Ali75: Zoloft to St John's Wort and Sam-e

[Ali75]

Hi,

 

I've been a 'lurker' since about February. I'm very impressed with this site and feel that Altostrata is truly a hero. I hesitated to post my story because it felt too long and convoluted, but I feel I could really use some advice (and maybe it's not so convoluted), so here it is. 

 

In 1996, shortly before my 21st birthday, I was prescribed Zoloft for major depression, which I had been experiencing for about a year (I had never had major depression before that). Soon after starting the Zoloft, the psychiatrist increased my dose to 200 mg. My depression was lifted and I felt like a new person. Over the next several years, I had a few more episodes of depression, plus some anxiety issues, but nothing as severe or long-lasting as the first episode, so I figured I should just keep taking the sertraline because it was probably keeping me from more serious depression. 

 

When I got pregnant at age 32, I lowered my dose to 100 mg and felt OK. At some point over the next few years, I started seriously questioning the wisdom of being on psychiatric medication for so long. I also had the vague sense that the medication was somehow preventing me from being fully human, in the truest sense if the word; it was as if it placed an invisible wall between me and others, as well as between me and my true self. So I decided to lower my dose and see what would happen. 

 

I went down to 75 mg a little over two years ago, in early 2016, when I was 40. I didn't feel great at that point but I didn't feel the kind of depression I had felt in the past. I was suffering from a lot of abdominal pain and nausea and was feeling run down and moody, but I attributed those symptoms to the after effects of major abdominal surgery I had undergone after my appendix had ruptured in 2015. I was determined to move forward with my taper and so, a few months later, in August of 2016, I lowered my dose to 50 mg. 

 

In January of 2017, although I was still feeling sick and moody, I asked my primary doctor how to transition from the 50 mg of sertraline I was on to St. John's Wort. I knew nothing about protracted SSRI withdrawal; I just figured if I could get off the sertraline and have St. John's Wort protecting me from relapsing into major depression, I'd be fine. She told me to lower my dose to 25 mg, start the SJW and see how I felt after a month. I went down to 25 mg of sertraline, started the SJW and stayed on that combination for 8 months. During that period, my mood was not great and I felt both detached and intensely emotional much of the time, but I was still dealing with a lot of GI issues, including SIBO, and I really wasn't sure if my lowered mood was due to the drop in sertraline or the SIBO, which causes nutrient deficiencies that can lead to depression. I also had been taking sertraline at that point for 21 years and really wanted to be rid of it once and for all. 

 

So, in August of 2017, I stopped the sertraline altogether while continuing with the SJW. I immediately started experiencing horrible insomnia, frequent brain zaps and dramatic mood swings. I still knew nothing about SSRI withdrawal and assumed that, aside from the brain zaps, this was the natural state of my brain, which had returned in the absence of the sertraline. 

 

At that point, I read 'The Mood Cure,' by Julia Ross because my goal was to find a natural alternative to sertraline to 'normalize' my brain chemistry. I tried 5-htp, which helped with mood and insomnia (I also tried some other amino acids which had strange effects on me). I decided to stop the SJW and stick with the 5-htp, plus 400 mg/day of SAM-e. My abdominal pain and nausea got worse with the 5-htp, but I was able to sleep better at night and my mood was at least stable. That was, at least, until February, when I started to feel extremely depressed for a few days. Then, I woke up one morning in the midst of a panic attack, accompanied by intense depersonalization and derealization and an overwhelming feeling that I was about to die. I had never had a panic attack in my life but knew what it was based on others' descriptions. 

 

I stopped the 5-htp and some other supplements immediately, thinking that one of them had triggered the episode. An almost constant feeling of panic stayed with me for about a week and then slowly started to fade. Once the panic and depersonalization subsided, I was left feeling extremely depressed again. Scared of taking more amino acids, I went back on the SJW, which started working again after a couple of weeks. 

 

Around this time, I discovered SA. It opened my eyes to the fact that everything I had been experiencing was part of a protracted withdrawal from the sertraline and not my 'true, depressed brain' reemerging after the sertraline was taken away. The panic attacks really drove that point home since I had never experienced anything like that before the sertraline.

