irishlondon A bit confused and in need of advice

[irishlondon]

Hi everyone,

 

I was on 50mg sertraline from February 2014 to January of this year.

 

In October 2014, I started developing pins and needles in my legs and burning skin. These symptoms were very distressing and caused a lot of sleepless nights. My GP thought it was anxiety and recommended in double my sertraline dose. After a few weeks on 100mg, the symptoms increased and my legs actually started to feel painful.

 

Another GP then reduced the dose back to 50mg, and suggested i reduce again to 25mg so see if that helps. She also prescribed Pregabalin to see if it would help with the strange sensory symptoms.

 

The leg symptoms moderately improved, so I thought I would try coming off the sertraline altogether. After 2 weeks at 25mg, i then went down to 12.5 mg for 3 weeks before stopping completely.

 

I have now been off sertraline entirely for about 3 weeks. I have had the "zaps" in the initial days but they have seemed to fade. But i am having terrible insomnia, palpitations and my the prickling burning sensations in my legs is nearly back to its worst level. 

 

Have I tapered too quickly? And is it too late now to try and go back on the 25mg? I guess what I'm asking is the damage done because the withdrawal has now started? 

 

Thanks so much for any advice you have

Ryan 

[clearday]

Hi -

 

All sounds like withdrawal symptoms -

 

Sounds like you tapered too quickly -

 

Someone will be along to help you decide whether to reinstate back on Zoloft and at what dose. 

 

Welcome! 

[Rhiannon]

Hi Ryan--

 

Welcome to the forum. I moved your post into our Introductions and Updates area, because that's where we "tell our stories" and get advice and support in our journey. The "Tapering" area is more for topics related to tapering in general (not so much just specifically our own individual situation). It will all make more sense once you've been around a while.

 

You have tapered much faster than we would recommend; we recommend cutting no more than 10% of your current dose at a time. See this link:

Why taper by 10% of my dosage?  

 

Can you give us more specific time frame for when you made your cuts? You went up to 100 in October, when did you go down to 50? When did you go to 25? When was the cut to 12.5? 

 

Since you came off the 12.5 three weeks ago (is that correct?) and you were at 12.5 for three weeks, I suspect going back on at 25 mg might be too much. Sometimes when people are in withdrawal, reinstating to a higher dose can cause too much activation, so we usually recommend trying a reinstatement at a smaller dose and seeing if that settles the withdrawal symptoms down.

 

Ideally I would recommend you reinstate at something like 8-10 mg, but given that you'd have to get a liquid or compounded formulation to do that, and you already (it appears) have access to doses of 12.5 mg, and you're only three weeks out, I would say in your case it might be good to restart the 12.5 mg and see if that helps settle down your withdrawal symptoms. It won't make them go away 100% immediately, nothing can do that, but it may stabilize you, improve what you're getting now, and stop it from getting worse.

 

(If you DO have the liquid and you can adjust your dose easily, I'd recommend trying the smaller dose first (8 mg or so) and seeing how that goes.)

 

Here's a topic on reinstatement (you are within the short-time window when it's most likely to work): About reinstating and stabilizing to stop withdrawal symptoms

 

Your nervous system is destabilized and in chaos and needs an opportunity to restabilize and rebalance itself. It's hard to say how long that will take. I can't answer "is the damage done" because I wouldn't say that damage has been done, exactly, just that things are a bit chaotic right now and your brain is trying to find its stable, balanced place. Here's something I wrote that might make it easier to think about what's going on with that:

http://survivingantidepressants.org/index.php?/topic/6447-best-of-sa/?p=91582

 

Finally, when you get the chance, please put your history into your sig line. That way, as your thread gets added to and evolves, people will be able to see your history without having to read back, which can get complicated.

 

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

 

Welcome to the forum. I think you may be able to get some help here, and you will definitely get a lot of understanding and support here.

