stepht527: not sure where to start ... sertraline

[stepht527]

@getofflex I will add that to my signature, thank  you. I also had a 36th birthday yesterday which I've been dreading, bringing up really tough things for me. So I can't tell if it's true anxiety or wd from trazodone. Should I hold at 37.5?

[getofflex]

1 hour ago, stepht527 said:

@getofflex I will add that to my signature, thank  you. I also had a 36th birthday yesterday which I've been dreading, bringing up really tough things for me. So I can't tell if it's true anxiety or wd from trazodone. Should I hold at 37.5?

I don’t know because I still don’t see it in your drug sig, therefore I don’t know how long ago you dropped to 37.5. 

[stepht527]

@getofflex sorry, it didn't update but now it's all set! 

[getofflex]

You could updose to 43 mg trazodone to help reduce WD symptoms.  Personally I would only do it if the symptoms are significantly impacting quality of life.  Give it at least a week because that is how long it takes to register with your system.  I would not go all the way to 50 mg because your brain has probably already partially adjusted to a lower dose, since you did your reduction a month ago.  

[getofflex]

Once you updose, unless you have a bad reaction to that, please hold on your drugs and doses for a while.  You’ve made quite a few drug changes in the past year or 2 and this tends to be quite hard and destabilizing on the nervous system.   I would give at the very least 3 to 4 months if not longer.  

[stepht527]

@getofflex thank you for your reply. I don't have a scale, so its pretty hard to do without that correct? Like I said, I've had av really hard birthday so it's difficult to pinpoint if it's from that or not. Should I maybe give it a few days? I was so anxious yesterday that today I feel an emotional hangover... very very very tired, apathetic, still anxious. This is all so confusing to me and I feel really discouraged and scared 😥

[getofflex]

Yes, I would give it a few days and see how you feel before updosing the trazodone.  I looked your drugs up on drugs.com, and there are some drug interactions between trazodone and your other drugs, which is a reason to avoid updosing the trazodone if you can.  In the past, or now, have you had these symptoms of serotonin syndrome as described below?  Fortunately, this rare, but something to be kept in mind.  At first I thought you were taking your trazodone in the morning,  I assume you take trazodone in the evening before bed?  What time do you take your sertraline?

 

I can understand why you are scared, but no worries, the staff here have plenty of experience with this sort of thing, and we will walk you through it.  As long as you are patient and cautious, and proactive about your tapering and health, you will get through this, and feel better someday.  

 

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.

Switch to professional interaction data

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.

Edited May 28, 2022 by getofflex

[getofflex]

For future reference, here is how to dose and measure small increments of trazodone.   

 

Tips for Measuring Doses and Tapering Off Trazodone

[stepht527]

@getofflex yes, I take my trazodone at bedtime, i didn't bother stating so in my signature because I just assumed it was always taken at bedtime for sleep. Yes I am Aware of the sev3 interaction with sertraline, which is why I sort of freaked out and subsequently lowered my dose. I have such a knee jerk reaction to things, I get scared and just want to fix it. I'm just so discouraged because I had almost a full month of feeling good- no appetite issues, no diarrhea, less ruminating, wanting to socialize more. Now I'm back to feeling no appetite which scares me the most. And the more I focus on it the worse the appetite gets. Ugh. Now that I'm thinking about it, it really all started on Wednesday when a coworker made a comment that emotionally sent me over the edge and I haven't bounced back since. I was asking her advice about if having kids was worth it, and she flat out told me No. This sent me into a spiral because I've been struggling with this, especially now that I'm 36. Sorry for the rant, just trying to get it all out. 

[getofflex]

I see. No need to apologize for the rant we are all going through difficult times on the site and we all understand. To reduce the interaction you can gradually Space out the time between taking your drugs by one hour at a time until you’re taking the sertraline and the trazodone two or three hours apart. Just change it by one hour per day so that should only take a couple of days.  

[stepht527]

On 4/29/2022 at 12:21 PM, 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 this is what you replied to me last month. That being said, do you think it's a moot point to space them out? 

[getofflex]

As long as you were only having these symptoms  in the morning then yes it’s probably a moot point.  However it wouldn’t hurt to space the drugs apart just to be safe.  

