How long roughly do withdrawal symptoms last?

[Mermaid16]

I am currently tapering off Sertraline, a quarter of a tablet at a time. This was fine when I was on the higher doses, but going from 25 to 12.5mg sees the withdrawal symptoms hanging around a bit longer. Main symptoms are exhaustion, high anxiety, nausea and 4 different moods an hour. I can go from anxious to ready to cry, to irritated. I don't know if I should bite the bullet and just stop taking it or wait until I have stabalised and then drop again, that way I don't have to go through it all again. I guess, I will wait and see how it goes. I'm on other anti depressants as well, so I guess the withdrawal isn't as bad as it usually would be, just more uncomfortable, especially when I'm at work and all I want to do is sleep, but instead I'm stuck staring at a computer screen. Just needed a vent.

[panic_down_under]

How long roughly do withdrawal symptoms last?

Unfortunately, this is one of those 'how long is a piece of string' questions that have no definite answer. Many have hardly any withdrawal symptoms, a few have extended withdrawal that can go on for months (although it can be difficult working out which symptoms are withdrawal and which anxiety), and everyone else will be somewhere between the extremes.


I don't know if I should bite the bullet and just stop taking it or wait until I have stabalised and then drop again

I'd stay on 12.5mg for at least a week before quitting.


I'm on other anti depressants as well, so I guess the withdrawal isn't as bad as it usually would be

Nortriptyline could be making a contribution to easing some withdrawal symptoms, but as it has little if any direct impact on serotonin pathways, not all of them. How much nortriptyline are you currently taking?

[Mermaid16]

Nortriptyline could be making a contribution to easing some withdrawal symptoms, but as it has little if any direct impact on serotonin pathways, not all of them. How much nortriptyline are you currently taking?

I take 100mg of Nortriptyline. Which I think I need to increase as it isn't doing much for my anxiety. I also take 22.5mg of Mirtazapine. I take 2mg of Clonazepam which I think I am tolerant to and 2.5mg Olanzapine. I was thinking of waiting until I'm off the Sertraline to increase the Nort. What are your thoughts? Thank you for your reply PDU. Tracy

[panic_down_under]

I was thinking of waiting until I'm off the Sertraline to increase the Nort. What are your thoughts?

Yeah, it's not a good idea to make two med changes at the same time as it can then become difficult to know which is causing any problems that may arise. I think a blood test to determine nortriptyline plasma levels before raising its dose would also be a good idea to check whether you're a fast/typical/slow metaboliser and get a guide to how much you may need to take.

And once you're stabilized on an effective dose weaning off the clonazepam should be next as there is good evidence benzodiazepines inhibit antidepressant effectiveness.

[Mermaid16]

I think a blood test to determine nortriptyline plasma levels before raising its dose would also be a good idea to check whether you're a fast/typical/slow metaboliser and get a guide to how much you may need to take.

Thanks PDU. I have had two blood tests for the Nort level, the first was 62% and the second one was 78%. The Psych is on holidays for a month, but said I can go up to 150mg of Nort. I was only on 100mg when my level was 78%, so I think I could safely go up if I wanted to, to 125mg. What are your thoughts? Thanks in advance

[panic_down_under]

I have had two blood tests for the Nort level, the first was 62% and the second one was 78%. The Psych is on holidays for a month, but said I can go up to 150mg of Nort. I was only on 100mg when my level was 78%, so I think I could safely go up if I wanted to, to 125mg.

I think the figures may be nanograms per millilitre (ng/mL). If so it suggests you metabolise the med faster than most as 78ng/mL is still at the low end of the 50-150ng/mL therapeutic range even at 100mg. There should be no safety issues with increasing to 125mg, or the recommended maximum 150mg, perhaps more, for that matter.

[Mermaid16]

PDU could you please tell me what is the difference between Clomipramine and Nortriptyline? Is there any reason why the Nort wouldn't be working? Thank you, Tracy

[panic_down_under]

what is the difference between Clomipramine and Nortriptyline?

Clomipramine is both a serotonin and noradrenaline, aka norepinephrine, reuptake inhibitor, nortriptyline only slows noradrenaline reuptake.


Is there any reason why the Nort wouldn't be working?

Your blood levels seem low given the dose so you may just need the take the recommended maximum 150mg to get a response, perhaps even a little more, Tracy. I have no inappropriate anxiety on the maximum plus dose of the TCA I take, but at only 25mg less it begins to resurface.

However, it could also be that nortriptyline simply isn't the right med for you. But the only way to really know is by maxing out the dose.