist tells me to taper to 25mg, taking it every day. I go down to 25mg and start to experience withdrawal + the adverse effects every day.
8. I have been tapering for 9 months. (See signature).

 

In these 9 months, I have survived as best I could. I am now on 10.9 mg. I had to taper faster than I would have liked (I would have liked to follow a reduction of 10% per month). The reason for lowering faster: the adverse effects of the drug. Thanks to my background in mindfulness and sports I have been able to endure the toxic effects every day. But when I couldn't take it anymore, I had to taper. So listening to my body I have done what I could.

 

I have discussed the daily pattern approx. (what I experience every time I take sertraline) here quite a few times. Remember here:

 

1) I take the drug at night (11:30 pm) in a calm and clear-headed state.
2) I wake up around 6:00–6:30 am. I have a lot of symptoms, which are extremely difficult to hold (internal agitation, internal tremors, tension and burning sensation in the head, muscular rigidity, clenched teeth). They make me desperate. If I wake up around 3-4 am I already have these symptoms. At 11-12 am to 6 pm I feel lethargic, sleepy, depressed, tired, sleepy, dizzy.
3) At night, symptoms reduced. I am calm and have mental clarity. I can think. I feel myself. When I take the drug at 11:30 pm the pattern repeats itself.  

 

Therefore, I have concluded that I cannot continue like this. In the last few weeks, I am developing a lot of suicidal ideation. I always experience activation side effects in the morning and usually dizziness-depression-drowsiness in the afternoon-evening. As the day goes by, the adverse effects of the drug decrease. In the evening-night, my state is generally much better. All the physical and psychological symptoms are gone. I have concluded that it is possible that the toxic effects of the drug have been my main problem and not so much the withdrawal as I thought.

 

Because of that, I'm thinking of retaking the dose every other day. I have carefully read the information in SA about not skipping doses. And I understand the logic and I share it. But I think it is info adjusted for people who do not have adverse effects when taking the drug. When I reduced the sertraline to 25 mg I wanted to go back to taking sertraline every day. I have fought these 9 months not to skip doses, enduring all the toxic effects. But in reality, most of the hell I've been through these 9 months may be more related to the adverse/toxic effects than the withdrawal. The truth is that I was skipping doses for 8 years (always in the same way) and I was a very functional, cheerful person, with a good state of mind and mood. I suffered a bit of insomnia at night and hyperactivity-brain fog until 2-3 pm in the mornings after the days I took the drug at night, but nothing compared to now. I skipped doses for 8 years not because I wanted to but because I couldn't take it every day due to its toxic effects. I tried several times in the process to take it every day, but I failed. Even one time, I took anxiolytics for 30 days to try to get my body to sertraline every day for a month. When I removed the benzo, the same adverse effects returned when taking sertraline every day. I had to return to the skipping doses regimen. There was never any way my system would tolerate the sertraline after reinstalling it in December 2012.

 

Now, since I started taking the sertraline every day for 9 months, my body suffers every day and I have constantly altered states of consciousness (more depressed, anxious, worried, suicidal thoughts, mental agitation), until the evening/night comes and I get better. I return to feel "myself". I take the drug at 11:30 pm and repeat the cycle.

 

I don't want to quit cold turkey (10.9 mg to 0). I want to keep reducing it gradually as I can. But I also don't think it's sustainable much longer to take the drug every day and sustain the side effects every day.

 

That's why I'm asking directly. Please, if you require more info ask me. It will be a pleasure to provide more info.

 

1. Would it be possible to start skipping doses again (every other day) to see if my state improves?
2. Could I continue to taper little by little but omitting/skipping doses (every other day)?

 

I am aware that it is not a recommended practice and the risk of inter-dose withdrawal. But the reality is that I never experienced that inter-dose withdrawal, and I always had problems with the toxic/adverse effects.

 

My idea is to leave the drug completely. I have finished with the drugs. I never want to go back to any drugs. I am closer to the end. But now, I feel that I have to be flexible in reducing it to 0. I would like to taper according to the 10% monthly rule and take the sertraline every day, but the truth is that although I have tried hard, it was not possible. I have to listen to my body before I keep listening to the theories. Sometimes the theories do not fit all cases.

