Experiences going off Zoloft (YANMD)
January 18, 2023 8:10 AM Subscribe
I've been using Zoloft on-and-off for ~3 years. I say "on-and-off" because when I've tried to go off it, my anxiety spikes, and I'm miserable, so I go back on it. Details below about my tapering, but is this a sign that I just... need the meds? Or, do I need to give it more time? YANMD
My PCP suggested Zoloft is best used to get "over the hump" while working on coping skills, and they recommend against using it as a long term solution. It also somewhat affects my libido. Plus, I suppose I have some shame about using meds for mental health. The thing is, I *have* been working on my coping skills, and I feel mentally fit, at least in terms of how I talk to myself, my ability to reframe situations, etc.
Most recently, I was on 50 mg of Zoloft for ~1.5 years. In the fall, I tapered down to 25 mg and felt good. At the end of Dec, I stopped taking it altogether. I've been miserable for the last few weeks.
In fairness, work is very stressful right now. But, even still, my anxiety response seems extreme. Not sleeping, on edge, irritated at the smallest things. I feel constantly "activated", even if it's not warranted by the situation. I'm using my coping skills, but my body seems determined to go into high-threat mode.
The same thing happened when I tried to get off Zoloft 2 years ago. After a couple months of being miserable, I went back on.
Is this a sign that I just... need to be on an SSRI? Should I give it a little longer to let my body get used to not having the meds? (It's only been about a month.) Is there something else I should consider?
My PCP suggested Zoloft is best used to get "over the hump" while working on coping skills, and they recommend against using it as a long term solution. It also somewhat affects my libido. Plus, I suppose I have some shame about using meds for mental health. The thing is, I *have* been working on my coping skills, and I feel mentally fit, at least in terms of how I talk to myself, my ability to reframe situations, etc.
Most recently, I was on 50 mg of Zoloft for ~1.5 years. In the fall, I tapered down to 25 mg and felt good. At the end of Dec, I stopped taking it altogether. I've been miserable for the last few weeks.
In fairness, work is very stressful right now. But, even still, my anxiety response seems extreme. Not sleeping, on edge, irritated at the smallest things. I feel constantly "activated", even if it's not warranted by the situation. I'm using my coping skills, but my body seems determined to go into high-threat mode.
The same thing happened when I tried to get off Zoloft 2 years ago. After a couple months of being miserable, I went back on.
Is this a sign that I just... need to be on an SSRI? Should I give it a little longer to let my body get used to not having the meds? (It's only been about a month.) Is there something else I should consider?
If work is pretty stressful right now, it might not be the best time to do this. It doesn't mean that it's a forever thing, but there might be a better time in future for you.
Your overall anxiety and stress about the situation might be alleviated by breaking down your feelings about the meds. I wouldn't necessarily take your doctor's opinion about their appropriate use as universal. I personally don't think there can be any shame in using them.
Think about it like glasses. Or any other medication. If your vision is improved by glasses, you're not 'weak' or something for using them.
It sounds like your framework is something like "if I can't get by without these meds, I am weak and should be ashamed". This couldn't be more wrong. It also doesn't account for the well-documented difficulties some people have getting off them.
posted by lookoutbelow at 9:10 AM on January 18, 2023 [4 favorites]
Your overall anxiety and stress about the situation might be alleviated by breaking down your feelings about the meds. I wouldn't necessarily take your doctor's opinion about their appropriate use as universal. I personally don't think there can be any shame in using them.
Think about it like glasses. Or any other medication. If your vision is improved by glasses, you're not 'weak' or something for using them.
It sounds like your framework is something like "if I can't get by without these meds, I am weak and should be ashamed". This couldn't be more wrong. It also doesn't account for the well-documented difficulties some people have getting off them.
posted by lookoutbelow at 9:10 AM on January 18, 2023 [4 favorites]
I can't get by without Zoloft but I am not you. If your anxiety response now is worse than before you started the meds, it may be an indication that things could improve the longer you're off. But if this is how you were before...you may need meds and that's okay.
I am surprised that your PCP suggested this particular SSRI for a short-term solution. It might be worth seeing someone who specializes in mental health, instead of general medicine, who can help you work through this med issue. Even more beneficial would be someone who can also prescribe meds, as this may not be the best med for your particular situation, both short term and long term.
posted by cooker girl at 9:46 AM on January 18, 2023 [2 favorites]
I am surprised that your PCP suggested this particular SSRI for a short-term solution. It might be worth seeing someone who specializes in mental health, instead of general medicine, who can help you work through this med issue. Even more beneficial would be someone who can also prescribe meds, as this may not be the best med for your particular situation, both short term and long term.
posted by cooker girl at 9:46 AM on January 18, 2023 [2 favorites]
You can find a whole range of opinions about antidepressants, and whether long-term use is justified, and whether they cause any harmful side-effects. My own view is that no matter what medication you take (antidepressant or otherwise), the best course of action is to take the lowest effective dose, and don't take the drug any longer than you really need to.
