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Sertralinsomnia

One a week skipping sertraline in specific cases

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My mother takes zoloft for 10 years now, and she has to take it for life because she has severe bipolar ilness, and since taking zoloft 50 mg everyday, she has been fine since then. Once in a while she skips a dose, like once a week or more, and i notice it seems to remove some type of tolerance, and the effect seems to be more pronounced. Is there any problems in skipping once in a week, or once in 15 days to prevent poop-outs or tolerance? I know that everyone is differente and it is not recomended for everyone, but it seem to work in my mother case, what are the risks? Steady state is reached in 4 days, so if one dose is misses in one week, steady state will return in a few days right? Any thoughts?

 

 

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I think that it is more likely that skipping a dose every week or so is causing further destabilising for your mother.

 

Can you describe exactly what changes you see after a skipped dose?   

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A little change in mood but nothing especial and sometimes not everytimes mild headache. But she recovers fast. I recognize the destabilization problem but it seems there is scientific research for the benefits of a once in a while pause from a dose in one or more days.

 

This topic has already been discussed in this forums, dont know where, just search for poop out or Antidepressant Tachyphylaxis. But i could not found anyone who says it could be a good think once in a while. Most say it will mess you up. I believe that it depends on the person and also on the AD being used.

 

I would like to share with you and all community this article from NCBI: i copied the part that matters, and it seems to be beneficial, its called drug holidays:

 

 

The link for this article is:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008298/

 

 

Drug holidays or decreasing the current antidepressant dose.

 

It is well known that psychotropic medications and drug combinations, in particular, can cause adverse events that accentuate clinical symptoms and may impede the potential clinical benefit of the drug. It is also known that classic drug tolerance or dependence, such as that induced by opioid drugs is treated by a gradual withdrawal of the drug to facilitate a restoration of the normal state. Similarly, the institution of a drug holiday for patients afflicted by ADT tachyphylaxis is a reasonable strategy if it can be accomplished safely.

 

The requisite length of a drug holiday for patients with ADT tachyphylaxis is not known, although the minimum interval may need to be at least 3 to 4 weeks to restore receptor sensitivity. It may not be clinically feasible to completely discontinue pharmacologic treatment via drug holidays in some patients.

 

Although it may seem somewhat counter-intuitive, depressive symptoms may improve in some patients when the dosage is simply reduced. In their paper discussing antidepressant tachyphylaxis, Byrne and Rothschild cite several case reports describing a symptomatic recovery of the initial antidepressant efficacy when the dosage of an SSRI was actually lowered.3

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