Lakelander82: Sertraline general query and tapering info

[Altostrata]

Those articles referred to cold turkey. You must have missed the part where you get severe withdrawal symptoms from reducing your drugs too fast.

 

Please understand my position. You've been a member of this Web site since 2016. Since then, you've been told dozens of times why a slow taper is important to avoid withdrawal symptoms. Then you decided to take a shortcut and cold turkey, followed by severe withdrawal symptoms, which you should have expected.

 

As we tell people over and over and no doubt told you, don't make any big cuts in your dosage or you'll run the risk of withdrawal syndrome. Once Humpty Dumpty falls off the wall, we don't have any magic cures. Reinstatement often works, that's the best you can do.

 

I can't tell how the reinstatement is working because you are making yourself worse with your ruminations and self-blame and you know that's so. You brought this on yourself doubly, both by going cold turkey against all advice and worrying yourself into a state. Think carefully, maybe you really want to be a psychiatric patient.

 

You broke it, you bought it, take responsibility for it. You don't want to own you made a big mistake. See Non-drug techniques to cope with emotional symptoms and do not post again until you adopt some of these techniques.

[Altostrata]

FYI -- Do you see the big red warning? That's been at the top of the reinstatement topic for years.

 

I just made it larger and red so nobody misses it, and repeated throughout that the possibility of reinstatement does not mean cold turkey is a shortcut. (Those warnings were already there, but I made them crystal-clear.)

 

Nobody here has ever before interpreted the reinstatement topic as suggesting cold turkey was a good way to stop taking drugs. If that was true, I could close up this site tomorrow.

 

On 10/8/2012 at 4:17 PM, Altostrata said:

ADMIN NOTE This topic is a general discussion of the principle of reinstatement. For case-by-case consideration of what YOU should do, please put your questions in an Introductions topic.
 
Do not put those questions in this topic, because detailed discussion of YOUR particular circumstances will take it off track and make this topic difficult for others to follow. The moderators will move any questions about YOUR particular case to the Introductions forum. Thank you.
 
Also see

After Reinstating or Updosing, How Long To Stabilize?

Stabilizing after a reduction -- what does that mean?

---

 

Don't suddenly go off medication assuming that reinstatement is a safety net.

....

 

 

[Lakelander82]

Yes alto I get that, but is my reinstatement dosage reasonable even though it’s the same as what’s was on?? My brain isn’t back functioning well now and I don’t now understand why it was recommended to go lower on dosage if you cold turkey for a few days but I’ve beenn told to go back to my original dosage? Does the reinstatement dosage not have to be lower going by the rules of this website if you cold turkey?? That’s all I want to know. Thank you.

[Altostrata]

How many times have I answered that question? Read this topic from the beginning.

 

Because you're making your symptoms worse, it's impossible to tell whether 12.15mg is sufficient or not.

 

I see no evidence in your response that you've even looked at Non-drug techniques to cope with emotional symptoms

 

 

[Cruizer]

Hi Lake Lander. Hang in there buddy. I just read through your last 3 pages of posts and you certainly jumped up and down with dosages all be it a few days. I too am on Zoloft and am currently holding at 19mg. I have had a bad time of it in the past 3 months where symptoms felt worse than they had in years. I had started to get stronger withdrawal symptoms in the months leading up and i just kept tapering. Then i had surgery and felt like i fell off a cliff. Now after 3 months of holding i am starting to feel better; not the best but better. The advice i would give you after reading your posts is to not overthink things and look for an exact answer to your questions. Some of the reactions we have during withdrawal can be a complete mystery and it is hard to find an exact reason for why? The more you search for answers the more you will feel anxious about finding them. My plan would be to hold where your at now for at least a few months. Dont even think about your dosage and if it is too high or low. Keep a daily record of how you feel so you can track your progress in the coming months. I rate my days for 0-4 based on avg symptoms for that day. This really helps when you look back to compare the months prior and whether your making progress. 

When i am really panicky i just go for a walk or have a hot bath. I find either of these two things can help at the time of severe panic. All the best to you my friend. 

