stepht527: not sure where to start ... sertraline

[stepht527]

I have been on and off sertraline since 2007 with the highest dose being at 200mg years ago. In between I have tapered off and tried other antidepressants ~2018 (venlafaxine, bupropion, fluvoxamine), then ultimately going back on sertraline, at 100mg. Last summer (don't remember the month), i started tapering off at a rate of what i thought was slow until i was ultimately on 12.5mg by September. I started getting really bad brain zaps and decided to go back to 50mg. Ever since then I have really been in a bad, anxious place, not realizing that perhaps it was antidepressant discontinuation syndrome; of going too fast last summer. The best way I can describe it is how Altostrata puts it in this article from https://journals.sagepub.com/doi/full/10.1177/2045125321991274

 

 "of symptoms, among them disorientation, depersonalization, insomnia, light and heat intolerance, indigestion, palpitations, and unease, punctuated by spontaneous weeping spells, attacks of sheer terror, or sudden plunges into unprecedented contentless black holes of pure dread." In addition, diarrhea every morning, no appetite, despair, trembling, just about every depression and anxiety symptom in the book at some point. Compound that with every day life problems and needless to say I've really been suffering. 

 

 My pysch thought maybe it was due to my cycle so instructed me to take 100mg the week before my period. I'm currently not sure what to do at this point. Should i go back up THEN back down? I have been on 50mg consistently now since October-ish. The problem is that I didn't write any of this down and though I could kind of just "wing it" so i dont really remember exactly what it is I was doing and I'm feeling really lost...and I'm an educated pharmacist! You would think i know better. 

So, since ive been on the 50mg since we'll say october, do you recommend tapering from 50mg by 10% every 30 days and going from there? Also, how does one get the correct dose? I know by experience having a split tablet in my mouth tastes awful and causes heartburn.

 

I should also mention that I am taking trazodone 50mg at bedtime, and lorazepam 0.5mg twice daily now.

 

Any advice would be greatly appreciated.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  It sounds as though a history of going on and off various psychiatric drugs, and then doing a fast taper back in the summer and fall, have caught up with you.  These drugs actually change the architecture of our nervous systems, and when we make drug changes, the brain tends to become confused, and this can cause destabilization and the symptoms your are experiencing.  Therefore, we suggest a very slow, cautious taper.  

 

Can you please give us specific information in your signature about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering sertraline/Zoloft

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

If I were you I would not take the 100 mg sertraline the week before my period each month.  Taking it irregularly is likely to further destabilize your already destabilized nervous system.  Unfortunately, many doctors are not as aware of the potential of psych meds to cause these problems as they should be.  It has to do with the way the drugs are marketed by the drug companies.  You are probably already aware of how aggressively they are marketed, being a pharmacist yourself.  

 

 

On 4/24/2022 at 3:53 PM, stepht527 said:

Should i go back up THEN back down? I have been on 50mg consistently now since October-ish

No I would not suggest this.  If you read my link above "Simple Slow and Stable" you will see why this is not a great idea.  

 

Question:  since you reinstated to 50 mg back in October, do you feel 1) better, 2) worse, or 3) the same, than you did prior to the reinstatement?  

 

When we know more, we can give you some suggestions to help out.  

[stepht527]

Thank you for replying.  I have entered a signature but it is very confusing for me, I have been all over the place and don't remember what i did.  "Oh, ill just try 50mg, no i'll try 12.5mg today," not being aware how how truly powerful and potent these drugs are.  It is very clear to me that my nervous system is/was dysregulated considering what i put it through in such a short period of time. 

 

To answer your question, 

2 hours ago, getofflex said:

Question:  since you reinstated to 50 mg back in October, do you feel 1) better, 2) worse, or 3) the same, than you did prior to the reinstatement?  

It's hard to say.  I reinstated because i was getting really bad brain zaps/dizziness for about a week (when i was completely off sertraline). After reinstating, I felt progressively worse, with my symptoms i described in my first post peaking in Jan-Feb.  I have been feeling slightly better, having okay days and having absolutely terrible days.

