Farewell Sertraline... Coming off your Medication

This may seem like a really ridiculous idea for a blog post - saying goodbye to my medication, but it feels important to me nonetheless.

My blog posts tend to reflect what is going on in my life at current, and being medication free for the first time in over 3 years feels like quite a significant current happening.

I have previously written some blog posts detailing my journey with using medication to manage my mental health, which can be found here:

~ Medication & Mental Health
~ Reducing or Withdrawing from Mental Health Medication
~ Medication Update & Tips for when things don't go quite to plan

However, just to re-cap...
I decided to go onto medication for the first time in July 2014 following a real crisis point with my mental health.  Previously I had always refused to take medication.  This was partly because I wanted to try to overcome my difficulties using my own resources (I still maintain that this should always be tried first), but also because I was deeply afraid of handing over control of my mind and body to a substance.  However, I had been in such a severe depressive state and realised even in the depths of my slumber that if I wanted to get better I needed to do something big, something that I hadn't tried before.
So I agreed to be prescribed Sertraline and until now really never looked back!
For information - Sertraline is an antidepressant that also eases symptoms of anxiety - it is the antidepressant that is most commonly prescribed for people with PTSD, but is also used to treat depression, anxiety and OCD.
As I hoped, after a few rough weeks when I first went onto the medication, it relieved me of my symptoms just enough to be able to engage in therapy and employ other techniques to further manage my condition.  It really did kick start my recovery, and I couldn't be more grateful to that little purse size packet of tablets!
About 2 years ago, I did go through a stage of reducing my dose with a view to possibly withdrawing.  The reasoning behind this was because directly following an increase in my dose, I started to develop seizures.  These seizures turned out to be non-epileptic, but at the time, due to the correlation and a very small possibility that the medication may have been causing the seizures, it was agreed that I could reduce my dose to see if it had any effect.  Now I am pretty sure it was just a coincidence that I started having seizures following the increase.  I was just pleased that the seizures ceased eventually.  In any case, that period saw me successfully reduce my dose from 75mg to 25mg a day.  When I tried to reduce further below the 25mg I seemed to experience increased anxiety, so I maintained the 25mg quite comfortably until recently.

Why I wanted to go medication free...
As I've said, I was very comfortable on Sertraline, maybe a bit too comfortable!
My instincts told me that the medication was probably not doing very much at all for me anymore.  I was on half of the usual minimum prescribed dose so there must have been limits as to how much such a small dose could do for me.  I felt like Sertraline served me well in lifting me out of a dark hole, but my life is now in a very different place - I am no longer suffering from a consistent depressive state.  I also felt as though most of the symptoms of my condition could not be controlled by medication.  As you will know if you are a regular reader of this blog, I am diagnosed with Dissociative Identity Disorder and Complex Post Traumatic Stress Disorder.  Sertraline had absolutely no impact on the amount I dissociated and switched between dissociative parts of me.  Despite being on Sertraline, I could still become very anxious and could enter a very depressive state temporarily when switching to some parts of myself.  I guess I figured there wasn't much point taking a medication that couldn't really have much impact on my main day to day difficulties.  I also felt I had developed more skills to manage my condition that are not dependent on medication than I had when I first started taking the medication. Sertraline is not particularly known for having any significant or worrying side effects associated with long term use, but I know that long term use of any antidepressant is not recommended.  In terms of my health, I felt like I would prefer to be off medication if I could be, especially if the medication was doing little for me.
At the same time though, I was quite terrified of coming off the medication and kept putting off the decision for about a year!
Sertraline was my comfort blanket.
I was so afraid of returning to the state I was in before I was taking medication that it made me reluctant to come off it.  I think you have to have some confidence to take that step, and I guess I must have found that confidence in the end.
Or, at least, I was confident enough to give it a go!

Reflections from my Medication Journey...
Before discussing more about my withdrawal, I just wanted to share a few reflections from my experience of being on mental health related medication.

Medication is definitely worth considering when it feels like everything else is failing.
I have absolutely no regrets about going onto medication for my mental health.
In fact, I have an awful lot to be grateful to it for - it lifted me out of a very dark place when it felt like nothing else could.  As a person who was previously completely anti-medication, I can honestly say that it definitely worth considering - don't see it as a weakness or a failure to help yourself, everybody needs a helping hand, and I can now vouch for the fact that the right medication can be life changing for some people.  What I do not agree with however is doctors dishing out antidepressants before even offering  any alternatives, such as making life changes, self-help and talking therapies.  Medication should be used as an aid alongside other initiatives aimed at improving your mental health.

