☼ Ajay -- Zoloft withdrawal

[summer]

Ajay... I reinstated when I was off for about three months. I was lucky I suppose... it did work for me.

 

I should add that I started another AD because I was depressed. I didn't realize it was WD. If I had realized that at the time, I wouldn't have reinstated.

[Nadia]

Hi Ajay,

 

I've just joined so am only recently reading your posts. I wanted to say I relate to a lot of what you are going through (I wrote a looong intro which is not anywhere near as clear as your intro post... I'm feeling particularly off today). I was on a higher dose of Zoloft (normally 100mg, 50mg for the last few years) and Wellbutrin XL (originally 300mg, lowered to 150mg) for most of the past 16 years (I had a few years of Celexa in there as well, so that's not being very exact... but basically Zoloft was/is my drug of choice). I have now been off of it for 8 months and am struggling with anxiety and sleep issues as well (and depression, of course). I recently have other even weirder issues, which are probably just related to the anxiety (like sensations being too strong and sticking with me for a long time, particularly smells, and feeling like I am losing my sense of self and like nothing is enjoyable ever).

 

At first I combated the waking up a million times a night and not being able to sleep in with melatonin and occasionally with valerian and xanax or clonazepam. Then a couple of days ago I decided that I was going to stop all supplements (except fish oils, a multivitamin, zinc, and chromium) and drugs (I was taking St. John's Wort, but suspect it was making me more anxious)... this in an attempt at leaving my poor brain alone to (hopefully) figure things out on its own. I'm not the patient type, though, and am used to being a very high-functioning individual. I used to pride myself in working 12 hours straight no problem. It is really difficult to deal with what I feel is a diminished self.

 

In any case, my boyfriend asked me if I had ever heard of EFT (Emotional Freedom Techniques)... he had talked to his brother, who said it had helped him through a period of anxiety and insomnia. He downloaded a PDF from the internet on it. It seems like total BS to someone like me (analytical, logical, skeptical), but I'm desperate so I tried it yesterday. I tried it with my anxiety and it worked, and then at night I tried it for sleep, and in the morning to be able to fall back asleep. I was able to sleep through about 6 hours, and then I was able to fall asleep in the morning for about another hour and a half!! And I felt calm and good! (Then I was awful again after noon, but I think it's because I tried to sleep EVEN MORE instead of getting to work... the downside of working at home.) So I offer it up as a possibility. It says it works even if you don't believe in it. All I can think is that it maybe it works because of a placebo effect, or distraction, or by releasing endorphins, or for the same reasons as acupuncture. And there seems to be some relation to cognitive therapy in that you repeat an affirmation. I'm about to try it again and hoping for another pretty good night's sleep. It's true that not getting enough rest makes everything so much worse... it's a horrible spiral.

 

Good luck... I too am thinking of throwing in the towel and going back on Zoloft, but after everything I've read lately, I think it would be a mistake. I never had full-blown anxiety like this before meds, and am pretty sure it's related to years of antidepressant use. I hope we all can hang in there somehow. Sometimes I feel like I can't take another minute of this, but maybe freedom is around the corner if we just stick it out.

[ajay]

Hi Nadia!

 

I have heard about EFT, and I've tried it before. I think some of it has to do with acupressure points.

It hasn't been as successful for me lately. I think part of the trick is choosing your phrases well.

 

Right now, I'm a mess. I woke up at 12:30 am. Desparate for more sleep, I tried some phosphatidyl serine, because I thought it was supposed to reduce cortisol. Well, maybe not so much - I haven't been able to get back to sleep at *all*. At 2:30, I had some almonds and hummus and tried to go back to bed. No luck. I'm exhausted and I have no idea how I will function at work today.

[ajay]

Okay, this morning I officially gave up.

 

I found an old prescription of zoloft. I cut a 25mg tablet into quarters (not precise) and I took one of the quarters (approx 6.25 mg).

 

In the TMI department, I'm at about day 15 of my menstrual cycle, and that seems to be a bad time for me.

