Erimus: my introduction and journal

[RachelSusan]

@Erimus I wanted to ask you a few questions, not because I am questioning anything you are doing/feeling, but rather for me. So I can get information that might pertain to me.

 

You mention a crash 4.5 months ago and then you said 6 months is your sweet-spot in terms of recovery.  Did I get that right?  How bad are your symptoms 4.5 months in? Are you able to share any of them and the severity? If it will cause you to feel worse or you just aren't up to it then please do not do so.

 

I ask because I had a crash at the beginning of November, with symptoms since then, but showing a small amount of improvement in their severity. Then the beginning of February I crashed again. Symptoms are severe.

 

Like I said, if you feel up to sharing any of your timeline I would appreciate it, but please please please do not do so if it will make you feel worse. 

[Erimus]

Hi @RachelSusan. I’m more than happy to share my experience, and I hope it helps or comforts you in some way.

 

Yes, I choose 6 months because that appears to be the minimum time needed to notice significant changes in symptoms. For example, my severe akathisia came on in May 2022 and mostly faded by November 2022 (I still can’t believe I speak of akathisia as a thing of the past !!).

 

Since the big crash withdrawal moves forward in a pattern of smaller subsequent crashes, with a crescendo of sorts. After the big crash the duration between the crescendos has extended from around 7 days to the most recent of 10 weeks. Over this time symptoms have waxed and waned, with a general trend towards decreased intensity and duration. I take this as a massive positive.  
 

The symptoms that came on after the crash were (in no particular order): Lower back pain (improving a lot); jaw tension (improving); tension headaches (manageable); intense muscle contraction in feet (so severe at times it has caused bruising and skin flaking, which I photographed as evidence), calves and hamstrings (still problematic); circulation problems in feet and hands, periods of extreme coldness, numb feet; wrist pain (much improved), knee pain (much improved), ankle pain (minor); neck pain, right shoulder pain (problematic but better, for a month it was awful), right hip pain (current bad one); agitation periods; stabbing pains in muscles (much improved); some GI issues (minor issue now). There’s more that I can’t think of but that’s enough misery for now.

 

I used to spend a lot of time laying flat on the floor to reduce pain, I haven’t done that in a long time which shows great improvement. First 4-6 weeks post crash the pain was too much to sit down. I’m so far beyond that now.

 

For me the crashes happen because the nervous system can’t keep up with the size and speed of dose changes. I take 50mg every day but my nervous system still thinks it is being short changed and should be getting more. I’m also unfortunate that it appears my CNS can only make very few changes each night. 
 

Sorry for the long passage of text. Feel free to ask away with any more questions, I’m not going anywhere anytime soon.

 

 

Edited February 27, 2023 by Erimus

[RachelSusan]

@Erimus Thank you for the information. I ask because my crash was at the beginning of November. Two things happened at the same time, I did a cut with my Gabapentin and changed my dosage of prednisone. All hell broke loose.  The first few weeks were dreadful and then it slowly improved a little, but never because normal or acceptable.  Then at the beginning February all hell broke loose again and here I sit.  Symptoms are brutal. There are two things that did happen shortly before the Feb. symptoms change, however I don't know if they played a role in this second crash.One, I got a vaccination for pneumonia, and two, for three days one of my doctor's had me take twice as much of an antibiotic that I take indefinitely for another medical condition. I don't know if either of those contributed or not.

 

Sometimes I get in this place where I start to wonder if this truly withdrawal. I wonder because the Feb, symptoms seems to flare up so drastically without a cut. Then I ask, if it isn't withdrawal then what is it?  Then I look at the possibility of testing and doctor's wanting to once again add some sort of medication into my life, or I ask myself should I just wait another month or two?  Since our entire medical model has changed in my community I guess it doesn't really matter because even if I was going to book an appointment tomorrow I won't see a doctor for months.  I also fear that some well meaning doctor might try to treat my symptoms without really resolving what the issue is. For example I hate to be treated for a heart disease when it is heart palpitations from withdrawal.

 

We have corresponded a little bit off and on and once again I thank you for good information and for listening.