[powerback]

Hang in there LL ,you got to get a handle on your rumination ,I'm on a hold since October and its painful but it can be a lot worse for me so I try to think of that .when we are in such a panic we think we are the only ones on the planet with serious issues .you need to build practice in mindfulness and helping yourself calm yourself through serious rumination and racing thoughts ,the wiring of your brain is tangled .

We are lucky SA is here ,if it wasn't we would be left with the doctors prescribing us serious med doses for symptoms of serious mental illness .

I was in this kind of state more than a year ago in my doctors office ,I nearly walked out on an more drugs and a phsyc ward .you need to rest your mind and your CNS for weeks .I'm not saying you will I just want to give an example of you will be ok ,please watch the obsession its driving you around the bend but  I understand totally.

You could channel your obsessions into healthy eating and wellbeing ,its what I do .

Take care . 

[Lakelander82]

Alto i have had sessions of reflexology done, took baths with epsom salts in them, prctised mindfulness, done some yoga, practised deep breathing, read books, all to no avail. 

[Altostrata]

Please find something that avails. We don't know of an immediate fix for your problem, and we cannot keep answering the same question over and over. You must make the effort to manage your ruminations, it all depends on you.

 

Still looking for evidence you've read the information in Non-drug techniques to cope with emotional symptoms

 

Or did you do this foolish thing so you could go back to a full dosage of sertraline? If that was your intention, you don't need discussion here to do it.

[Lakelander82]

Yes alto, ive had a read through them from the Emotional freedom technique or tapping to Forgiving myself and changing the channel to something else. Forrest bathing is something i would do when i take the dog for a walk. Ive also done EMDR with a CBT therapist in order to fotgive myself for missing the two tablets. Ive also tried adult colouring in books as art therapy and mediatated to clear my mind but its still full of worry. Deep belly breathing is something I’m doing all the time now, making sure the expiration is longer than the inspiration. I’ve read through the windows and waves pattern of recovery many times through these past two years. Acceptance is something im working on. 

Im just disconcerted that missing two tablets has done this to my sleep, is it likely permanent now, and is it my worrying and fretting thats causin it or actually missing two doses? Im not falling asleep to 5 in the morning. Everytime i try to fall asleep i get a heart flutter or muscle twitch that wakes me up. To answer your question, no i had no intention of returning to full dosage of sertraline, it was just a rush of blood to the head because i was feeling very lethargic/ fatiqued on 12.15 mg of sertraline during my taper. 

[Altostrata]

Try this: Don't post here about your obsessive worrying. We're not going to reward it with attention.

 

Figure out a way to separate your symptoms from your obsessiveness.

 

Any further posts containing obsessive rumination with not be published.

 

 

[Cruizer]

You have done a lot in the last 2 weeks including CT and doubling your dose. I am not suprised your feeling the way you do. I know how bad it can feel and also how we try to find something to make us feel better. Just on reading your posts it looks like you are scrambling for everything that might help immediately. Unfortunately there is no quick fix with what you have done. Only time will help. Thinking you have done yourself irreversible damage is definitely not helping your situation and trust me. 

When i did some CBT one of the excercises i did was to ask myself what proof i had to my thought/assumptions? In your case what proof do you have that you have done yourself irreversible damage by CT for 2 days? I would think the answer is not alot... however what proof do you have that you will eventually get better from this? Well i think there is plenty of evidence on this site!! Plenty of people before you have had rough patches even for months and gotten better. How you feel now could be completely different to how you feel next week or next month. 

[FarmGirlWorks]

Dude, read the success stories -- over and over and over. When I feel really crazy bad, they help remind me that it is not permanent -- it is not -- and it just takes hella time and patience. There is no way around it, unfortunately. And don't give up on various non-drug coping techniques. Sometimes what didn't work before does now because you're ready for it. For instance, "changing the channel" started working for me after a year off drugs. Now I use it all the time to stop rumination. Anyway, hang in there! You are as strong as anybody else here.

[Lakelander82]

Thank you cruiser and farmgirl, I needed that reassurance. I went to bed on top of the world last night only to wake up and nervous mess this morning. I’m not ruminating about this I’m just saying it how it is. The really funny thing is I don’t feel one bit depressed, just wired with anxiety. Cold turkeying for two days is not recommended of course but it’s not the worst crime in the world. 