 

This may be a huge mistake. My intention is to try to stabilize bit, maybe back on 25mg, and then taper down again, but slowly this time. I took a quarter tablet in hopes that if I react badly, that would be a small enough amount that I could manage whatever goes wrong. I'm not happy about this at all, I just can't handle the withdrawal symptoms and I'm hoping I can start over. To be honest, I took the dose about half an hour ago and I'm already starting to regret it...

 

In any case, I'll let you know how it goes.

[lupe]

I hope it is ok that you took the Zoloft and you start feeling better. I understand the desperation to feel better.

[Altostrata]

I hope so too, Ajay. Let us know how it works.

 

lupe and Ajay, would really appreciate a new topic and discussion of EFT in the Symptoms and What Helps section. It sounds like something others might find helpful.

[Nadia]

Oh, Ajay, I know just how you feel. About three weeks ago I said "I give up" but I went further... I took 50mg of Zoloft and 150mg of Wellbutrin! (I know, stupid, stupid to not taper up even). Well, my anxiety got MUCH worse that night (which is normal, I always feel shaky and tense when starting on the meds), and I immediately felt guilt and regret. I almost felt I was punishing myself for not getting better on my own. I felt so bad that I didn't take anything the next day and have not taken anything since (except for St. John's Wort, which I discontinued about three days ago). What got me to stop was thinking if I went back on them I couldn't get pregnant and I was still thinking I might want to.

 

It's so hard when you have to function at work. I have three jobs right now (freelance jobs, not job jobs) that I'm really behind on... I've been making all sorts of excuses, and the pressure is growing. I'm so afraid they'll realize I am suffering crippling anxiety and can't work. Sometime I think I just need to take more meds to get through those jobs so I can finish them and then live off my meager savings and ask for support from my parents to take time off work and then taper very slowly. But I've resisted so far.

 

Whatever you decide, let us know how you are doing!

[summer]

Okay, this morning I officially gave up.

 

I found an old prescription of zoloft. I cut a 25mg tablet into quarters (not precise) and I took one of the quarters (approx 6.25 mg).

 

In the TMI department, I'm at about day 15 of my menstrual cycle, and that seems to be a bad time for me.

 

This may be a huge mistake. My intention is to try to stabilize bit, maybe back on 25mg, and then taper down again, but slowly this time. I took a quarter tablet in hopes that if I react badly, that would be a small enough amount that I could manage whatever goes wrong. I'm not happy about this at all, I just can't handle the withdrawal symptoms and I'm hoping I can start over. To be honest, I took the dose about half an hour ago and I'm already starting to regret it...

 

In any case, I'll let you know how it goes.

 

Ajay... just FYI - if you decide not to take it... just stop. One-quarter of a 25mg tablet isn't very much. I'm also wondering if it will do anything at all... it's a small amount.

 

Many of us have gone back up, stabilized, and then began a slow taper. I'm one of those people. That said... the AD merry-go-round is one I want off of. I had about a week of wondering if I should go back to 15mg b/c I felt awful. I can only tell you that I'm so glad I waited it out. It also gives me more confidence that I can taper further (fingers/toes/eyes crossed). My desire to get off this crap seems to offset those days when I feel terrible... so far.

 

I wish you the best, Ajay, with whatever you decide to do.

[Altostrata]

ajay and nadia -- if you can, just show up and do the work. If you manage to present a calm facade, they don't know you're doing it with only a fraction of your intellect. This is what my therapist told me when I was in the throes of withdrawal, and it proved to be true.

 

Otherwise, you just have to give yourself a break, take time off, and recover.

[Nadia]

That is so true... on Saturday I had a work meeting and I managed to somehow disguise what I was feeling... even though I was feeling like I was going to die right in front of my client, he noticed nothing! At one point when it got really bad I just excused myself to go to the bathroom and then just continued. As for the actual WORK... we'll see how that goes over. I am such a perfectionist that even if I do a half-assed job it might just be all right. And if not... well, I have to face the fact that maybe I'll be asked to redo something. I guess I'm worried about my reputation being ruined, but it would probably take a lot for that to happen. I hope anyway... if not, I guess it wouldn't be the end of the world. There a lot of burnout in my field and people are used to it.

