samanthaelizabeth: How do you manage to keep working while taper off

February 20, 2018

That sounds like a plan. I think I really messed up my system by rapidly getting off 2 years ago. I thought I didn’t need them anymore. I guess I forgot about the 5 depressions I had preceding the drugs. Although now I’m thinking the drugs made me keep getting depressed. Who really knows? Too bad I didn’t find this site then. I was stable till I had a setback this year. Then the doctor tried a lot of things. I got very manic on them. Really bad. So, I got off almost everything too fast again. The doctor. Now I am absolutely paranoid and terrified of the drugs. Unfortunately, I am not so happy with the depression I’m in although I had a little bit of a better day today. The depression happened before the drug withdrawal. I was trying to help it with trying all this stuff. So, how bad is your ms? That must really be difficult. You really think t was triggered by the drugs? I’m just saying, don’t think they’ll keep working for you forever. They can really turn on you.

February 20, 2018

5 hours ago, apace41 said:

What you ultimately decide to do is your decision. Degen has given you very good information and advice. I will say, however, that there are definitely success stories on this site and others. The suggestion that nobody heals after tapering is not accurate and serves to unnecessarily scare members.

Best,

Andy

I didn't "suggest" anything. I am simply gathering information for myself, so I can make an informed decsion. The suggestion that I am unnecessarily scaring members is inaccurate. But thank you for your opinion.

February 20, 2018

38 minutes ago, Downbutnotout said:

That sounds like a plan. I think I really messed up my system by rapidly getting off 2 years ago. I thought I didn’t need them anymore. I guess I forgot about the 5 depressions I had preceding the drugs. Although now I’m thinking the drugs made me keep getting depressed. Who really knows? Too bad I didn’t find this site then. I was stable till I had a setback this year. Then the doctor tried a lot of things. I got very manic on them. Really bad. So, I got off almost everything too fast again. The doctor. Now I am absolutely paranoid and terrified of the drugs. Unfortunately, I am not so happy with the depression I’m in although I had a little bit of a better day today. The depression happened before the drug withdrawal. I was trying to help it with trying all this stuff. So, how bad is your ms? That must really be difficult. You really think t was triggered by the drugs? I’m just saying, don’t think they’ll keep working for you forever. They can really turn on you.

Yes, I know. So the best I can hope for is trying to taper to a lower dose. I have been on this drug for 19 years so i'm sure it popped out a long time ago. But I never noticed because I was too busy with my career. I wll do whatever I need to in order to stay functional. Yes, I have MS and I have been in denial about it since I was diagnosed. Even thought my last "flare up" left me unable to speak (this was managed by 5 days of IV steroids) or write with lesions in my brain so large that they looked like tumors "Tumefactive MS" Also, I do believe my very brief stint with Effexor caused an autoimmune response in my body and my body is now attacking my myelin sheath in my brain.

February 20, 2018

Well I guess now I won't be getting any advice for expressing my thoughts?

February 20, 2018

11 minutes ago, samanthaelizabeth said:

Yes, I know. So the best I can hope for is trying to taper to a lower dose. I have been on this drug for 19 years so i'm sure it popped out a long time ago. But I never noticed because I was too busy with my career. I wll do whatever I need to in order to stay functional. Yes, I have MS and I have been in denial about it since I was diagnosed. Even thought my last "flare up" left me unable to speak or write with lestions in my brain so large that they looked like tumors "Tumefactive MS" Also, I do believe my very brief stint with Effexor caused an autoimmune response in my body and my body is now attacking my myelin sheath in my brain.

Sounds like you know what you’re doing. You sound very determined. I’m sorry about your ms. That’s a big thing to have to live with. I thought effexor was a miracle drug. Not so much now. After my rapid taper, my “psychiatrist” had me try Zoloft. It was the first one to make my hyper and manic. You’re lucky you can take it.

February 20, 2018

10 minutes ago, samanthaelizabeth said:

Well I guess now I won't be getting any advice for expressing my thoughts?

Good for you.

