Hi everyone

My thanks to this community as I have learned some useful insights here.

Hoping some might be able to offer any advice on my situation.

History is in my signature but basically I was put on Sertraline 100mg in 2014

to deal with OCD/severe anxiety caused by too rapid withdrawal from a 1 year course of Pregabalin that cured a post surgical nerve pain.

I stayed on 100mg Sertraline until 2025. In this 2014-25 period I always suffered from a level of restlessness, activation, underlying anxiety, abnormal muscle tension, especially in the legs and shoulders/neck), which I thought were effects from the previous trauma but I have since found out were effects from the Sertraline. I went straight from Pregabalin withdrawal to sertraline so identifying new drug vs lingering effects were blurred in that whole situation (If I had started sertraline in my pre-Pregabalin state Im sure I would have stopped it within weeks.) I managed to cope with these side effects by walking for long periods every day “burning off” the activation and getting lots of physio and massage. I always thought these symptoms was just trauma and PTSD from my earlier experiences, my doctor never identified sertraline as possible cause.

However, in early 2025 I injured my leg and a spiral began where for a while I was no longer able to counteract the drug effects and I became more anxious, and not sleeping. I increased my sertraline to 150mg on Dr advice but that made my exact symptoms that I had been suffering from worse, and they then improved when I went down to 100mg. So we made the connection to the Sertraline. The same long term effects continued however, a bit worse than before, so in mid 2025 i decided to come down off the drug and did it much too fast and got the same whole package of withdrawal effects (severe insomnia, anxiety, severe muscle tightness and cramping, muscle tremors in legs and arms, nerve pain in arms, mood swings etc). Some of these were new (e.g insomnia), and others were basically worse versions of the drug side effects (muscle tension, restlessness etc). Interestingly, when I got to 0mg the neck and shoulder tightness/pain stopped.

I reinstated up to 20mg in late 2025, at this level I could sleep again. The neck/shoulder pain came back within the first day of reinstatement and worse than it had ever been. After 3 months some of the worst withdrawal symptoms faded eg insomnia, nerve pain in arms, but I continue to suffer from really bad muscle tightness, anxiety/activation and the neck shoulder muscle pain. These are side effects that I always had on the drug but are now worse than they ever were when I was stable at 100mg for the ~10 years. It seems that with everything that has happened I have become more sensitised to the drug.

Unfortunately the drug and associated the muscle pain and other drug effects (hormones etc?) seem have a curious effect in that they lead to fairly rapid overgrowth of connective tissue as I have developed facial fibromas (thickened hard nodules) within months in the areas that are most painful, and this only increases muscle pain further.

I take the drug before bed, the effects come on after about 30 minutes of taking it and are then suppressed overnight with sleep onset. Then when I wake they come in with full force and then slowly dissipate over the course of the day.

In mid may I started micro-tapering hyperbolically at a 15% rate, reducing to 16mg by mid June and 13.7mg by mid July. The side effects have dissipated a little bit I think but still remain strong and the neck/shoulder pain is now increasingly concerning as it has spread to the muscles near my throat and it is becoming sometimes painful to drink water, sneeze etc. being near the throat this also increases my anxiety - vicious cycle.

Unfortunately my ability to exercise (walk) to try to “burn off” the activation is limited as I have developed a painful wart on my big toe, probably due to being immune run down, that is unfortunately placed and difficult to treat , and I also developed ingrown toenails due to swollen feet that had to be operated on last month. I also have more leg muscle pain and tightness than pre-withdrawal. Being more activated I feel pain much more viscerally, it causes a limp aggravating my knee, which is already painful due to the muscle tightness, and all the wart treatments are hard to tolerate as they involve incurring more pain over a period of time. Pain of any kind increases all my other symptoms markedly. Exercise that is too vigorous eg swimming seems to aggravate symptoms. I am going to try slow work on an exercise bike to see if that helps. I am constantly activated, sitting and doing mindful things like Lego or drawing doesn’t help. I feel like I am basically “coked up” all the time. The only thing that reduces the activation and tension is tiredness - if I have a bad nights sleep I am noticeably less activated the following day but I don’t think intentionally reducing sleep is a good idea.