[Altostrata]

Proves we expect far more from ourselves than others expect of us!! Most of us can just relax and accept ourselves.

[ajay]

Unfortunately, I've had problems with a few projects at work for awhile now and I'm having a hard time working through them. So the disappointment I feel from others is definitely not helping my state of mind. Yet I don't feel strong enough to find something new yet.

 

When I read articles I don't quite understand, I get this combination feeling of anxiety, frustration, and shut-down. I just want my brain back! Right now I'm having troubles with concepts that really aren't that challenging.

 

But I'm trying to plod on through it anyway.

[Altostrata]

Difficulty concentrating is a common withdrawal symptom. Do your best. It does get better.

[Nadia]

I have to say the work issue is the main thing tempting me to go back as well and I really empathize. I've found that I'm useless for work in the morning, and even simple tasks like addition and subtraction can be a challenge. But sometimes what is affecting me more is the anxiety about feeling fuzzy-headed, rather than an inability of thought per se. Like I give up easier, panicking that I'm not going to be able to do anything, or because I have a headache because everything seems so complicated. Then later I realize my thinking is not sooo far off. That underneath the fuzziness and fear my brain is really still there. Hmm... yes, like intelligence is still there, but not concentration.

 

I find I can work from 6 to 9 pm OK. Are you able to change your work schedule at all? Are you also better or worse depending on the time of day?

[ajay]

Good questions, Nadia.

 

I do seem to manage a bit better in the afternoon, Maybe from about 4-6. The past few days I've been able to get a little work done.

 

My plan is to continue the small dose of Zoloft for at least two weeks to see if it makes any difference in restoring sleep or reducing the anxiety. It has only been a few days, so I can't really evaluate it yet.

 

I had my first meditation class this week. Because I couldn't sleep past 1 am this morning, I tried meditating on my own with the CD from class. Part of my brain absolutely would not let go and relax. I didn't have that problem in class. On the upside, I was actually aware of the full scan for the first time, since in class I seem to drift off.

 

I'm trying to just "be" and not get so frustrated about the lack of sleep, since the frustration makes it worse. It makes an incredible difference when I can get some rest, though, so it's hard not to get frustrated. I honestly think I could handle most of the other stuff in my head if I could consistently get 6 hours of sleep a night...

[ajay]

...It occurs to me that going back on the Zoloft may exacerbate the insomnia, not improve it. I guess I was forgetting that the game is different now. That's one thing about the posts and papers about alternatives to antidepressants - they're all working with normal depression, not w/d.

[Nadia]

Ajay... please don't answer if you're not comfortable with my question, but I was wondering how the tiny bit of Zoloft you took affected you?

[ajay]

Nadia, please ask me questions! It makes me feel helpful.

 

So far, I would guess that it is making it even more difficult to sleep. I had a similar problem with the Nuvoxil supplement I took - it was energizing, which kind of helped the depression, but boosted the anxiety and made it hard to sleep. The other thing I have noticed is that the funny "brain sunburn" feeling is back.

 

I've decided that unless things get intolerable, I will stick with my two week plan.

 

I know everyone responds differently to things, *especially* in withdrawal, but frankly, I'm still not sure trying the zoloft again is a good idea. I do think lack of sleep makes things worse. I was desperate for some relief and I would guess that you are, too.

 

I was hoping that the mechanisms which kept my cortisol levels in check (before I went off the zoloft) would be restored somewhat. This was probably naive.

 

I will be happy to keep you updated.

[Altostrata]

Sorry, folks, it seems once withdrawal symptoms take hold, our systems become sensitized and antidepressants are too stimulating. This is why reinstatement doesn't always work.

[ajay]

yeah, I can't say you didn't warn me.