 

It is possible that for 8 years (since reinstatement), I was never able to tolerate sertraline anymore. However, I heard from a psychiatrist that I had to take it "for life" and did what I could (skip doses). Since 9 months ago, when I stopped skipping doses, I have lived in hell with the number of symptoms I experience daily until the level of the drug in my blood decreases. Maybe it's time to change and listen to me again, despite the fear.

 

I would appreciate @Altostrata if you could assess if I could be a case where the toxic/adverse effects are greater and more dangerous than withdrawal. Perhaps that could justify taking the drug every other day while I continue tapering off. At least try it and see what happens. I suppose that this option is better than reducing straight to 0. Staying for much longer in the reduction regimen that I have been doing for 9 months, I feel that it is not sustainable. I am suffering too much.

 

As I said before, any question you need to understand the situation better is welcome. I greatly appreciate the help provided.

 

Warmly,
Maze.

 

[ChessieCat]

Please provide daily symptom notes again so that your situation can be re-assessed.

[Maze]

Dear @ChessieCat and @Altostrata,

 

The pattern for each day is very similar to this. I attach it previously here and it is not very different now.

 

9:00 - 11:30 pm: Tired but calm and clear-headed.
11:30 p.m. Sertraline
6:30 am: insomnia (I cannot sleep anymore because of the effect of the sertraline). Wake up: hyperactive, restless legs, muscle stiffness, brain fog, bruxism. Head and jaw pressure. Nervousness
6:30 am - 2:00 pm approx: hyperactivity, brain fog, muscle rigidity, bruxism remains (although they gradually decrease with the hours and emerge tiredness, sleep, lethargy, sleepiness, etc. ).
2:00 - 7 pm approx: grogginess, lethargy, fatigue, sleep. (symptoms of hyperactivity reduced and almost disappeared). My mind is clearer than in the morning.
7:00 - 11:30 pm: I feel tired but have more mental clarity. No hyperactivity at all.
11:30 p.m. Sertraline and sleep.

 

Anyway, I attach here some daily symptom notes below.  The pattern is always the same although it may vary slightly. I always take the drug at 11:30 pm. I develop hyperactivity at night and during the morning of the next day. Symptoms more related to tiredness-fatigue-dizziness begin  in the afternoon and continue in the evening. I feel good at night. I repeat the cycle.

 

Thanks,

Maze

____

 

Daily Notes

 

April 20

23:30. Sertraline and go to sleep.

 

April 21 (11.2 mg)

 

7:30 am. Restless legs. Nervousness. Anxiety. Hyperactivity.
8:30. Bruxism. Head and jaw pressure. Hyperactivity. Akathisia.
9:30.  Bruxism. Head and jaw pressure. Hyperactivity.
11:00. Anxiety. hyperactivity
12:00. Anxiety. hyperactivity. Dizziness. Dopey.
12:40. Nausea. Dizziness.Sleep. Groggy.
16:00. Tired. Stunned. Dizziness.Groggy.
18:00. Severe tiredness. Sleep. Dizziness.
19:30. Severe tiredness. Dizziness.
22:00. Clearer mind. Calm. I feel like "myself"
23:00. Normality. Clearer mind. Calm.
23:30. Sertraline.

 

April 22 (11,2)

 

6:30 am. Bruxism. Muscular stiffness. Head and jaw pressure.  Restless legs. Anxiety.
8:45. Bruxism. Muscular stiffness. Head and jaw pressure. Hyperactivity.
11:00. Bruxism. hyperactivity. Dopey. Muscular stiffness. Severe difficulties to concentrating. Stiff hands when writing.
13:15. Bruxism. hyperactivity. Groggy. Dopey.  Muscular stiffness.
14:30. Severe fatigue. Tiredness. Drowsiness. Numbness.
16:30. Severe tiredness. Respiratory difficulty. Drowsiness. Dizziness.
19:30. Dizziness.
21:30. Calm. Feeling ok.
23:00. Normality. Clearer mind. Calm.
23:30. Sertraline.