Don't expect any medication to change your life -
You can only do that yourself!
This may sound a bit hypocritical after describing some medication as 'life changing'.
However, what I mean is that no medication can improve your overall life situation and personal circumstances.  You have to look at the factors in your life that have a negative impact on your mental health and try to change them.  Taking medication can offer you some relief from your symptoms so that you are in a better position to be able to take steps to improve your life.
Medication can't change your life, but it can help you to change your life.

Make sure you are happy or at least on board with what you are taking.
It is really important to know what you're taking - it's your body it's going into after all!  Especially when you are trying something new, it can be helpful to know what to expect and what side effects you are likely to experience.  If your doctor hasn't explained this sort of thing to you (mine certainly never did!) then ask them to - that is what they are there for.  Also, if you have capacity and insight into your mental health then you should feel involved in the decision making around your medication.  It is of course important to listen to the the professionals and be willing to trust their judgement to some extent, but at the same time, it is you who is going to have to take the medication, and in my view, you are more likely to want to take something if you are on board with it in the first place.  When I told my psychiatrist that I was willing to try medication for the first time - his recommendation was to put me on anti-psychotics.  At this point, I was not yet diagnosed with Dissociative Identity Disorder. I reported hearing voices and seeing things that other people couldn't, so I can understand why a doctor would have come to that conclusion.  However, I knew in myself that these symptoms were not symptoms of psychosis - it felt connected to the trauma I had been through and it felt as though it was coming from within me, rather than externally.  I would like to say that I refused to take antipsychotics because of this gut instinct, but what resonated as the main reason behind my refusal was that I was aware that a common side effect of antipsychotics is weight gain, and the anorexic part of me could not entertain that as a possibility!  Nethertheless, I am so glad I did trust my instinct and refuse to be prescribed them as a year or so on it was confirmed that my symptoms were not consistent with psychosis.  It was actually my suggestion to try Sertraline - the psychiatrist agreed though said he doubted it would do much for me - it seems he was wrong...
You know your mind and body - your opinion does matter and should be taken into account.

Stick with it and ride out the side effects - it will be worth it in the end!
I remember my first two weeks of taking Sertraline as almost the most physically ill I've ever felt.  It was basically like have flu for two weeks - I had more or less every common side effect on the list.  It is important to read the information pamphlet that comes with the medication - sometimes it can be worrying to read but knowing what to expect and what is classed as 'normal' in terms of side effects can be reassuring.
If you experience the more serious and high risk side effects then of course you should seek medical attention and stop taking the medication following medical advice.  However, if it is just a case of feeling uncomfortable and finding the side effects unpleasant, then it is worth riding it out.  The worst of my side effects disappeared after two weeks and I didn't really experience any side effects once I had been taking it for a month.  With a lot of medication, you will not feel better straight away - it took me 8-9 weeks until I started experiencing an improvement in my mood and anxiety.  It can be very frustrating during this initial period, especially if you are not feeling great physically as well, but it is worth giving the medication the best possible chance of working.  Even if it takes a while to work, these medications are prescribed for a reason - they are proven to work, so see it through it will probably be worth it in the end.

DID & Medication
 I just wanted to share a few thoughts on Dissociative Identity Disorder and medication. As you know, I have a DID diagnosis. There is currently no medication that is proven to ‘cure’, ‘prevent’ or ‘improve’ the symptoms of DID. Medication can only be given to improve or take the edge off some of the associated symptoms such as low mood, poor sleep, and anxiety. From my experience, I have seen that DID is very resistant to medication - I could still become incredibly anxious despite taking medication that was supposed to improve my anxiety, and I still experienced very sudden and extreme changes in mood when switching between parts despite being on antidepressants. I am not saying the medication was of no use to me at all, it was of huge use when I was suffering from a consistent depressive episode, but there were limits to what it could do once that had passed. I consider myself very lucky to have just been put on antidepressants, as I have come across other people with DID who are prescribed a huge cocktail of medications including antipsychotics, often with quite significant side effects. From what I have seen, all this medication has very little impact on DID symptoms and a sufferer’s day to day functioning. To me, it makes complete sense that DID is medication resistant. After all, DID is routed in trauma and no medication can ever change what has happened to you. Therefore, in my view, I believe that medication should be kept minimal in the case of DID.

How I actually went about reducing and withdrawing from my medication… 

 Seek advice from a medical professional and come off it gradually 
Please rest assured that I didn’t just suddenly make a decision to stop taking my decision and stopped. I told my psychiatrist that I wanted to come off my medication and why, and he agreed to it. With most medication it is recommended to taper off it gradually as this will lessen the chance of experiencing withdrawal symptoms.
 Your doctor or whoever prescribes your medication should give you a plan of how much to reduce the dose by and when, and you should be reviewed and monitored during that time.