 

Warm wishes.

[HealthHopeHappiness]

Hi @Erimus I am always so interested in your posts as your symptoms and patterns really mimic mine. I just wondered how you dealt with the muscle pain, particularly the shoulder pain? I have non-stop muscle contractions in my right shoulder and nothing is helping. I don’t want to take up your thread asking questions about me, so feel free to pop over to my thread if you have time or energy.
 

@RachelSusanwhat you say about wondering if it is truly WD but having a fear of involving medical professionals is exactly how I feel too. It’s so hard. 
 

Take care both of you. 

[Erimus]

I’d hazard a guess that your symptoms are related to an unstable nervous system reacting to different triggers in unusual ways @RachelSusan. When you have multiple variables at play it’s hard to discern what’s happening. Obviously it’s easier for me because the only changing variable I have is the protracted sertraline withdrawal. I’m fortunate in the sense I don’t currently have any non-withdrawal health problems I need to manage.

Vaccination and antibiotic dose changes can definitely trigger a sensitised nervous system, but it sounds like they were unavoidable. If you leave everything the same (to the best of your ability) things will improve. I know how you feel constantly questioning if it’s withdrawal or something deeper. When nothing makes sense all you can do is hold and hold. It’s hard and defeating but the body craves it.

[Erimus]

Hi @HealthHopeHappiness. Managing the pain is hard. The shoulder problem was really bad for around a month, but is improving in a windows and waves pattern.

My pain management technique simply consisted of finding a comfortable position (for me it was sitting) and just riding out the storm. I try to distract myself as much as possible. Other than that just time, incredible patience, and hope. 
 

I take cod liver oil and drink a mug of bone broth daily. Hopefully they’re helping somewhat but it’s difficult to tell.
 

 Best wishes.

Edited February 28, 2023 by Erimus

[RachelSusan]

@Erimus

3 hours ago, Erimus said:

I know how you feel constantly questioning if it’s withdrawal or something deeper. When nothing makes sense all you can do is hold and hold. It’s hard and defeating but the body craves it.

This makes a lot of sense.  So right.  Thank you.

[Erimus]

Quick update from me. I was going to do a lengthier update but progress has been disappointing. I’m in a bad wave at the moment and I expected to be a lot better by this point. I should know by now that this ‘condition’ has no awareness of time. Mentally I am very sound, probably the most in over 2 years, but physically still very broken.

 

Will return in another 2 or so months, hopefully with news of improvement. Hope everyone is doing okay.

[Erimus]

Been a while since I updated my topic. Going forward I've decided not to bother until I have some real, positive improvements to post.

 

It's been 2 years since I made the catastrophic decision to drop my dose whilst already (unbeknownst to me) deep in withdrawal. I have no words to describe the horrific journey I have been on over these last two years, and that doesn't even include the year of hell prior to that. I've experienced varying amounts of pain every day for the past 11.5 months, joint pain is mostly gone but the muscle contractions/pain is still a huge problem. I'm carrying two muscles strains that have never fully healed, one from June 2022 and one from Feb 2023. The latter has pushed me close to breaking point but I think I reached rock bottom in June this year. I still don't walk properly due to the contractions in my legs but I am going out more than I was a few months ago. Digestion is still pretty solid bar in a period of bad bloating and an episode of nausea.

 

Recently I have started to become more interested in the things I used to care about pre-psych drugs. I have also become increasingly sad about all the life I have missed out on so young, I avoided social media for so long because seeing friends moving on with their lives was too painful for me. Despite this, I am grateful to actually feel any kind of normal emotion. We're heading towards winter here, which I find is the hardest part of the year in withdrawal. I hate the cold and I hate the dark, especially when I'm already trapped indoors. Having a mind that requires stimulation, but a broken body, makes it difficult to manage expectations.

 

I often wonder if stopping the drug completely would've been less painful than this excruciating effort to stabilise, but I'm too far in to contemplate that now. One of these days I will come here with news of improvement, but for now it's still disappointment disappointed. 