[stepht527]

@getofflex I mean the symptoms are definitely worse in the morning for sure. But for the last month, they've been very mild or non existent and have tapered off throughout the day. Making another change right now scares me so maybe I'll hold for a little bit...

[getofflex]

Then it sounds like you are not having serotonin syndrome from the sertraline and trazodone together, and those previous symptoms were from your exaggerated cortisol spike.  Wait and see if your current symptom set resolves in a few days, and if it does, I would still hold for a while, just to allow your nervous system time to adjust to your current drugs and doses.  What other symptoms are you having now besides anxiety, overwhelm, and crying?  How is your sleep?  How is your eating? 

 

I hope you read my links in my first post, you will see how these drugs work with our brains, and why holding and slow tapering (10% or less) are so important. It may just be that you are in a wave.  The way to deal with a wave is to not react, and to just ride it out, like a surfer.  Not easy, but in the long run, better than reacting and making another drug or dose change, which is likely to just make the situation worse.  Like Ariel said, check with the staff before you make a drug change.  

 

If it doesn't resolve in a few days, and the symptoms are significantly affecting your quality of life, let us know, and we will see about doing an updose as previously discussed, since these symptoms could very possibly be caused by doing too big of a reduction of trazodone a month ago (25% reduction 50 to 37.5 mg). 

[stepht527]

2 minutes ago, getofflex said:

 What other symptoms are you having now besides anxiety, overwhelm, and crying?  How is your sleep?  How is your eating? 

 

My sleep is good, until i wake in the morning in a sweat, shakiness and body trembling, pretty much like a panic attack. Then my body and mind gets so tired from it. My appetite is poor. When I feel good I eat A LOT. as soon as I start feeling like this I get scared and my appetite is gone. I thankfully have been able to force myself to eat 3 meals the past few days (although not snacking or anything). I have been reading on this site for hours and it's such good information, but also overwhelming and is consuming me. So when we have a wave, the best thing to do is hold and ride it out? Ugh I feel so frustrated by this. Feeling like a completely different person from a week ago. I guess I need to practice patience. 

[getofflex]

You may want to spend less time reading in here and find things to do that take your mind off WD.  This can help lessen your anxiety.  Walks outside are wonderful for destressing and helping you heal.  Yes, we already told you waves should be ridden out.  

[Marconius]

Stepht527,   I'm thinking of you and hope you're doing okay.  I relate to your challenges and how confusing this whole process is.  Just wanted to say "Hi".  How are you doing?

[stepht527]

@Marconius thank you for reaching out and checking on me. My symptoms were pretty bad f or a few days and just starting to feel somewhat okay again.  My appetite is slowly coming back which is the biggest stressor for me for some reason. I am holding everything for a few months and if all is well I start my 10% sertraline taper. My biggest issue is being consumed and obsessed with all of this... can't stop thinking about it and how long it's going to take to get my life back. Hope you are doing okay as well. 

[Marconius]

I hope you continue to feel better and your appetite improves.  Things have been rocky for me the last couple of weeks.  I just updosed my Paxil a little bit to 2 mg from 1.85 last night.  I'm hoping that helps to stabilize me, and if it does, I'll be staying there for a good while.  My appetite is very low right now, so I understand that challenge.  I'm forcing myself to eat pizza now.  

[stepht527]

@Marconius that's great! 2mg is still a long way from 20mg. Did you taper by 10% the whole time, and have you found that you are slowly Starting to feel better?

[Marconius]

Thanks, I'm glad to be only at 2mg.  I've been tapering from 10mg Paxil since the Fall of 2019 at a rate of 10% of the previous dose.  It was all very manageable and tolerable up until late March of this year when I was just under 2mg.  It's true that the low doses are the hardest to get off of.  I started experiencing increasing anxiety, low appetite, and restlessness to name a few symptoms.  Because the last couple of weeks have been really bad, I decided to updose to 2mg.  I'm hoping that I'll find stability soon.

[stepht527]

Can someone please provide some insight?

 

I am on 3 meds: sertraline, trazodone, lorazepam. According to the guidance on this site,  I'm going to be tapering my sertraline first (most activating).  By the 10% route, i'll be done with my sertraline taper in about 7 years, which is fine, but I'm struggling with the fact that I will need to be on a benzo for at LEAST 7 more years, and longer. I don't want to further my addiction even more.