There is some evidence that long-term use of antidepressants can actually worsen the very condition that they are ostensibly treating. In other words, some researchers claim that long-term antidepressant use can induce chronic depression. The term for this is "tardive dysphoria". This theory is controversial, though I find it plausible.
Also, withdrawal from antidepressants is linked to unpleasant symptoms, like insomnia, anxiety, "brain zaps", and others. This theory is not controversial. Pretty much everyone agrees that some people (not everyone) can experience these symptoms.
If I were in your shoes, I would decide whether I could tolerate the existing symptoms until they hopefully resolve over time. If I couldn't do it, then I would resume taking the 25 mg dose of Zoloft and gradually taper it down to zero, which is the strategy that's typically recommended in these situations. Of course, you should do this under the supervision of doctor, preferably a psychiatrist who has experience in weaning patients off of long-term antidepressant use.
posted by alex1965 at 10:21 AM on January 18, 2023 [3 favorites]
There is some evidence that long-term use of antidepressants can actually worsen the very condition that they are ostensibly treating. In other words, some researchers claim that long-term antidepressant use can induce chronic depression. The term for this is "tardive dysphoria". This theory is controversial, though I find it plausible.
Also, withdrawal from antidepressants is linked to unpleasant symptoms, like insomnia, anxiety, "brain zaps", and others. This theory is not controversial. Pretty much everyone agrees that some people (not everyone) can experience these symptoms.
If I were in your shoes, I would decide whether I could tolerate the existing symptoms until they hopefully resolve over time. If I couldn't do it, then I would resume taking the 25 mg dose of Zoloft and gradually taper it down to zero, which is the strategy that's typically recommended in these situations. Of course, you should do this under the supervision of doctor, preferably a psychiatrist who has experience in weaning patients off of long-term antidepressant use.
posted by alex1965 at 10:21 AM on January 18, 2023 [3 favorites]
Get a new PCP. Yours seems to have very little understanding of... well let's just leave it at serotonin.
posted by DarlingBri at 10:33 AM on January 18, 2023 [4 favorites]
posted by DarlingBri at 10:33 AM on January 18, 2023 [4 favorites]
I went off Zoloft a few years ago with a slower taper - I recall both the reduction from 50 to 25 and from 25 to zero had an intermediate step when I was taking one dose one day and one the next (so either 50/25 or 25/0), each time for at least three weeks. It took a couple of weeks to feel normal once I stopped completely. And yes for trying to aim the taper for a non-stressful period - a friend was literally told "let's wait until the divorce is final" when discussing hers.
And it's a bloody cliche, but yoga helped a lot. It gets me out of my head for an hour a couple times a week, and it lets me enjoy that feeling of being more present than I was on meds. Also other mindfulness things, like forest walks and making time for creating or experiencing art.
posted by I claim sanctuary at 10:41 AM on January 18, 2023
And it's a bloody cliche, but yoga helped a lot. It gets me out of my head for an hour a couple times a week, and it lets me enjoy that feeling of being more present than I was on meds. Also other mindfulness things, like forest walks and making time for creating or experiencing art.
posted by I claim sanctuary at 10:41 AM on January 18, 2023
Zoloft is a pill that can be cut, so you can slow your taper even more with a pill splitter. Maybe try 3/4 for a month to six weeks, then half, then a quarter, then a quarter every other day. Good luck.
posted by kate4914 at 10:47 AM on January 18, 2023
posted by kate4914 at 10:47 AM on January 18, 2023
getting off these meds can be HARD. i've been on and off many, and i remember zoloft being one of the harder discontinuations. this is not a sign you NEED meds. this is a sign it is hard as fuck to get off some meds.
another med may work better for you (i've seen wellbutrin used short term [like for SAD or PMPD] not zoloft). or maybe if you tough it out miserably in two months you'll feel better after you've gone through the withdrawal. and even if the half-life of a drug is like a day, it can take a looooooong time for the withdrawal to resolve.
everyone's different and it sucks.
posted by misanthropicsarah at 10:56 AM on January 18, 2023 [1 favorite]
another med may work better for you (i've seen wellbutrin used short term [like for SAD or PMPD] not zoloft). or maybe if you tough it out miserably in two months you'll feel better after you've gone through the withdrawal. and even if the half-life of a drug is like a day, it can take a looooooong time for the withdrawal to resolve.