 

My thought is to stabilize a little more on the 50mg for a couple more months before even starting the taper.  I also will not continue to take 100mg a week before my period.

 

Some questions i have:

1) according to my math it would take me 7 years to get completely off sertraline. Is this correct? And if so, could i try a faster taper until i get to a lower dose? I realize it takes a lot of time and patience, but I can't fathom being on this for 7 more years.  Could I do 45mg for a month, then 35, 30 25 etc. then when i get down to say, 12.5 do a much slower taper?

 

2) When can I start tapering the trazodone and lorazepam? I can't imagine waiting until the sertraline is done....

 

3) Is it normal to doubt yourself and think "What if i AM supposed to be on this and I go crazy without it?". 

 

4)how can you differentiate between withdrawal symptoms/ADRs of the actual drug/actual depression and anxiety? They all tend to overlap and it can be really overwhelming and confusing.

 

I am truly grateful for this site and have learned so much already about these drugs, way more than I ever did in the 8 years of when I was pharmacy school. If I ever get through this hell I would love to be an advocate for helping people the same way you all are.

 

 

[Onmyway]

Hi Stepht, 

Welcome to SA from me as well.  I will try to answer some of your questions below: 

 

 

1 hour ago, stepht527 said:

Some questions i have:

1) according to my math it would take me 7 years to get completely off sertraline. Is this correct? And if so, could i try a faster taper until i get to a lower dose? I realize it takes a lot of time and patience, but I can't fathom being on this for 7 more years.  Could I do 45mg for a month, then 35, 30 25 etc. then when i get down to say, 12.5 do a much slower taper?

Should be less. It is unclear at this point whether you are suffering from ADE from the updosing to 50mg. When we are in the throes of withdrawal, our nervous system is highly destabilized so a reinstatement of a high dose can actually cause more havoc. Does taking your medicine make you worse within a couple of hours? In that case we may be dealing with ADE. That may justify going faster in the beginning. Have a look at these studies and see what you think. You could also try a 10% cut and if that actually improves your symptoms then it might be a reason to go down slightly faster. 

 

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

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

 

1 hour ago, stepht527 said:

2) When can I start tapering the trazodone and lorazepam? I can't imagine waiting until the sertraline is done....

We recommend tapering one drug at a time and usually the more activating drug. Many of the withdrawal systems are based on an alerting response - i.e. activating of the CNS - anxiety, panic attacks, terrors, insomnia etc. so keeping the more sedating drugs stable usually helps. If you discover that half way through you are more sedated you can try lowering the other ones. You would then hold the activating drug. 

Some people lower by a much smaller percentage but all of their drugs at once - i.e. 2% each month but all drugs. Our recommendation is still to do the most activating drug first and one at a time. 

https://www.survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/

 

1 hour ago, stepht527 said:

 

3) Is it normal to doubt yourself and think "What if i AM supposed to be on this and I go crazy without it?". 

Yep. It is normal. It is not true however that you need the drugs. These drugs are no better than placebo on average. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

and the chemical imbalance theory is not supported at all  - look up the chemical imbalance myth and the way psychiatry has tried to walk that back 

 

1 hour ago, stepht527 said:

 

4)how can you differentiate between withdrawal symptoms/ADRs of the actual drug/actual depression and anxiety? They all tend to overlap and it can be really overwhelming and confusing.

What we do to help distinguish ADR/withdrawal symptoms or interdose withdrawal from the benzo etc. is we ask the member to keep detailed notes of their daily symptoms. If your symptoms spike after you take one drug, then it's likely an ADR; if your symptoms get worse closer to your next dose of your benzo, then it's probably interdose withdrawal. Alto has more experience with this and if you want to post notes we can try to figure things out. Check out the first post here on instructions on how to do it. 

 

1 hour ago, stepht527 said:

I am truly grateful for this site and have learned so much already about these drugs, way more than I ever did in the 8 years of when I was pharmacy school. If I ever get through this hell I would love to be an advocate for helping people the same way you all are.