[Altostrata]

Read this The Windows and Waves Pattern of Stabilization

 

You will be very lucky if your withdrawal symptoms are temporary. You might post in I was stupid and went cold turkey

[Lakelander82]

Alto i missed two days, there still should have been some sertraine left in my bloodstream. From 12 to 6 to 3, so there should have been at least 3 mg left in my system so it wasnt conpletely a cold turkey in the true sense.And it wasnt a cold turkey from 50 to 0. 

[Altostrata]

You quit taking citalopram in the middle of your taper, after we coached you in tapering for 2 years. You knew that skipping doses wasn't a good idea. Whatever you did, it led to very uncomfortable feelings, isn't that so?

 

Please stop wasting my time arguing over this. You are not owning your mistake. You did it, it happened, you cannot rewrite history. You keep on ruminating about it because you cannot accept that you made a big mistake. You want to deny it happened. Sit with it. If you need to, talk to a therapist about it. Don't waste staff time here.

[Lakelander82]

I totally accept i made a mistake alto in stopping the sertraline for two days, im not blaming anyone else at all. Its becauae i made a mistake that im beating myself up that i cant recover from this now. My brain is just mush from ruminating, i dont now how much of my problem is down to my ruminating and how much is down to stopping for two days. I yawn a lot and cry a lot and i feel better, is that some form of healing everytime i cry? 

 I wake up early in the morning now all the time 

[Altostrata]

How early in the morning? How has this changed?

 

Have you seen any improvement in symptom pattern over the last 2 weeks?

[Lakelander82]

5 or 6 in the morning, sometimes i wake up more that once, and i could always sleep the clock around. I find it hard getting off to sleep now, as soon as im relaxed i get a shock from my muscles or a heart palpitation that wakes me up or the least wee sound is enough to prevent me knocking off to sleep but in saying that i did get off to sleep at around 12am last night and slept to 6 am. My parents, CBT therapist and girlfriend all think its down to me ruminating about missing the two doses rather than the action of actually missing them - i really dont know. 

I think my panic has improved a bit where i would just panic in the house over nothing-  i still feel raw in the morning and better in the evening. I find it hard to go into public spaces again, and interact with people, i panic at the least wee thing. I cant switch my mind off or stop the guilt from missing the two days, but i know i have to. I know i will probably be chastised for this but would a switch to a longer acting one like prozac help me? 

[Altostrata]

Reinstatement is working. Learn to be calm during waves and windows.

[Petunia]

10 hours ago, Lakelander82 said:

I find it hard getting off to sleep now, as soon as im relaxed i get a shock from my muscles or a heart palpitation that wakes me up or the least wee sound is enough to prevent me knocking off

 

I had this problem too, its quite common when your nervous system is unstable and sensitized. Get yourself some ear plugs, they help a lot. If you can't get out to get some, or don't have anyone who can get them for you, order some online.

[Songbird]

On 5/27/2018 at 6:50 AM, Lakelander82 said:

My parents, CBT therapist and girlfriend all think its down to me ruminating about missing the two doses rather than the action of actually missing them - i really dont know. 

 

I think there is some truth to this.  Not to say that missing two doses had no effect, but I suspect that a large part of the cause could be your ramping up your anxiety with worrying thoughts.

 

I think your best bet for help with this is to learn some mindfulness techniques.  In essence, you become the observer in your mind and just watch what is going on - kind of like you're a scientist studying some phenomenon.  The idea is that the observer is objective and does not get involved in the drama or pass any judgment on it.  Your goal is not to try to stop it happening, but just let it happen and don’t give it much importance.

 

When ruminating thoughts come, you can step back from them in your mind, observe the thought happening and say to yourself "oh, there's one of those thoughts again".  Watch the thoughts as if they are clouds floating by, or cars driving past.  Accept that the thoughts are there, but don’t attach any importance to them. 

 

It can also help to give your internal negative/worrying voice a name (e.g. “doom cloud", “chatterbox", "monkey mind" or whatever name you want) so that you can separate this voice from your real self.  When you are able to perceive that this voice is not “you”, it becomes easier to step back from it, get some distance from it, and observe it more objectively.

