evlar: Oblivious sertraline fast taper, next steps?

[evlar]

Hey guys. I'll try to briefly summarise my (relatively short) history with Sertraline. 

 

I made all the mistakes this site warns of. CTing, fast tapering, taking days off, changing time of day, never allowing the drug to stabilise... Reinstating at a high dose. 

 

Perhaps my saving grace is that I wasn't on it long, and it was only one.

 

Anyway: advice requested. I have been Sertraline free since beginning of April (almost 6 weeks). My 'waves' are manageable - mostly because I now have this site, some hope that they will pass, and an understanding of what might really be going on.

 

Should I reinstate? Or just wait it out? The insomnia coming back could push what is currently manageable into unmanageable territory...

 

Anyway, the history:

 

2021 Feb started Sertraline 50mg 
2021 Apr 25mg 
2021 July 12.5mg
2021 Aug 0mg

 

Without realising at the time, my windows and waves were happening since beginning on the drug:

 

weakness, brain fog, low mood and lack of drive, irritability, anxiety, mild headaches, mouth ulcers, dizziness/lightheadedness.

 

Originally went on Sertraline to help insomnia. It worked. I slept.

 

2-3 months after coming off, insomnia came back, so I went back on the Sertraline and started magnesium at 400mg. Starting Sertraline at 12.5mg for a few days, then upping to 25mg:

 

2021 Nov 25mg
2022 Jan 12.5mg
2022 mar 6.25mg - also started on ashwaghanda 1000mg per day
2022 Apr 0mg 

 

When I first went back on, I experienced the most intense anxiety I ever have. I felt zero control. That lasted a week or so.

 

During this second period the cyclical symptom pattern was more noticeable. The highs were higher, the lows werent lower, but they were more obvious in comparison. Insomnia again cleared up. However the bleak, numbness of the downs, lasting anywhere from a day to 10 days was more pronounced.

 

I cannot stress enough how I was totally winging it. I have only just found your site the last few days. I had no idea any of this existed. I thought I was being super slow and cautious going down the way I did... And also, I can see I have made almost every mistake in your playbook! 

 

I never allowed the drug to stabilise in the first place. After the first 8 weeks, my doc said that it should be working by now. Hence I dropped the dose, to see if that would fix it. I then tapered too fast, and by the way was sometimes missing days, always experimenting by taking it at different times of days (and boy did I notice that difference! Knocked me for six)... V imprecise tablet cutting. Etc.

When I went off it in mid 2021, I felt great (mostly) for those 3 months. I was super surprised when it went pear shaped. 

-------------

 

So what I would love to know is where to go next? What do the wiser among us recommend? I'm confident I don't need the drug anymore to sleep, it's just the withdrawal. 

 

I'm also currently on 1000mg ashwaghanda, 250mg magnesium citrate, 2 drops of vit D. 

 

For more history and context: since about the age of 14 my nervous system has not been given much chance to rest. Whether it was

 

- highly anxious periods of time

- recreational drug use

- using coffee to do all nighters for uni

- trying all kinds of really intense sleeping routines and shcedukes to increase energy level

- trying crazy diets and switching them regularly (raw vegan, keto done wrong for 2 years, paleo, water only fasting, intermittent fasting, carnivore diet... Etc)

- rolling the dice with supplements and changing them on the regular!

- moving countries a lot

- highly stressful jobs with long hours and very high risk (financial speculation for example)

- extreme sports and the adrenaline fuel that comes with it 

 

So I can see now that my nervous system just might be a little, tiny bit over sensitive? What is striking me is that consistency in whatever happens next is going to be key for the poor system to be able to recover. 

 

The sad part is, when it was doing its best to heal, my response was 'oh another problem for me to fix by making big changes!!'. 

 

What an insidiously harmful cycle.

 

Funny thing is I'm now a confidence coach and career coach. All the **** listed above has lead to me wanting to help others going through severe rejection of themselves and the various symptoms that manifests in day to day life. In terms of reacting to anxiety inducing thoughts and images and physical states, I'm better than ever, and understand myself better than ever. 

 

I could never quite understand why I was doing all the right things, and still felt like a shell of a human half the time. Perhaps now I can accept that it's the nervous system.

 

Lots of love and strength to you all.

[Altostrata]

Welcome, @evlar

 

How are you feeling now, compared to 2 weeks ago? What's your sleep pattern?

[evlar]

Hi @Alostrata

 

Thank you for the approval and response and welcome.