Thank you for your kind words.

It is nice to hear that our work makes a difference. 

And there is a lot to learn still for all of us

Welcome to our community, 

OMW

 

Edited April 27, 2022 by Onmyway

[Karma]

A little note from Karma - I was on Effexor for 21 years. I spent the last 13 years of that slowly, patiently tapering off of it. At some point along the line, I felt joy again and that was wonderful. At that point the drug no longer had a complete hold on me. I just had to avoid going too fast and causing a backlash of withdrawals as my brain adjusted to life without the drug. I had to be gentle with myself.

 

While it still took time for me to taper off of my drug completely, I was able to do it without major withdrawals because I listened to my body (keeping daily logs - which I still keep to this day). 

 

I am tapering off of Gabapentin now. I reduce by 1 mg every 5 days because that is what works for my body right now and Gabapentin has a very linear withdrawal profile. When I am done with that, I will taper off of Xanax. I am not concerned with how long it takes; I celebrate my successes along the way.

 

Please don't focus on how long the road ahead may be. Focus on doing the taper without causing uncomfortable disruptions in your life. 

 

Love and light,

Karma

[stepht527]

21 hours ago, Onmyway said:

Does taking your medicine make you worse within a couple of hours?

@OnmywayI take the sertraline at bedtime. I do know that I wake up often in a pool of sweat, anxious, get the runs, shaky. I usually always feel better once evening hits (not sure if this is just due to the fact that the day is over and I get to sleep soon).

 

When should I actually start the taper? Should I stabilize for a couple more months on 50mg  for good measure?

 

Also, since lorazepam is technically pending PRN (correction made in following post), how are you supposed to keep track of your symptoms that way? Should you take it scheduled rather than prn?

 

Edited April 27, 2022 by ChessieCat
added correction

[stepht527]

@Onmyway the lorazepam is prn not pending, sorry autocorrect!

[stepht527]

@Karma

Thank you for the insight, i appreciate it. What is so concerning to me is that i have all of these scary symptoms, and i just dont know if its from the actual drugs themselves, any withdrawal reactions, and if so, which drug? Or is it just anxiety and depression i am dealing with. It is all so overwhelming to me right now and I'm scared I'll never get better

[stepht527]

I should also mention that I am 35 and we are going to be trying for a baby. My husband is supportive but really wants to be a father. Me being on these meds worries me. There have been conflicting studies for their safety during pregnancy, but I don't really have a choice, I'm not a spring chicken anymore. Does anyone have any experience with slow tapering while pregnant (I'm not pregnant yet). 

 

Also, how do I know if I'm stabilized? It's hard to distinguish when I feel like the drugs themselves are causing so many problems.

 

I truly look forward to hearing any advice, this is all so overwhelming and I'm consumed with it

[getofflex]

On 4/27/2022 at 3:36 PM, stepht527 said:

What is so concerning to me is that i have all of these scary symptoms, and i just dont know if its from the actual drugs themselves, any withdrawal reactions, and if so, which drug?

 

Please do a daily journal as OnMyWay suggested, so we can determine if you are having an adverse reaction, or is you are having withdrawal.  Please post your journals on here, so we can help you distinguish patterns.  Here is an example.  

 

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

Please update your drug signature to show that you are no longer taking sertraline 100 mg the week before your periods, and any other drug changes you've made.  

 

Did you know there is a major interaction between trazodone and sertraline?  This could explain your symptoms of sweating, shaking, anxiety, and diarrhea.  There are also moderate drug interactions.  If I were you, I would gradually space the dosing of sertraline to earlier in the day, this will help to ameliorate the bad interaction.  This is according to www.drugs.com: 

Interactions between your drugs

Major

traZODone  sertraline

Applies to: trazodone, sertraline

Using traZODone together with sertraline 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. Do not stop using any medications without first talking to your doctor.

