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Dr. K, Psychiatrist
Category: Mental Health
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Experience:  15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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subject Serotonin Syndrome ****** I want to withdraw from zoloft which was given fo

Resolved Question:

subject: Serotonin Syndrome

******
I want to withdraw from zoloft which was given for panic attacks and dysthymia over 6 years ago. Was at 250 mg and have been cutting down for months to 100. Next step would be 50 and then zero - if no problems exist.

My reasons for wanting to cut out zoloft is that i am now dealing with Hashimoto's and resultant aggravated arthritis pain, headaches and tiredness, malaise.

doc gave ultram for pain management and hopefully can be uplifting for mental state in some patients. I've read some very positive reports from former SSRI patients.

I would rather have the ultram than the zoloft. Since not recommended that they be taken together, i am concerned even tho' md and pharmacist have their stamp of approval.

Any thoughts? I also was given clonazepam same time as zoloft for same reasons. Was up to 4mg per day and have cut down to 2mg per day and want to get to 1mg where i will stay. Any thoughts?
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. K replied 3 years ago.
I agree with your MD & pharmacist. Theoretically, it's best not to combine these meds...but many people take both all the time with no major problems. Here is the exact nature of the interactions:

1) sertraline + tramadol
sertraline will increase the level or effect of tramadol by affecting its liver metabolism. (so basically, you should always start with a low dose of tramadol...even half the usual dose if you want to be conservative & play it safe)

2) sertraline + tramadol
sertraline and tramadol both increase serotonin levels. This really doesn't matter. The risk of serotonin syndrome is rare. You can review the symptoms of this syndrome & just keep an eye out for it. I've seen patients on maximum doses of 2-3 antidepressants and tramadol who haven't had this syndrome.

3) sertraline + tramadol
sertraline decreases effects of tramadol by decreasing metabolism. This effect is milder than the 1st 2, and it actually counteracts the 1st effect mentioned above.

It's fine to try to slowly wean off clonazepam, but I would do one thing at a time to play it safe. You have three goals: 1) lower zoloft, 2) add tramadol, and 3) lower clonazepam...doing one thing at a time is the gentlest way to succed.

I hope this helps. Let me know if you need more info.
______________________________________________________________________
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once you are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
Customer: replied 3 years ago.
Thank you. I would like to know if tapering from zoloft is any particular problem. I did take paxil for a couple of years and quit cold turkey with any trouble. In other words, it is not nearly as bothersome or even dangerous as stopping the Clonazepam.

Am I correct in assuming that my plan to take 50 zoloft for a couple weeks and then just stop is considered by you to be generally safe = realizing you are not giving me actual 'advice'.

Regarding Conaz., was going to go from 2 to 1.5 for 2 weeks then 1 mg. that is still a fairly large amt so i thought it would be safe. Do you, in general, concur?

Thank YOU Doctor,
Nancy
Expert:  Dr. K replied 3 years ago.
Most people can taper off SSRI meds (like zoloft or paxil) without any problems; of course, the main thing to watch out for is any return of depression or anxiety symptoms.

Some people are more sensitive to these meds and experience mild withdrawal symptoms (including electrical sensations in the brain). Some really sensitive people experience these symptoms quite severely for even months. Here are some links:

http://psychcentral.com/lib/2011/ssri-discontinuation-or-withdrawal-syndrome/

http://bipolar.about.com/cs/antidep/a/0207_ssridisc1.htm

Paxil tends to be one antidepressant that has more withdrawals than others because it doesn't last in your blood stream quite as long. So if you got off of paxil without any problem, my bet is that getting off of zoloft will be easy too. If you really wanted to take a more conservative route you could go to 25mg before stoping it.

And yes, withdrawals from clonazepam can be worse (and yes even dangerous or fatal) than meds like zoloft/paxil. Going down by 0.5mg every 2 weeks is a very safe way to get off clonazepam. It is a relatively long acting med that stays in your bloodstream quite a while so it even helps to taper itself & reduce withdrawal risks.

I hope this helps...anything else?
______________________________________________________________________
Please let me know if you need more information. We can continue the dialog until you are satisfied. Once you are happy with the answers don't forget to hit the ACCEPT button & provide expert feedback. Also remember that this is not an official doctor patient relationship and not a substitute for a full live psychiatric evaluation. Thank you for using justanswers.com
Dr. K, Psychiatrist
Category: Mental Health
Satisfied Customers: 357
Experience: 15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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15 years clinical experience in all areas of psychiatry. Holistic and practical approach.