February 20, 2018

10 minutes ago, Downbutnotout said:

Sounds like you know what you’re doing. You sound very determined. I’m sorry about your ms. That’s a big thing to have to live with. I thought effexor was a miracle drug. Not so much now. After my rapid taper, my “psychiatrist” had me try Zoloft. It was the first one to make my hyper and manic. You’re lucky you can take it.

Well I don't know how lucky I am. I would have never gotten on an AD if some stupid doctor didn't prescribe Ativan to me for pressure headaches. I didn't know anything about drugs and quit cold turkey flushing them all down the toilet and went through hell for three months until I got on Zoloft. Oh it makes me so mad!

February 20, 2018

9 minutes ago, samanthaelizabeth said:

Well I don't know how lucky I am. I would have never gotten on an AD if some stupid doctor didn't prescribe Ativan to me for pressure headaches. I didn't know anything about drugs and quit cold turkey flushing them all down the toilet and went through hell for three months until I got on Zoloft. Oh it makes me so mad!

Yeah, tell me about it. I tried Ativan for a couple of weeks. My husband asked the psychiatrist for a medicine to calm me down. That’s because she upped my effexor and it made me manic. I only took if for a couple of weeks. At first, I thought it was great until it made me super depressed. I kept begging for it after that. My husband takes it for arthritis, but in his case he is able to occasionally take it, and is not addicted to it. So, I went off that too. She really wanted me to take klonopin. But I turned that one down. I’ve been having such a good time the last few months. Yes, I’m mad too!!

February 20, 2018

We don't pressure people to taper to zero. Taper to the extent you feel comfortable.

When you bring symptoms to us that sound like excessive drugs, we can only suggest reduction.

It's up to you to decide what is best for you.

PS Dr. Shipko has a rather drastic-sounding informed consent process because he wants his patients to know that going off drugs can be rocky.

February 20, 2018

15 minutes ago, Altostrata said:

We don't pressure people to taper to zero. Taper to the extent you feel comfortable.

When you bring symptoms to us that sound like excessive drugs, we can only suggest reduction.

It's up to you to decide what is best for you.

PS Dr. Shipko has a rather drastic-sounding informed consent process because he wants his patients to know that going off drugs can be rocky.

Thank you Alto. I wasn't implying that SA was pressuring anyone to taper to zero at all. I just don't think that it would be wise for myself to do so. I still haven't gotten a response from Chessie about an earlier question as I was not getting a general consensus from other mods. How long do I wait on 200 mg before I begin a slight taper?

February 20, 2018

Well your Intro topic has certainly had some traffic since I left for work this morning. It's taken me a bit of time to go over what's been posted.

Instead of making a 10% reduction you could try a 5%. I doubt that that small amount of reduction would reduce your symptoms BUT if you don't feel any worse than you do now that would mean that it is okay to continue reducing. If 2 or 3 weeks after reducing 5% you are feeling no worse than before the reduction you could then try a 10% reduction (and hold for 4 weeks) OR do another 5% reduction (and hold for 2 or 3 weeks). The goal is to reduce your drug load and thereby, hopefully, reduce what is possibly/probably serotonin toxicity and the uncomfortable symptoms which you are getting. You have several options after you get your drug load lowered 1) decide that you are going to stay on that lower dose and not try and get off the drug 2) hold at that dose and you might find that you then decide to taper again at a later date 3) keep on tapering.

This is the topic discussing the SERT occupancy Why taper paper: dose-occupancy curves

And these are some excepts from it:

This first one is talking about when you take a drug, not reducing your drug.

On 07/04/2016 at 8:00 PM, ChessieCat said:

I've just found a post in someone's topic by Brassmonkey which contained this explanation:

"These drugs work by making physical changes to the nerve endings referred to as "down regulating". In general the first 5mg (you take) affect about 60% of a persons nerve ending while (taking) 10mgs affect about 80% . Increase the dose to 20mg and only 85% are affected. So a lot of changes happen with the first 5mgs."

I hope that helps to explain it.

On 01/08/2016 at 11:21 AM, ChessieCat said:

I found this explanation by NZ in a post to Otter: Regarding the SERT diagram

On 31/07/2016 at 2:13 PM, nz11 said:

....