 

 

 

Moderate

LORazepam  traZODone

Applies to: lorazepam, trazodone

Using LORazepam together with traZODone may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

Moderate

LORazepam  sertraline

Applies to: lorazepam, sertraline

Using LORazepam together with sertraline may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Edited April 29, 2022 by getofflex

[getofflex]

On 4/24/2022 at 3:53 PM, stepht527 said:

The problem is that I didn't write any of this down and though I could kind of just "wing it" so i dont really remember exactly what it is I was doing and I'm feeling really lost.

Can you be more specific what you mean by this?  Did you forget or skip doses, or did you vary your dose?  

[stepht527]

5 minutes ago, getofflex said:

Can you be more specific what you mean by this?  Did you forget or skip doses, or did you vary your dose?

@getofflex I varied my dose. Even as a pharmacist I wasn't aware of how potent these drugs are. 

 

I am aware of the sev3 interaction of serotonin syndrome with trazodone/sertraline.  Do you think spacing them apart will actually alleviate this, or does it not matter? I do know that i wake up in the morning, as soon as i open my eyes, with anxiety, sweating, fast(er) heart rate, tremor, and need to diarrhea (or just looser stool).  Which scares me...if it's serotonin syndrome then do i taper off both at the same time?

 

My day yesterday (4/28)

 

6am woke, very sweaty/shaking/anxious. took 0.5mg lorazepam, went back to sleep

8am woke again, still anxious. loose stool

9am did a meditation. feel less anxious. ate a banana

12 went to yoga

1230 had lunch/smoothie

1-3pm on this forum, getting scared and worried

~3pm start to fill a little bit more anxious

5pm took 0.25mg lorazepam

6pm ate dinner. feeling slightly less anxious

7pm went for a walk

930pm took 37.5mg trazodone, 50mg sertraline

9:45pm fell asleep

 

 

Today so far is the same, waking up the same exact way. Feel more down today, more anxious.

 

 

[AnastasiaA]

Hi stepht527,

I have the same problem. I'm 32 now and it's time to have a baby, so, this was the main reason why I stopped taking drugs.  All the doctors tell me that taking drugs can have some bad effects on the baby,but it's the position of all doctors in my country. I've heard that in some countries doctors allow pregnant women taking antidepressants. Now I have anxiety and ruminating thoughs and it seems impossible to get ready for pregnancy. I just can't imagine taking care of myself and the baby in such a condition, so I understand you.

[getofflex]

On 4/27/2022 at 5:36 AM, stepht527 said:

@OnmywayI take the sertraline at bedtime. I do know that I wake up often in a pool of sweat, anxious, get the runs, shaky

You don't wake up feeling this way until 6:00AM? I was assuming it was a couple of hours after taking.  If you wake up like this at 6:30 am, it could very well be the morning cortisol effect.  For many of us in withdrawal, this morning cortisol effect is very exaggerated, and it's not uncommon to feel this way in the morning upon awakening.  

 

So from 9:45 Pm to 6:00 AM the next morning you are asleep? If so, that is very good for a person in withdrawal.  

 

17 minutes ago, stepht527 said:

Which scares me...if it's serotonin syndrome then do i taper off both at the same time?

Not necessarily.  We suggest tapering off of one drug at a time.  And we suggest only making one drug change at a time.  A drug change would be changing the time you take your drug, changing the dose up or down, changing the form (eg tablet to liquid).  

 

If I were you, I would first start taking my sertraline earlier in the day, gradually.  Push the time sooner by 1 hour per day.  So today, take it at 8:30 PM, tomorrow 7:30 PM, etc.  This will help lessen the drug interaction.

 

First, give yourself a month or two to stabilize.  Give you nervous system a break.  Then, I would start a 10% taper of the sertraline.  You want to taper the more activating drug first.  This link talks about what stability consists of.  

 

Stability

 

Please do continue to keep a daily journal, with specifics of your drugs, their dosages and times, you symptoms, especially before and after you take the drugs.    