The dilemma I have is that I have started reducing the drug, and but the drug side effects have not dissipated enough yet and the muscle ones are becoming increasingly debilitating (especially neck throat). I have some way to go to get the drug out of my system at the current rate - many months - and I don’t know if I can hold on that long, especially if I start to develop the connective tissue fibromas in these areas. If I speed up the taper I will probably increase withdrawal symptoms a bit, and these withdrawal symptoms will likely aggravate the drug side effects as they are so similar. This happened during my first taper and also happens when I have outside stress of any kind. Any stress seems to amplify the drug side effects.

My psychiatrist has discussed giving me a “brake” eg Promethezine or Lorazepam to sedate and counteract the Sertraline, but they have reluctance as these might lead to tolerance and lose their effectiveness over time? And complicate things. Before I started my hyperbolic taper we tried milder options - Propanolol and Clonidine - but they either didn’t help, caused symptoms of their own (eg feeling sick, bad nausea) or actually increased the sertraline side effects. If I stop the drug quickly or entirely again I will go back into the hell of full withdrawal.

So I feel a bit stuck. I feel like I have three options:

• I could continue at the current rate or slower and try to struggle through it, or add a benzo/other brake and taper off it after. Or try ameliorating with some other remedy - herbal etc

• I could speed up the rate to get off quicker, risking heightened withdrawal effects that also worsen drug side effects (could add or not add a benzo)

• I could quit the Sertraline and try to deal with all the withdrawal effects with a benzo or whatever else.

I’d be most grateful for any ideas or suggestions. Thanks so much, God bless.

Edited July 20Jul 20 by Lighty
Title change.

Welcome to the forum!

 

This is a volunteer-run, community forum aimed at helping those who are tapering and/or experiencing difficulties with psychiatric medications and withdrawl syndrome. We are not medical professionals and cannot offer medical advice. We simply offer support and opinions which you could use as talking points with a medical provider knowledgeable in withdrawing off psychiatric medications.

 

Please familiarise yourself with the forum rules and the disclaimer located here: Guidelines

 

33 minutes ago, hylti761 said:

I stayed on 100mg Sertraline until 2025. In this 2014-25 period I always suffered from a level of restlessness, activation, underlying anxiety, abnormal muscle tension, especially in the legs and shoulders/neck)

Yeah this isn't too uncommon those drugs are activating by nature, combining that with your pregablin withdrawal, which could have made your nervous system more sensitive.

35 minutes ago, hylti761 said:

In mid may I started micro-tapering hyperbolically at a 15% rate, reducing to 16mg by mid June and 13.7mg by mid July. The side effects have dissipated a little bit I think but still remain strong and the neck/shoulder pain is now increasingly concerning as it has spread to the muscles near my throat and it is becoming sometimes painful to drink water, sneeze etc. being near the throat this also increases my anxiety - vicious cycle.

Yeah it is such a pain, but that is the loop with the adverse reaction/wd managment.

38 minutes ago, hylti761 said:

I could continue at the current rate or slower and try to struggle through it, or add a benzo/other brake and taper off it after. Or try ameliorating with some other remedy - herbal etc

Adding another drug would be pretty bad, you would be adding more fuel to the fire, I think Omega 3 and/or magnesium supplementation could help you out with the activation, My personal experience with omega 3 more is that it does make my nervous system less activated.

With the Omega 3, I would recommend something like This would be good as it's a relative low dose of omega 3 (300mg total) and you could take as much omega 3 as you need, Whether it's more or less.

If you decide to try magnesium, magnesium glycinate would be usually recommended.

always start out with low doses and slowly increase them if you have no issues, with magnesium glycinate you may need to start with less than a 1 capsule dose to see how it affects you.

