Starwalker: Short term Sertraline + Pregabalin taper

[Starwalker]

Hello! I found this site after searching for side effects and tips on tapering the medications I was prescribed.

 

Around mid Deecember of 2022 I had a bad nervous breakdown after a big panic attack. I had been dealing with GAD and panic attacks for years before this, so it was nothing new to me, but this particualr episode threw me into a loop that had me experiencing anxiety like I never had. I couldn't eat, sleep or leave the house. I was terrified of every sensation and had constant nightmares and nocturnal attacks. It got so bad I had to take time off work and see a psychiatrist. I was first prescribed Pregabalin, which I started taking on Deecember 21, 2022. I could only tolerate 75mg a day, since more left me dizzy and weak, so that's the dose I have been mantaining.

 

Pregabalin helped me sleep and eat much much better, taking me out of the anxiety loop. However, I was still very much agoraphobic. After New Years I was adviced to start on a long term treatment plan which included an SSRI. My doctor prescribed Sertraline. I started on 12,5mg for 2 days, and when I upped to 25mg on the 3rd day, I couldn't sleep. The other side effects were tolerable and not so bad (some diarrhea, GI distress, headaches, temperature regulation issues) and from what I kept reading on Reddit, they were common and would go away. But the insomnia was terrible, I had never had such trouble sleeping. I would get 1-3hs of sleep or literally nothing at all and then I would not feel tired the following day and have energy to do more than I was used to. This began to feel terrifying. I was adviced by my doctor to move all of my Pregabalin dose at night to help with sleep. This would have mixed results, it worked some days and not others, but would also leave me incredibly fatigued and weak until like 5 or 6pm on the next day.

 

After 10 days I had enough. I felt like my doctor was not listening and I was frankly a bit afraid of having a manic episode. I said I wanted to stop the Sertraline. I did not taper this. I had lowered my dose to 12,5mg again and had been taking this for around 5 days, so I just stopped taking it. I didn't have much trouble just stopping, but to be honest, I had symptoms of mild dysautonomia before this entire ordeal so a lot of the WD symptoms I tend to have often just because of that. I also got a respiratory infection right after I stopped the Sertraline, which gave me a high resting HR (as viruses usually do) and fatigue for a few days. I was much better after this cleared.

 

It's been over 2 weeks since I stopped the Setraline and moved my Pregabalin dose back to how I was originally taking it (twice per day). My normal sleeping patterns resumed! I'm only feeling fatigued/lightheaded/exercise intolerant on and off but, again, this has not been news to me as I have had these symptoms since before this entire ordeal. And it's Summer over here, which is my worst season.

 

I guess I'm joining for support/opinions on taping the Pregabalin. It has helped but I'm trying CBT along my old Psychotherapy. And after the Setraline, I would like to depend on these kind of drugs as little as possible.

 

Thanks for reading and all the work everyone here does!

[Gridley]

Welcome to SA, Starwalker.  Thanks for completing your signature.  We're a site for tapering off psychiatric drugs, and we're happy to help you in your taper.

 

Regarding the Propranolol, are you taking this for cardiac reasons or for its psychiatric (calming) effect?  Propranolol affects the brain and needs to be tapered.  Did you want to taper this also?

 

We recommend tapering no more than 10% of your current dose every four weeks. 

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Pregabalin, including how to get the non-standard doses you'll need for a 10% taper.

 

Why taper by 10% of my dosage?

 

CBD oil has a significant drug interaction with Pregabalin and is not recommended.  Check out the interaction on any drug interaction site.  Here's one:

 

Drug Interactions Checker

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycerinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

PThis is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community.  I hope you’ll find the information in the SA forums helpful for your situation.  I'm sorry that you are in the position that you need the information, but I am glad that you found us.

 

 

 

 

 

 

[Starwalker]

Hi Gridley, thanks for your response.

 

To answer some of the questions, the propranolol is for cardiac reasons, I have a benign arrhythmia as well as an slightly high HR at rest, so it was prescribed to me for those by a cardiologist back in 2021. So I can't stop it and don't really intend to. It bothers my chronically low BP sometimes but I can deal with that eating extra salt.