 

17 minutes ago, stepht527 said:

 I varied my dose. Even as a pharmacist I wasn't aware of how potent these drugs are.

It's very important to not vary or skip doses, unless we are intending to do a taper or updose, or purposely changing the times we take the drug.  This will tend to destabilize our nervous systems, and make our symptoms worse.   

Edited April 29, 2022 by getofflex

[stepht527]

2 minutes ago, getofflex said:

You don't wake up feeling this way until 6:00AM? I was assuming it was a couple of hours after taking.  If you wake up like this at 6:30 am, it could very well be the morning cortisol effect.  For many of us in withdrawal, this morning cortisol effect is very exaggerated, and it's not uncommon to feel this way in the morning upon awakening.  

 

So from 9:45 Pm to 6:00 AM the next morning you are asleep? If so, that is very good for a person in withdrawal.  

@getofflex dont get me wrong, i've had my days of being jolted at 1am or 4am in the middle of the night. But generally, the trazodone works really well in the fact that it puts me out. I do notice i toss and turn quite a bit though. I too, thought it may have been the morning cortisol effect. If that's the case, moving the administration of the sertraline back an hour every day like you suggested would be a moot point then, right?

 

Would you say that i am in withdrawal still from last summer's fiasco? That's the thing--am in withdrawal, am i stable?

 

I spoke with my doc yesterday and he called in the sertraline liquid, so i can start that taper whenever i am ready. I was thinking june 1st. Thoughts?

[stepht527]

@getofflex Also, i've planned out a preliminary tapering schedule. While I realize that its not the recommended 10%, i believe i can try to go faster in the beginning then taper more slowly when i reach the really small doses.  My doctor laughed at this and said it was the slowest taper he's ever seen, (as he's classically trained to taper much faster), but i am adamant about not going too fast. What are your thoughts on this? 

 

 

[getofflex]

I wouldn't do the 15% or 20%.  It should be 10%.  As long as the chart is a 10% reduction of each previous dose it's fine.   Listen to your body with each reduction, and be willing to be flexible and change your taper as time goes on.  

[getofflex]

21 hours ago, stepht527 said:

I spoke with my doc yesterday and he called in the sertraline liquid, so i can start that taper whenever i am ready. I was thinking june 1st. Thoughts?

Wait until you feel stable to begin tapering. 

 

Stability

[stepht527]

@getofflex i made this chart with the intention in mind if i an not able to do the 20% reductions in the beginning if course i will cut it to 10%. Looking around this forum it seems that some people can get away with the 20% at the beginning. 

[stepht527]

forgive me if this is already explained somewhere, i just cant seem to find it. I take 0.5mg of lorazepam in the morning and 0.25mg in the evening. Im having a brain fart, and i know this is a dumb question, but how would i taper this by 10%? The divided doses are confusing me.

[ChessieCat]

You could reduce both doses by 10%.  To calculate this you multiply the current (individual dose) by 0.9 (for a 10% reduction).

 

0.5mg x 0.9 = 0.45mg (new morning dose)

 

0.25mg x 0.9 = 0.225mg (new evening dose)

 

To double check:

 

0.5mg + 0.25mg = 0.75mg (total old dose)

 

0.75mg x 0.9 = 0.675mg (total new dose)

 

0.45mg (new morning dose) + 0.225mg (new evening dose) = 0.675mg

 

Working it out both ways (calculating the reduction on individual doses then adding them together and calculating on the total dose) shows that the final amount the same.

 

I hope that helps.

 

Remember that the following reduction needs to be calculated using the new dose/s, ie 0.45mg and 0.225mg.  So 0.45mg x 0.9 and 0.225mg x 0.9.

[Blossom71]

On 4/30/2022 at 2:50 PM, stepht527 said:

Looking around this forum it seems that some people can get away with the 20% at the beginning. 

Hi @stepht527

I was able to do larger cuts in the beginning but that was from a dosage of 150mg. I could likely make those larger cuts as I was probably over medicated. Since January I have been tapering down from an 18 month hold at 50mg.  It’s been a rocky road while I find a drop rate that’s manageable. My last drop of 1.67% has just just kicked in and while not especially problematic I am feeling it. 
 