[Nadia]

OK, that is good to know. When I tried to go off meds in 2008 I also got to the anxiety phase about three months in. I chickened out almost immediately, I was too afraid of messing up at work. I remember I had to continue to take clonazepam while reinstating because the Zoloft/Wellbutrin I started taking again amped me up. I think I kept on taking all three until finally the anxiety subsided and I went back to what felt like normal. God knows what further damage I did by doing that (2 more years of meds), or how much of the severity of symptoms I'm experiencing now is a result of that. And now that I think of it, it's pretty amazing how persistently I stuck with the side effects of taking the meds again, whereas now I feel like I have no patience. I guess it is just the lure of the promised land around the corner. I have to think positive that way about staying OFF the meds!

 

The reason I originally asked is because I read the intro to Dr. Glenmullen's "The Antidepressant Solution", and he says that one way to distinguish between withdrawal and relapse is if you feel immediately better when you take the meds again, that means it was withdrawal. I think that for people who are going what we are going through, months later, though, that is not right. Maybe if we had JUST stopped taking them and we were talking about those initial brain zaps, wanting to cry, etc. we would get immediate relief from taking the meds again, but we are dealing with a further stage, where like Alto pointed out in a different post, we have gone through the initial brain readaptations and now have some other brain/body readjustments going on. My doctor thought that what I was going through couldn't be withdrawal since so many months had passed, but what convinced me that something fishy was going on is that I NEVER had ANYTHING like this before I ever took meds. If it makes any sense, the depression and pain I dealt with back then were much more "benign". A lot of what I have felt these past few months seemed familiar at first, but what I went through last night in particular (those crazy waves of body on fire with anxiety things and fear) has me convinced this is in no way an "original condition" expressing itself. I still wonder if reinstating and then tapering would help... but Alto seems to think it wouldn't at this point. I was thinking of writing to Dr. Glenmullen to share my experience, because I think although his book is helpful, it can be misleading.

[Altostrata]

Right, Glenmullen is talking about fairly quick reinstatement, while withdrawal is in the acute stage.

 

Usually, if a person has had withdrawal symptoms for many months -- post-acute withdrawal syndrome -- additional antidepressants of any type don't work, they are too stimulating.

 

Nadia, the results of reinstatement get more unpredictable the further away you are from the last dose of the antidepressant. It may work for you, it may not.

 

It's up to you -- you pays your money and you takes your choice.

[ajay]

Nadia, in the spring of 2010 I went off the zoloft for about 2 months. I got an anxiety attack and went back on the zoloft and it seemed to help then. *But* I hadn't gotten to the insomnia stage yet. I think by the time we get that far, it's a whole 'nuther ball game. I've noticed that most of the papers that discuss withdrawal talk about the early phase stuff and don't seem to track the patients for over a month. I also get the sense that they imply any problems with discontinuation mean that the patient isn't ready to come off the meds. Frustrating. The psychopharmacologist I went to said it was highly unlikely that I was experiencing withdrawal because I went off the drug so long ago and was taking such a small amount when I stopped. She also said she takes people off drugs all the time without problems. I didn't ask if she had any patients who'd been on ADs for 15 years... I probably should have.

 

I would say the anxiety and fear I'm experiencing now are close to the worst of what I've ever felt. And some of it is totally new to me, like moments of claustrophobia. So I agree that it doesn't seem like a 'relapse.'

[Altostrata]

ajay, that's exactly it. The papers on withdrawal generally are talking only about the acute withdrawal phase, they don't follow patients later.

 

I've also found it a very weird illogical mindset that they attribute severity of withdrawal to an "unremitted" mood disorder, but that's psychiatry for you. (See Anosognosia and the NYTimes series on it.)

 

It's entirely possible that the majority experiences only a few weeks of withdrawal symptoms, and more severe and prolonged withdrawal is reserved for a relative few. I ballpark it like this: 75% resolve in a few weeks, 15% resolve in a few months, and 10% develop prolonged withdrawal syndrome.

 

That's just a guess. It could be that that, like so much negative information about SSRIs, evidence of prolonged withdrawal syndrome has been suppressed. I have some evidence that this is so -- see 2006 From Dr. Richard Shelton about prolonged withdrawal syndrome.