everyone's different and it sucks.
posted by misanthropicsarah at 10:56 AM on January 18, 2023 [1 favorite]
Best answer: I tried to come off Zoloft last year, after about 4 years at 100mg. My experience sounds very similar to yours. I had been working on mental fitness and feeling good, and I was curious to see how it felt to come off it. I had some acute withdrawal symptoms for a few weeks (brain zaps and dizziness), after which I settled into an "always activated" kind of existence, where my brain was in threat mode all the time. That incessant anxiety led to a deep depression that I hadn't felt in decades (but was familiar to me from past experience). I went back on the meds after about 10 months and quickly felt much better. The experience was quite unsettling, and has left me with the feeling that I might need to be on this SSRI forever.
One good thing I have learned in the process is that the shame of my mental health struggle exists whether I am taking drugs or not, so the drugs are not actually the source of shame. This has helped me to accept the treatment more openly.
One bad thing to consider is that maybe the SSRI has somehow made things worse, that my baseline is now "ruined" and it was a mistake to ever take the medicine to begin with because now I truly can't live without it. I have seen a fair bit of this opinion in reading other peoples experiences of SSRI withdrawal. The current scientific and medical data on this issue seem inconclusive, but I guess it's not an inconceivable possibility. My withdrawal experience was very bad, but it was not a completely unfamiliar kind of terrible, so I am reluctant to come to the conclusion that the SSRI has made things worse for me. I also worry about how the narrative of "The medication is actually bad for you!" actually plays into mental health stigma instead of against it.
It's also possible that I did not taper correctly or manage my withdrawal appropriately, and I could be living "Zoloft free" right now, but the side effects have always been minimal for me, so at this point in time I feel like I am making the best tradeoff for myself by continuing to take Zoloft.
posted by grog at 11:09 AM on January 18, 2023 [2 favorites]
One good thing I have learned in the process is that the shame of my mental health struggle exists whether I am taking drugs or not, so the drugs are not actually the source of shame. This has helped me to accept the treatment more openly.
One bad thing to consider is that maybe the SSRI has somehow made things worse, that my baseline is now "ruined" and it was a mistake to ever take the medicine to begin with because now I truly can't live without it. I have seen a fair bit of this opinion in reading other peoples experiences of SSRI withdrawal. The current scientific and medical data on this issue seem inconclusive, but I guess it's not an inconceivable possibility. My withdrawal experience was very bad, but it was not a completely unfamiliar kind of terrible, so I am reluctant to come to the conclusion that the SSRI has made things worse for me. I also worry about how the narrative of "The medication is actually bad for you!" actually plays into mental health stigma instead of against it.
It's also possible that I did not taper correctly or manage my withdrawal appropriately, and I could be living "Zoloft free" right now, but the side effects have always been minimal for me, so at this point in time I feel like I am making the best tradeoff for myself by continuing to take Zoloft.
posted by grog at 11:09 AM on January 18, 2023 [2 favorites]
Prozac/fluoxetine has a much longer half-life and is said to be easier to get off of. You could ask to switch to Prozac then taper off.
Also try tapering much slower. I am currently tapering Lexapro/escitalopram at 1/4 pill every 3 days, then will go to every 4 days.
posted by haptic_avenger at 11:30 AM on January 18, 2023 [1 favorite]
Also try tapering much slower. I am currently tapering Lexapro/escitalopram at 1/4 pill every 3 days, then will go to every 4 days.
posted by haptic_avenger at 11:30 AM on January 18, 2023 [1 favorite]
Best answer: I tapered off Zoloft (after being on 25mg for three years and 50mg for about a year) extremely slowly. It took about three months. I found the best method to be a sort of mixed-dosage taper, like so:
Two weeks alternating 50mg/day and 25mg/day
Two weeks alternating 50 mg/day and then 25mg/day for two days
Two weeks at 25mg/day
Two weeks alternating 25mg/day and half a 25mg pill (12.5mg)/day
Two weeks alternating 25mg/day and 12.5mg/day for two days
Two weeks at 12.5mg/day
no more Zoloft!
When I tried a faster taper I had intense, noticeable depressive experiences as a result. I was taking Zoloft for anxiety, not for depression. This slower taper allowed me to skip the depressive fits and just revert to my baseline generalized anxiety disorder (ha), which I then began taking other meds for which work better for me.