 

I'm feeling a little worse. Currently in a wave (that's the bad one, right?) Of the usual symptoms: head pressure, weakness, activation, brainfog and lack of motivation...

 

And, funny timing, last night was the first time in many months that I suffered with insomnia. I woke up middle of the night and found it difficult to get back to sleep. Having patchy sleep with crazy dreams.

 

I'm going to buy myself a sleep mask and some fish oil.

 

I'm also going to buy the kit I need to make Sertraline drops. Whether or not I use it depends on how resilient I am to the symptoms...

[evlar]

Oh and my sleep pattern is:

 

Bed around 10-10:30

Asleep by latest 11

Awake 6:45-7:15

 

Some days I take a nap in the afternoon

[Altostrata]

Yes, if your withdrawal symptoms are getting worse, you might consider reinstatement of perhaps 1mg to start, using sertraline liquid. This may be ordered by a GP, or you can make your own -- this topic explains how Tips for tapering off sertraline (Zoloft)

What is withdrawal syndrome? 
 
About reinstating and stabilizing to reduce withdrawal symptoms 
 
The Windows and Waves Pattern of Stabilization 

 

Be sure to take your dose at the same times each day. Please let us know how you're doing.

[evlar]

Update:

 

I now have the tools to reinstate, I have not yet.

 

I have tried the fish oil (the brand you recommend on the other post) and 2/4 days have been particularly 'activated' (agitated) - but both those days it was taken on an empty stomach or with a protien shake. Inconclusive thus far.

 

Generally symptoms have been increased in intensity, however the insomnia was only 1 night, phew.

 

 

[evlar]

Update:

 

I've had severe anxiety and mild insomnia since last posting. I also had a couple of days of flu like symptoms, followed by (Sorry) diarrhea for a few days. It was following recovery of that flu/GI symptoms that the severe anxiety began, and has persisted for a week.

 

I am about to take my first 1mg of sertraline, attempting reinstatement.

[Altostrata]

Please let us know how you're doing.

[evlar]

So far it's day 3 of reinstatement. There haven't been any worse symptoms, perhaps a slight improvement but inconsistent. I will keep it up until the end of the week.

[Altostrata]

Please observe your progress for at least a week. We expect effect of reinstatement to be subtle and gradual.

[evlar]

Hi Alo,

 

1 week in. I have noticed a subtle change. I'm using Dr glenmulens sypmtom tracker, and have noticed a general reduction in symptom severity, and 1 or 2 almost symptom free days.

 

The days when I have not tried to 'solve' any problems, have been the best. However much my mind may want to fix everything!

 

Like I said before, I never allowed the medication to settle (3 months on same amount never happened) at any time. That fact (and speaking to a doctor) makes me believe I should give the medication a chance to help me, by going on at the regular dose (25mg) for 6+ months, as that is what research/doctors suggest is the minimum amount of time for it to make its true difference.

 

I suppose I am weighing up between staying at 1mg in order to come off easier (and potentially see no benefits of the medication and be just the same as before I went on) VS going up to 25mg for 6 months+ and feeling the supposed benefits of the medication.

 

Any thoughts gratefully received.

[Altostrata]

Empirically, you have found that 1mg is sufficient to reduce your withdrawal symptoms. We often see this, or perhaps a little more, is sufficient to stabilize withdrawal. If you intend to go off sertraline, why would you want to increase to 25mg?

 

We cannot speak to the benefits of the medication. You'll have to decide for yourself.

[evlar]

Thank you Alo. 💜

 

The reason I thought about increasing was to feel full effects and supposed benefits of going on Sertraline in the first place - under the assumption that perhaps I am a 'lifer' (that life would be better on it) - rather than someone who just wants to get off it. 

 

However I am willing to keep experimenting with this, as you say, empirical evidence, thus far.

 

I have a question - I don't remember reading whether or not I am to expect windows and waves after reinstatement, as the patterns stabilise? Though I assume I am.

[evlar]

Checking in: I've been 17 days on 1mg. After initial period of improvement in anxiety levels for a week or so it is now wavey.

 

Periods of 4-5 days of higher symptom scores, mostly more fatigue and mood related, rather than anxiety, which has mostly remained within tolerable limits.

 

Symptom pattern has shifted from anxiety as the major challenge, towards fatigue, worsened mood, trouble concentrating and agitation.

 

Generally becoming agitated in the middle of the day, and fairly flat/low mood in the evenings.

 

Still sleeping pretty consistently, and respecting my bed times.