How To Discontinue Zoloft (Sertraline)

In our latest question and answer, the pharmacist discusses how to safely discontinue the SSRI Zoloft (sertraline).

May 12, 2018

Al1 asked

I have been on 50 mg of Zoloft for four years.I want off.

My doctor recommended I take it every other day, then every two days, then every three days, etc., and said I should be off the medication in three weeks. That was two months ago.

Her method was awful and I have never had such an awful experience in my life.The brain fog is the worst symptom. On her method, it was so bad I was unable to function and felt like I had lost all control of my life. I have a full time job that requires me to think, and I can't afford to let the brain fog get that bad again.

I took matters into my own hands and began cutting my pills in half and taking those every other day for a week, then I took 1/4 a pill every other day for two weeks, and I am now in my second week of taking 1/8 a pill.

Up until the 1/8 a pill, the brain fog eventually subsided, but came back when I lowered the dose. I still feel brain fog on the 1/8 pill even after two full weeks of this dose.

I take the pills at night, so the day after taking a pill, all is well. It's the second day, when I'm due to take a pill that night, that is hard. Should I continue taking 1/8 of a pill until my brain fog is gone, and then try to stop the pills completely?

Or should I tough it out and stop the pills already, since it seems like the brain fog is not going away? I can't cut my pills any smaller than this, so I know my next step is to stop them completely. I'm just terrified that the brain fog will be too much to handle.

Answer

There is no single recommended way to safely discontinue a SSRI (selective serotonin reuptake inhibitors) like Zoloft (sertraline) as everyone's medication situation and circumstances (e.g. age, comorbidities, concomitant medications) are different. Nevertheless, many sources and guidelines offer guidance. 

One of the largest studies on the matter recommends that most, if not all patients who take SSRIs should taper their dose over at least four weeks if you have been on the medication for at least six weeks. For those who are having particular difficulty with withdraw symptoms, one study recommends to be more conservative and reduce your dose by 25% every four to six weeks. This means that it can take some individuals over 3 months to stop their SSRI!

It is also important to know that tapering may not completely eliminate symptoms of withdrawal. When tapering, if symptoms are problematic, it may be a good idea to return to previous dose that was well tolerated and taper more slowly. 

In addition, if your current tapering method of Zoloft isn't working (e.g. taking doses every other day), you want want to try an alternative approach, such as slowly lowering your dose every few weeks but continue to take the medication daily. Sometimes withdrawal symptoms are more severe if there is too long of a time between doses.

What Are The Symptoms Of Zoloft Withdrawal?

Withdrawal symptoms are generally reported as the acronym FINISH:

  • Flu-like symptoms
  • Insomnia
  • Nausea
  • Imbalance
  • Sensory disturbances
  • Hyperarousal

In terms of how long withdrawal symptoms last, according to one source, they usually begin & peak within one week of a dose change and can last anywhere from one day to three weeks.

Remember that it is not uncommon for it to take weeks or even months to successfully discontinue Zoloft with minimal withdrawal symptoms. It also sometimes takes alternatives approaches if your current tapering method isn't working. Be sure to discuss options with your doctor for the best method for your situation and so you can be monitored for side effects.

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