This is a roundabout way of saying that I wouldn’t start with a 20% drop. I started with 10% and the withdrawal symptoms were moderate.

 

Anyway, I hope things settle down for you and wish you luck when you start to taper - whatever you decide.

[ChessieCat]

Please see Figures 3 & 4 on page 5 of the document which is for sertraline.  You will see that at a certain dose the curse becomes steeper.  Your dose of 40mg sertraline is at the start of that steep part of the curve.

 

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.161.5.826

 

To understand it better please see this topic (there is a link to this paper in the topic but I wanted to link you straight to the graph that is relevant for you).

 

why-taper-sert-transporter-occupancy-studies-show-importance-of-gradual-change-in-plasma-concentration

 

Edited May 12, 2022 by ChessieCat

[stepht527]

@ChessieCat @Blossom71

 

Thanks for your replies. I decided that I am definitely going to taper by 10%. It will take me longer to get off, but at this point I'm viewing it as just preventing withdrawal, and at least I'm on the right track of getting off!

 

 

I do have another question though, about my trazodone. On 4/28 I tapered down to 37.5mg (a reduction of 25%...I did my math wrong). I was really scared I had serotonin syndrome and was afraid that it was contributing to my symptoms. I actually have been feeling better throughout the day, less anxious, wayyyy less tired. I realize now that 25% is too steep of a jump, but it's been almost 2 weeks..do I go back up now? Or just continue with 37.5mg?

[stepht527]

Is anyone able to answer my question above? Still taking the 37.5mg, it's been about a month now.  not sure whether to go back up or stay.

[Onmyway]

5 hours ago, stepht527 said:

Is anyone able to answer my question above? Still taking the 37.5mg, it's been about a month now.  not sure whether to go back up or stay.

If you're feeling better, no need to go back up. 

[stepht527]

1 hour ago, Onmyway said:

If you're feeling better, no need to go back up

Thanks for the response. I do generally feel better, though have been a little bit anxious, not sure if it's because I'm expecting it so I'm psyching myself out. Also, I'm scheduled to start tapering my sertraline June 1st (10%). Do you think I should wait a few months to do this or should I be fine?

[ChessieCat]

Instead of making a 10% reduction you could do a much smaller reduction, eg anything from 1%-2.5%.  That way if your body/brain is not yet completely ready for another reduction any fall out/withdrawal symptoms from a small reduction will not be as bad.  Doing a small reduction might also cause less stress/anxiety.

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

 

 

[Marconius]

stepht527,  I'm so glad to hear you're feeling better than you were in late April!  I've read through your entries and the knowledgeable responses.  I just wanted to let you know that I'm rooting for you and thinking of you.  I've had a very hard time getting off of Paxil.  I'm down to 1.85mg (for reference, a min. "therapeutic dose" is 20mg).  I've learned the hard way that for many people, tapering gets harder the lower you go.  I recently hit a rough patch, and I'm trying to find stability now.

 

As for Trazadone, I used to take that for sleep years ago.  I had no trouble getting off of it, and I didn't taper off it.  But that's just my experience, so please go slowly with it if you feel that's best.  I just read online that it's a serotonin modulator, not a true ssri, so that may be why it wasn't hard for me to come off of it.

 

As for the sertraline, slow is the way to go.

 

Good luck, and I hope you continue to feel better real soon!

 

- Marconius

[stepht527]

@Marconius thank you for the reply and the kind words...You've come so far from 20mg and you're almost there! 

 

Today I woke up pretty anxious. Yesterday I got very overwhelmed and overstimulated at work and just cried when I got home. I'm now wondering if this is the beginning of a wave.

 

Is a wave a sign that you should change something, or just ride it out? I've been feeling pretty good for a good stretch and now I'm really freaked out that I might go back to square one.

