CK1 asked
I have concerns about recently being prescribed Sertraline/Zoloft for the past 6 weeks the last 4 weeks at 100mg, 2 weeks prior at 50mg) mainly for anxiety issues and some situational depression due to a lot of stressors. As times have passed, my hands shake more and more making it difficult to write, etc. I want to get off this medicine but don't have a family doctor due to recent relocation and only being treated/prescribed when I was in a hospital. What is the best way to titrate down?
Answer
Zoloft (sertraline) is classified as a SSRI (selective serotonin re-uptake inhibitor) and works by increasing the amount of the neurotransmitter serotonin in the brain. It is most commonly used to treat depression and anxiety disorders.
Although relatively uncommon when compared to other potential side effects, Zoloft (sertraline) is associated with several central nervous system effects including:
- Tremor (i.e. 'shaking')
- Hyperkinesis (i.e. 'muscle spasms')
Per the package insert for Zoloft, the above CNS side effects occur in about 2% of patients.
While not seen during the clinical trials, there have been certain movement disorders reported during post-marketing experience. These include:
- Akathisia (i.e. feeling of restlessness)
- Dystonia (i.e. muscle contractions resembling a tremor)
The incidence of the above reactions, or whether or not they are attributable to Zoloft isn't known as they are reported voluntarily from an uncontrolled sample size. It is therefore difficult to establish a relationship to Zoloft exposure.
In regard to tapering and discontinuing Zoloft, there are many options. However, it would be prudent to go through your doctor to find the best method of discontinuation for your particular situation.
Tapering Zoloft (Sertraline)
It is recommended to taper SSRI medications slowly and discontinue rather than stopping cold turkey to avoid potential withdrawal symptoms. Abrupt discontinuation of these medications can cause an array of side effects and withdrawal symptoms that are noted by the acronym FINISH:
- F: Flu-like symptoms
- I: Insomnia
- N: Nausea
- I: Imbalance
- S: Sensory disturbances
- H: Hyperarousal
These symptoms, if they occur, typically begin one week after stopping or decreasing your medication and are generally the worst by 1-2 weeks.
In terms of tapering, approaches are mostly based on anecdotal evidence and there is no single recommended way. It is always best to discuss what may work best for your individual case with your prescriber.
For Zoloft (Sertraline), it is generally recommended to:
- Decrease the current dosage by 10-25% every week for 4-6 weeks if you have been on the drug for at least a few months.
While this may not completely eliminate the chances of withdrawal effects, it should certainly reduce them. If you do get withdrawal effects, they are usually transient and mild. You can treat certain side effects (e.g. headache) with over the counter medications like Tylenol or Advil.
If the withdrawal symptoms you experience become too problematic, it may be prudent to return to the previous dose and titrate may slowly. It is important to be monitored and to adjust your tapering strategy based on symptoms of withdrawal or the return of your depressive symptoms. As always, be sure to discuss your situation with your doctor before trying any kind of taper or changing your medication in any way.
