KarenG2: 3rd try in 20 years to taper off an SSRI

[KarenG2]

Hello,

 

I am trying again to taper off my SSRI, this time tapering Sertraline with the adjunctive use of very small, intermittent, precise doses of psilocybin.  My previous tapering attempt was about 10 years ago tapering citalopram.  My withdrawal symptoms were debilitating nausea, dizziness, ataxia, and headaches.  After 18 months I was only able to tolerate a dose reduction from 25 mg daily dose to 22.5 mg using liquid citalopram to fine tune the dosing.  Depression also returned when I finally gave up that attempt.  I am currently using liquid sertraline and am finding that it seems more rapidly bioavailable and I'm sleeping better than I have in years and so far no withdrawal effects.  My fear is that the liquid may be so bioavailable that it is in effect, increasing my blood concentration of the medication.  Does anyone else have a similar experience with liquid Sertraline?

 

Thank you.

[Altostrata]

Welcome, @KarenG2

 

On 5/14/2022 at 3:36 AM, KarenG2 said:

I am currently using liquid sertraline and am finding that it seems more rapidly bioavailable and I'm sleeping better than I have in years and so far no withdrawal effects.  My fear is that the liquid may be so bioavailable that it is in effect, increasing my blood concentration of the medication.

 

What has been your sertraline tapering schedule? Generally, we think being able to sleep while tapering is good. What about this is concerning you?

 

(We don't know anything about psilocybin aiding withdrawal.)

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[KarenG2]

Thank you for your response.  All previous attempts to taper have resulted in insomnia.  The liquid sertraline produced heavy sleep the very first night of use and the sleep has been unusually heavy all subsequent nights as I have decreased the liquid sertraline dose.  While I am happy to be sleeping well, I fear that the heavy sleep is a sign of increased absorption of the liquid form of the drug, which could result in a higher blood concentration from which to have to taper from.

 

History:

2001 began Citalopram 25 mg daily

2008 began to taper the drug using minute dose decreases of liquid citalopram over the next 18 months.  The next year, my healthy 54 year old sister on Citalopram died of a sudden cardiac arrhythmia.  News came out around that time that citalopram was implicated in cardiac arrhythmias.

2009 After 18 months, dose had been reduced to 22.5 (which was as fast as I was able to tolerate).  At that time, withdrawal symptoms were still present and depression returned as well.  I became quite discouraged and resumed the 25 mg dose.

2018 I switched from Citalopram 25mg to Sertraline 150mg daily.

2021 in response to worsening depression and my reluctance to increase Sertraline dose, I began a schedule of microdosing psilocybin, with a dose of 0.15g every 3rd day.  I experienced a marked improvement in depression after one month on this schedule.  That improvement persisted for three months, and has gradually diminished but never as bad as before the month of microdosing.

2022 I consulted with a psychiatric pharmacist familiar with the therapeutic use of psychedelics and received some guidance on dose reductions, with the use of psilocybin to be used as needed to help with withdrawal symptoms.

April 18, 2022 began Sertraline dose reduction from 150mg daily to 135mg daily

May 9, reduced dose from 135mg to 120mg daily.  I am planning another dose reduction to 105mg since I have not experienced any ill effects, to date.

So far, I have experienced no withdrawal symptoms and have decreased my dose 20% over the past four weeks, using liquid concentrate.  I expect more withdrawal symptoms as my total dose drops, especially below 100mg/day.  In fact, once my dose is at 100mg/day, I can temporarily stop the liquid and just use the 100mg tablets I have. My fear is that when I am off the liquid entirely, my sleep may begin to suffer and worse yet withdrawal symptoms may come roaring through.  If, by some chance I can tolerate that next reduction, I will probably need to begin a slower taper and eventually hope I can hold the taper to 10% per month.  The pharmacist has suggested using the psilocybin to help mitigate withdrawal symptoms. 

For a useful lecture on the concurrent use of psychedelics and antidepressants, see: https://support.us17.list-manage.com/track/click?u=a37e752fc0d7d9d37fe6ddb67&id=0796d8998e&e=1765dd3d2b

 

[Onmyway]

31 minutes ago, KarenG2 said:

While I am happy to be sleeping well, I fear that the heavy sleep is a sign of increased absorption of the liquid form of the drug, which could result in a higher blood concentration from which to have to taper from.

Karen, you would be tapering based on your medicine dosage not the blood availability so this should not impact your taper. I would advise not switching  between liquid and tablets - stick to whichever you pick - you want stability. 

 

Given your history of failed attempts at tapering before, I'd suggest being more careful this time. Sometimes withdrawal catches up to you even if the beginning is ok. I tapered off of 40mg citalopram to 5 mg over 5 months without any issue by big jumps (did not know SA before) and when I went from 5 to 0 all hell broke loose and I have been trying to taper off of 2.5mg reinstatement ever since. 

 

I would be careful with psilocybin as well. We recommend that members not take any other psychoactive drugs during withdrawal (incl. alcohol, pot, street drugs). Even some supplements and drugs (steroids, some antibiotics) can exacerbate WD symptoms. 

 

These links may help. 

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

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

The Brassmonkey Slide Method of Micro-tapering - Tapering - Surviving Antidepressants

 

OMW

[Altostrata]

10 hours ago, KarenG2 said:

While I am happy to be sleeping well, I fear that the heavy sleep is a sign of increased absorption of the liquid form of the drug, which could result in a higher blood concentration from which to have to taper from.

 

I wouldn't worry about this.

 

10 hours ago, KarenG2 said:

2022 I consulted with a psychiatric pharmacist familiar with the therapeutic use of psychedelics and received some guidance on dose reductions, with the use of psilocybin to be used as needed to help with withdrawal symptoms.

 

To my knowledge, nobody knows anything about this, it's a sciencey rumor floating around the Web. Withdrawal syndrome is not the same as "relapse" of "depression".

 

Many opportunists are offering miracle cures. Psychedelic Support may well be one of them. Anyone calling themselves a psychopharmacologist is instantly suspect.

 

10 hours ago, KarenG2 said:

April 18, 2022 began Sertraline dose reduction from 150mg daily to 135mg daily

May 9, reduced dose from 135mg to 120mg daily.  I am planning another dose reduction to 105mg since I have not experienced any ill effects, to date.

So far, I have experienced no withdrawal symptoms and have decreased my dose 20% over the past four weeks, using liquid concentrate.  I expect more withdrawal symptoms as my total dose drops, especially below 100mg/day.

 

We often see that when people are taking the higher dosages of antidepressants, they often can reduce 1/3-1/2 rather easily. Strongly recommend you be careful about observing the result of any decrease. You are correct, at a lower dose, it probably will be more difficult for you to taper. That dosage amount is individual, we cannot predict it, that's why we advise caution. Please see Tips for tapering off sertraline (Zoloft)
 

I would not assume psilocybin is protective against withdrawal. 

 

 Please put your drug and withdrawal history in your signature

[KarenG2]

Thank you folks for your helpful responses and all the links to resources.  It has been quite useful.

[Lindseyb]

On 5/20/2022 at 10:42 PM, KarenG2 said:

 

2022 I consulted with a psychiatric pharmacist familiar with the therapeutic use of psychedelics and received some guidance on dose reductions, with the use of psilocybin to be used as needed to help with withdrawal symptoms.

Who did you consult?

[KarenG2]

https://www.spiritpharmacist.com/  It is expensive , but I was seeing a therapist at the time who had a membership in his program.  His credentials look pretty good to me.  Good luck!