 

Another technique that might help is to write things down.  Getting the worrying thoughts out of your head and onto paper can help to alleviate them.  After writing down your worrying thoughts, you might like to write some positive affirmations.  Think of some things you would like to be true and write as if they already are (e.g. “I am calm.  My system is calming down and restabilising.  It’s going to be all right”).  I have found this very helpful so give it a try.

 

 

 

[Lakelander82]

Thanks Songbird for the suggestions, i am trying to implement all these things. I feel a lot better in the evenings than I do in the mornings. The interesting thing is when I was on my long slow taper, i would feel a lowish mood in the mornings (but little to no anxiety or a feeling of being wired in the morning) whereas now after missing thise two doses,  I still dont feel great in the mornings but its more a wired, extremely hypersensitive on edge feeling. If i was to choose between the two feelings, i would  choose the low, depressed mood - any day of the week. I only watched a video of an interview with a boxer this morning on youtube and it was enough to push me over the edge into anxiety and panicky feelings - I haven’t had a nervous system this wired in quite a long time. Birds flying past and small sounds make me jump out of my skin. 

My appetite is still not great, nerves seems to mess up my digestion.  Sleep isnt bad but i keep waking up at 5 or 6 in the morning, I  fall alsleep for another couple of hours, wake up and then fall asleep for another while. I have a high libido in the mornings again which is strange, because normally I’m too tired to feel anything early in the morning. It seems to be the more anxious I am, the higher my libido, so in the evening time my libido is lower. Weird. 

[Lakelander82]

I had another sleepless night last bar sleeping from 7am to 11am this morning. Its had to tell whether this reinstatement is working or not, i had been sleeping okish this last week or so, going to sleep at 12am/ 1am and waking up at 6am or 7am in the morning only to return to sleep for another hour or so and wake up again. This sleeping difficulty is so unusual for me. When i dont sleep much I feel far more senitised the next day. The internal tremors in my abdomen area and legs arent as bad i think. 

[Altostrata]

I think we mentioned waves and windows?

 

You'll have to figure out if you did anything to break your sleep. Did you stay on the computer late? Have any alcohol? Keep yourself awake worrying?

 

If you did any of these things, you'll know what to expect if you don't manage them better.

[ChessieCat]

It's important to think back to see if there is a reason like Alto mentioned so that you change it if there was something.

 

However, having the odd bad night of sleep happens to all people, not just people who are tapering.  Even something as simple as a change in temperature during the night can disrupt your sleep.  Or unusual noises, eg a loud truck going past (which may rouse you up and disturb your sleep but you may not be aware that there was a noise that caused it because it is gone before you are awake enough).

 

If you realise that there was nothing that happened during the time before bed time that may have caused the poor night of sleep you need to accept that you had 1 bad night and not worry about it because it can end up causing you to have more bad nights.

[Lakelander82]

I slept 8 solid hours again last night from 12 am to 8 am, I am a conundrum at times. It’s the drifting off to sleep when youre like this that can be quite annoying, its the strangest sensation, you're tired and you want to sleep but you’re nervous system is doing its best to wake you up.  I’m still very sensitised this morning though, small sounds such as the ceiling cracking etc go right through me. The old panicky feelings in public places and out among people have returned as well which is the most disconcerting I have to say, these were more or less non existent during my slow taper. I have to stay as I am on this dose because changing dose or adding any other drugs would only make things worse. 

[Songbird]

17 minutes ago, Lakelander82 said:

I slept 8 solid hours again last night from 12 am to 8 am, 

 

That is great to hear!

 

17 minutes ago, Lakelander82 said:

It’s the drifting off to sleep when youre like this that can be quite annoying, its the strangest sensation, you're tired and you want to sleep but you’re nervous system is doing its best to wake you up.  

 

This is a known phenomenon in withdrawal, it is frustrating.

 

18 minutes ago, Lakelander82 said:

I have to stay as I am on this dose because changing dose or adding any other drugs would only make things worse. 