 

1 )Is it dangerous to stay on lorazepam scheduled for that long? I'm having a hard time wrapping my brain around it. 

2) after the sertraline, would it be to taper trazodone THEN lorazepam?

 

If anyone has any wisdom or experience with this that would be amazing. 

[Marconius]

Hi, I'm not a moderator, so I can't give advice on what to do, but I'll share my experience with tapering a benzo.  I was on Klonopin (10mg/day at night if I remember correctly), and more as needed.  A new psychiatrist in 2015 wanted me to get off the Benzo.  I tapered over about 12 - 15 months.  It wasn't easy and I had a lot of withdrawal symptoms, but I'll tell you that tapering off Klonopin wasn't nearly as bad as coming off of Paxil.  Everyone's experience is unique, so everyone will have a different time frame.

[stepht527]

@getofflex my symptoms are slightly improving since the drop to 37.5mg about a month and a half ago but not back to baseline. But my instinct is not to updose, just to stay and stabilize. Thoughts? 

[getofflex]

53 minutes ago, stepht527 said:

@getofflex my symptoms are slightly improving since the drop to 37.5mg about a month and a half ago but not back to baseline. But my instinct is not to updose, just to stay and stabilize. Thoughts?

Sounds like a great plan to me.  We suggest here to listen to your body, which you are doing.  

[stepht527]

On 6/7/2022 at 4:23 PM, stepht527 said:

Can someone please provide some insight?

 

I am on 3 meds: sertraline, trazodone, lorazepam. According to the guidance on this site,  I'm going to be tapering my sertraline first (most activating).  By the 10% route, i'll be done with my sertraline taper in about 7 years, which is fine, but I'm struggling with the fact that I will need to be on a benzo for at LEAST 7 more years, and longer. I don't want to further my addiction even more.

 

1 )Is it dangerous to stay on lorazepam scheduled for that long? I'm having a hard time wrapping my brain around it. 

2) after the sertraline, would it be to taper trazodone THEN lorazepam?

 

If anyone has any wisdom or experience with this that would be amazing. 

@getofflex thanks for your quick reply! Do you have any insight to what I posted on Tuesday?

[getofflex]

On 6/7/2022 at 3:23 PM, stepht527 said:

I am on 3 meds: sertraline, trazodone, lorazepam. According to the guidance on this site,  I'm going to be tapering my sertraline first (most activating).  By the 10% route, i'll be done with my sertraline taper in about 7 years, which is fine, but I'm struggling with the fact that I will need to be on a benzo for at LEAST 7 more years, and longer. I don't want to further my addiction even more.

 

1 )Is it dangerous to stay on lorazepam scheduled for that long? I'm having a hard time wrapping my brain around it. 

2) after the sertraline, would it be to taper trazodone THEN lorazepam?

 

Please click on this link, and this issue is addressed about halfway down in the first post, starting with the heading Benzos are addicting! Why not quit the benzo first?: 

 

Tapering Multiple Drugs

 

Lets just take things one step at a time.  Work on the sertraline.  Just wondering what was the reason you dropped the trazodone from 50 mg to 37.5 mg on 4/28?  Because you did a 25% drop of the trazodone, I wouldn't be in any hurry to reduce your sertraline.  Please make sure you are stable from this before you do any more drug changes.  

 

Stability

 

WD Normal

[stepht527]

@getofflex the reason why I dropped 25% of trazodone is because I read about it's nasty metabolite, particularly in conjunction with sertraline and kind of panic-dropped. I was scared and I tend to be reactive, which I'm working on, but it's hard! I agree to take things one step at a time. Bit since I've been on lorazepam since 2020, i wasn't sure if i should take it for 7 more years after the sertraline taper is finished. Two years vs 7+ more..I read all of the articles you mentioned, which is helpful. I won't be starting my sertraline taper until September tentatively, to give my body a few months to stabilize, just in case. 

[getofflex]

1 hour ago, stepht527 said:

@getofflex the reason why I dropped 25% of trazodone is because I read about it's nasty metabolite, particularly in conjunction with sertraline and kind of panic-dropped

Ah well this makes sense.  

 

1 hour ago, stepht527 said:

I won't be starting my sertraline taper until September tentatively, to give my body a few months to stabilize, just in case. 

Sounds like an excellent plan.  

[Marconius]

Stepht527,  Thinking of you.  How are you doing?