 

At the same time Dr. Shelton wrote this letter to me, he published 2006 The nature of the discontinuation syndrome associated with antidepressant drugs, in which he asserted withdrawal symptoms last only a couple of weeks and any symptoms after that are due to "something else" -- one of your more interesting medical terms.

 

That paper was sponsored by Wyeth, manufacturer of Effexor, one of the worst drugs for withdrawal syndrome.

 

There's more evidence for a cover-up of prolonged withdrawal syndrome as well. I'll be posting more when I get time. In the meantime, Researchers seek prolonged antidepressant withdrawal cases.

 

Through this and other avenues, prolonged withdrawal syndrome is about to become part of the debate about whether antidepressants might do more harm than good.

[Nadia]

So many studies are sponsored by drug companies, it's crazy! My niece has ulcerative colitis (an autoimmune disease that affects the gut, related to Crohn's disease), and it is the same deal. I found a diet called the Specific Carbohydrate Diet, and she has been on it since she was 4 years old with very good results. However, her gastroenterologist doesn't believe her problem has anything to do with diet, and has had her on a chemo drug they also use for leukemia for over 4 years... even though most of her other patients, who are not on the special diet, have had relapses and she has not. The doctor will not even READ the Specific Carbohydrate Book. She says that there are not studies that prove that diet has anything to do with it. Of course they aren't! All the studies, support groups, etc. for those diseases are sponsored by drug companies! And unfortunately my sister is too scared not to follow the doctor's orders.

 

I also have a pharmacist friend who once told me, when I was getting off Celexa, that the formula for Celexa was developed and thrown out by the makers of Zoloft (if I remember correctly) because they were getting some nasty test results. But instead of discarding it, they sold it to Lundbeck, who marketed it. I don't know if it's true, but what certainly is obvious is that so many of the new drugs that come out each year are only there because patents run out and drug companies want to be able to charge more for new meds since their old ones can be made by generics.

 

Certainly the length of time on the drug has to be a factor. It seems like all of us are having issues either because we have been on medication for so long, or because we have had "atypcial" reactions (which of course may not be so atypical after all) to a drug even from being on it for a short time. I'm just hoping my brain takes less time to heal than it did to adapt to the drugs. Much less! I hope that for all of us with all my heart.

[Nadia]

Hey Ajay,

 

How are you doing? I hope you're hanging in there. Just a note to tell you you're in my thoughts.

[ajay]

Thank you Nadia! Your message almost made me cry.

 

I am hanging in there, but I'm in a rough patch. As with other stimulants, the sertraline keeps me from sleeping. The anxiety is awful. The diarrhea never really left, but it's worse since I started taking the tiny dose of sertraline, and I feel sick and nauseous. Of course, I've also only been getting 3-4 hours of sleep so that could be a factor as well. Even though it has only been 6 days now, and I'm taking very little, I think I'll be spending some time in the tapering forum next.

 

For the record: I wanted to try the sertraline for two weeks to see what would happen. I guess I've been reading a bit too much. As I recall, I was thinking:

 

 

• sertraline has secondary effects besides the SRI mechanism. Some of these seem to help neuroplasticity (though as discussed elsewhere, there may be some issues with the neurons that are created).
• These secondary effects might also play a role in what's affecting the HPA axis (un)balance. And these effects wouldn't be stimulated by the various seratonin boosters like tryptophan and 5HTP.
• Trying it for two weeks might be long enough to get a sense of whether reinstatement would work. My thought was that it had to be enough time for the secondary effects to start, which is perhaps more realistically 4 weeks or so.
• I was miserable and desperate to try something that would help me feel better.

 

 

Yeah, it's a dumb idea to be a guinea pig in your own experiment. I know myself well enough that my current dilemma is: Do I wait it out, so I know for sure that it's not gonna work and I don't try this again in 6 months thinking "maybe if I had just waited a bit longer..."?

 

It does help me a little with the crushing depression aspect. But I'm so physically exhausted that I'm not sure how much that matters. I feel like I'm moving and thinking through gelatin. Again, I know everyone is different, but I would *not* recommend the path I have taken.

 

I wish I worked with more people. I seem to do better when I'm distracted and scheduled, and I'm having a hard time getting enough self discipline to schedule myself.