As for the CBD, I meant CBT as in Cognitive Behavioral Therapy! I don't do drugs of any kind nor do I smoke or drink at all (I do not even drink coffee/black tea as caffeine usually bothers me) so I'm quite covered on these fronts fortunately!

 

If it helps anyone, or just for the sake of recording, I wrote a longer version of my signature with every med/dose change I've gone through since Decemeber and the symptoms I've had.

 

2022:
-During Dec: 1 use of 0.25mg Clonazepam for constant anxiety after a big panic attack.
-20/12: 025.mg Clonazepam after a bad nocturnal panic attack.
-21/12: Started 75mg Pregabalin. 50mg in am and 25mg pm. Later settled for 25mg 3 times a day as the 50mg left me dizzy and weak.
-29/12: No Pregabalin + single dose of 5mg Paroxetine + 0.25mg Clonazepam. (I was seeing a new psychiatrist here)
-30/12: Ditched the Paroxetine+Clonazepam plan. Resumed Pregabalin and searched for a second opinion.

 

2023:
-7-8/01: 12.5mg Sertraline (am). New psychiatrist. Had a nosebleed after like 10hrs of first dose + GI distress.
-9-10/01: 25mg Sertraline (am). Insomnia + GI distress.
-11/01: 12.5mg Sertraline (pm). Moved 50mg Pregabalin to pm. 0.25mg Clonazepam (am) after insomnia.
-12/01: 25mg Sertraline (pm). Spotting mid-cycle (rather uncommon for me), insomnia, dizzy and weak.
-13/01: 12.5mg Sertraline (pm) + full Pregabalin dose (75mg) moved to pm. Spotting, insomnia.
-14/01: 12.5mg Sertraline (pm). Spotting, GI distress, dizzy, weak.
-15/01: 12.5mg Sertraline (pm). Fatigue.
-16/01: 12.5mg Sertraline (pm). Insomnia, fatigue.
-17/01: Stopped Sertraline. Moved Pregabalin to 37.5mg twice a day.

 

Currently: 31.25mg Pregabalin twice a day + 10mg Propranolol twice a day (been taking this since 2021, never stopped).

 

I gotta say the side effects related to bleeding were super weird, I only discovered it happened to others by reading forums.

Thanks for the links about tapering! I will ask my current Psychiatrist for a taper schedule soon, so I can compare what she says. I have started tapering 3 days ago by cutting the pills. The pills I take have 2 scores, giving you 3 square pills of 25mg each. I have started the first decrease of 12.5mg (half a 25mg square pill) which allows me to take 1 25mg pill + a quarter of a 25mg pill (6.25mg) twice a day. The reduction here is not 10%, but nearly 17%. This may be more rushed, but I've only taken this drug for 5 weeks, so I want to see if I can tolerate bigger reductions. The idea is to keep tapering by cutting off quarters of the square 25mg pills. Unfortunately, Pregabalin is not sold in liquid form here, but if these reductions end up being too big, I plan on buying an electronic scale and just crushing pills to measure smaller doses. Or I would need to go the liquid route by making a solution. For now I plan on holding the reduction I made for at least 2 or 3 weeks. If this first reduction gives me problems I'll go back and do a proper 10% one. I've had lightheadedness, some minor anxiety and low blood pressure since this reduction but we're also having storms with hot weather and I'm about to start my period, all this always makes things worse for me. It's a bit hard doing this when WD symptoms are symptoms I tend to have often despite these drugs!

 

Thanks for all the info, it really helps! I'll get some magnesium and fish oil to try out and update about the Pregabalin situation as I go.

[Gridley]

46 minutes ago, Starwalker said:

if these reductions end up being too big, I plan on buying an electronic scale and just crushing pills to measure smaller doses.

 

My suggestion would be to do this sooner rather than later.  Even if you can tolerate the larger cuts, it's much better to have a consistent dose.  Good luck and please keep us informed as to how you're doing.