Edited September 20, 2023 by Erimus

[littlebird]

1 hour ago, Erimus said:

Recently I have started to become more interested in the things I used to care about pre-psych drugs.

This is great! Hoping to get there soon myself.

 

1 hour ago, Erimus said:

We're heading towards winter here, which I find is the hardest part of the year in withdrawal. I hate the cold and I hate the dark, especially when I'm already trapped indoors.

Ugh, been there. Have you ever used a light therapy lamp? I started using one when I lived somewhere really dark and I think it helped a little. Should probably try it out again. I also got one for my partner's desk as they struggle with seasonal depression in the winter, and it was a less bleak winter for them (but still rough). 

 

1 hour ago, Erimus said:

Having a mind that requires stimulation, but a broken body, makes it difficult to manage expectations.

Yuuuuuuuup! I'm disabled and immunocompromised, so a lot of things that help others are off limits to me. Solidarity, friend. You're not alone in this!

[HealthHopeHappiness]

On 9/20/2023 at 5:55 PM, Erimus said:

Been a while since I updated my topic. Going forward I've decided not to bother until I have some real, positive improvements to post.

 

It's been 2 years since I made the catastrophic decision to drop my dose whilst already (unbeknownst to me) deep in withdrawal. I have no words to describe the horrific journey I have been on over these last two years, and that doesn't even include the year of hell prior to that. I've experienced varying amounts of pain every day for the past 11.5 months, joint pain is mostly gone but the muscle contractions/pain is still a huge problem. I'm carrying two muscles strains that have never fully healed, one from June 2022 and one from Feb 2023. The latter has pushed me close to breaking point but I think I reached rock bottom in June this year. I still don't walk properly due to the contractions in my legs but I am going out more than I was a few months ago. Digestion is still pretty solid bar in a period of bad bloating and an episode of nausea.

 

Recently I have started to become more interested in the things I used to care about pre-psych drugs. I have also become increasingly sad about all the life I have missed out on so young, I avoided social media for so long because seeing friends moving on with their lives was too painful for me. Despite this, I am grateful to actually feel any kind of normal emotion. We're heading towards winter here, which I find is the hardest part of the year in withdrawal. I hate the cold and I hate the dark, especially when I'm already trapped indoors. Having a mind that requires stimulation, but a broken body, makes it difficult to manage expectations.

 

I often wonder if stopping the drug completely would've been less painful than this excruciating effort to stabilise, but I'm too far in to contemplate that now. One of these days I will come here with news of improvement, but for now it's still disappointment disappointed. 

Sorry to hear you are still struggling on through the WD journey. It really is the pits. You are getting out more despite the leg contractions, that’s good going. Good news too about your digestion being relatively stable. 
 

I hear you re having a mind that needs stimulation coupled with a body that feels broken. It’s incredibly difficult. Keep holding on, a day at a time. Your posts are always so articulate and always have hope threaded through them in some way, despite the difficulties you face. I’ll hold hope for you too. In the meantime, take good care. 

[Erimus]

Just as I thought the tide was starting to turn with the physical pain and suffering, another almighty kick to the teeth today. I strained a muscle in my upper back drying my hair after showering, I am in so much pain. Not only physically but emotionally it has broke me, the thought of another injury that doesn’t heal and months more suffering has destroyed my mental state. When it’s this bad I don’t know how to go on. I’m sick and tired of physical pain. I was just beginning to get out more and function a bit better. I’m not sure how many more knocks I can psychologically take.

[hellasound]

I’m sorry to hear about your recent strain. I’m like that too if I as much turn my head too fast i feel a muscle in my back contract and I’m in pain for a week. Every muscle in my body is tense I even tried getting a massage yesterday it did nothing. And my knees are painful I grimace every time I have to bend them. 

[Erimus]

I am in a terrible wave, the worst I have felt since early June. There are no words to describe the things sertraline has done to my body over the last 3 years. It's also the 2 months of the year I hate the most during withdrawal. I am a stubborn old mule but my resolve is being pushed to the limit at the moment. Will post again next year.