Regarding the SERT diagram.
Here's my take on it.
The SERT study (and its diagrams) is not about tapering per se. However it does provide a validation for the tapering regimen that is recommended on this site. And what people have found to provide the best chance of getting of these drugs and staying off.
10% of the previous dose per month tracks according to a decreasing geometric progression and provides a very close approximation to the SERT graphs. (a kind of logrithmic curve only we are travelling in reverse direction) Which is what the mid section of these graphs follow.
Recall: Abrupt changes in serotonin levels is what can trigger suicidal and homicidal ideations.
So we do not want to taper in a manner that triggers abrupt changes in serotonin levels.

Note: The graph does not follow an arithmetic progression ie a straight line trajectory.
Hence inferring the safest way to taper and the way to follow the graphs is to make each drop smaller than the previous drop. (Done by making each successive dose a % of the previous dose, each successive drop will be smaller)
This has proven the best way to get off the drugs. It allows the brain time to adjust to a smaller dose and remain stable.

Note also how critical it is at lower doses ...the serotonin occupancy is very dose sensitive at lower levels ie at lower dose levels small changes have big effects unlike at large doses there is not so much of a change. Perhaps because there is an over-saturation of the drug.
This is why many people can get from 60 to 20 say without too much trouble but struggle to go lower after that.

Similarly you appear to have gotten from 200 to 100 okay (emphasis on 'appear to' as wdl symptoms can be delayed and we dont know what may be currently in the pipeline) but sooner or later if you don't slow down you will crash heavily.
In other words the lower you go the slower you must go. Following a straight line trajectory may eventually cause you to fall off a cliff.

Online support groups such as this have found that 10% of previous dose (not the original dose) is the best way to taper and minimize withdrawal symptoms. Some may be able to go faster some have to go even slower.

My long pontification can be summed up in one sentence:
Alto: We show the receptor occupancy curve in reverse to suggest you have to come off the drugs slowly to match the curve and avoid causing a precipitous slide towards the end.

On 22/09/2017 at 6:56 AM, ChessieCat said:

This is a graph representing a "perfect" 10% taper of the previous dose with 4 week holds.

And brassmonkey who has been at ZERO drugs for quite a few months now:

On 22/09/2017 at 12:25 PM, brassmonkey said:

I think I'm just about the only one that I know of for an almost perfect taper. The only variations I did were an extra two weeks when I had bronchitics at around 18mg and an extra 6 weeks at 10mg just to let things settle out. Once I got below .75mg it was tricky to maintain 10% because of the scales, but I kept it as close as possible. That lasted for about 6 drops. Then again by necessity the last couple of drops were 25% and 50% because of limitations of the scales and eyeball method. From everything I've seen I was very lucky to have such a smooth and trouble free taper.

February 20, 2018

@ChessieCatI don't know what to do. I'm sorry. I am not happy right now at all. In fact i'm sitting here crying. I sweat profusely all day, I wake up drenched in sweat. This hasn't happened in all the years I was taking Zoloft. Is it possible that my very short taper and then reinstating caused this? I can't talk to my husband about this, he doesn't understand he hates these drugs and thinks I can just stop taking them. That's its mind over matter. I'm on the verge of going back to my doctor to switch medications. This whole situation is going to end up landing me in the hospital. I'm only 51 years old and hopefully have 20 years left. Am I supposed to take these drugs for another 20 years, maybe I should so I don't ruin my life? I don't even have a stable baseline from which to taper. I am very hard on myself. I'm pissed that wellbutrin caused me to quit all those jobs after moving here, I thought that I wasn't happy being here in another state and I was having massive panic attacks because of leaving all my friends and everything. I've ruined my career! If I'm not happy now, what will happen to me if I taper? I don't know how to be happy anymore without my Zoloft. I would never be in this situation if that f'n doctor never prescribed Ativan to me back in 1999, that stuff sent me into a tail spin. I was a hard working, strong person who went throught a lot of crap in life but handled it. Please guide me on what to do. I don't want to disrupt my husband's life. He currently is thinking that i'm not working because of my MS and that is not the case at all. Please guide me on what to do.

