Pip: Cold Turkey'd Sertraline, regretting, what do?

[Pip]

Hey all,

After years of trying various SSRIs and always suffering with problems reaching orgasm and just generally feeling numb, I want to give "giving up" another go. Unfortunately I went about this in a silly way and came off 40mg of Lustral (Sertraline) cold turkey. I've done this before with other SSRIs and have occasionally tapered off them with my GP's help but always considerably faster than this site recommends. As such I would really like to give tapering another go, but I've now been off the Lustral for just over a week.

Side effects are, for the most part, something I can cope with. However, I am finding myself getting inexplicable anger outbursts and it's quite scary for me and the people I love. I have heard that withdrawal symptoms can disappear sometimes within 24 hours of going back on the drug, and so am trying to work out whether it would be better to go back on the 40mg of Lustral and then taper slowly, or to stick with going cold turkey.

Also, if I were to go back on to the 40mg, how long would I be recommended to stay at that dose before I began the tapering?

 

I recall having quite angry outbursts when I was younger, but since I have been taken off and on and had swapped around many SSRIs from the age of 16 it would not surprise me if these outbursts correlate with my withdrawals from these drugs.

 

I am with a counsellor currently and have been with her for well over a year. Any ideas I take from this board will be run past my GP and my therapist as I really, quite passionately do not want to live life on SSRIs (emotional numbness, sexual dysfunction), yet neither do I want to be depressed or needlessly angry.

 

Sorry if I've rambled on a bit, my mother is Welsh.

 

- Philip (Pip)

[Wingbatty]

The angry outbursts will continue (personal experience) for a long time. That is withdrawal, NOT a sign that you need the med. I guess it is a matter of whether you can hold yourself together, stay prepared for the anger and find ways to deal with it - or if it becomes overwhelming & you want to go back to a taper.

 

If you decide you need to go back to a taper, try returning at a half-dose. Maybe you don't have to go back to the full 40 to find some relief. If half works, stay on that for a few weeks & then do a slow taper.

 

Someone else here can tell you whether going cold turkey means you'll have to deal with the anger for longer or not.

 

The occasional person CAN go cold turkey. It's just not a great idea. Personally it makes me wish I were dead, I feel so ill. If you're already there, why not try to soldier on? If you can do that without your life falling apart, anyway.

[Pip]

The occasional person CAN go cold turkey. It's just not a great idea. Personally it makes me wish I were dead, I feel so ill. If you're already there, why not try to soldier on? If you can do that without your life falling apart, anyway.

 

I'm roughly a week in and the anger only occurred on the last couple of days. I'm so torn. I might be one of those people that you speak of, in which case it may be a matter of weeks and then the problems will dissolve. But then, I may not be, and I really don't want to needlessly put the people I love through the stress of dealing with an unpredictable angry version of myself.

 

I've spoken with my therapist who gave me the impression that there is a chance that maybe I might work better on merely a lower dose, but that by tapering the drug slowly I'll give myself the best chance of avoiding withdrawal symptoms and finding the optimum dose for me to live with (be it 0mg or 30mg or whatever). As such I'm fairly certain I will be asking the doctor if I can go straight back on Lustral but fairly quickly move into tapering.

 

My sexual issues disappeared within a very short time since giving Lustral up, and this will make going back onto the drug hard for me, but I will know that in the future I can look forward to being me again and being able to enjoy the more intimate moments with my partner. It's there, in my future.

[strawberry17]

Hi Pip

Welcome to the forums, as you're new here and this is your first posting about your situation I have moved it to introductions, then you can keep coming back to this post to update your progress.

As you've only just cold turkey'd a week ago I think you should be safe to go back on full dose, and that might be the best thing to do, you'll probably stabilise quite quickly and then be able to do a 10% taper, this will be SO much safer than stopping the drug dead, yes you might be lucky, but I wouldn't risk it, withdrawals can hit like a tsunami months after the last tablet and then you can end up in a right muddle. I was on sertraline for years so can relate to a lot of what you've said about the emotional numbness and sexual dysfunction, I hated it, I found that my feelings came back quite quickly when I started tapering, hopefully the same would happen for you.

[R187]

hi pip,

regarding your ct i'd go back on if i were you. i fast tapered off 25mg sert in march last year and am still having wd's. A reinstatement and slow taper would be my advice. you're only a week off- i'm sure you could reinstate without issues. My real WD problems started 6 weeks after i'd cold turkeyed - if i was in your position i'd go back on. Good luck x

[Nikki]

I know people who went off their ad's easily, however they still did a taper. It may not be worth the risk. I would try a smaller dose than you were on and see how it works.