[Starwalker]

Hello! It has been a long while. I was hoping to post here at the end of my taper to let everyone know how the ride had been for me and leave a reference for others who might be going through the same, but I think I'm having my first setback, so I'm gonna document it here.

I am now down to taking 9.3mg (9.375mg according to calculations) of pregabalin. I can confidently say I haven't had much trouble tapering all these months, up until to now. My reductions had consisted of more than the recommended 10%, closer to 25% reductions. I would hold each reduction for 4 weeks and then do another. This worked well for me. My symptoms after a reduction were mostly very mild and manageable, just increased anxiety at round the 5-7 day mark after a reduction.

It took me 7 months to get to where I am now. I held my May dose for longer than 4 weeks because some friends from abroad were visiting and I knew that would be stressful. After they left, by the beginning of June, I did a reduction. By this point I was getting impatient, and admittedly, the pills are getting really hard to cut evenly, so I decided to hold this reduction for less time (2 weeks) and do another so I could take 1/4 of a 25mg pill (so, 6.25mg) and not have trouble w uneven pieces of pills.

At first, this wasn't bad. I felt the usual anxiety after a reduction, but nothing unbearable or new. It passed. At around the 15 day mark, I had a stressful situation at home involving my bedroom that lasted for 2 days. This gave me total insomnia, I slept 2 hours the first day and barely nothing on the next day. My anxiety skyrocketed. For the first time in like 7 months, I had a major anxiety attack with panic attacks and all. I entered an awful loop of unbearable and scary anxiety and constantly feared I would end up the way I was before I was prescribed Sertraline and Pregabalin. I went to a family friend who is a homeopathic doctor and she gave me some homeopathy and advised me to take magnesium. I started a few homeopathic remedies and magnesium glycinate. I also decided to undo the last reduction and go back to the pregabalin dose I was taking in June. I improved gradually over the course of a week until my sleep became normal and my anxiety calmed down. I started taking the magnesium in 2 separate doses of 125mg each, at around 5pm and then before bed. Both with food.

I should mention I was going through PMS before this situation, which brings me to my next point: several days later, I am at around a week before my period and my anxiety is insane again. It started suddenly 3 days ago, like flipping a switch. I did no changes at all on anything I'm taking. No new reduction in Pregabalin dose, no new meds, nothing. The only change has been that I've been taking the entire magnesium dose before bed (350mg).

I have read on reddit that some people find the glycine in magnesium glycinate activating. I wonder if this could be the case? I have been taking magnesium for around 15 days now, and the only time I started experiencing this bad anxiety again was around 3 days ago when I started taking the entire supplement pill at night. When I take it, sometimes I experience a bit of internal heat? But this could also be my anxiety, since changing doses of stuff or taking something new always scares me (and I am a bit wary of magnesium because of electrolytes, even though I have read it's very safe). Weirdly enough I have been sleeping very well, so if this was activating to me surely it would interfere with my sleep? I don't know!

I'm inclined to think this bad bout of anxiety is withdrawal and is being worsened by my hormones. Any thoughts? Has anyone here had bad reactions to glycine in magnesium? I feel like my brain just wants to blame something other than my hormones but honestly if my nervous system is being sensitive I don’t wanna rule this out either.

I'm having a hard time staying hopeful and my mind leads me very to dark places during these anxiety lows. Fortunately I am doing therapy many times a week and my family is supportive but whew! It's hard to take into account that it won't last forever sometimes.

Thanks for reading and I would appreciate any feedback or comments or similar experiences, even if it's other women saying their cycle definitely affects their withdrawal.

[Starwalker]

Small update: I didn't take the magnesium glycinate last night and slept at like 6am, only getting around 4 hours of sleep with awakenings in between.

 

I had a strong headache since Saturday that got better though. I've read of others getting headaches and activation from glycinate but again, if this was the cause I think my sleep would have been affected, but it was really good and actually improved while taking the magnesium glycinate. I will take half a pill with breakfast to test how I feel.

[Emonda]

Welcome @Starwalker,

 

20 hours ago, Starwalker said:

I was hoping to post here at the end of my taper to let everyone know how the ride had been for me and leave a reference for others who might be going through the same, but I think I'm having my first setback

 

I thought I was going to do the same....I had the taper all under control, and then I didn't! We all experience setbacks (waves) on our journey...keep fighting.