Best of luck, and consider designing your own, slower, taper structure.
posted by byzantienne at 12:47 PM on January 18, 2023 [1 favorite]
Two weeks alternating 50mg/day and 25mg/day
Two weeks alternating 50 mg/day and then 25mg/day for two days
Two weeks at 25mg/day
Two weeks alternating 25mg/day and half a 25mg pill (12.5mg)/day
Two weeks alternating 25mg/day and 12.5mg/day for two days
Two weeks at 12.5mg/day
no more Zoloft!
When I tried a faster taper I had intense, noticeable depressive experiences as a result. I was taking Zoloft for anxiety, not for depression. This slower taper allowed me to skip the depressive fits and just revert to my baseline generalized anxiety disorder (ha), which I then began taking other meds for which work better for me.
Best of luck, and consider designing your own, slower, taper structure.
posted by byzantienne at 12:47 PM on January 18, 2023 [1 favorite]
You said: "Is this a sign that I just... need to be on an SSRI?"
We are not you, your doctor or your therapist so none of us is qualified to answer this question since "need" is such a strong word. It sounds like you'd be fine either going back on the meds or trying to cope without them. The question is what is more important to you right now: feeling less anxious or riding the rollercoaster of challenging emotions while you adjust?
There is absolutely no shame in taking an SSRI and fuck anyone who makes us feel that way. Sometimes I take meds; sometimes I don't. But what do I never do? Tell people what's right or wrong for them. I'm sorry you're feeling so stuck in this cycle, and I know firsthand how it can feel like neither option is right. The sexual side effects can really suck, I hear you. My only advice would be to find a psychiatrist, not just your PCP, you trust who is known for being fully supportive about medication but also conservative in their prescriptions. My therapist helped me with this and, if you also have a therapist, hopefully they can recommend a MD. A PCP is a wonderful resource but really just the starting point in this. They want to help but their methods of helping are much more limited than a specialist. There are many treatment options and you can definitely find what's best with time. For now, do what's best in the short-term or maybe medium-term!
posted by smorgasbord at 6:50 PM on January 18, 2023
We are not you, your doctor or your therapist so none of us is qualified to answer this question since "need" is such a strong word. It sounds like you'd be fine either going back on the meds or trying to cope without them. The question is what is more important to you right now: feeling less anxious or riding the rollercoaster of challenging emotions while you adjust?
There is absolutely no shame in taking an SSRI and fuck anyone who makes us feel that way. Sometimes I take meds; sometimes I don't. But what do I never do? Tell people what's right or wrong for them. I'm sorry you're feeling so stuck in this cycle, and I know firsthand how it can feel like neither option is right. The sexual side effects can really suck, I hear you. My only advice would be to find a psychiatrist, not just your PCP, you trust who is known for being fully supportive about medication but also conservative in their prescriptions. My therapist helped me with this and, if you also have a therapist, hopefully they can recommend a MD. A PCP is a wonderful resource but really just the starting point in this. They want to help but their methods of helping are much more limited than a specialist. There are many treatment options and you can definitely find what's best with time. For now, do what's best in the short-term or maybe medium-term!
posted by smorgasbord at 6:50 PM on January 18, 2023
Zoloft was no good for me I switched immediately to a different med, Mirtazipine, and am still on it two decades later. Still need it.
posted by billsaysthis at 9:39 PM on January 18, 2023
posted by billsaysthis at 9:39 PM on January 18, 2023
Working with a psychiatrist, I've successfully stopped taking Paxil (and later) Zoloft by cross-tapering with Prozac, which is readily available in liquid form.
posted by Jesse the K at 9:02 AM on January 30, 2023
posted by Jesse the K at 9:02 AM on January 30, 2023
This thread is closed to new comments.
Some people find it very difficult to go off SSRIs, especially at the pace recommended by doctors. People on spaces like Surviving Antidepressants will recommend going much much slower and slowing down as you approach 0 — they do things like get a liquid version and reduce by 10% a month.
I’m off Lexapro now after 7 years medicated, and it was really really hard. I didn’t want to fuss with the liquid stuff, so I jumped from a quarter of a pill to 0. I basically had a mental breakdown 2 weeks later, and it took me a few months before I felt OK again. It’s been 8 months now, and I’m feeling back to normal — actually better than ever after some lifestyle changes!
Unfortunately, what I have learned in this experience is that everyone is different and there seems to be a huge lack of quality studies about the SSRI withdrawal experience. So I can’t tell you what to do or how long this will last. But one option would be to reinstate the lowest dose you felt OK on, and then next time you try to go off to go much slower.
Good luck to you, no matter what you decide to do. I’ve been there and I know it’s so hard! Feel free to PM me if you want to talk more.
posted by vanitas at 8:44 AM on January 18, 2023