Omega 3 supplementation is usually safer in my opinion, regarding nervous system effects, So i recommend you start with the omega 3 first, and then later try magnesium if its not enough or you don't react well.

44 minutes ago, hylti761 said:

1. I could speed up the rate to get off quicker, risking heightened withdrawal effects that also worsen drug side effects (could add or not add a benzo)

2. I could quit the Sertraline and try to deal with all the withdrawal effects with a benzo or whatever else.

At the end you need to decide what speed of a taper is good for you, I think rushing to 0 shouldn't be the only option, as you already tried that and you felt very bad and returned to the drug because it was too much, Hold your dose for now, let your pain slowly subside with time, and I hope omega 3 or magnesium could help out with the over activation, so you won't feel like you are crashed between 2 walls.

Tapering Information

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

If you have any more questions let me know, I'm also sure other members here could comment and shed more light and opinions regarding how to proceed with your taper.

2 hours ago, hylti761 said:

Hi everyone

My thanks to this community as I have learned some useful insights here.

Hoping some might be able to offer any advice on my situation.

History is in my signature but basically I was put on Sertraline 100mg in 2014

to deal with OCD/severe anxiety caused by too rapid withdrawal from a 1 year course of Pregabalin that cured a post surgical nerve pain.

I stayed on 100mg Sertraline until 2025. In this 2014-25 period I always suffered from a level of restlessness, activation, underlying anxiety, abnormal muscle tension, especially in the legs and shoulders/neck), which I thought were effects from the previous trauma but I have since found out were effects from the Sertraline. I went straight from Pregabalin withdrawal to sertraline so identifying new drug vs lingering effects were blurred in that whole situation (If I had started sertraline in my pre-Pregabalin state Im sure I would have stopped it within weeks.) I managed to cope with these side effects by walking for long periods every day “burning off” the activation and getting lots of physio and massage. I always thought these symptoms was just trauma and PTSD from my earlier experiences, my doctor never identified sertraline as possible cause.

However, in early 2025 I injured my leg and a spiral began where for a while I was no longer able to counteract the drug effects and I became more anxious, and not sleeping. I increased my sertraline to 150mg on Dr advice but that made my exact symptoms that I had been suffering from worse, and they then improved when I went down to 100mg. So we made the connection to the Sertraline. The same long term effects continued however, a bit worse than before, so in mid 2025 i decided to come down off the drug and did it much too fast and got the same whole package of withdrawal effects (severe insomnia, anxiety, severe muscle tightness and cramping, muscle tremors in legs and arms, nerve pain in arms, mood swings etc). Some of these were new (e.g insomnia), and others were basically worse versions of the drug side effects (muscle tension, restlessness etc). Interestingly, when I got to 0mg the neck and shoulder tightness/pain stopped.

I reinstated up to 20mg in late 2025, at this level I could sleep again. The neck/shoulder pain came back within the first day of reinstatement and worse than it had ever been. After 3 months some of the worst withdrawal symptoms faded eg insomnia, nerve pain in arms, but I continue to suffer from really bad muscle tightness, anxiety/activation and the neck shoulder muscle pain. These are side effects that I always had on the drug but are now worse than they ever were when I was stable at 100mg for the ~10 years. It seems that with everything that has happened I have become more sensitised to the drug.

Unfortunately the drug and associated the muscle pain and other drug effects (hormones etc?) seem have a curious effect in that they lead to fairly rapid overgrowth of connective tissue as I have developed facial fibromas (thickened hard nodules) within months in the areas that are most painful, and this only increases muscle pain further.

I take the drug before bed, the effects come on after about 30 minutes of taking it and are then suppressed overnight with sleep onset. Then when I wake they come in with full force and then slowly dissipate over the course of the day.