 

--Rhi

[dalsaan]

Hi Ryan

 

Welcome to the forum. I'm sorry you have been struggling lately. It's sometimes difficult to say what's happening exactly when there has been a lot of changes. You have certainly been on the sertraline long enough to be experiencing withdraws. These could also be exacerbated by a reaction to the introduction of Pregabalin.

 

We have seen many people reinstate within the first month of stopping. Reinstatement doesn't always make things better. Pease read this thread before making your decision http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

Our fundamental position is conservative. We recommend starting reinstatement with a micro dose to see how your body responds. By that I mean 1-5 mg. Once stabilised you can develop a tapering plan that is more gentle on your system.

 

Can I ask you to complete a signature with your drug history. That will be shown in every post you make. It saves us having to find this info in your thread. How to fill out your signature http://survivinganti...your-signature/

 

 

Dalsaan

[Rhiannon]

Dalsaan, I was sort of thinking maybe because it had only been three weeks off, and only six weeks before that he or she was on 25 mg--that is, it's been rather fast coming down--that maybe more than 1-5 mg might be appropriate? Maybe the brain hasn't adapted all the way down that far yet? I'd like to know what Alto says.

 

What I was thinking was, it can take a while to get access to those smaller doses, you have to get the liquid or get something compounded, that can take a while to arrange, and at three weeks out maybe "soon" is important, hence the suggestion to go back to the 12.5, which otherwise might be a bit high.

 

I'd like to hear what the other moderators think about this. I'll post a report so we can chime in. Ryan, as you can see, the moderators don't always agree 100% on the best course of action, but allow us to discuss it a bit. Altostrata is the one with the most experience so I want to see what she thinks. We will come to a consensus fairly quickly.

 

You can tell who is a moderator by looking to the left, under their name and avatar--it will say "moderators" and "staff."

[Altostrata]

Welcome, irishlondon.

 

You can see we're thinking going back on a bit of sertraline. My guess is to try 12.5mg.

 

Re: the leg symptoms. Magnesium is very good for these kinds of symptoms. See http://survivingantidepressants.org/index.php?/topic/1300-magnesium-natures-calcium-channel-blocker/
 

Sometimes people find fish oil helps with the brain zaps, see http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
 

[JanCarol]

G'day IrishLondon - welcome to SA!

 

You have received wise advice above, Alto has much experience with these rollercoaster rides, and I would let her guide me any day.

 

You will be tempted to do lots of things.  My only input is to suggest:  don't.  Do what Alto says, and then wait.  And when you are having trouble, wait some more.  Give the reinstatement at least a week to see if it helps.  Going on and off and on and off the drug again only causes problems later.  Also it is not recommended to skip days between doses - it is important to stay stable (many doctors advise this, even though it is unwise).

 

Pregalbin - what little I know about it - would be numbing, depressing.  It would help with sertraline side effects, but that's kind of like robbing Peter to pay Paul.  Doctors don't seem to recognize that these SSRI drugs have profound effects, many of them undesirable, and when they crop up, the doc says, "Oh, well, now you're bipolar," or "oh, so now you have restless legs," and give you more drugs instead of taking away the drug that was causing the problem.

 

Furthermore, they are more than clueless about how to taper off the drugs.  This place is more conservative than most - and that's because we like to "heal as we go" instead of taking a big drop down the cliff and trying to put a person back together like Wil-Ey Coyote.  It's better to climb down very slowly, than to end up in a heap at the bottom of the cliff.

 

Don't worry about going back on the drug - at a low dose it should soothe your withdrawal symptoms, without giving you the toxic effects you are getting before.  However, at the first sign of those toxic effects, you may need to adjust.

 

I love my magnesium!  If you are having a rough day, you can take a warm (not hot!) Epsom Salts bath, and it will soothe your muscles and help replenish your magnesium.

 

Welcome to SA!

[irishlondon]

Hello everyone,

 

Thank you so much for your kind replies. I have just seen them as I was looking in the Tapering forum and could only see 0 replies there.