[getofflex]

I'm very sorry to hear this, @Erimus.  I'm thinking of you and praying for you.  When was your last reduction, and what was the dose before and then after the reduction?  

 

3 hours ago, Erimus said:

It's also the 2 months of the year I hate the most during withdrawal.

I also dislike November and December in general.  I can relate. 

 

3 hours ago, Erimus said:

I am a stubborn old mule but my resolve is being pushed to the limit at the moment.

Just keep that stubborn resolve!  You can do this!  Try to take it a day, or even a minute, at a time.  Read this post, it will help. 

 

Techniques for Managing Withdrawal

[Erimus]

Thanks @getofflex. My signature is up to date. Been on 50mg of sertraline since September 2021; mirtazapine unchanged since I started it in Nov 2020.
 

The short version is my reaction, and withdrawal reaction, to sertraline has been severe. Not much I can do about that now, stuck with the hand I’ve been dealt. 
 

What I have experienced over the last 13 months I can only think to describe as extreme fibromyalgia-type symptoms. Basically just extreme joint and muscle pain for just over a year. Joint pain is pretty much gone now but muscle pains still as extreme as ever. The circulation in my legs and feet has also been severely impacted. They are often purple, red, and extremely cold throughout the day. Difficult to explain these symptoms, even to people on here who know the dangers of these drugs. 
 

I push most of it away into a part of my mind so deep I pretend it isn’t there, and try to live as normally as possible given circumstances. I’m pretty mentally sound these days, 2 years ago I was basically bed ridden. Now I’m still physically crippled but more present and alert. In between that I had a period of akathisia that lasted 6 months (May-Oct 2022) and involved me walking miles each day to satiate the restlessness. Can’t even imagine being so physically able as of now, weird how things fluctuate throughout this journey.

 

Sorry for the essay. Thanks for reaching out. Hope all is well post psych drugs.

Edited November 6, 2023 by Erimus

[peaceandlove]

Long time no talk. I hope you feel better 💕

[getofflex]

I’m terribly sorry to hear of the awful things that you have been through. However, it does sound like you are improving if you were bedridden two years ago. It sounds like you have a lot of strength and endurance.

[Erimus]

Time heals everything. That is what keeps me going, and the fact I have no choice but to continue lurching forward. It’s human nature to survive all adversity. It’s amazing how strong your mind is without you even knowing.

[getofflex]

I applaud your strength and willingness to endure hardship.  Someday it will pay off.   

[Erimus]

It’s Christmas Day here and I am in so much pain. It feels like I’m at the point where I can’t go on anymore with this approach.

 

27 months with no dose change and I don’t feel like I’m ever going to stabilise again on the sertraline. I don’t have words to describe the muscle contraction and pain I feel in my legs and feet each day. The pain has been going on since October 2022.

 

I don’t really know how I move forward from this but what I’m doing now isn’t working. I feel like I have to stop this drug because it’s killing me. 
 

I was always staunchly against other medication but the past few weeks I have been considering the idea of low dose lamotrigine more and more each passing day. Obviously that would require finding a psychiatrist to prescribe it, which would no doubt take ages in itself, by which point things might be improved.

All I know is I can’t keep living like this and ignoring these symptoms any longer. My body is screaming at me to do something, anything, to stop this.
 

 

[Erimus]

It’s difficult to balance the fear of making things worse with the severity of my symptoms. Mentally I feel fine which is a plus, but the physical pain isn’t liveable. When it’s this bad I can barely move, I sit in a chair grimacing until I can take my dose of mirtazapine at 9pm and ease the symptoms.

[Altostrata]

On 12/8/2021 at 3:29 PM, getofflex said:

....

Interactions between your drugs

Major

sertraline  mirtazapine

Applies to: sertraline, mirtazapine

Using sertraline together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. 

 

Several of the symptoms you mention, including the sweating, muscle tension, and GI issues, are described above.  It's a good thing that you plan to taper off.  The trick is going to be tapering off the drugs without triggering major withdrawal symptoms.  Here is a link about serotonin syndrome on our site: 

 

Serotonin Syndrome

....