In mid may I started micro-tapering hyperbolically at a 15% rate, reducing to 16mg by mid June and 13.7mg by mid July. The side effects have dissipated a little bit I think but still remain strong and the neck/shoulder pain is now increasingly concerning as it has spread to the muscles near my throat and it is becoming sometimes painful to drink water, sneeze etc. being near the throat this also increases my anxiety - vicious cycle.

Unfortunately my ability to exercise (walk) to try to “burn off” the activation is limited as I have developed a painful wart on my big toe, probably due to being immune run down, that is unfortunately placed and difficult to treat , and I also developed ingrown toenails due to swollen feet that had to be operated on last month. I also have more leg muscle pain and tightness than pre-withdrawal. Being more activated I feel pain much more viscerally, it causes a limp aggravating my knee, which is already painful due to the muscle tightness, and all the wart treatments are hard to tolerate as they involve incurring more pain over a period of time. Pain of any kind increases all my other symptoms markedly. Exercise that is too vigorous eg swimming seems to aggravate symptoms. I am going to try slow work on an exercise bike to see if that helps. I am constantly activated, sitting and doing mindful things like Lego or drawing doesn’t help. I feel like I am basically “coked up” all the time. The only thing that reduces the activation and tension is tiredness - if I have a bad nights sleep I am noticeably less activated the following day but I don’t think intentionally reducing sleep is a good idea.

The dilemma I have is that I have started reducing the drug, and but the drug side effects have not dissipated enough yet and the muscle ones are becoming increasingly debilitating (especially neck throat). I have some way to go to get the drug out of my system at the current rate - many months - and I don’t know if I can hold on that long, especially if I start to develop the connective tissue fibromas in these areas. If I speed up the taper I will probably increase withdrawal symptoms a bit, and these withdrawal symptoms will likely aggravate the drug side effects as they are so similar. This happened during my first taper and also happens when I have outside stress of any kind. Any stress seems to amplify the drug side effects.

My psychiatrist has discussed giving me a “brake” eg Promethezine or Lorazepam to sedate and counteract the Sertraline, but they have reluctance as these might lead to tolerance and lose their effectiveness over time? And complicate things. Before I started my hyperbolic taper we tried milder options - Propanolol and Clonidine - but they either didn’t help, caused symptoms of their own (eg feeling sick, bad nausea) or actually increased the sertraline side effects. If I stop the drug quickly or entirely again I will go back into the hell of full withdrawal.

So I feel a bit stuck. I feel like I have three options:

• I could continue at the current rate or slower and try to struggle through it, or add a benzo/other brake and taper off it after. Or try ameliorating with some other remedy - herbal etc

• I could speed up the rate to get off quicker, risking heightened withdrawal effects that also worsen drug side effects (could add or not add a benzo)

• I could quit the Sertraline and try to deal with all the withdrawal effects with a benzo or whatever else.

I’d be most grateful for any ideas or suggestions. Thanks so much, God bless.

I’m in a similar situation.

In the midst of trying to decide what to do.

I’ll let you know what I decide 🙂

Welcome to the forum @hylti761

I am very sorry to read of your struggles. Your experience is common. Stopping Pregablin too quickly would have injured your nervous system, the doctor (as usual) misdiagnosed you with relapse and treated the symptoms of WD with Sertraline. This pretty much always just makes things worse. As your nervous system is so senstive now taking the drug is giving you side effects. As you noted,you may not have had these had you just taken Sertraline in the first instance. Once the nervous system gets punched every other move we make is further upset for it unfortunately.

I think you are already doing the right thing. The only thing I would have done differently is RI at a much lower dose than you did. Hopefully that would have eased the WD symptoms and minimised the adverse effects.

As it stands my suggestion would be, you continue to taper off holding and adjusting the rate inline with the WD symptoms you get till you feel the adverse effects ease off. From there I would taper more carefully to avoid further harm.

I not would take additiional drugs personally, I know some would and it is your choice, but as @Lighty has rightly said, in our opinion it is just adding fuel to the fire.

