GreenIvy: tapering while raising a family

[GreenIvy]

Hello, I have been on 25mg of zoloft Sertraline for 10 years for depression. I would like to taper and hopefully be off this drug in the future because I want to have more children. I am still young and do not want to be on this drug for the rest of my life.   I have 2 small children and was on this medication for both pregnancies. I worry about the effects the medication may have had on my children being exposed during pregnancy.  I feel frustrated for the fact that when I was first prescribed this drug in my early 20's the doctor neglected to tell me how difficult it would be to get off this drug and that I could put my future children at risk.  If I successfully taper slowly over 3 years, I  feel afraid of the withdraw symptoms. Mainly I feel afraid because I know the withdraw symptoms can be debilitating and I have a job, husband, and 2 small children.  

 

Do people taper when they have all these family responsibilities? I worry it would be too much of a risk to go all the way down to 0mg.  I am thinking I should just try to make it to a lower dose.

[GreenIvy]

Introduction

 

Hi, I have been on 25 mg sertraline for 10 years and would like to begin tapering because I don't want to be on this medication for the rest of my life since.  

 

 

Edited April 19, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Onmyway]

Hi @GreenIvy, 

welcome to SA. Sorry you have been put on these drugs so young (me too) without being told of the reproductive consequences.

However, fear not, you can come off of them. If you taper your drugs properly from the start you should feel little if any withdrawal symptoms and should be able to be present for your family during the process and enjoy seeing your little ones grow. Most of us, suffering here, did not do it the right way. In very rare circumstances even slow tapers can be difficult but there is no reason to think that you are one of those cases. 

 

Here is most of what you need to know about tapering. Read it carefully and ask questions if something is unclear or you need advice. 

Important topics in the Tapering forum and FAQ - Tapering - Surviving Antidepressants

 

The key is to taper very slowly and stop and hold if symptoms appear. 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

 

To begin, can you please create a drug signature? It will help us advise you better. 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

Please read the above links and let's get you ready to start
OMW

 

 

[GreenIvy]

Thank you @Onmyway. I updated my signature.   I did an excel sheet of a 10% taper schedule from 25mg to 0.5mg. It looks like it will take a little over 3 years to taper. Does that sound right? It is a very long process. 

[ChessieCat]

Yes, that sounds about right, but it may take longer because SA suggests holding for longer if you are going through additional stress or are sick.  Also the suggested jump off dose is about 0.025mg.  It took me 6 years to get off 100mg Pristiq.

 

Even though it seems ridiculously long, it is a safer way of getting off your drug with minimal withdrawal symptoms and being able to live your life as normally as possible whilst doing it.

 

And every reduction you make means less drug you are taking.  There came a time whilst I was tapering that it felt silly taking such a low dose, but because of what I have learned here at SA and what I have seen other members go through, it made sense to keep tapering carefully.  And I kept reminding myself that it wasn't me that needed the drug, it was my brain that needed it.

 

Getting off a psychiatric drug has nothing to do with how strong and determined we are as a person.  The brain has adapted to getting the drug and it needs to be taken away gradually to allow the brain to get used to not getting as much of the drug.  If it is taken away quickly, that is what can result in withdrawal symptoms because the brain is busy trying to regain homeostasis.

[GreenIvy]

Thank you Chessie cat and Onmyway!  I updated my excel sheet to make my jump off dose 0.025mg.

[Onmyway]

On 4/20/2022 at 6:49 AM, GreenIvy said:

Thank you @Onmyway. I updated my signature.   I did an excel sheet of a 10% taper schedule from 25mg to 0.5mg. It looks like it will take a little over 3 years to taper. Does that sound right? It is a very long process. 

@GreenIvy, 

if you find yourself not having any WD symptoms on this 10% a month decrease for a few months, you can trial a 10% every 3 weeks decrease. There is some risk with that as some symptoms may be delayed but may be worth a try at the higher doses. It becomes harder to do it at the lower ones as they tend to be more difficult to wean off of. 

 

I am glad you are doing a proper taper plan. We are here to support you throughout. 

OMW

[GreenIvy]

I have 2 questions about tapering. 