[Marconius]

@stepht527, Good morning!  You're welcome, and thanks for the supportive words. 

 

It may seem that I'm almost there, but I still have a long way to go.  It's the last 1-2mg that I find to be the hardest.  I'm holding at 1.85mg for probably a month or two, and if I'm feeling good, I'll continue tapering at about 3-5% every 4-6 weeks.

 

I'm sorry to hear about your anxiety this morning.  I find mornings to be the most difficult.  As for feeling overwhelmed and overstimulated, I totally get that.  When things are bad for me, my hearing is super sensitive and my tinnitus gets worse.  People's laughter drives me crazy.  My vision gets a little duller and I notice more eye floaters.  It's as if the stimulus filtering mechanism is compromised.  I was experiencing these symptoms and increased anxiety just recently, and I went up from 1.71 to 1.85mg.  I had a wonderful night's sleep after that and woke less anxious without nausea.  I had a window of a couple of days, then some withdrawal symptoms came back, but not as bad.  So for me, going up a bit was a wise choice, and I'm staying at this level until I'm very steady.

 

So, going up a little bit can be a useful strategy if things get intolerable.  The tricky thing is to decide whether to ride it out or not.  Maybe a small bump up might be helpful for you?

 

Good luck, and I hope your day improves!

 

 

[Ariel]

Hi @stepht527

Following along on the sidelines. 

 

On 5/26/2022 at 1:51 PM, stepht527 said:

Today I woke up pretty anxious. Yesterday I got very overwhelmed and overstimulated at work and just cried when I got home.

 

It is common in WD to wake up with anxiety. More info and suggestions on how to manage it here. 

 

Feeling overwhelmed, overstimulated, and crying are also very common WD symptoms. 

 

On 5/26/2022 at 1:51 PM, stepht527 said:

Is a wave a sign that you should change something, or just ride it out? I've been feeling pretty good for a good stretch and now I'm really freaked out that I might go back to square one.

 

I'm not a mod, but based on my personal experience I'd say "just ride it out". This is easier said than done, as the very nature of being in a wave can be quite uncomfortable. However, I'd err on the side of caution and try to not react to the wave by starting to artificially change things. Unless you know that something specific triggered the wave -- e.g. you've been drinking alcohol, which has triggered a wave, definitely do not drink any more alcohol. That's the only kind of "change" -- eliminating the problematic trigger -- that I can think of would be advisable.

 

Otherwise, when you are in a wave or generally experiencing an increase in symptom quantity and intensity, the best thing to do is slow down and be very gentle with yourself. Listen to your body as best you are able (to be fair, listening to one's body can be tricky while in a wave as its multitudinal unpleasant signals and sensations can pose interference; listening to one's body is not an exact science, it's a practice -- just do your best), and hang in there.

 

Here you can learn more about the importance of 

Keep it simple. Keep it slow. Keep it stable.

The Windows and Waves Pattern of Stabilization

Stability - Stop jumping around!

 

As for being "freaked out" about going "back to square one" -- this sort of anxious thought, often driven by neuro-fear and a dysregulated WD nervous system, is a characteristic of the wave itself. That's the wave talking, not the reality. The voice of the wave is anxious, afraid, worried, and it will feed you a doomsday narrative that things will be terrible forever. This is not true; it only feels like it in the moment, but that is an illusion. This wave will pass. It can be helpful to practice becoming aware of "the wave's voice" vs. your own voice. With practice and patience, through listening and acceptance, you will familiarize yourself with how the different voices sound and how they are telling different stories, and you will get better at distinguishing what is true. 

 

Consider reading up on

Neuro-emotions

Dealing With Emotional Spirals

Non-drug techniques to cope with emotional symptoms

Acceptance and Hope

 

You wonder what a wave is a "sign" of. Fundamentally, I believe, it's a sign that the body is in healing process.

One way to think about it is that when symptoms flare up they are emblematic of the body actively being in the process of repairing itself. There is complex, healing activity taking place beneath the surface, and what we consciously perceive are these uncomfortable, unpleasant sensations. In other words, we may feel awful, and at the same time our body is doing vital work.