 

Good idea to keep things the same.  In the meantime, try some regular relaxation exercises (e.g. progressive muscle relaxation, meditation, gentle yoga, etc.) to help calm your nervous system.

[Lakelander82]

I also must include these sentiments. For most of my taper as i have mentioned on numerous periods, i would get periods of calm followed by tension then crying then back to calm again and so on. It was low level manageable stress and tension and the weeping always eliminated it. At present (since missing my two doses) i am also seeing the same pattern but the anxiety and tension that preceeds the crying is gut wrenching, mind churning, extreme anxiety. The weeping always and I mean always levels me out for another while until the anxious period kicks in again. When i doubled my dose for those two days to 25mg way back three weeks ago, the antidepressant blocked off my ability to express emotions through weeping and instead everything was repressed and it basically sent my nervous system beserk. I do hope the incessant crying is my way of my system restoring itself through the excretion of stress chemicals and emotions. I must reiterate that i dont feel remotely depressed, just wired. 

[Altostrata]

Is there any way you can remind yourself that you will have waves and windows? Having to type it out over and over in a response is very tiring.

[Songbird]

7 hours ago, Lakelander82 said:

It was low level manageable stress and tension and the weeping always eliminated it. ...  The weeping always and I mean always levels me out for another while until the anxious period kicks in again.  ... I do hope the incessant crying is my way of my system restoring itself through the excretion of stress chemicals and emotions. 

 

I've had similar experiences with crying, it is a good tension release.  I don't know what it is doing biochemically, but I think it must be one of the body's natural coping methods.

[Lakelander82]

Most likely is a tension release alright Songbird. I’m very irritable now, every little mishap and inconvenience is pushing me over the edge into anxiety and panic, lots of little things send me into crisis mode, it’s like I have very little control of this monster. I’ve still a pain in my chest and my appetite is still poor. Ive lost weight no doubt, I was usually around 12stone in weight but I’d say I’m more likely 11stone at present. I’ve still got trembly legs that are worse in the morning. I can drive to places ok but don’t like being too far from home at present because it feels as if I’ve less control being far from home. I don’t really like being in crowds of people at present. 

 I’ve little to no depression -  Two CBT therapists said I didn’t look depressed either. The dull, lifeless pupils of a depressed person are a dead give away, mines are bright, massive and for want of a better word, just look wired. 

I’m sleeping about 9 hours at night, with a few sleep interruptions but nothing major. I’m three weeks and two days back on my original dose of 12.15mg of Sertraline, but I know I have to give it more time. 

[Altostrata]

Perhaps you can ask your therapists for coaching in stress reduction techniques, sounds like you need those, too.

[Songbird]

Hi Lakelander, you might find Dr. Claire Weekes' techniques helpful.  She has a number of great books and recordings about learning to handle anxiety. 

See this topic:The Dr Claire Weekes method of recovering from a sensitized nervous system

[Lakelander82]

Yes thanks songbird I have read Claire weekes books a number of times, peace from nervous suffering and hope and help for your nerves. It will be 4 weeks on Sunday since I returned to my original dose of 12.15mg. Some things have improved like the abject terror and horrific panic attacks at home. I’m not crying as much as I used to, but I still do several times a day and feel relief afterwards. Is it a good sign that I haven’t lost the ability to cry? My legs aren’t trembling anymore either. I’m trying to get out and about as much as possible but I’m limiting myself to quiet country walks with the dog and short drives here and there, I’m not in among crowds of people much or really driving far from home. In terms of agoraphobia, what level of severity is this? 

Tbh I don’t know if my nervous system can get back to the same state when I was reasonably stable on 12.15mg, I still panic at stupid little innnocuous things when I’m out and about, things I wouldn’t have batted an eyelid at on my slow taper. My mum thinks it’s all down to confidence, the panic attack eroded my confidence away and that’s why I’m having difficulty in public places again and that I need to build the confidence back up...I don’t know about this theory. My appetite is still poor, only forcing down two meals a day and my sleep is still poor. Absolutely no depressed mood at all. 

[Altostrata]

Hello, Lakelander. What do you understand about waves and windows?

 

What is your sleep schedule and pattern?