 

1. When an individual follows the correct slow taper guidelines, has there been people who were able to continue working and maintain daily responsibilities throughout the entire process? I know that withdraw symptoms can be debilitating. But if tapering is done properly and one listens to their body, have there been people who carried on with daily life.  All of the horrible stories  I read make me cautious. (Please provide examples of people who followed the recommended tapering guidelines)

 

I am asking because I have a family to raise  2 kids and am taking classes to advance my career. 

 

2. Regarding withdraw symptom:  since sertraline zoloft is the only drug I am on, does this drug have withdraw symptoms more commonly associated with it that I should be on the lookout for?

[Onmyway]

Hi @GreenIvy

yes, if you follow the proper tapering guidelines things are manageable. I quit from 5 to 0mg after a 5 month taper from 40 citalopram and the first five months were absolutely awful even though I reinstated within a month - the day the Horowitz article came out. Things slowly stabilized and I have been able to hold a relatively demanding professional job while tapering from reinstatement. My nervous system is sensitized (I had been on these drugs for almost 20 years when I tried to stop) so I drop by less than 10% a month and if I feel withdrawal symptoms I hold for a few extra days or a week or a month. But I am at the low end - 0.7mg so the low end is harder and smaller drops might need to be considered. I am having windows and waves - some days are much worse than others but they are all manageable.

 

Symptoms that have improved were: 

sleep - the first 5 months I got about 2-4 hrs a night, I would be constantly jerked awake in terror multiple times. Sometimes slept even less, now I can get 6 regularly, sometimes more. The terror awakenings are still here in waves but much better also. And I have learned to manage them better. Get out of bed and do stuff, which with two kids you probably have to do anyway. 

 

paresthesias - at some point I had half of my body (left side head to tow) tingling. It was very disconcerting, completely gone. 

 

akathisia - the first month I had akathisia, some physical, some mental and that was absolute hell but haven't had it since

 

neuro-emotions - my fuse is still short - I get angry easily which is so unlike me and have to remove myself from situations but overall I am doing much better in this department; I can still go into rumination cycles after a drop - they can be anything from the past to some present situation but it is not to the level it was in the very beginning (proper awful withdrawal). I had sheer terror from random things - like buses! - after the fast taper. First few months I felt absolute disgust at everything, had derealization, the world was bleak and at times as scary as hell. Now, that's gone though some emotional distress in waves is not unheard of. 

 

dizziness and nausea - I could only eat ginger cookies the first 4-5 months -  totally gone, very healthy appetite;

 

anxiety was non-stop in the beginning - has largely improved

 

fatigue - I have occasional fatigue usually after a cold or some other viral illness and it can linger for weeks but I think that is probably more viral than WD. I don't think i have any physical symptoms left now when I think about it.  Emotional are manageable. 

 

On occasion I have had symptoms like hyperacusis - sounds feeling much louder but it is much rarer now. 

 

The reason why I am listing the first 4-5 months and now is to demonstrate the difference between serious withdrawal from rapid taper (I tapered 40mg to 0 in 5 months by going 40-30-20-10-5-0 until all hell broke loose)  and the withdrawal symptoms of a slow taper after reinstatement and stabilization (now). I reinstated at 2.5mg - would have tried less but didn't have SA at the time. I still have bad days and anxiety and rumination and irritability can be annoying. But it is nothing to the level it was in the beginning with a fast taper. 

 

Tbh, I don't see another way to get off of these drugs than to go very slowly. That is why I do what I do here so people don't have to go through the hell that I went through.

 

You can also do this with our support. You just have to listen to your body. This is absolutely doable. Even with a job and kids and other demands. It is not an easy process by any means. But it is doable. YOU can do it. 

 

OMW

Edited December 1, 2023 by Onmyway

[GreenIvy]

Thank you for your response!!

[GreenIvy]

For anyone who took sertraline zoloft during pregnancy: Did your children NOT have developmental delays and NO behavioral issues?

 

I have a toddler and baby and want to be hopeful that they will not have issues down the road even though they were exposed to ssri during pregnancy (started with 25mg zoloft decreased to 12.5mg in the first pregnancy and started at 50 mg zoloft decreased to 25mg during the second pregnancy). 

 

I feel upset that my obgyn and psychiatrist told me it was completely safe. 

