Lou asked
Been on Zoloft 50 mg daily x 1 yr. I asked for increase in dose, so bumped up to 100 mg over last 5 mo. Now getting put on flecainide 150mg twice daily, metoprolol 25 mg twice daily. I see that Zoloft and flecainide don't play well together. I talked to the cardiologist who said drop Zoloft to 50 mg, which I did a week ago. I would like to get off it to be safe. PCP who prescribed it is out of town. What do you recommend on tapering Zoloft 50 mg?
Answer
Zoloft is classified an as SSRI (Selective Serotonin Re-uptake Inhibitor), the most commonly used class of antidepressant. Most sources recommended to taper SSRI medications, such as Zoloft, if they have been used continually for an extended period of time. Stopping these medications abruptly (i.e. "cold turkey") can cause adverse reactions and withdrawal symptoms. These withdrawal symptoms are often noted by the acronym 'FINISH'.
Zoloft (Sertraline) Withdrawal Symptoms
As stated above, withdrawal symptoms are often noted by the acronym 'FINISH':
F: Flu-like symptoms
I: Insomnia
N: Nausea
I: Imbalance:
S: Sensory disturbances
H: Hyperarousal
If withdrawal symptoms occur, they typically begin one week after stopping or decreasing your medication and are generally the worst by 1-2 weeks. Not everyone will experience withdrawal symptoms and if they occur, they are generally mild in severity.
How To Stop Taking ('Taper') Zoloft (Sertraline)
In terms of tapering, it should be noted that approaches to tapering medications effectively is mostly based on anecdotal evidence and there is no single agreed upon method to do it. Different individuals may require different approaches based on their medical history and other factors. It is always best to discuss what may work best for your individual case with your prescriber.
For Zoloft (Sertraline), many sources recommend a taper similar to the following:
- Decrease the current dosage by 10-25% every week for 4-6 weeks (if you have been on the drugs for a few months).
While this may not completely eliminate the chance of experiencing withdrawal effects, it should certainly reduce them.
If you do experience withdrawal effects, they are usually transient and mild. You can treat certain side effects (e.g. headache) with over the counter medications like Tylenol. If symptoms become too problematic, options include returning to the previous dose and titrate more 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.