 

April 23 (11,2)

 

7:30 am. Internal agitation. Restless legs. Bruxism. Severe tiredness.
8:30. Hyperactivity. Bruxism. Gases. Head pressure and heat. Jaw pressure.
9:30. Hyperactivity. Internal agitation. Nerves. Groggy. Suicidal thoughts.
10:30. Internal tremor. Nerves. Restless legs. Anxiety. Suicidal thoughts.
11:30. Severe nausea. Akathisia. Anxiety.  Tiredness.
13:15. Bruxism. Hyperactivity. Groggy. Dopey. Muscular stiffness.
3:30 p.m. Tiredness. Bruxism. Drowsiness. Dizziness.
21:00. Feeling normal. Calm.

[Altostrata]

On 4/24/2022 at 10:00 AM, Maze said:

1. Would it be possible to start skipping doses again (every other day) to see if my state improves?
2. Could I continue to taper little by little but omitting/skipping doses (every other day)?

 

 

It's possible for you to do this, but we do not endorse #1 or #2. We do not know what will happen. You're on your own.

 

Since you find sertaline to be activating, why not take it earlier in the day?

[Maze]

Dear @Altostrata,

 

2 hours ago, Altostrata said:

Since you find sertaline to be activating, why not take it earlier in the day?

 

Thanks for the reply. Taking sertraline in the morning (for example, 8:00 am) would lead to full symptoms 4-5 hours later (12 am). These symptoms would spread throughout the day, disabling me for as long as I am awake. And then it would repeat the cycle. Taking sertraline before going to sleep makes me feel a little bit calmer at next evening-night. At least I can breathe at night. Sertraline is not only activating for me but also causes cognitive problems that dissipate as the drug leaves the blood. It is not a good activation. It is an activation that disables me. Why would be a good idea to take sertraline in the morning?.

 

2 hours ago, Altostrata said:

It's possible for you to do this, but we do not endorse #1 or #2. We do not know what will happen. You're on your own

 

If it is not recommended that I take sertraline every other day, what other options are there? When adverse effects are intolerable, what other options are there? Since taking sertraline every day my life has gotten a lot worse. I suffer a lot. Clearly, the drug is toxic to me. Why is there a problem in trying to take sertraline again every other day, which is what worked for me for 8 years?

 

Thanks,
Maze

[Altostrata]

I believe we've discussed this thoroughly earlier in this topic. Please read it from the beginning.

[Erimus]

How are you doing @Maze?

[Maze]

Dear @Altostrata and SA community,

 

I haven't updated my status here in a while, but a lot has happened. Unfortunately, I urgently need help. At least to gain more clarity and act in the right direction. Sorry for the length of this text, but it is important and necessary to explain the situation. I am also sorry for my English, but I will try to explain myself as best as possible.

 

I have updated my signature. I had to cold turkey the drug (sertraline) at 9,1 mg. I have been doing a reduction in the last 10 months, enduring the adverse effects of the drug, but in May I couldn't take it anymore. The adverse effects plus cumulative withdrawal were too severe. The adverse effect was generating terrible akathisia that had me walking around my house from one place to another without being able to stop. Akathisia along with the withdrawal was dangerous and I knew I had to leave the drug.

 

At that time, I was already living with my parents, and I was afraid to leave the drug at my parents' house. I didn't know what would happen. So I went to a psychiatrist and she listen to me. After that she admit me as inpatient hospital to take me off sertraline (from 9mg to 0). He agreed to admit me to the hospital for that purpose and not to put me on any other drugs except for a low dose of Klonopin/Clonazepam/Rivotril (0.25mg), which I maintain to today.

 

The first day I was admitted to the hospital, the drug was withdrawn. The adverse effects of sertraline went away immediately after withdrawing the drug. The akathisia ceased. However, on the fifth day after the withdrawal, I began to experience new severe symptoms, which have been evolving until today. Despite the emerging symptoms, I was discharged from the hospital and told that it was my decision if I wanted to continue outpatient treatment.

 

Since then, I have been experiencing very severe withdrawal. I still live in my parent's house since I cannot care for myself correctly. I lost my job as I am physically and cognitively impaired. During the last 2,5 months, I feel that my nervous system is entirely de-regulated and collapsed. It's totally out of control. I have experienced many symptoms (which have also changed in intensity and form): dysphoria, extreme anxiety, cortisol spikes, depression, fatigue, constant bruxism, sudden need to sleep, internal tremors, recurring suicidal thoughts, muscle and joint pain, balance problems, nausea, breathing and walking difficulties, severe cognitive problems - I have not even been able to watch TV -, loss of physical strength, tooth pain, feeling of derealization, lack of motivation for everything (although I make an effort to do things with difficulties), emotional anhedonia, among other symptoms. Also, I feel weird: I feel like it's not me. I feel like another person (i.e., as if I had another personality). I lost all self-confidence and self-esteem when I have always been a person with self-confidence and self-esteem. I also feel like I'm losing my mind because all the suffering.