[Onmyway]

Hi @GreenIvy, 

the studies that I have seen look at the rate of ASD in people exposed to SSRIs in the womb. The best ones are population level observations from the Nordic countries. They show that the rate of ASD is increased but not by that much. When not adjusted for maternal depression or anxiety (whatever they mean for the child) the risk ratios were around 2 (so double the incidence) but after adjusting the differences were smaller and not statistically significant - i.e. could be due to chance. Even if the rate was increased, it was still small - less than 2-3% of exposed babies. What you can do is keep an eye on the children and if they do exhibit signs of delays get them early intervention.

 

I don't think anyone should take these drugs in pregnancy (or at all) but often women are misinformed. However what's been done has been done. You can't change the past. Good news is you were on quite low doses. Take good care of yourself and your babies and we will all hope for the best.

 

Sending you hugs, 

OMW

 

PS. Articles that report on SSRI use and ASD

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832387/

https://pubmed.ncbi.nlm.nih.gov/28528584/

 

[GreenIvy]

8 months into Taper and feel great

 

I have been tapering for 8 months now. I was on 25mg sertraline for about 10 years. I have been doing 10% decreases every 25 days. Currently my dose is 9.8mg.  I feel great with no withdrawal symptoms yet.  I'm considering doing 20% decreases since I'm feeling so good.  My question to everyone is, what would you advise? Is it risky to decrease more rapidly?

 

 

Edited November 19, 2022 by ChessieCat
added topic title before merging with intro topic

[ChessieCat]

My answer to this would be a resounding NO.  I would definitely not be trying to go any faster.  I will provide information explaining about this below.

 

SA's recommended taper method which is no more than 10% of the current dose followed by a hold of at least 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Your topic title is "tapering while raising a family".   I'm sure that you want to continue doing that whilst feeling okay.  The idea of tapering is not to get off the drug as quickly as possible but to get off it with minimal withdrawal symptoms and be able to live your life as normally as possible.

 

I'm pleased to read that your taper has been going well and that you feel good.    You have reduced your dose by a lot which is fantastic.  Please don't get impatient and possibly make things worse now.  Being able to look after your family is very important.  Consider what it might be like if you had to do this whilst experiencing withdrawal symptoms.  Check out this withdrawal symptoms list in the link below.  When I reduced my Pristiq from 100mg to 50mg after 2 weeks I was unable to type; I am a professional typist since 1974.  SA suggested taking more Pristiq, which I did, and only 4 HOURS later (not days) I was able to type again.  Because I had a benchmark I knew it was not placebo.

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Many members find that the lower their dose gets the slower they need to go, reducing less and/or holding longer.  Please see Post #1 of this topic and watch the video linked at the top of the post (the link goes to the relevant section in the video; you don't have to watch the whole video) which explains the SERT dose occupany:

 

Why taper paper: dose-occupancy curves

 

The suggested stopping dose is about 0.025mg.

 

When to end the taper and jump to zero?

 

managing-the-endgame-taper

 

[ChessieCat]

One common withdrawal symptom that members have is insomnia.

[GreenIvy]

Thank you!

[Happy2Heal]

On 11/19/2022 at 1:49 PM, GreenIvy said:

I'm considering doing 20% decreases since I'm feeling so good.  My question to everyone is, what would you advise? Is it risky to decrease more rapidly?

oh dear, no, you don't want to do that!!

you are feeling good BECAUSE you are going slowly.

 

it is very risky to try to speed up this process.

 

keep to the planned schedule and you will be fine.

 

 

[Thorin]

Hi, looks like you are doing well. Just commenting as I am withdrawing from meds while parenting also. Although my kids are teenagers so that probably makes things a bit easier (maybe not always 🙄). It can be difficult being ‘there’ as much as I’d like to when I’m feeling bad. Fortunately I have been able to talk to my kids about it (again, teenagers) so they understand (as much as they can). I give myself permission to take it easy if I have to. On those days (or weeks) I just make sure they have food and everything they need. I make sure they know that I love them and explain that I’m not feeling well but will again soon. I guess I’m saying that as long as you look after yourself you can definitely do this as a parent. I understand there’s a much bigger commitment with little kids though. I’m sure you’ve got this.

[GreenIvy]

Thank you for your kind reply!