 

20 hours ago, Starwalker said:

My reductions had consisted of more than the recommended 10%, closer to 25% reductions.

 

I'm not a moderator, but I wonder if this has contributed to the current setback. I've read that there can be a delay for WD symptoms (sometimes many months) and a cumulative effect of tapering. I drop by 2% per week for 4 weeks, then hold for 2 weeks. I notice on week 4, the cumulative effect of the preceding weekly drops. I feel more on edge, more irritable, more anxious, worse sleep etc.

 

20 hours ago, Starwalker said:

By this point I was getting impatient, and admittedly, the pills are getting really hard to cut evenly

 

Yep, can relate to this, too. I have to resist the urge to go faster. I just have to accept this is going to take a long time to do it successfully. I found it hard to cut pills accurately too. I ended up making my own liquid and using a syringe to get my dose as accurate as possible, as well as taking the dose at exactly the same time each day. Do your meds come in liquid?

 

20 hours ago, Starwalker said:

I entered an awful loop of unbearable and scary anxiety and constantly feared I would end up the way I was before I was prescribed Sertraline and Pregabalin

 

Sounds like one of those dreaded waves. They come and they go. I've had two shockers this year that lasted maybe 6 weeks each, but with the support of my wife and this website, I stuck it out and the waves subsided.

 

20 hours ago, Starwalker said:

I'm inclined to think this bad bout of anxiety is withdrawal and is being worsened by my hormones.

 

Definitely WD related. As to hormones...I'm a bloke approaching 50, so I clearly have no personal experience, but I have read others say this is a reality for them.

 

I hope some of my comments have been helpful. You are doing well to get this far. Hold your taper and stabilise. Then, don't taper any more than the recommended maximum of 10% per month. Consider the brass monkey slide approach too. I've found it more tolerable as my dose gets smaller.

 

Wishing you well.

[Tulip52]

21 hours ago, Starwalker said:

Hello! It has been a long while. I was hoping to post here at the end of my taper to let everyone know how the ride had been for me and leave a reference for others who might be going through the same, but I think I'm having my first setback, so I'm gonna document it here.

I am now down to taking 9.3mg (9.375mg according to calculations) of pregabalin. I can confidently say I haven't had much trouble tapering all these months, up until to now. My reductions had consisted of more than the recommended 10%, closer to 25% reductions. I would hold each reduction for 4 weeks and then do another. This worked well for me. My symptoms after a reduction were mostly very mild and manageable, just increased anxiety at round the 5-7 day mark after a reduction.

It took me 7 months to get to where I am now. I held my May dose for longer than 4 weeks because some friends from abroad were visiting and I knew that would be stressful. After they left, by the beginning of June, I did a reduction. By this point I was getting impatient, and admittedly, the pills are getting really hard to cut evenly, so I decided to hold this reduction for less time (2 weeks) and do another so I could take 1/4 of a 25mg pill (so, 6.25mg) and not have trouble w uneven pieces of pills.

At first, this wasn't bad. I felt the usual anxiety after a reduction, but nothing unbearable or new. It passed. At around the 15 day mark, I had a stressful situation at home involving my bedroom that lasted for 2 days. This gave me total insomnia, I slept 2 hours the first day and barely nothing on the next day. My anxiety skyrocketed. For the first time in like 7 months, I had a major anxiety attack with panic attacks and all. I entered an awful loop of unbearable and scary anxiety and constantly feared I would end up the way I was before I was prescribed Sertraline and Pregabalin. I went to a family friend who is a homeopathic doctor and she gave me some homeopathy and advised me to take magnesium. I started a few homeopathic remedies and magnesium glycinate. I also decided to undo the last reduction and go back to the pregabalin dose I was taking in June. I improved gradually over the course of a week until my sleep became normal and my anxiety calmed down. I started taking the magnesium in 2 separate doses of 125mg each, at around 5pm and then before bed. Both with food.

