inupup: Terrified to death. 11 months after rapid taper off 8 years setraline/zoloft 50mg - had akathisia trying to reinstate 25mg. What are my options. Am i screwed?

[inupup]

Hi all. I found this site far too late. I'm in a desperate situation socially/financially with the way things are going and want to know what my options are. 
It's been 11-12 months (May 2022) since i tapered off 8 years of sertraline 50mg way too fast. 50mg --> 25mg for 4 weeks, then stopped. 
7-8 months in (Jan 2023) I tried reinstating sertraline 25mg (too high i know) but was immediately hit with INTENSE akathisia. The most hellish experience I've had. Took the sertraline for 3 days to confirm this was an adverse reaction - it was.

I am unable to function now., much less work. I've only JUST started having some brief windows of normality, but this isn't good enough. I want to be back at work by mid-July, when my leave period ends.

I can't go back on sertraline after what happened with the akathisia right?
What are my options? Suffer through this nightmare and likely ruin my life in the process?
Or can I try another SSRI (if so, which one?)

Please help me. My god i am truly losing it. 


 

[Shep]

Hi, @inupup.

 

Other than the 3 days you reinstated back in January 2023, you've been completely off sertraline since May 2022 or June 2022, so reinstating likely will be dangerous at this point.

 

Your nervous system is likely to hyper-react to any amount at this point.

 

On 5/14/2023 at 4:57 PM, inupup said:

I've only JUST started having some brief windows of normality, but this isn't good enough. I want to be back at work by mid-July, when my leave period ends.

 

The fact that you're getting windows is wonderful. You may only have a few more months of waves because the worst may be behind you. But it's important that you continue to treat your nervous system kindly in order to continue this healing trend. 

 

Are you able to go back to your job with accommodations, such as gradually easing in part time? Or working remotely? 

 

Are currently taking any supplements? We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

When adding in or subtracting supplements, we advise only making one change at a time and in small increments. Please see:

 

 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

Please also check out these links listed in the non-drug coping thread. 

 

Non-drug techniques to cope with emotional symptoms

 

It's very important that we learn to handle regulating our emotions off these drugs and how to handle stress, this is especially important as you go back to your job. And these are things that are good to know anyways. Many of us find that learning these techniques make us much more able to handle stress than we ever were able to handle before starting these drugs. 

 

I also get a strong vibe that catastrophizing may be an issue. Forgive me if I'm mis-reading this. If this is an issue, please have a read of these links:

 

Dealing With Emotional Spirals

 

"Change the channel" -- dealing with cognitive symptoms

 

Please continue to use this thread to document your recovery and ask questions. 

Edited May 17, 2023 by Shep
fixed typo

[inupup]

Thank you @Shep
I have deteriorated this last month - unable to sleep, suicidal, constant panic, diminishing self cares.
My symptoms are widespread:
 

·        Neurological/cognitive

- Severe brain fog -impaired cognition, concentration, short term memory, information processing, word retrieval,

- Overload phenomena with significant resultant anxiety

- Zero stress tolerance (psychological, physical, physiological stress)

·         Crushing fatigue and exercise intolerance / postexertional malaise

·         Broken sleep with adrenaline surges

·         Imbalanced and feeling uncoordinated. Tremors.

·         Constant headache

·         Orthostatic and heat intolerance

·         Bladder urgency and frequency

·         Constant thirst, needing to eat every 2-3 hours

 

·         Uncontrollable obsessive racing thoughts

·         Severe constant anxiety, sympathetic arousal, agitation, intense dread, visceral fear

·         Suicidality due to overwhelming distress

·         Feeling like I am “losing my mind” – derealisation, depersonalisation

·         Rapid mood swings

·         Complete anhedonia



100% agree about catastrophization....but right now, I cannot control my thoughts or emotions, despite my best attempts with grounding, breathing, meditation, etc.

In my desperation, i emailed a prominent doctor and researcher in this field and they recommended a tiny dose reinstatement - in their experience, >80% recover within a few weeks of reinstatement, including those >12 months out.
My appointment with the doctor is tomorrow and I will ask for the prescription.
On the one hand, I am scared of taking it. On the other, my state is becoming truly unliveable. If there is a sliver of chance that a small dose like 1mg sertraline could stabilise me, then i'll take it.

My thoughts/behaviours are becoming increasingly disorganised, as you can probably tell from the way this message is structured!!
Will try to give updates
 

[Shep]

On 5/14/2023 at 4:57 PM, inupup said:

I've only JUST started having some brief windows of normality, but this isn't good enough. I want to be back at work by mid-July, when my leave period ends.

 

Are you still having some windows? 

 

 

7 hours ago, inupup said:

In my desperation, i emailed a prominent doctor and researcher in this field and they recommended a tiny dose reinstatement - in their experience, >80% recover within a few weeks of reinstatement, including those >12 months out.

 

I don't know about that percentage, but the closer you are to stopping, the easier it is to reinstate. Please see:

About reinstating and stabilizing to reduce withdrawal symptoms

 

This thread will explain how to get to those very low doses:

Tips for tapering off sertraline (Zoloft)

 

That's great you have a doctor who has at least some insight into withdrawal. If you're able to get a liquid formula of the drug, that will make it easier to get a tiny dose for reinstating and tapering off later. 