 

Regarding sleep, I suspect that thanks to the benzo dose, I can sleep until 5-6 am (I take it around 11:30 pm approx.). Around 5-6 am, I usually wake up with cortisol-anxiety spikes that can last until noon generally. I find managing this feeling of panic, terror, and anxiety very complicated. I suspect that without the benzo, it would be even worse, and I would not be able to sleep. I am afraid that if I stop clonazepam, my sleep will be affected even more, and I will wake up earlier in even worse conditions. However, I know that probably after 3 months it is time to taper off the clonazepam. Likewise, although I used to take naps after eating, now it is impossible. My body is on alert and I can't nap. I close my eyes but I can't sleep.

 

I want to mention that these symptoms never existed before I started taking sertraline 12 years ago. At that time, I was mainly experiencing tension headaches, low anxiety, derealization and low mood, but all were very very mild compared to the broad set of current symptoms.

 

In these 2,5 months, I have done important acceptance work to manage the situation, but I feel that it is tough and I do not know if I will be able to tolerate it. I feel that the mornings are too complicated. As I said, I wake up with huge anxiety spikes that build throughout the morning, coupled with massive dysphoria. This feeling makes me want to kill myself. Extreme anxiety creates a strong suicidal tendency and I feel like I'm on edge. I try to handle it but it is extremely difficult. My condition improves a bit in the evenings, although I still experience anxiety and dysphoria. In night I am generally much better. Generally, I feel exhausted (but it is not life-threatening). I feel calmer and more like myself. So, I go to sleep and the pattern of symptoms of anxiety-cortisol spikes and extreme dysphoria begins the following day again. In a text I read, Mark Horowitz (the psychiatrist), described the same thing in his experience: “and I would absolutely dread waking up, because I knew when I woke up, I would wake up to surging panic. I felt like I was on the edge of a cliff being chased by an animal.” Very accurate.

 

So, at this point, I wanted to ask for help and advice. Truly, there are days when I wouldn't mind committing suicide if I were alone in the world, but I feel like I don't want to destroy my family's life. My parents and sister are helping me a lot, but seeing me in this state and with suicidal tendencies must be tough. Also, my mom is a GP. She thinks I'm doing the wrong thing by going through withdrawal instead of taking another drug. She says I should take another drug to try to stabilize me and then, later on, taper. She is scared and I understand this perfectly. But... I worked so hard to get off the sertraline...

 

I want to maintain flexibility, so I don't feel like returning to another drug is a failure. However, I think I have an opportunity to get off psychiatric drugs. Therefore, my first option is to continue to maintain withdrawal and slowly reduce clonazepam in the coming weeks-months (I has been taking it since June 1). I found a benzo reduction psychiatrist who follows the Ashton manual and is willing to help me. I also see a section here on SA about reducing benzo.

 

However, I don't know if I'm going wrong along the way, as I feel like one day I will commit suicide if I can not tolerate withdrawal hits so hard. I don't know if I can tolerate the withdrawal. Or even if sustaining the withdrawal is recommended. I feel that it the situation is very dangerous and not everything is as I would like it to be. It is as it is. Maybe, should I reinstall the drug?

 

I have read in SA about the possibility of reinstating the drug at low doses. The problem with this option is that I had adverse effects on sertraline for many years. As I suffered from adverse effects so many years, I had to take sertraline every other day as I have explained in previous posts (the psychiatrist said I had to take it every day even with adverse effects, but I could not tolerate it). Also, last year I couldn't do the sertraline taper even more slowly as my body couldn't tolerate the drug (even when I tried). So, now I'm afraid of the reinstall option since I cold turkey the drug at 9 mg because I couldn't take it anymore (after 10 months of reducing).