 

On 1/16/2022 at 8:33 AM, Erimus said:

....

Each day I take the dose at 11am and am often left with a myriad of symptoms that peak at about 330pm. Some of these symptoms include intense head pressure, an inability to concentrate, teeth chattering and grinding, mild tingling in my head occasionally, shallow breathing, restlessness. Around 4pm then begins what I can only describe as a ‘comedown’ of sorts as the symptoms ease slightly into the evening, I assume this correlates with blood plasma concentrations of the drug.

 

I’ve started a symptom diary including when I take what and will post each day for the next week.

 

I take mirtazapine at 9pm each night. I feel at my best (least intensity of symptoms) late in the evening and first thing in the morning, before the sertraline dose at 11am.

....

 

 

On 6/13/2022 at 7:30 AM, Erimus said:

....

At least now I know what the problem is. Only in the last 6 months or so have I worked out that the drugs were making me feel this way. Now just the almighty task of getting off them.. what a life ay!

 

On 12/12/2022 at 3:19 AM, Erimus said:

Turns out there’s nothing wrong with my liver enzyme results from the blood tests. It was the total protein result from the liver panel that was ever so slightly high.

....

 

 

On 7/30/2022 at 12:24 AM, Erimus said:

I was planning on taking a break from SA until mid September, things were very slowly improving and I felt the best I had since April 2021 when the dose change merry go round began.

 

Then I caught covid. Today is the second day of severe symptoms. I think this is the joint most pain and discomfort I’ve ever endured in my life. The huge inflammation from the immune response has shocked my nervous system and I am in what I can only describe as hell. Last night I slept 40 mins, my legs buzzed intensely from 6pm yesterday all through the night and have not stopped this morning. Before covid my sleep was the best it has been in over a year. I have a raging fever and am taking full doses of both paracetamol and ibuprofen just to survive the high temperature and immense pain.
 

The omeprazole taper was going well, I got down to around 13mg with no symptoms. The constant state of wired and fight/flight has led to constant stomach acid production. Last night I didn’t have any tea and found myself dry heaving over the toilet at 2am due to endless stomach acid eating away my insides. I’ve gone back up to 20mg but the wired feeling has not stopped. I have to keep forcing small amounts of food down every few hours to soak up all the acid.

....

 

@Erimus Do you still feel worse after taking sertraline in the morning and better in the evening?

 

Elevated liver protein could indicate slight damage from the drug combination. Drug-drug conflict in the liver is exactly how the combination of sertraline and mirtazapine can cause serotonin toxicity or, at the extreme, serotonin syndrome.

 

Mirtazapine has a potentially long half-life, up to 40 hours. It's very possible you have a substantial amount of the prior night's mirtazapine in you when you take sertraline in the morning, your symptoms become more severe when the serotonin reaches peak plasma 4.5-8.4 hours later and wear off when the drug plasma levels of mirtazapine and sertraline are lower in the evening.

 

You may have stabilized from sertraline reduction some time back, but continue to experience adverse drug-drug effects. You also may still be suffering the aftereffects of having covid.

[Erimus]

Thanks for the lengthy reply @Altostrata. The symptoms are always at their worst from around 1100 until I go to bed, peaking at 1530-1630. Today there is no improvement in the evening. Yesterday I felt much better than today.

 

I had severe joint pain from October 2022 to February 2023. I also had akathisia from May-Nov 2023 which has completely cleared up. My thinking is that if these symptoms can go away then so can the muscle pain. I am well aware of long-covid immplications. I actually had my best window since the last drug change (in Sep 2021) a couple of weeks after contracting covid (August-Sep 2023).

 

My liver results are back to normal now. I am aware of the drug interaction issues, but having being stable on 100mg sertraline and 15mg mirtazapine, I assumed that it would be possible to reach the same level of stability on 50mg sertraline and 15mg mirtazapine. Perhaps I am incorrect.

 

If I do have serotonin toxicity, I assume the only way out would be gradually reducing the offending drug (sertraline) despite being in withdrawal. I guess it's a damned if I do, damned if I don't scenario. After waiting so long to try and stabilise I feel I am at a point where action is necessary.