[GreenIvy]

For 3 months I increased my taper to 20% because I got impatient. I should have listened to the advice by sticking to 10% decreases, now I'm paying for it.  After 3 doses decreasing by 20%,  I am now having withdraw symptoms. I am having anxiety that seems to stay most of the day, but worse in the morning and evening. I switched to liquid sertraline which may be contributing to the symptoms.  I have also been waking up around 2am with anxiety attacks. And more emotionally sensitive and crying easier. I am switching back to the powder sertraline from my compound pharmacy and holding at my current dose 2.34mg.  Once I stabilize I will decrease by 10% again!

 

Can someone tell me how long this withdraw wave may last based on the information I provided? Or what is the typical length of a withdraw wave while waiting for the body stabilize at the current dose? 

 

Why does my body have more anxiety in the mornings and evenings? Strangely my body will wake myself up with an anxiety attack in the early morning hours.

[Onmyway]

2 hours ago, GreenIvy said:

 

2 hours ago, GreenIvy said:

 

Can someone tell me how long this withdraw wave may last based on the information I provided?

 

Or what is the typical length of a withdraw wave while waiting for the body stabilize at the current dose? 

 

Why does my body have more anxiety in the mornings and evenings? Strangely my body will wake myself up with an anxiety attack in the early morning hours.

Nobody knows how long it will take - could be weeks, months or years until you stabilize. I would guess a few months but once you are destabilized we don't know. 

 

We think it's because you are more sensitive to cortisol but we don't know why mornings are worse. Look up Cortisol mornings on the Symptoms forum. 

 

OMW

[GreenIvy]

@Altostrata

Tonight at bedtime,  I started having tremors and shaking internally. It has been going on for an hour so far and won't stop. I did take 0.5mg of melatonin, but the tremors are keeping me awake.  

 

What can I do to alleviate the tremors? Should I ask my doctor to reinstate at a higher dose? I'm currently on 2.34mg

[Altostrata]

Your rapid tapering has caused you to develop withdrawal symptoms, which can be very odd and come in waves.

 

It appears you started 20% decreases when you were taking 5.72mg. If I were you, I might try going back to 4mg, see if that's enough.

 

Why did you think it was a good idea to make 20% decreases?

[Cheeky]

Hi @GreenIvy, 

Im a mother of two boys and yes it can be done with time and patience. Unfortunalty there is no shortcut.  

Please listen to the moderator here as they are amazing and have been through this. 

[GreenIvy]

@AltostrataThank you, I appreciate everyone's reply. I wanted to do a more rapid taper because eventually I want to have another baby and am already in my mid 30s.  But I realize that was an unwise decision to do the 20% tapering.   I will talk to my pharmacy and doctor and try to reinstate at 4mg.

[GreenIvy]

I reinstated at 4.58mg of the powder sertraline with my compound pharmacy.  I had questions about the insomnia I am experiencing. 3 days ago I slept 4 hours, 2 days ago I slept 30 minutes, and last night I got 1.5 hrs of sleep.  I took a 0.5mg of melatonin 2 nights ago at 8pm, but I did not really help me. Last night I took 1mg of melatonin at 8pm and got a little more sleep. Are there any others supplements you suggest I can take when I wake up in the middle of the night? I was under the impression not to take melatonin again in the middle of the night . Should I be concerned about too putting too much stress on my nervous system if I take supplements? I saw the post about milk peptides, is that the best one supplements to take when I wake up. What about Benadryl? 

[Altostrata]

You've only taken one 4.58mg dose. You'll need to give it more time to see what it does.

 

What times o'clock do you take your drugs, with their dosages? 

[GreenIvy]

@Altostrata @Onmyway @Cheeky

I have good update, i slept through the night for the first time in 3 days. 24 hours after I reinsted my nervous system calmed down.  Thank you for your help.  Going forward,  I will stick to the 10% decrease plan when I feel ready.  

To explain my intentions to rush getting off the medication was influenced by me working in the Nicu. I was working with newborn babies and saw some babies harmed by ssri and psychiatric exposure in pregnancy such as heart problems,  withdraw, difficulty breathing, and one baby with craniofacial anomalies which was reported to be caused ssri exposure. Working in the Nicu ultimately,  led me to find your group and learn about tapering.  Now my intentions are to take tapering slowly and follow the advice  you have  provided through all the research  on this website. 