 

To some extent one might compare it to the experience of being sick with a bug. What one consciously perceives could be fatigue, fever, aches, chills, congestion, pain, tummy upset, etc. -- all these undesirable symptoms that we think of as "being sick". And while we are experiencing those annoying symptoms, what is happening on the inside is that the body's immune system is working hard to stave off pathogens, produce antibodies, fight infection, protect itself, restore equilibrium, etc. What we consciously experience is thus not the threat itself but an array of (secondary and tertiary) reactions to how the body is responding to that threat. (I'm not a scientist or medical professional or any kind of expert, so this is by no means a technical explanation; merely a crude analogy in an attempt to convey some aspect of the dynamics at work. If it doesn't make sense or feel useful, ignore and discard.)

 

Point being: if you hold steady and keep it simple, slow, stable and allow your body to do it's phenomenal healing work, you will not suddenly be thrust backwards to square one. It might not consciously feel like you are taking steps forward, but you are. Healing is happening all the time, even when we don't consciously feel it. 

 

Hang in there, steph.

A wave can be challenging; it can also be a good opportunity to practice being a really good friend to yourself. Get to know yourself. Practice listening to your body. Explore non-drug coping techniques. Experiment with what it feels like to focus on your breath, or to take a cold shower, or to rest without stimuli in a dark, quiet room. A wave is an invitation to get into the nitty-gritty of sentient, sensate experience moment-to-moment and inquire into the possibility of softening into What Is.

And remember: this wave will pass. 

 

Wishing you all the best on your healing journey,

A.

 

 

 

 

 

 

[Ariel]

@stepht527

 

While I was writing my previous post, you received a message: 

 

5 minutes ago, Marconius said:

So, going up a little bit can be a useful strategy if things get intolerable.  The tricky thing is to decide whether to ride it out or not.  Maybe a small bump up might be helpful for you?

 

Please always consult with a moderator before making any changes. 

 

Just to emphasize that neither Marconius nor I are moderators or experts on your situation. We are your community peers speaking from our respective personal experiences, trying our best to be helpful. 

 

Please do not make any drug changes without first thoroughly conferring with SA staff. 

 

Kind wishes to you (and to you, too, Marconius, if you see this) <3

A.

 

 

[getofflex]

On 5/26/2022 at 6:51 AM, stepht527 said:

s a wave a sign that you should change something, or just ride it out? I've been feeling pretty good for a good stretch and now I'm really freaked out that I might go back to square one.

No, a wave is not a sign you should change something.  It is actually the opposite - it is a sign your nervous system is destabilized, and your system needs stability, which means not changing things, especially not your drugs.  The only thing that will heal the symptoms of withdrawal is time, and proper non drug self care.  

 

2 hours ago, Ariel said:

I'd err on the side of caution and try to not react to the wave by starting to artificially change things.

What Ariel said above is spot on.  Also, please read my 2 links about stability, and non drug coping techniques in my first post to you.  (2nd post in this thread) 

 

I'm assuming your drug signature is up to date, and you've made no drug changes since reinstating to 50 mg sertraline back in October? 

 

 

 

[stepht527]

28 minutes ago, getofflex said:

I'm assuming your drug signature is up to date, and you've made no drug changes since reinstating to 50 mg sertraline back in October?

@getofflex still on 50mg sertraline, however if you read a few posts above I decreased trazodone to 37.5mg kind of in an error since 4/28. Like I said I've been feeling good since then, until now. But I do have some personal things happening as well this week. 

[getofflex]

Please add this info to your drug history in your signature box.  Mods keep track of a lot of people so we can’t read all the posts in all the threads.  You made a pretty big drop in your trazodone - 25%.  This is a much bigger drop than what we advocate here 10%.  Sometimes these things take several weeks for the symptoms to show up.  There is a strong possibility this is contributing to your problems. 

Edited May 27, 2022 by getofflex