 

7 hours ago, inupup said:

If there is a sliver of chance that a small dose like 1mg sertraline could stabilise me, then i'll take it.

 

You may want to start out with even less than 1 mg, considering how long it's been since you've been on this drug. If you don't have a reaction, you can always slowly increase, but do be very careful. Your system is already acclimating to not having the drug. 

 

Please make sure that you're not panicking and scaring yourself and making this worse. Are you able to get disability pay for your expenses while you're not able to work? Do you have any close friends or relatives to help out? 

[inupup]

On 6/12/2023 at 10:31 PM, Shep said:

 

Are you still having some windows? 

In the last 4 weeks, i have had 1 day of feeling okay. But otherwise I have completely deteriorated since getting into a tailspin learning about this PWS business

On 6/12/2023 at 10:31 PM, Shep said:

That's great you have a doctor who has at least some insight into withdrawal. If you're able to get a liquid formula of the drug, that will make it easier to get a tiny dose for reinstating and tapering off later. 

 

You may want to start out with even less than 1 mg, considering how long it's been since you've been on this drug. If you don't have a reaction, you can always slowly increase, but do be very careful. Your system is already acclimating to not having the drug. 

 

He is not my doctor as he lives overseas... he is just someone well known to the community who, i imagine, is often emailed by people suffering from withdrawals wanting help.
We don't have liquid zoloft here in NZ so i will have to make my own suspension.
Thank you for the word of caution Shep about dosage - i will aim for 0.5mg 


 

On 6/12/2023 at 10:31 PM, Shep said:

Please make sure that you're not panicking and scaring yourself and making this worse. Are you able to get disability pay for your expenses while you're not able to work? Do you have any close friends or relatives to help out? 

You're right in that i am completely panicking and scaring myself - my agitation and spiralling thoughts are uncontrolled and i cannot for the life of me make a decision and stick to it.
The brain fog is severe. I don't know what to do. 
Regarding work...it's a bit high risk because i was a junior doctor, fresh out of university and working for 1 year.
There is a sense of time pressure to "get well" and have regular GP/medical input to monitor my "progress". 
My parents and partner don't really believe me about this withdrawal business and just want me to "get better" and try the antidepressant.

Chances are, my partner (of 2 years) will leave if i can't get better because this is just too much for anyone to have to put up with. That leaves me with my aging parents - no other family support in this country. 

There is also the intense shame of being this way, not able to work or show up, being misunderstood and judged by others. 
I already have a complicated health history with "CFS/ME" too. Everything is too much. 

I cannot imagine continuing on like this for another year or two. This state is absolutely unliveable.
I am scared to death and wish I had a crystal ball 
========================

My thinking is so haphazard i cannot trust it.
I did something stupid last night - i had a bottle of 5htp 100mg lying around. Thought "maybe this will help me sleep" and took 1 pill last night.
What a disastrously stupid thing to do! Because i was originally going to reinstate the sertraline this morning...but i realised upon waking that 5htp + sertraline in a sensitised system is a STUPID IDEA!!!!

The half life of 5HTP is 2-7 hrs, so i will wait until tomorrow morning before trying 0.5mg sertraline. 
 

 

[Shep]

13 hours ago, inupup said:

Regarding work...it's a bit high risk because i was a junior doctor, fresh out of university and working for 1 year.
There is a sense of time pressure to "get well" and have regular GP/medical input to monitor my "progress". 
My parents and partner don't really believe me about this withdrawal business and just want me to "get better" and try the antidepressant.

 

If you haven't already, you may want to go ahead and check out the journals forum. With your medical background, you'll likely find them very useful.

 

From journals and scientific sources

 

There are also some good resources in the first post in this thread:

 

How do you talk to a doctor about tapering and withdrawal?

 

13 hours ago, inupup said:

My thinking is so haphazard i cannot trust it.
I did something stupid last night - i had a bottle of 5htp 100mg lying around. Thought "maybe this will help me sleep" and took 1 pill last night.
What a disastrously stupid thing to do! Because i was originally going to reinstate the sertraline this morning...but i realised upon waking that 5htp + sertraline in a sensitised system is a STUPID IDEA!!!!

The half life of 5HTP is 2-7 hrs, so i will wait until tomorrow morning before trying 0.5mg sertraline. 

 

You may want to wait a bit longer to make sure the 5HTP is completely out of your system AND that your system has had a chance to recover. If you had a broken ankle, you likely would still take it easy even after you got the cast off. 

 

It's always best to be cautious.

 

Please let us know how you do over the coming days. 

[ls8719]

Hi @inupup 

 

I’m so sorry you’re having such a difficult time. Your story resonated with me as I’m currently off work (second extended period this year) and I also jumped off Sertraline after being on for 7 years and suffered horribly as a result. 
 

I reinstated at 0.5mg after 6 months, which was risky but I felt some improvement from it. I was able to go back to work after the reinstatement. You may find that reinstatement helps some of your worst symptoms and hopefully you will be able to get back to some more normality. 
 

I very much identify with the shame and spiralling thoughts you mention. I think the WD makes the shame 100 times worse though, the neuro-emotions are my biggest WD symptom and during waves they can be a daily, unrelenting battle. They are very difficult to cope with.
 

What I would say, and hopefully it gives you some comfort, is that it does get better. It doesn’t feel it at the time but the intensity of this will pass. 
 

Wishing you all the best.