 

Nikki

[Jemima]

Hi, Pip-

 

Welcome to the forum.

 

I think your best bet is to go back on Lustral immediately at a lower dose than what you were taking, perhaps half to a quarter of it. After a couple of weeks at that dose you'll know if you've stablized at that level. If not, another updose would be in order. Reaching a point of stabilization where tapering can begin is a very individual matter, so I can't tell you how long you'd stay at a stabilizing dose.

 

I think it's especially important for you to avoid cold turkey withdrawal because of the on-and-off pattern of your past antidepressant usage. Your system is probably so sensitized by now that another cold turkey episode would result in a really bad and prolonged withdrawal. I don't know that for certain, but you'd be taking a big, scary chance.

 

By the way, I'm quite impressed with your therapist's approach to this. It's rare to find someone with her knowledge of withdrawal. We wish more doctors, especially psychiatrists understood it.

 

When you have a few free moments, please put your drug history in the signature section of your profile. That will help us understand your situation and give better advice. Here are directions:

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

[Altostrata]

Welcome, Pip.

 

Cold turkey runs a higher risk of developing severe and prolonged withdrawal syndrome, which can last many months.

 

We can't tell the future. To reduce the risk, if I were you I'd go back on a quarter-tablet. If that or more seems to eliminate the withdrawal symptoms, stabilize there and plan on tapering slower in a month or so.

 

See this topic about how to taper sertraline http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/

[Pip]

Hey all,

I'm not going to reply to all of you individually but I would like to thank you all for being very welcoming. Sorry for not posting this in Introductions to begin with, I was not hugely concerned with following the guidelines as - at the time - I was feeling quite panicky and just looking for suggestions. I've gone back to my original dose of 40mg at the moment but will be talking to my doctor tomorrow (hopefully) about when and how I could lower the drug slowly. I hear there are liquid forms, but am unsure how willing my doctor would be to give me them instead of a pill... hopefully they will though as that would make it a lot easier to lower my dose slowly and accurately.

 

I'll try to get round to filling out my signature, but to be honest my memory is very hazy. I know I've tried a lot of SSRIs in the past, also Seroquel, and am currently on Lyrica (Pregabalin) for anxiety as well. However, with regards to dates and dosages I have no clue. I know I've tried Prozac for example but I have no idea how much I took or when.

 

Hope you're all well

[strawberry17]

Pip - I believe Sertraline is now available in the UK in liquid form, if you think your doctors might be a bit iffy or refuse, might be worth printing off some info from the tapering forum to take with you, or I took this book along with me: http://www.amazon.co.uk/Coming-Off-Antidepressants-Successful-Withdrawal/dp/1845292561/ref=sr_1_1?s=books&ie=UTF8&qid=1357763154&sr=1-1

[Jemima]

I'll try to get round to filling out my signature, but to be honest my memory is very hazy. I know I've tried a lot of SSRIs in the past, also Seroquel, and am currently on Lyrica (Pregabalin) for anxiety as well. However, with regards to dates and dosages I have no clue. I know I've tried Prozac for example but I have no idea how much I took or when.

 

How about an approximate length of time that you've been on SSRIs altogether, and whatever you're currently taking?

[Pip]

How about an approximate length of time that you've been on SSRIs altogether, and whatever you're currently taking?

 

Is this OK? Sorry for it being a paragraph - I'm awful at being concise.

[Altostrata]

Too bad the doctors didn't realize ALL the SSRIs cause sexual dysfunction.

[Jemima]

 

How about an approximate length of time that you've been on SSRIs altogether, and whatever you're currently taking?

 

Is this OK? Sorry for it being a paragraph - I'm awful at being concise.

 

That's fine, Pip. Thanks for making the effort.

[peggy]

Hi Pip,

Welcome!

I am a little confused. In your original post you say you went off sertraline cold turkey, but then you say you reinstated celexa...is this correct? Your symptoms are from CT the sertraline - you should reinstate the one you are having the withdrawal symptoms from - they are not really as easily interchangeable when in the midst of withdrawal.

 

Can you clarify this?

[Altostrata]

Good question, peggy. When did you start 40mg of Citalopram? 600mg Pregabalin?

 

What times of the day do you take them?

 

What other drugs are you taking? See http://www.drugs.com/drug_interactions.html to check potential interactions among your drugs.