 

I tried benedryl last night. It didn't work.

[ajay]

So I was looking for more specifics on the secondary effect of sertraline and I found this very cool link:

 

http://www.functionalneurogenesis.com/blog/

 

specifically,

 

http://www.functionalneurogenesis.com/blog/2011/07/in-press-the-neurogenesis-depression-hypothesis-confirmed/

 

side note: Keep walking. Exercise helps neurogenesis!

[Nadia]

Oh, Ajay, I'm sorry to hear you are having a rough time. At least know you are not alone!

 

That is a very interesting link. What part of the abstract says on that latest post is so close to what is happening to me, I feel a lot of empathy with these mice!:

 

"Relative to controls, neurogenesis-deficient mice showed increased food avoidance in a novel environment after acute stress, increased behavioural despair in the forced swim test, and decreased sucrose preference, a measure of anhedonia."

 

I get hungry, but I have to force myself to eat and derive no pleasure from it, and I don't have any cravings for sugar. I'm normally a huge fan of dessert. I despair easily with difficult (and even really not so difficult) tasks. So maybe we are neurogenesis-deficient for a while after quitting SSRIs? Maybe more notably so if during our time taking SSRIs neurogenesis was stimulated by the drugs?

 

Believe me, I understand your attempt at reinstatement. I still toy with the idea, even now... things like, "what if I can go back on the meds and reach stability, and just stay on them until they stop working? Or start tapering?" What I am going through is so hard-core and seemingly unbearable, I constantly go back and forth between suicide and reinstatement as possible solutions. And if you read that antidepressants help neurogenesis, your experiment seems a fair one.

 

I don't know about the sticking it out or not... I had the same sort of dilemma with what that ayurvedic doctor gave me... valerian and some drops of god knows what "to open my heart". I feel like I'm SO much worse after that, but I don't know if it's related or not. So I quit on a knee-jerk reaction, and seem to go wildly from option to option (for example, I keep switching where and in what position I [don't] sleep). My mom told me this morning I need to be more patient and just stick with one thing. That is so hard when you feel like you have your hand on a hot stove and you're looking desperately for something to soothe the pain. The added complication for us humans is that we can think ourselves sick, so maybe you're right that if you quit now, you'll always have that curiosity about what would have happened. But here's a further question: let's say reinstatement does work, and you stabilize. Do you plan on sticking to that dose? For how long? To then taper slowly and hope for the best? I do kick myself often about not tapering, but I also remember back to 2008 when I did a fair taper and still had anxiety after a few months.

 

These questions drive me crazy. I have decided for now to stick it out and not reinstate, but believe me, I revisit the question several times a day. Especially because what a return to "normal, no meds" would be at this point for me is a complete unknown. I spend a lot of time thinking about what I was like before I ever took meds, and if I was content enough to want to live. But that was 16 years ago... so much of my adult life is me on meds, I think I would be a totally different person. Though then I think of the things that have persisted even through taking antidepressants.

 

There is so much literature out there that says being depressed puts you at a higher risk for stress and such, that SSRIs can protect you from that. So what I'm thinking now is that if this is a matter of neurogenesis, of having our hippocampi and amygdalas regain functioning INSTEAD of through medication, through other means, then we have to exercise our brains and bodies. Meditation, walking, maybe even those brain exercises like the Lumosity ones (better some free version of them)? And I think a lot about what people here have said about working out that empathy/happiness muscle. I tried today, sitting in the sun and looking at flowers and petting the cat. And yesterday I tried laughing though mostly I was faking it.

 

I know what you mean about self-discipline and your work... I am working from home and feel very isolated. But at the same time, if I took on a job outside, I think I would get very stressed... and stress prevents neurogenesis... ARGH, it is like a Catch-22. I have the same sort of dilemma between following a strict routine (to reduce stress) and doing new, varied things (to stimulate regrowth).

 

I have to run but I am here.

[Altostrata]

Guys, please, some perspective.