 

I feel trapped. I would like to ask what would be better options (or less harmful options):

 

1. To maintain the abstinence until it passes (bearing in mind that by now I have sometimes thoughts of suicide and I am dysfunctional daily. I had to quit my job meanwhile and try to live the day with a lot of suffering. In addition, the duration of withdrawal is unpredictable from what I read in SA experiences).
2. To reinstall another drug to try to stabilize me and later withdraw it slowly and appropriately. (I guess it is impossible to know if another drug would help me or if I can suffer an adverse reaction. I was thinking of something like escitalopram, citalopram, fluoxetine or another ISRS, but I am afraid of a possible adverse reaction similar to what I have suffered for a long time with sertraline…).
3. Reinstalling a very low dose of sertraline, despite the risk of adverse effects, including akathisia. (This was the reason I started to withdraw the drug and why I was unable to make a slow and proper withdrawal)
4. Other options I can not see.

 

The situation is very difficult. I am writing because I don't know how long I will be able to endure the symptoms I experience when I wake up and in the morning. It's like my brain is hijacked and it's not me. I can't make rational decisions. I can't tolerate anxiety despite practicing mindfulness for over 10 years. It's a very chemical feeling that is superior to my self-regulation abilities. It drives me over and over again to want to kill myself until it disappears. Neuro-emotions? Dysregulated HPA?

 

I feel that the psychiatrist misled me saying that I had to take sertraline for so long and I feel that now I will not be able to get out of this situation. I feel very sorry for my family, they don't deserve something like that. I ended up taking sertraline for 12 years as my psychiatrist said I had to take sertraline for life (you know, the chemical imbalance and insulin story). Also, I studied in the Psychology degree that ISRS were safe and that they did not generate dependency. It is a lie obviously.

 

As I say, I intend to live without psychiatric drugs. Taking them brought me to the bad place where I am, but I have to make intelligent decisions and consider all options. I have read of many people who had to reinstate as the withdrawal was intolerable. Sometimes determination and effort is not enough, and things are not as I would like them to be, but as they are. I hope you can suggest something from your expertise to think about that.

 

If you have any questions it would be a pleasure to answer them.

 

Thanks for the help in advance.

 

Maze.

[Altostrata]

Hello, @Maze I am sorry you've had such a difficult time.

 

You've been wanting to quit sertraline for a long time. While you had adverse effects of the drug, we have warned you the cost of going off sertraline quickly might be withdrawal symptoms. You decided you wanted to risk this, and found a doctor who would help you do this with the aid of hospitalization and a benzo.

 

Now you are experiencing the outcome of going off sertraline. 

11 hours ago, Maze said:

Regarding sleep, I suspect that thanks to the benzo dose, I can sleep until 5-6 am (I take it around 11:30 pm approx.). Around 5-6 am, I usually wake up with cortisol-anxiety spikes that can last until noon generally. I find managing this feeling of panic, terror, and anxiety very complicated. I suspect that without the benzo, it would be even worse, and I would not be able to sleep. I am afraid that if I stop clonazepam, my sleep will be affected even more, and I will wake up earlier in even worse conditions. However, I know that probably after 3 months it is time to taper off the clonazepam. Likewise, although I used to take naps after eating, now it is impossible. My body is on alert and I can't nap. I close my eyes but I can't sleep.

 

Quite frequently, people experiencing withdrawal syndrome have a bad reaction in the morning like yours: 

 

Waking with panic or anxiety -- managing the morning cortisol spike

 

You are taking a benzo specifically to make antidepressant withdrawal syndrome tolerable. This was prescribed to you by a doctor with your full knowledge that this would be the withdrawal process.

 

The effect of clonazepam may wear off overnight. You may need to take a smaller dose of clonazepam in the morning as well as the dose you take in the evening.

 

It seems to me that your central question here seems to be if you should continue to take clonazepam, and we can't answer that. The benzo was your doctor's plan. You need to talk to your doctor if you fear you cannot tolerate withdrawal syndrome without the benzo.

 

Sorry, we cannot answer questions about your current medical care. You should be directing your questions to the doctor who took you off sertraline. We cannot advise you about other drugs. We don't know what a reinstatement of a low dose of sertraline would do. 

 

Many people do rely on a benzo to get them through many months of withdrawal syndrome, this is not unusual. Some doctors advise it. Eventually, you will need to taper off the benzo, of course.

[Singhpunjabi]

How r u doing now?