February 20, 2018

Should I stay on 200mg for awhile longer? I just want to be happy again.

February 20, 2018

I slept good last night, Didn't even wind up on the couch like I always do because once I wake up in the middle of the night I can't go back to sleep unless i'm in a room by myself.

February 20, 2018

Right now, I just wish I could take something so I could take a nap. I am stuck between a rock and a hard place. There was no need to keep me on this drug for so long, After I stabilized from the Ativan in 1999 The doctor should have started weaning me off! Now I don't know what to do. I feel like these doctors have ruined what is left of my life. I have a decision to make, stay on this drug at 200mg, start tapering, or switch meds. I've called Dr. Shipko he is in Pasadena, CA close to where I grew up, hopefully he wall return my call.

February 20, 2018

1 hour ago, samanthaelizabeth said:

I'm only 51 years old and hopefully have 20 years left. Am I supposed to take these drugs for another 20 years, maybe I should so I don't ruin my life? I don't even have a stable baseline from which to taper. I am very hard on myself. I'm pissed that wellbutrin caused me to quit all those jobs after moving here,

I can't give you any tapering advice as I did a CT of Zoloft 10 months ago a few months before finding this forum (thank god, I found it). I am 51 too and really cling to getting better as it is daunting to think that a psychodrug could ruin my life. And being in perimenopause, we women are getting a double-whammy. I cling to success stories. Thinking of you and hope you get some mod advice soon.

February 20, 2018

I really don't know what to do. I need some advice. I don't want to take this drug anymore but I'm afraid to taper. If you read my story, it's not in my intro topic but further down. You will see what led me to take zoloft. I'm afraid that I will go back to that dark place that I was in from the Ativan in 1999. I'm not happy now and that doesn't give me the confidence to try and taper. It's hard typing this when I would much rather talk to someone. I just want to be happy. Maybe I should switch to another drug? I feel like i'm dammed if I do and dammed if don't.

February 20, 2018

Nobody understands these drugs. I was just speaking with my brother and trying to explain to him and he just said it takes 21 days to create an addiction and 21 days to break it!

February 20, 2018

@Altostrata I just spoke with Dr. Shipko he suggested adding Wellbutrin and not tapering the zoloft at all He said for as long as I have been on this drug that I would end up disabled and there are no guarantee's what the end result would be. So WTF do I do now?

February 20, 2018

I don't think I need to make any comment on this:

29 minutes ago, samanthaelizabeth said:

@Altostrata I just spoke with Dr. Shipko he suggested adding Wellbutrin and not tapering the zoloft at all He said for as long as I have been on this drug that I would end up disabled and there are no guarantee's what the end result would be. So WTF do I do now?

Interactions between your drugs

Major

bupropion sertraline

Applies to: Wellbutrin (bupropion), Zoloft (sertraline)

Talk to your doctor before using buPROPion together with sertraline. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of sertraline, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Major

bupropion mirtazapine

Applies to: Wellbutrin (bupropion), Remeron (mirtazapine)

BuPROPion may rarely cause seizures, and combining it with other medications that can also cause seizures such as mirtazapine may increase that risk. You may be more susceptible if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

February 20, 2018

Great, i'm screwed!

February 20, 2018

3 hours ago, samanthaelizabeth said:

Please guide me on what to do.

You have been provided with all the information that we are able to give you. You have been doing your own research. We are not able to make the decisions for you.

Please read back through your Intro topic.

February 20, 2018

Okay, I guess my only option is to start tapering now. I'm going to put 100mg tablet in a glass with water. How much water do I use so I can get this down to 190mg?

February 20, 2018

There is a discrepancy in what you have posted. In your own topic you said Shipko said you should taper. Perhaps you meant should not taper.

17 minutes ago, samanthaelizabeth said:

Yes, but I'm not happy now how in the world would I taper? I spoke with Dr. Shipko today he didn't have alot of time but he told me I should taper, even slowly with the amount of time that I have been on this drug. He said even with a slow taper I could end up disabled and there are no guarantees of what the outcome would be. I wouldn't even consider Abilify but told me he would add Welllbutrin. This is getting ridiculous, now I will be on 3 drugs! I can't get a clear view of what I should be doing.