 

Now that the neurotransmitter imbalance theory is falling into disrepute, there's been a surge of discovery about the supposed beneficial effect of antidepressants on neurogenesis. This is the new rationale for prescribing antidepressants.

 

However, many non-drug activities also contribute to neurogenesis, such as exercise, meditation, Sudoku, etc. How does drug-stimulated neurogenesis compare with these activities? Surprisingly, no one has looked into this.

 

As for the supposed ill effects of depression, sure, it's better for you not to be depressed, in many ways. For example, perhaps depressed people tend not to take care of themselves and listen to their bodies, and continue bad lifestyle choices.

 

On the other hand, treatment with psychiatric drugs, including antidepressants, incurs serious health risks such as diabetes, heart problems, osteoporosis, etc. They have been shown to shorten life spans.

 

Much of what we "know" about antidepressants is propaganda, including how terrible depression is for your health. Since the definition of "depression" is so vague in these studies, what they might ultimately show is that life is bad for your health.

 

Many of us live lives that are much too stressful and we need to slow down and take care of ourselves and our human relationships, not take drugs so we can handle the stress.

 

So, please, take all the pro-drug studies with a grain of salt. The entire body of literature is corrupt. The only studies that do not have an incentive to falsify results are the negative studies. That is the pathetic condition of psychiatric research and practice today.

[Nadia]

Whether or not antidepressants promote neurogenesis is for me at this juncture a moot point. Even if they do, there are just too many risks involved. My point was that it makes sense when you are feeling desperate to be better to be lured by these studies... just as we were lured into taking antidepressants in the first place to relieve our pain.

 

I totally agree that we should find better, healthier, safer sources of neurogenesis... nutrition, exercise, meditation, learning, "brain-training" exercises. The positive thing to glean from these studies is that the hippocampus is smaller in chronically depressed individuals, but that, contrary to what they once thought, neuronal regeneration IS possible in this area of the brain. Which means there is hope for us.

 

Ajay, check this out (if you haven't already): dbm.neuro.uni-jena.de/pdf-files/Luders-NI09.pdf

[Altostrata]

I question those "shrunken hippocampus" studies, too. What did they mean by "depressed"? Is it possible those people in the study were also very sedentary? How far from the mean were these "shrunken" organs? Was enough info gathered to determine a mean? Usually, this is the flaw in any research that comes up with a physiological correlate to depression. We really know very little about this stuff.

 

After all I've been through with adverse effects, my conclusion is the "cure" is worse than "depression" -- see the papers associated with this Robert Whitaker blog post http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria

 

Even if antidepressants cause neurogenesis, the nervous system pays in other ways. Neurogenesis is not the whole story.

Edited August 12, 2014 by Petu
fixed link

[ajay]

Great paper, Nadia! Of course, I only get the gist of it.

 

I'm a mess today. I'd decided that it's time to stop my sertraline reinstatement experiment. I figured it'd be smart to take smaller amounts of sertraline rather than just stop taking altogether. So here's how I over thought it:

 

Zoloft has a half life of about 26 hours (pretty close to 24)

so, after 6 days of taking about 6.25 mg, before taking anything, the amount of zoloft in my system is about (3 + 1.5 + .75 + .375 + 0.1875 + 0.09375) = 5.9 mg.

 

I figured I could taper down by taking crushing a half tablet (12.5mg) and making a 30mL suspension in water (about 0.416 mg/mL). If I then drank 10mL of the suspension, that would be about 4 mg of sertraline. Made sense, so that's what I tried.

 

Except I'm a jittery mess today. Even the acupuncture didn't calm me down.

 

So I re-thought it:

 

zoloft solubility in water is 3.8 mg/ml.

Assuming this solubility applies to the tablet form, then dissolving a half tablet (12.5 mg) in less than 50 mL would mean that the solution would contain the max solubility of approx 3.8 mg/mL of sertraline. So 10 mL = 38 mg. Er, not so good.

 

Edit: okay, I guess my brain really doesn't work anymore. 12.5mg in 30 mg water is less than 3.8 mg/mL, so my re-thinking is moot. never mind.