 

Before reading your advice, I reinstated at 25mg two days ago. Should i stay there, or reduce to 12.5mg like you have recommended? 

 

My anxiety and insomnia are really terrible and the leg symptoms persist. i worry that at my doctor's appointment coming up, she will try to increase the sertraline dose back to 50mg to get the anxiety under control. Would that ever be the right thing to do or am I just letting myself in for prolonged pain? 

 

To be honest I find it all a bit scary and not sure what to do.

 

Thank you so much again

Ryan

[dalsaan]

was there any change after you reinstated the 25mg?   It can take a week or so to kick in in terms of addressing withdrawal symptoms if its going to do so but an adverse reaction can happen immediately.  Have your anxiety or insomnia been worse, stayed the same or gotten better since reinstating?

 

D

[irishlondon]

Hi Dalsaan,

 

I think they may have improved a little. My sleep hours are all over the place - it's 5am here in the UK and i'm still awake - but i slept in very late today and managed to sleep without taking any antihistamines to help me sleep. So i've seen that as a little bit of improvement. 

 

I feel a bit helpless because I know my doctor is going to advise going back up to 50mg and i have no idea whether that would be the right thing to do or not.

 

Thanks for your support - this is all new to me, and i feel i've just been taking these drugs blindly without any idea of the long term effects

 

Ryan

[dalsaan]

When is your next appointment with your doctor?

[dalsaan]

This has, at one point or another, been 'all new' to us as well. We are happy to provide you what support we can.

[irishlondon]

Hi Dalsaan,

 

I have an appointment on Friday with my GP. Just really annoyed at myself because for most of January I was doing well - and then I decided to rush things and come off the medication altogether. It was stupid I know - and if only I knew this website existed I would never have done it. 

 

Thanks again for replying - 6am here and still no sleep, but I know that's a common symptom of withdrawal

 

Ryan

[dalsaan]

So did you feel ok at 25? Did it lessen the burning etc? Sorry for all the questions, just trying to be clear on your experience.

[irishlondon]

Yes after Christmas holidays, the doc recommended I reduce to 25mg. For most of January I felt good, the burning had reduced and I felt I was less stressed and more focussed on other things. So in the last week of January I decided to reduce again to 12.5mg and stayed there for I think around 2 or so weeks. I then went to the US on holiday in the second week of February and it was there that I stopped taking the sertraline completely. I noticed my anxiety increase as well as the sleeplessness shortly after stopping, and while on holiday I had to take OTC sleeping tablets on most of the nights. At the time I thought it might just be the jet lag and stress of the travel but now I am home and the anxiety and insomnia has only worsened. 

 

Ryan

[Fresh]

Hi  Ryan ,  it's a good sign that the last 2 days taking 25mg have been a little better.   If you were going to have a bad reaction , you would have noticed by now.

As dalsaan said , this was all new to each of us at one stage.    You'll get there.

 

Best wishes ,    Fresh

[dalsaan]

Ok. What you are trying to do at the moment is take enough so that you don't experience bad withdrawals but not too much so that you have an adverse reaction. You want to stabilise for a while on a dose that works for you and then taper down very slowly so as to not trigger withdrawal, all the while learning as many non drug ways to manage anxiety.

 

It sounds like 25mg might be a dose that can address the withdrawal and not kick off the adverse reactions. We need more time to establish that. It may also be that 12.5 would have been enough but we don't know. Whether you stay on 25 is a decision for you. If you decide to keep it at 25 now and stabilise (and you don't have a return of the burning etc) you should say to your doc that this dose doesn't set off the side effects etc and I don't want to increase.

 

By Friday you should have a stronger sense of how your body is responding to your reinstatement.

 

I'm sorry we don't have clear cut responses, we can't predict the future but we can explain what our thinking is so that you can make an informed choice

 

 

 

Dalsaan

[irishlondon]

Thank you Dalsaan and Fresh,

 

I know now i'll just have to read my body and see how things go. My legs are burning so badly in bed now - this was the original symptom that kicked everything off back in October. It feels like my thighs are sunburnt. I've read this can be an anxiety symptom but it's just awful. It did relent for most of January and the beginning of February but now it is back in full force. 