[getofflex]

What you are experiencing is destabilization of your nervous system caused by tapering too quickly by decreasing 20%.  I'm glad to hear that the updose has helped you, and you were able to get a good nights sleep.  Don't be taken off guard if you experience some waves in the future, as your nervous system may take some time to stabilize again.  Hopefully this won't happen, but if this happens, please don't react and jump up on your dose.  It will take at least a week for the drug to fully register in your system, and even more time to become fully effective.  Instead, try to learn and use non drug coping techniques to deal with the symptoms.  

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

The more careful we are about making changes to our drugs, and the more we make only small changes, and allow plenty of time between changes, the less we will suffer.  I see too many people in here make big reductions, frequent changes, jump on and off drugs, etc., and this is a recipe for significant problems that may take many months to sort out.  

 

Edited July 29, 2023 by getofflex

[GreenIvy]

@Altostrata I am taking the 4.58mg of sertraline between 2 and 3 pm. And I'm taking a 0.5mg melatonin around 8 to 9pm.

[Altostrata]

It's important to take the low doses on a consistent daily schedule. Please let us know how you're doing. 

[Cheeky]

8 hours ago, GreenIvy said:

@Altostrata @Onmyway @Cheeky

I have good update, i slept through the night for the first time in 3 days. 24 hours after I reinsted my nervous system calmed down.  Thank you for your help.  Going forward,  I will stick to the 10% decrease plan when I feel ready.  

To explain my intentions to rush getting off the medication was influenced by me working in the Nicu. I was working with newborn babies and saw some babies harmed by ssri and psychiatric exposure in pregnancy such as heart problems,  withdraw, difficulty breathing, and one baby with craniofacial anomalies which was reported to be caused ssri exposure. Working in the Nicu ultimately,  led me to find your group and learn about tapering.  Now my intentions are to take tapering slowly and follow the advice  you have  provided through all the research  on this website. 

 

Great need I'm happy for you. The secret to this is just going slow and reading your body signs. I'm happy you got a good night's sleep.

[GreenIvy]

@Altostrata Last night I only slept 1 hour. I took 0.5mg melatonin before bed. My body woke me up in an anxiety attack.  The night before i only slept 4 hours. Is there something I can take to help me stay asleep.  Should I just ride this insomnia wave and wait for it to resolve itself on its own over the next couple of weeks? Do you think I should talk to my doctor about increasing my 4.58mg of sertraline to a higher dose?

[Blossom71]

Hi @GreenIvy

 

So am I right in that you've been taking the new dose for 5 days?  In my experience 5 days isn't long enough to stabilise on a new dose.  Days 4-7 are usually the days when my symptoms are at their worst.  It takes me roughly 10 days for things to start to settle and around 14 days to feel much better.  The longer i go between changes the better I feel.

Also I want to point out that as you have increased, some of those symptoms may be side effects rather than withdrawal.  So you may be experiencing both side effects AND withdrawal. I have found that both take a similar time frame to settle individually, but the cumulative effect may be longer.  Also, you'll be dealing with the cumulative effects of 3x 20% drops.   

Obvs this is my experience only, but i personally wouldn't recommend going any higher until you get a better idea of whether you are going to stabilise on your new dose.  And that could take days/weeks. Jumping around doses will only further add to those effects.

Patience is your friend here x

[Onmyway]

Hi @GreenIvy, 

this is not uncommon for me either - your body eventually catches up on the sleep. I would suggest to ride it out and not add things. 

At this point you are trying to keep things stable -  not add  new variables to the equation. Increasing may hurt as well because after a cut your body needs to make adjustments and by the time are going back to the higher dose some of these adjustments have been made (receptors becoming more sensitive, hormone and other neurotransmitters changing to adapt to the new status quo). So now you are asking your body to make new changes again. Your body needs stability. Yo-yo-ing is not helping. Adding new things is not helping. 

 

OMW

[Altostrata]

On 7/29/2023 at 8:08 AM, GreenIvy said:

I have good update, i slept through the night for the first time in 3 days. 24 hours after I reinsted my nervous system calmed down.

 

Quote

 06/2023 : 2.93mg Liquid, 07/2023: 2.34mg Liquid Going back to powder sertraline 07/27/2023 Reinstated 4.58mg of capsule powder sertraline and holding

 

You updosed to 4.58mg sertraline only a week ago.

 

How has your sleep changed over that time?