[Pip]

Hi Pip,

Welcome!

I am a little confused. In your original post you say you went off sertraline cold turkey, but then you say you reinstated celexa...is this correct? Your symptoms are from CT the sertraline - you should reinstate the one you are having the withdrawal symptoms from - they are not really as easily interchangeable when in the midst of withdrawal.

 

Can you clarify this?

 

Hi Peggy,

You are understandably confused. I ran out of Sertraline while up at my girlfriends house, which prompted me to attempt to CT it. Unfortunately when I got back and read up about how some of my symptoms could have been from CTing, I decided to go back on them. However, I still didn't have any, so I went on Citalopram. In my defense my doctor very clearly stated that you could change from one drug to the other without hassle. I figured this might have meant that I could use the Citalopram until I got my next batch of Sertraline.

 

The issue here is that I am essentially a rather confused individual, and at the time of doing this my confusion was only made worse by having rather strong mood swings (from elation to anger to depression) and as such my thinking was way off. I am aware that the two drugs operate in different ways and as such cannot be used in place of eachother.

 

The question is what to do now. I now have my prescription of Sertraline but for the last two days have taken Citalopram.

 

When did you start 40mg of Citalopram? 600mg Pregabalin?

 

What times of the day do you take them?

 

I started the Citalopram 2 days ago, mistakenly thinking I could just use them until I got my Sertraline prescription through. The Pregabalin I have been on for probably over 2 years. I had a nervous breakdown after my girlfriend at the time left me, attempted suicide and was eventually taken to a Psychiatrist who prescribed (among other things) Pregabalin for my anxiety. It very quickly got to 600mg a day and I love it. I take 300mg in the morning and 300mg at night. I take all other drugs in the morning.

 

My GP surgery checks all medication on a computer system for drug interactions and I've also had my pharmacist mention when there was a query on an interaction.

 

Update on GP chat about tapering

 

My GP has suggested the following taper regime and assured me more than once that it would be slow enough to give me the best chance to avoid the withdrawal symptoms.

 

50mg tablet daily for 2 weeks (the dose I was on)

 

25mg (half 50mg tablet) daily for a week

 

and finally 25mg (half 50mg tablet) every other day for a week

 

He didn't really seem interested in my request of possibly going slower and I left feeling a bit foolish for pushing the idea.

[Altostrata]

If I were you, I'd reinstate the sertraline.

 

As you've gone cold-turkey, your nervous system might be sensitized and you might find that tapering schedule too fast.

 

The guidelines for tapering your GP should be following allow for tapering at an individualized rate:

 

Here are the NICE guidelines for doctors: http://survivingantidepressants.org/index.php?/topic/2448-nice-antidepressant-discontinuation-guidelines-for-uk-doctors/

 

And the MIND UK guide, which is very straightforward: http://www.mind.org.uk/mental_health_a-z/7996_making_sense_of_coming_off_psychiatric_drugs

[peggy]

Hi Pip,

GP's and even psychiatrists are not well educated about these medications and frequently cause needless distress for people by either not advising them completely or by giving them incorrect advice.

 

Hopefully you can just reinstate the sertraline without any problems, stabilise and then look at a more gentle taper. You are going to have to try to be assertive with your GP about requesting a more gentle taper - perhaps if you print out one of the guidelines that Alto linked you to and take it to him he might be more agreeable. Or, you can just not tell him that you are tapering and just keep filling the 50mg script.

[Pip]

If I were you, I'd reinstate the sertraline.

 

Thanks for the reply, have reinstated Setraline and am looking into tapering more slowly than the doctor suggested. I'd really rather be safe than sorry.

 

Or, you can just not tell him that you are tapering and just keep filling the 50mg script.

 

Thanks Peggy, am probably going with this option as I really don't like trying to debate or be assertive with Doctors. I just feel like they have all the education behind them and they hold all the cards. Anything I or any of the literature says can be countered by the Doctor and I would have no idea if they were right or wrong and if they were wrong I wouldn't have the knowledge to be able to argue the point. It's just not an even playing field and I don't feel comfortable with it.

 

I'm sure I read something on the Tapering board about sensitive weighing machines that would allow you to measure up doses of a ground pill (like Sertraline) and if that's the case I'd probably invest in one of those (if they weren't too expensive), but that'd give me peace of mind in knowing I wasn't rushing the process.

[Altostrata]

See this topic about how to taper sertraline http://survivingantidepressants.org/index.php?/topic/1441-tips-for-tapering-off-zoloft-sertraline/