 

Sorry to be so negative but I'm glad I can come here.

 

Ryan

[dalsaan]

Has it gotten worse since you reinstated?

[irishlondon]

No not worse Dalsaan - it has been like this on and off for the past week, even before reinstating. Sometimes pins and needles, sometimes burning, sometimes restlessness. 

[dalsaan]

Ok. I've asked the other mods for their view on the 25 or lower question so alto or Rhi might jump in as well

[irishlondon]

Thank you so much Dalsaan, I really do appreciate you help. 

 

Many thanks again

Ryan

[dalsaan]

Have you tried magnesium? Alto recommended it. I take it for sleep

[Songbird]

I've read this can be an anxiety symptom but it's just awful.

I don't think it is anxiety. It sounds more like restless leg syndrome, or it could be a paresthesia. Magnesium is often effective for restless legs, some people find vitamin B12 and vitamin D helpful.  You may need to take the magnesium daily for a few weeks to see a significant improvement.

[Rhiannon]

Hi!

 

Given that you're back on 25 mg, I think your best bet is probably to stay right there for a while. It's hard to say for sure, but generally when people are in withdrawal, changing and tweaking things around causes more trouble than anything else.

 

What's important now is to give your brain a consistent, stable chemical environment. Your nervous system is now struggling to stabilize, to find homeostasis (a state of functional balance) and the best thing you can do is to not change meds at all for a while now. Just take your same dose at the same time every day. Your symptoms will wax and wane, that's normal, but you should find that overall the trend is towards improvement in spite of some days being worse.

 

And give your nervous system gentle support by keeping things very stable. Read the advice in the "keep it stable" part of this:

http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

It sounds like you're concerned that your doctor may pressure you to go back on 50 mg, but the choice is still up to you. Let her know that you feel you came off too fast at the end, you are now back on 25 mg where you were good before, and you'd like to give it some time to see if you can feel well again on 25 mg.

 

Let her know that you want to be on the lowest effective dose for you. Doctors can't really argue with "lowest effective dose." They might tell you that your dose is not high enough to be effective, but patiently explain that you would like to see for yourself, because the recommended doses are based on averages, but you are not an average, you are an individual.

 

Maybe that will work. I find "lowest possible dose of the fewest possible meds" is something that doctors are usually more comfortable with than "I want to get off meds."

 

Anyway, let's get you stable on that 25 mg. It will take some time. While you're waiting it out, you can read up on tapering in our Tapering section and figure out a plan of attack for when you're ready to finish your taper.

 

I would also recommend reading the book Anatomy of an Epidemic by Robert Whitaker, when you get the chance.

 

Best of luck, keep us posted.

 

Oh, and PS: you might print out the charts in the Tapering section, here: http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

which show that even at very low doses these drugs are still having considerable impact. That's something else you can show a doctor especially when they question the need to come off very slowly at the lowest doses, or the value of taking a low dose at all.

[irishlondon]

Thank you so much Rhiannon,

 

I just need to be patient now and hope things get better.

 

I should have seen this coming. I was getting teary for no reason a week or so ago. But I kept going. I realise I shoulc now have probably gone back on the Sertraline at that point. Should have caught it before I got to this stage.

 

Thank you again for being so helpful

Ryan

[antidepressantsNoMore]

Even if you tamper normally, the truth is, you are going to have some symptoms and you are going to have to deal with them. Anxiety is part of w/d.

 

It is smart that you are tampering rather than do the stupid thing like I did, and go off the drug cold turkey.

 

There are plenty of supplements that help with anxiety. I probably sound like a broken record giving out this advice but magnesium will help you w/d no doubt. So take that stuff.

 

 

Good luck.

[Fresh]

Hi  Ryan , how are things going for you lately?