I would suggest focussing on coping skills such as acceptance and distraction and hope by reducing the dose further (carefully) you can get the relief you need.

Acceptance is key - Why does acceptance feel impossible?

 

Sleep in WD

 

Medications, Supplements and Other Substances in Withdrawal

What have you used on your Warts? Have you tried https://www.chemist-4-u.com/salactol-wart-paint-10ml-treats-warts-verrucas-corns-calluses?ppc=1&ppc=1&gad_source=1&gad_campaignid=23689020126&gbraid=0AAAAADMV1WTqHC2o1tC0DSKE6SP_8f9w4&gclid=CjwKCAjwsfzSBhB5EiwAOGyqScWfPhBBWSL0d9N_bRy4cq3_pauWnupf3fC9LmAbPPIGJgwel8LvwxoCIyUQAvD_BwE

I found this the most effective solution and it won't upset your nervous system.

Chippy

Welcome to the forum.

As @Chippy said, adding in more drugs can be quite risky.

Even your psychiatrist is worried about dependence on benzos, and I would point out that if dependence and then withdrawal is something you've had difficulties with with antidepressants, it seems likely that this would potentially also be an issue with benzos that are widely acknowledged to cause this even by mainstream western medicine.

While it's true that it is for you to judge whether your current situation is worth the risk of adding them in, I really do want to emphasise that the risks of these drugs are typically very much understated by mainstream medicine, just as they are for antidepressants which you have unfortunately come to learn firsthand, so I'd very much caution that this makes weighing up this risk very difficult.

Thanks everyone and sorry for my delay in replying. Since my message I have continued micro tapering, slightly slower at 10% rate as I thought perhaps 15% was too fast. Currently at ~12.5mg.

Unfortunately the activation/unease/wiredness is still

strong and the associated neck and throat muscle pain/spasm is getting harder to bear, often quite severe sharp pain when eating and drinking next to the Adam’s apple but also now during other times as well. These are vulnerable ‘fight or flight’ areas. Due to its location the symptoms in turn drive up the activation massively.

I am trying to power through but it’s getting very difficult, so I don’t know what to do. It would be easier to struggle through if I didn’t have a main concern - that I can’t afford to develop permanent fibromas in these delicate areas as they will press on surrounding tissues (these have developed quite rapidly in other areas of the body where I have suffered sertraline-driven muscle pain).

9 minutes ago, hylti761 said:

Thanks everyone and sorry for my delay in replying. Since my message I have continued micro tapering, slightly slower at 10% rate as I thought perhaps 15% was too fast. Currently at ~12.5mg.

Thanks for letting us know, are you putting in holds here and there, micro tapers really need this. 15% is generally too quick for most. 10% we the max we suggest in a month, as you go lower you often need to reduce the speed. Can you update your signature for us please?

10 minutes ago, hylti761 said:

Unfortunately the activation/unease/wiredness is still

strong and the associated neck and throat muscle pain/spasm is getting harder to bear, often quite severe sharp pain when eating and drinking next to the Adam’s apple but also now during other times as well. These are vulnerable ‘fight or flight’ areas. Due to its location the symptoms in turn drive up the activation massively.

Sorry to hear, are you noticing things are worsening with your taper? It is best to listen to what your body is telling you, if things are worsening then I would hold and get to a better place before reducing. Finding your baseline is key.

11 minutes ago, hylti761 said:

I am trying to power through but it’s getting very difficult, so I don’t know what to do. It would be easier to struggle through if I didn’t have a main concern - that I can’t afford to develop permanent fibromas in these delicate areas as they will press on surrounding tissues (these have developed quite rapidly in other areas of the body where I have suffered sertraline-driven muscle pain).

I wouldn't power through, tapering too quickly can cause all sorts of problems, are you finding as you reduce any obvious improvements in dose related symptoms that you talked about above?