 

From February until a couple of weeks ago, I was feeling stable on the SJW and SAM-e and really felt I was on the road to recovery. Then, I began to feel 'off' again - depersonalization with a lost sense of self - and I started to worry that taking the SJW and SAM-e might be interfering with my brain's ability to heal properly. I (foolishly) abruptly stopped both and became severely depressed again. I felt I couldn't go on in that state, primarily because I have young children and I can't really be decent mother while in the depths of depression. So, I got back on the SJW and SAM-e a few days ago and I feel all right again (when I say 'all right' I mean I still don't feel quite like myself and I'm still experiencing a variety of symptoms, but at least I'm not severely depressed at the moment). 

 

My fear is that by taking the SJW and SAM-e, I am preventing my brain from really returning to normal. I know that the general recommendation around here is to stay away from supplements that act on neurotransmitters during withdrawal. Even if I found that I only needed one of the supplements to prevent depression, I wonder if it would still interfere with recovery. Interestingly, on Kelly Brogan's website, she says she uses St. John's Wort, as well as 5-htp and tryptophan, when patients are tapering. I don't know if she thinks they're a good idea during recovery, though. I guess I'm wondering if anyone knows anyone who recovered from SSRI withdrawal while taking St. John's Wort or SAM-e or another supplement that helps increase serotonin levels in the brain? My hope is that one day I won't need any of those supplements but it seems as though, at the moment, I can't really function without them. Any thoughts or suggestions would be greatly appreciated.

[SkyBlue]

Hello, and welcome to SA.

 

I'm glad you've been reading around the site. Yes, you are definitely in withdrawal from stopping Zoloft in August 2017. I'm sorry that you're in protracted withdrawal, but I'm glad that you've identified the problem, and that you know your situation is most certainly not due to your "underlying brain chemistry." 

 

What's important now is for you to stabilize. Many people find that supplements can be activating and actually make things worse (even the kinds recommended by people like Julia Ross and Kelly Brogan). 

 

Because you had problems with stopping the supplements abruptly, it seems that it would be best to taper off of them, similar to the way we have people taper off SSRis for the least disruption to the nervous system.

Are they in a taper-friendly form? Are they tablets, or capsules? 

I'm not super well-versed in tapering supplements, but within the community, we'll figure something out. 

 

Can you please summarize their medication history in a signature -- you have probably seen thse around the site, below people's posts: a list of drugs (and in your case, supplements), doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Account Settings – Create or Edit a signature

 

A few more links: What is Withdrawal Syndrome?

A helpful way to track symptoms: Glenmullen’s withdrawal symptom list.

 

Again, welcome. 

[SkyBlue]

Hi again, 

 

Yes, there is a thread on St. John's wort, http://survivingantidepressants.org/topic/652-st-johns-wort-hypericum-perforatum/

 

and Altostrata said: 

 

"St. John's Wort is a noradrenergic, which is why it causes "mania" -- like SNRIs. Generally, people with withdrawal syndrome do poorly with anything that is stimulating. If you have withdrawal anxiety or insomnia, it may make those symptoms worse."

 

And here is a topic on tapering SJW; see Alto's post (third on the page):

http://survivingantidepressants.org/topic/5864-tapering-st-johns-wort/

[Ali75]

Hi,

 

Thank you for the information. I'm sorry I didn't respond sooner - there's a lot going on in my life and I didn't feel ready to deal with this.

 

I sort of tapered off the SJW. For awhile I wasn't taking any and felt OK. Then, another wave hit and I began taking 1 capsule/day (I had been taking 3). Now I'm sort of taking it sporadically. I think of it as sort if a safety net when I feel desperate. I don't know if it's doing any harm, but I don't feel any negative side effects. Ideally, I'd like to stop it altogether but I get very scared, mainly because I have young children and feel I can't completely fall apart.

 

I would like to stop the SAM-e altogether. I haven't been able to find any information on the best way to taper SAM-e, but I did read that it has to be tapered. I bought 200 mg pills, since 100 mg ones don't seem to be available anymore (and they are enteric coated and can't be cut). I was thinking of starting out by alternating the 400 mg and 200 mg pills for a week, then trying 200 mg every day for a couple weeks, then every other day for awhile, then stopping completely. Does that sound like a good way to do it?

 

I actually forgot to take the SAM-e this morning and by noon was feeling withdrawal symptoms, mainly very intense depression and nausea. This is why I have been so scared to try to taper off of it. Any advice you can offer would be greatly appreciated.

 

Thank you again.

[SkyBlue]

No, we don't recommend alternating doses because it can be very destabilizing. 

It would be best to taper more slowly. 