I should mention I was going through PMS before this situation, which brings me to my next point: several days later, I am at around a week before my period and my anxiety is insane again. It started suddenly 3 days ago, like flipping a switch. I did no changes at all on anything I'm taking. No new reduction in Pregabalin dose, no new meds, nothing. The only change has been that I've been taking the entire magnesium dose before bed (350mg).

I have read on reddit that some people find the glycine in magnesium glycinate activating. I wonder if this could be the case? I have been taking magnesium for around 15 days now, and the only time I started experiencing this bad anxiety again was around 3 days ago when I started taking the entire supplement pill at night. When I take it, sometimes I experience a bit of internal heat? But this could also be my anxiety, since changing doses of stuff or taking something new always scares me (and I am a bit wary of magnesium because of electrolytes, even though I have read it's very safe). Weirdly enough I have been sleeping very well, so if this was activating to me surely it would interfere with my sleep? I don't know!

I'm inclined to think this bad bout of anxiety is withdrawal and is being worsened by my hormones. Any thoughts? Has anyone here had bad reactions to glycine in magnesium? I feel like my brain just wants to blame something other than my hormones but honestly if my nervous system is being sensitive I don’t wanna rule this out either.

I'm having a hard time staying hopeful and my mind leads me very to dark places during these anxiety lows. Fortunately I am doing therapy many times a week and my family is supportive but whew! It's hard to take into account that it won't last forever sometimes.

Thanks for reading and I would appreciate any feedback or comments or similar experiences, even if it's other women saying their cycle definitely affects their withdrawal.

I took magnesium for years prior to starting my tapering again last November.  Once I started tapering I could no longer tolerate magnesium nor caffeine and had to quit both immediately.

[Starwalker]

Hello Emonda! Thank you for the encouragement.

 

2 hours ago, Emonda said:

I'm not a moderator, but I wonder if this has contributed to the current setback. I've read that there can be a delay for WD symptoms (sometimes many months) and a cumulative effect of tapering. I drop by 2% per week for 4 weeks, then hold for 2 weeks. I notice on week 4, the cumulative effect of the preceding weekly drops. I feel more on edge, more irritable, more anxious, worse sleep etc.

 

Yeah, I knew my reductions were bigger than the recommended here, but I had had virtually no issue until now, so I got greedy Sadly Pregabalin is not sold in liquid form in my country, so I have been thinking of either asking for a new prescription for capsules and buying a good scale, or going the homemade liquid route just like you. The liquid seems like a less intimidating approach! I'll have to polish my math skills.

 

2 hours ago, Emonda said:

Sounds like one of those dreaded waves. They come and they go. I've had two shockers this year that lasted maybe 6 weeks each, but with the support of my wife and this website, I stuck it out and the waves subsided.

 

6 weeks!!! Oh my! I'm glad to hear you have great support at home, that sounds awful. Trying to be patient with all these symptoms is probably the worst part. Gotta remind myself it will all pass at some point.

 

Thank you for the comments and well wishes! I will look into the Brass Monkey approach and definitely won't do such big reductions after this, lesson learned 😧. Hope you have a good week!

[Starwalker]

52 minutes ago, Tulip52 said:

I took magnesium for years prior to starting my tapering again last November.  Once I started tapering I could no longer tolerate magnesium nor caffeine and had to quit both immediately.

 

I'm sorry to hear that! Caffeine does affect me greatly, it always has but seems to be worse now, so I understand. Fortunately, I took half a pill of the magnesium glycinate again today in the afternoon and it actually helped calm me down, so I'll take some more before bed and see how that goes.

[Emonda]

2 hours ago, Tulip52 said:

Once I started tapering I could no longer tolerate magnesium nor caffeine and had to quit both immediately.

 

I'm with Tulip52 on the caffeine, plus alcohol and chocolate. I could originally tolerate all three, but no longer. Magnesium seems to help me, but we are all different.

 

Sorry if that was discouraging regarding my 6-week wave...not my intent. It was a perfect storm of stress. A reasonable response given the circumstances....but it passed. I was just trying to say that waves are normal. They will come and go 🙃

 

Until next time...