Jamrock: Sertraline micro-taper, seeking guidance

[Jamrock]

Hello all, 

 

I'm a 31 M who has been on Sertraline since 2009. 2009-2016 at 100mg with various instances of dose changes when feeling better. Self tapered, as no psychiatrist offered any meaningful support. Never dropped below 50 mg. 2016-2020 I made a permanent change to 87.5 mg due to side effects, and this helped ease negative symptoms (constipation, sleepiness, and occasional inner restlessness). Again lowered the dose at certain periods, in the hope of getting off completely, but was never able to get below 50 mg due to extenuating circumstances (not withdrawal, but stressful life occurrences). Was at 68.75 mg at the end of 2019, but a traumatic injury coupled with the onset of the COVID-19 pandemic forced me to go back to 87.5 mg to stabilize. This helped emotionally, but medication side effects became more severe, and I made the decision to taper off permanently, once and for all. I was cutting by 10% per month at the end of 2020, and shifted to 5% per month in 2021 due to withdrawal effects (insomnia, inner agitation, tinnitus, ear worms, and hypersensitivity). Held at 62.5 mg from April to October and symptoms abated. Have now begun a multiyear micro-taper combining pills and liquid. 

 

My question is regarding how exactly to structure this micro-taper going forward. I've read through the site and saw Brassmonkey's protocol, for example, but I'd greatly appreciate more specific advice in my case. If I continue to cut by 5% per month, is there any difference between dropping by .1 mg per day over the course of the month or dropping by .75 mg per week over the course of month? I can see the argument for both sides (the former being a more gradual daily drop, the latter being a larger drop but allowing for more time to stabilize/assess symptoms), but I'm wondering if there's any compelling reason to choose one over the other, and whether any of your personal experiences back this up. I am currently taking two 25 mg pills and then making my own liquid solution with these pills (half Ora-Plus, half water for a 1 mg to 1 mL ratio) to avoid the alcohol-based commercial liquid when administering the rest of the dose. 

 

Thanks so much,

Jamrock

[Altostrata]

Welcome, @Jamrock

 

On 10/21/2021 at 4:11 PM, Jamrock said:

I was cutting by 10% per month at the end of 2020, and shifted to 5% per month in 2021 due to withdrawal effects (insomnia, inner agitation, tinnitus, ear worms, and hypersensitivity). Held at 62.5 mg from April to October and symptoms abated.

 

Good idea to hold and let your nervous system settle over those months.

 

No, there's no difference between decreasing by 0.10% per day or 0.70mg per week. (0.75% per week would be a little faster.) In fact, people might find smaller, more frequent decreases more tolerable than simple decreases of 5% or 10% per month in an exponential taper, of course, calculated on the last dosage, with the amount of the decrease getting progressively smaller.

 

How have you been calculating your decreases?

 

If you're taking 62.5mg, you're taking 50mg with the rest in homemade liquid?

 

To help us out, follow these instructions Please summarize your drug and withdrawal history in your signature You may need to use a computer to do this.

 

 

[hayduke]

Hi @Jamrock

 

Daily cuts may work, though I found I was in a constantly unsettled state instead of the weekly cut which was more of a pattern with more ease typically appearing towards the tail end of the week.  I eventually found Brass Monkey's pattern was the most suitable template for me most of the way down.

 

But we're all different and were put on different drugs...you may find a daily micro taper works for you.  I found it was good to try a few different taper modes along the way...just be gentle moving about 🙂

[Jamrock]

Hi @Altostrata

 

I've been doing a 5% reduction based on the prior month's dose. I started in Oct 2020 at 62.5 mg, so I'm near the end of the 3.1 mg drop to 59.4 mg. 

 

As far as the administration, yes, that is correct. I'm taking two generic 25 mg pills and the rest as a homemade liquid made from these pills. 

 

Hi @hayduke

 

This advice makes a lot of sense. I've adopted part of BrassMonkey's protocol by holding for 5-7 days after the month of daily micro-tapering, but I've also wondered myself whether a larger, more "predictable" weekly micro-taper was better. 

 

If I were to switch to @brassmonkey's approach, would you suggest I start the next month by dropping .75 mg the first week? 

[hayduke]

Here's the topic, for reference:

 

 

To answer your question, you would take 10% of your present dose, divide by four to give 2.5% of your present dose, and take a 2.5% cut each week for four weeks, then just sit tight for another two.  Rinse, lather, repeat!