Is this discontinuation syndrome?

[little scientist]

Hi all,

A brief history - on 150mg for around 18 months now, started sertraline itself about 22 months ago and went 50, 100, 150mg over the course of a couple of months I think.

Before christmas, my GP and I discussed reducing my dose in the new year, ie around about now. I have been feeling so good for the last 18 months despite stuff that life has thrown at me, including my Dad dying (it was anticipated and didn't come as a surprise), that I decided to take the leap and start the reduction.

Two weeks ago, I started the reduction by dropping to 125mg (rather than doing the 150mg/100mg alternate days which GPs seem to prefer). The first ten days or so were absolutely fine, felt no change, but the last 3 or 4 days have been worse - I have felt far more twitchy and on edge.

Does this sound like discontinuation syndrome? should I have done the alternate days thing? I thought dropping to a dose between 100 and 150mg would be gentler than the alternative days of taking 150 and 100mg, but I am now wondering if this was a mistake :/

Any thoughts welcome x

[panic_down_under]

Two weeks ago, I started the reduction by dropping to 125mg (rather than doing the 150mg/100mg alternate days which GPs seem to prefer). The first ten days or so were absolutely fine, felt no change, but the last 3 or 4 days have been worse - I have felt far more twitchy and on edge.

Does this sound like discontinuation syndrome?

Withdrawal symptoms usually begin before plasma levels stabilize to the new steady-state after a dose reduction and the rule of thumb is they stabilize within 5 times the half-life of the drug, ~26 hours for sertraline. So I would have expected symptoms to begin in under 6 days.

It might be the underlying disorder reasserting itself, or an anxious mind playing games. Withdrawal is a complicated psychosocial process beyond just chemistry and biology. Expect to suffer and an anxious mind may well produce what you fear.

I thought dropping to a dose between 100 and 150mg would be gentler than the alternative days of taking 150 and 100mg, but I am now wondering if this was a mistake :/

No, you did the smart thing. I don't know where doctors got this fairly recent alternate day crap from, maybe it's a response to the slow-release SNRIs, but it is a bad idea even for that drug class, imho, because it sets up a roller-coaster effect on plasma levels. It might not matter much with longer half-life antidepressants such as citalopram (Celexa), escitalopram (Lexapro) and fluoxetine (Prozac) - though I can't understand why anyone would bother as withdrawal is usually less of an issue with these, but gets progressively more problematic as the drug half-lives get shorter.

[little scientist]

The symptoms may have started to make themselves visible before that - I noticed I was far more prone to stress in the first week. I do wonder if its an anxious mind playing games on me as you suggest!

thanks for the reassurance regarding the mechanism of lowering the dose - the alternative day thing, followed by every two days etc has always seemed odd to me as its surely going to create a much more fluctuating blood level of the drug?

I'm going to see how I get on in the next week or so

Thanks for your reply!

[little scientist]

Well I thought it might be time for an update. It was back in February that I last posted and things are good, I am pleased to report!

The drop to 125mg went well despite the very short blip I had. I think the blip was caused by hormones! I soon recovered from it I saw my GP in March and she was pleased I had begun the drop, and how well I had handled it and was happy for me to reduce further when I felt ready to

I maintained a good frame of mind for a good couple of months and decided to take the next step and drop to 100mg. I am good and stable at this dose.

Life is also stable - I got a new job 7 months ago and I love it there. For the first time since my PhD, I actually feel respected and valued! I don't think my boss quite realises how much this job has helped me.