In your own topic you said not tapering:

45 minutes ago, samanthaelizabeth said:

Dr. Shipko he suggested adding Wellbutrin and not tapering the zoloft at all

February 20, 2018

Just now, samanthaelizabeth said:

How much water do I use so I can get this down to 190mg?

This has already been explained in your topic. The mods don't have the time or energy to continually repeat the information. And we have many new members joining the site weekly who need to be provided with information that, unlike you, they don't have.

February 20, 2018

On 21/02/2018 at 8:49 AM, ChessieCat said:

There is a discrepancy in what you have posted. In your own topic you said Shipko said you should taper. Perhaps you meant should not taper.

Yes that was my error, he said not to taper.

In your own topic you said not tapering:

Edited February 23, 2018 by ChessieCat
bolded SE's reply within the quote

February 20, 2018

Sorry, I guess I'll have to figure this out for myself.

February 20, 2018

On 2/18/2018 at 10:27 AM, samanthaelizabeth said:

Thank you @ChessieCat

How do I measure 100ml of water?

February 20, 2018

On 2/18/2018 at 3:36 AM, ChessieCat said:

It is possible, and quite easy, to create your own liquid by dissolving Zoloft tablets in water. You just add 100mg tablet to 100mls of water, leave overnight, stir and extract and dispose of the excess and take the rest.

I'm sorry to ask this again, but I never got an answer. How much is 100mls of water? I only have a 5ml syringe- I would have to fill that up 5 times.

February 20, 2018

After much consideration. I am thinking my best bet to decrease my med load would be to taper off of the Mirtazipine. I am just going to stick with my 200mg of zoloft.

February 20, 2018

You could use a small cooking measuring jug to measure 100mls of liquid. Place that in a small container which has a lid. Add the tablet and leave overnight. Next morning shake the container then extract 10mls with a syringe (and discard) if you are reducing to 190mgs Zoloft, or extract 20mls with a syringe (and discard) if you are reducing to 180mgs Zoloft.

Edited February 20, 2018 by ChessieCat

February 20, 2018

10 minutes ago, ChessieCat said:

You could use a small cooking measuring jug to measure 100mls of liquid. Place that in a small container which has a lid. Add the tablet and leave overnight. Next morning shake the container then extract 10mls with a syringe (and discard) if you are reducing to 190mgs Zoloft, or extract 20mls with a syringe (and discard) if you are reducing to 180mgs Zoloft.

Thank you @ChessieCat, I know I've been a pain. I apologize. I think it would be best for me to taper the Mirtazipine right now. I've been on it for 6 years and don't want to approach the 10 year mark. I have successfully come off of it before with now problem (other than now that I think about it some nausea) So i've we could switch over to tapering the Mirt I would be very grateful. I've been on Zoloft for too long and don't want to rock the boat. But the Mirt- I don't want to continue taking it. I have 15 mg tablets right now (was thinking about getting the soltabs) Could you please advise me on the tapering of Mirt? Dissolve in water? How long can I keep the solution in water?

February 20, 2018

To search for topics on SA I use a search engine and include survivingantidepressants.org in my search string.

February 21, 2018

@ChessieCatWhile I appreciate everyone's help and advise on this site. For now, I am not ready to taper anything. My zoloft is no longer working, but I need to be in a more positive frame of mind before I can begin any kind of tapering process. So if/when I am ready to taper I will be back for guidance. Although, there might be another drug added to the mix! Good luck everyone, I wish you the best! At least I learned from this site not to switch to another AD, so thank you!

February 22, 2018

samanthaelizabeth, please DO NOT make drug suggestions to SA members. Thank you.

February 22, 2018

3 minutes ago, ChessieCat said:

samanthaelizabeth, please DO NOT make drug suggestions to SA members. Thank you.

Sorry.

samanthaelizabeth: How do you manage to keep working while taper off

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