[Ali75]

How would I do that without 100 mg tablets? Should I just try taking 200 mg and see what happens?

[brassmonkey]

Both SAMe and SJW are effectively SSRIs.  They work in the same manner, affect the same parts of the body/brain and need to be managed in the same manner.  Both of them tend to reach tolerance very quickly in a manner of a few months, but still require a long slow taper to get off of. SJW can be tapered a bit faster, but SAMe requires the same 10% every four weeks taper as other SSRIs.  There supplements may be "all natural" and sold OTC but they are every bit as nasty as the prescription versions.

[Ali75]

Thanks for your reply.

 

It seems that SAM-e isn't quite the same thing as an SSRI. From what I understand, it's a chemical that we all have in our bodies already, but in depressed people, levels have been found to be low.

 

Having said that, I agree that during antidepressant withdrawal, these supplements probably get in the way of the brain returning to normal, and I definitely want to stop taking them. I just don't know how to taper SAM-e when the pills only come in 400 mg and 200 mg and can't be cut. Any advice?

[Altostrata]

Hi, Ali. It's a myth that "depressed people" lack SAM-e or any variety of serotonin.

 

For tapering tips, see SAM-e (S-adenosyl-L-methionine) - Symptoms and self-care ...

 

Also, with Google, search "site:survivingantidepressants.org SAM-e" and you'll see our discussions about SAM-e.

 

FYI New Jersey members, please check in here

[Ali75]

Thank you for the clarification, Altostrata. I wasn't sure if that was true about low SAM-e in depressed people or another chemical imbalance myth to explain depression.

 

Thank you for the links. I will check them out.

[Ali75]

I just wanted to give an update re the SAM-e situation. One company makes a liquid SAM-e, so I bought some and have been tapering it by about 10% every month. The taper has been going OK - I’m in the middle of a bad wave right now but I generally haven’t noticed any major dip in mood with each reduction of the SAM-e. I would have had no way of knowing that SAM-e had to be tapered like an SSRI, so THANK YOU, brassmonkey, for the information!

[Altostrata]

Thanks, Ali. Please add this information to SAM-e (S-adenosyl-L-methionine)

[Ali75]

17 hours ago, Altostrata said:

Thanks, Ali. Please add this information to SAM-e (S-adenosyl-L-methionine)

Sure, I just added it.

[Vasherr]

Hi, @Ali75,

 

long time has passed since Your last update, how are You doing?

 

Wishing You a lifelong window!

[Ali75]

Hi @Vasherr, 

I’m doing somewhat better than I was when this started but I’m not doing great. I felt I was making progress for awhile and then I got covid in August 2021. After that, I took a turn for the worse and felt awful for months. It was back to constant brain fog, depression, anhedonia, dramatic mood swings, lost sense of self, etc. I started to feel better by around June and was doing decently for a couple months, but by September I was feeling pretty consistently bad again, with a few windows here and there. I believe I’m at the beginning of perimenopause, which, like long covid, would be another thing compounding my withdrawal symptoms. When I started the withdrawal, I read success stories by people who had taken sertraline for many years, like I had, and had recovered in four or five years. It has been more than five years now and I feel far from normal. It’s very discouraging and makes me wonder if I’ll ever really recover. I wish I had better news to report, but unfortunately I’m still struggling a lot.

 

Thank you for checking in and for your well wishes. Wishing you a complete recovery soon!

 

Edited October 2, 2022 by ChessieCat
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[Vasherr]

Hi, @Ali75,

 

yeah, covid can complicate things, i know.

I've gotten covid at the beggining of this year and like a magic wand it made me hypersensitised and unable to tolerate my venlafaxine dose, I have found studies that say that covid is sensitising CNS and also messing up neurotransmitter levels, so it is no surprise that it can make us miserable.

 

Healthy people can experience it as a whole range of mental symptoms and sadly we are even more prone to reacting to something like that.

 

I still am in a wave, was making progress but I have gotten sick again, praying to all heavens that it is not covid, and that I am not bound to experience hell again, but we'll see, last time agressively cutting my dose was the answer so if it happens I at least have something that I can try to alleviate the suffering.

 

If it won't happen I think that I am ready to try reducing a bit, as keeping the dose stable made me feel worse in the long run.

 

I hope that we both can get some relief soon, and that all this suffering will at last get recognised by medical community.

 

Wishing You a lifelong window!

V.