[Erimus]

I was hoping to have a better foundation before I started tapering, to ensure maximum chance of success. But perhaps I will never reach such a point.

[Altostrata]

2 hours ago, Erimus said:

having being stable on 100mg sertraline and 15mg mirtazapine, I assumed that it would be possible to reach the same level of stability on 50mg sertraline and 15mg mirtazapine.

 

You may always have had the drug-drug interaction, and it got worse. Tolerance for the drug is not static.

 

My guess is you do not have withdrawal symptoms any more, you are suffering from adverse effects of sertraline.

[Erimus]

10 hours ago, Altostrata said:

My guess is you do not have withdrawal symptoms any more, you are suffering from adverse effects of sertraline.

So, what to do? Start tapering? I’ll be honest the thought scares me but, like I said, I don’t think doing nothing and praying is the correct solution anymore.

[getofflex]

If it were me, I would start tapering.  If the idea scares you, try tapering only 2% or 5% instead of the usual 10%, just to see how it goes.  You can also micro-taper:  

 

Micro-Tapering

[Erimus]

43 minutes ago, getofflex said:

If it were me, I would start tapering.  If the idea scares you, try tapering only 2% or 5% instead of the usual 10%, just to see how it goes.  You can also micro-taper:  

 

Micro-Tapering

I’ve always had in my mind that my first drop would be 1mg down to 49mg, just to test the waters. That would be 2%. Given my situation, and from lots of reading here, I wouldn’t even attempt 10%.

[Erimus]

I’ve got most the equipment already, having helped my Mum start her own taper in June. I would just need a method for crushing the tablets. Id prefer not to switch to a liquid to avoid any possible cross-over issues.

[getofflex]

4 hours ago, Erimus said:

I’ve always had in my mind that my first drop would be 1mg down to 49mg, just to test the waters. That would be 2%. Given my situation, and from lots of reading here, I wouldn’t even attempt 10%.

I think this is a wise decision.  

 

4 hours ago, Erimus said:

I’ve got most the equipment already, having helped my Mum start her own taper in June. I would just need a method for crushing the tablets. Id prefer not to switch to a liquid to avoid any possible cross-over issues.

No problem.  If it were me, I would use a mortar and pestle, available on amazon.  Some people use 2 spoons.  You can also get a pill grinder on amazon for this purpose: 

 

On 9/28/2019 at 5:04 PM, Frogie said:

I don’t know if this is where I should post this or not. If not, could a moderator please move it.

 

 I have been crushing my Xanax with the back of a spoon on a plate. It took forever to get them into a fine powder. That was the worst part about having to weigh them out and putting the powder in capsules.

 

 I found, on Amazon.com a pill grinder. It’s made by B&C Home Goods and called Premium Pill Grinder. It was $15.99 and worth every penny. You pour the pills in, put the handle on and turn it. It grinds the pills into a fine powder and has a storage container on the bottom.

 

Just wanted to share in case anyone was interested in saving time and a mess crushing your pills by hand.

 

 

Using a Scale to Weigh and Measure Dose

 

 Tips for Tapering Sertraline

 

 

Edited December 27, 2023 by getofflex

[Erimus]

I had a go with the pestle and mortar I bought in July 2022. It's stainless steel and it actually works great. Saves me spending on some pill grinder/coffee grinder.

[Erimus]

Just posting this here so it's easier for me to find in the future.

 

 

[HelenR]

Hi @Erimus

I've just read your posts. How are things with you and I can't find any posts describing what happened to you once you started to taper your Sertraline.

Hopefully you've had improvements.

[Erimus]

Good question @HelenR. I'm afraid I won't be able to answer that until I've started.

[HelenR]

@Erimusoh I'm sorry to hear that. I guess your body is in enough pain so you don't feel ready to subject it to anymore.

I have been stuck in 5mg of citalopram for just over a year and then I had COVID which halted my progress back to square one so I too shall hold off but hopefully not for another year.

Do update us when you feel ready and I really wish you calmer days to come.