 How to come off medication gradually...
As I’ve said, medical professionals should be able to give advice on how to taper off your medication, though from experience, I know this doesn’t always happen!
My consultant didn’t offer up very much advice about how to reduce my medication at all - when I asked him how I should do it, he said that I could take a dose every other day for ‘a bit’ or just come off straightaway as I was on such a low dose already. To be honest, he seemed thoroughly unbothered by the whole affair, even though for me, this was a big step to take. This may just be a case of me having a very complacent and probably overworked consultant psychiatrist (I felt as though I was keeping him up throughout the whole appointment)! I sincerely hope that you encounter someone more helpful who readily offers up practical advice. If you end up in the position that I was where you feel as though you are facing coming off your medication alone, then I would really recommend reading an online guide provided by Mind. I followed their guidelines as far as I could, reducing the dose by a very small amount (I think they suggest reducing by 10-20% each time), staying on that reduced dose for two weeks before making a further reduction. Even if that meant using a kitchen knife to shave off a bit of tablet each time! It isn’t very accurate when cutting up tablets, but I generally managed to at least get most of the cuttings roughly the same size! Then, once I was on the smallest dose I could possibly cut, I started taking that dose every other day for two weeks. I then went down to every two days, then every three days etc. After doing two weeks on every three days, I decided I felt ready to stop altogether.
I have now been medication free for over three weeks now, and it all seems to be going fine. I experienced very little withdrawal symptoms, if any!
I had the odd headache, which felt similar to the ones I got when I first went on the medication, but it could have easily been caused by something else and didn’t really affect my functioning.

One of my greatest strategies for reducing my medication - I would only take a dose on the days with a cute doggie or kitty on them <3

Tell someone you're coming off your medication 

As I’ve mentioned, you should have regular medication reviews with a medical professional, especially when you are coming off your medication. However, it can also be helpful to tell another trusted person who you are close to. Coming off your medication can feel like a really big step, a bit daunting even, so it can help to be able to have someone to talk to about it.

It can also be helpful if someone close to you knows that you are reducing and withdrawing from your medication, as they may be able to see whether it is affecting your mood and general wellbeing.  They may also be able to spot if your mental health is showing signs of deteriorating - two pairs of eyes can be better than one.

I did tell some close friends and family that I was reducing my medication with a view to withdrawing completely.  However, the person who I mainly discussed it with was my therapist.  It was reassuring when she confirmed that she spotted no real change in me too.

Try not to think on it too much...

Be open to other possible explanations...

Having had a bit of a difficult experience the last time I tried to reduce my medication, I was obviously quite anxious about the prospect of something going wrong this time.  I knew that the only way I could go ahead with my plan to reduce and withdraw was by trying not to think about it too much, and not drawing too much of my attention to it.  I also knew from my previous experience with it that if I was to encounter any difficulties related to my mental health, or physical health, during this time, I was likely to blame it on the fact that I was reducing my medication, and that was likely to cause me a great deal of anxiety.

What I found helped was to think of all the alternative explanations if I faced a few difficulties - in most cases I was able to see that these things would have always affected me in that way regardless of whether I was on my medication or not.

When I took my medication every morning, I tried to do it quite mindlessly and focused on what I was doing that day, rather that the tablets getting smaller.

Distraction can definitely help!

Be mindful about when you are making significant reductions and try to plan around it

Hypocritically, I didn't really follow this bit of advice!

My first week of being completely medication free was spent moving house - it all turned out fine, but with hindsight perhaps I could have picked a lesser week to do it.

What I would advice though, is to have a good balance of activity on the weeks where you are making the most significant reductions.  If you have little on, then reducing your medication is likely to become the main thing you think about, which could cause anxiety.  I think it would be ideal to be fairly busy, but have some events and activities that you can cut back on if you're not feeling on top form.

It is an achievement!

When I reduced to taking my medication every other day, it felt quite daunting when I had my first day 'sans sertraline' for over three years, but it also felt like quite an achievement.  Taking medication everyday had become a part of my daily routine, as well as checking ingredients for grapefruit, which you are not allowed to have if you're on sertraline!  I thought I might find it weird or difficult to adjust to not taking medication at the same time every morning, not cutting up my tablets for the week every Sunday, and having to remember my pill box if I was heading out somewhere early.  I didn't.  I think because I reduced so gradually, it just seemed to feel like a natural transition.  Life without medication even feels slightly liberating...

As I think I've made clear, I am no longer completely anti-medication, and it is a bridge I would consider crossing in the future if I needed to.  Though I am hopeful that I may well not need to.

Letting go of the crutch or comfort blanket your medication can become is a scary step, but when you make the transition to go it alone, it feels like a real achievement - so make the most of you new medication free existence ;)

Love and Strength,

The One Day Seeker