 

So maybe even though it's really approximate, I may be better off cutting pills with a razor blade...

 

Yeah, okay. I'm done. I'm sure I'll still be tempted by benzos (especially tonight, because I'm exhausted and I really need to get some sleep). Now my only issue is trying to figure out how to stop taking the sertraline. Even though it has only been a week and it's such a small amount, I don't dare just stop cold turkey.

[Altostrata]

Yep, that's overthinking. The solubility calculations from pharmacology really apply only in the lab with pure substances.

 

As Rhi has pointed out, you're creating a suspension. A Zoloft tablet contains lots of stuff besides Zoloft.

 

So, if you're using a 12.5mg half-tab, and want to take 6.25mg, the easiest way to calculate it is dissolve 12.5mg in 12.5mL water and take 6.25mL. You figure the active ingredient (Zoloft) is fairly evenly dispersed.

 

I found if I made solutions at dilutions other than 1mg:1mL, I had to keep notes to remind myself how much water to use and how much of the solution to take.

 

PS I've tried similar calculations with half-life; the thing is, it's *half-life*, meaning the original dose still has a ways to go before its out of your body. Plus, metabolization may not be entirely linear, which is why doctors allow 5 half-lives before they consider the drug cleared. If you take a drug with a half-life of 26 hours every day, in about 3-4 days, the curves showing metabolism will overlap, leading to what's called "steady state," considered to be a relatively consistent level of the drug in your bloodstream 24 hours a day.

[Nadia]

I question those "shrunken hippocampus" studies, too. What did they mean by "depressed"? Is it possible those people in the study were also very sedentary?

 

How far from the mean were these "shrunken" organs? Was enough info gathered to determine a mean? Usually, this is the flaw in any research that comes up with a physiological correlate to depression.

 

We really know very little about this stuff. After all I've been through with adverse effects, my conclusion is the "cure" is worse than "depression" -- see the papers associated with this Robert Whitaker blog post http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria.

 

Even if antidepressants cause neurogenesis, the nervous system pays in other ways. Neurogenesis is not the whole story.

 

True... but on the other hand, it makes sense that if you are depressed, you stay indoors, if you stay indoors, you are not active, if you are not active you get more depressed... etc. It would not surprise me that this would have an effect over time on the health and vitality of your hippocampus and other areas of the brain. It may be complete BS, but it fits with ideas of neuroplasticity, "use it or lose it", "neurons that fire together wire together", etc. There may be scientists out there who see this as a reason for defending antidepressant use, but for me it is the opposite. Like Norman Doidge said in that video that someone posted in the self-directed neuroplasticity thread, "the neuroplastic brain is a fragile brain" (or something like that)... this means that it is just as susceptible to positive and negative influences. In terms of depression, for me this means: don't give in to your depression. Work away from it... exercise your brain, your thought, your emotions, your happiness. It makes sense to me because I have always thought of how I go in and out of depression as "spiraling"... I can go on a negative spiral and end up in a really dark place, or a I can try to halt that and redirect and go on a positive spiral. This means work. Getting someone or something else to do your work (i.e. an antidepressant) is, in the end, not going to cut it. So maybe the hippocampal shrinking is not even real, but I still find it a valuable metaphor and inspiration to meditate and exercise my brain to try to improve its functioning.

[Nadia]

Ajay, I'm no good at math, but I bet the suspension could also affect you differently in that the Zoloft is diluted and will hit peak serum levels more quickly as it is more readily digested. I remember reading you process Zoloft (and other meds) differently if you take them with food or not as well. Supposedly it takes longer to have an effect but has a more stable, constant effect if taken with food. So maybe that could help?

 

As for the not sleeping, do you have a bathtub? I tried Alto's suggestion of an Epsom salts bath before bed yesterday, and was able to sleep a 5 hour stretch for the first time in days, even though I didn't have the recommended amount (5 cups! I only used 130 grams). It was amazing. I'm still exhausted, but so much calmer. Today I was able to find bulk magnesium sulfate and am going for it again. I'm not sure it will work twice in a row, but just the one night of partial sleep has done wonders for me!