Coming off sertraline to get pregnant.

Hi Laura,

Firstly, did your doctor advise you to do 100mg one day and then 50mg the next?

My understanding is that by changing your dosage in this way, you are putting your body in a constant state of flux whilst it tries to readjust to the different levels, hence the headaches. Coming off sertaline is not pleasant but can be made easier if done correctly. Tapering should be done by first decreasing the dosage until you reach 50mg, then the frequency, missing more days as time goes on.

The reason you can reduce from 50mg to nothing by gradually changing the frequency is because 50mg is such a low dose your body can handle it - this is why there is no 25mg tablet available, it would have no significant effect either way.

By reducing your dose you may find that your sex drive starts to return, when I stopped completely it returned fully. Unfortunately this didn’t aid conception and the stress eventually saw me needing sertaline again, this was 14months after stopping. I couldn’t believe after going through the awful side effects of stopping and then trying for so long without I was back to square one.

My doctor advised me that the risks during the first few months were slim and as I was only on 50mg slimmer still. To avoid withdrawal symptoms showing in the infant she advised tapering off them gradually before the third trimester, this way if I did need to start again I would only have been off them 6 months. Trying to stay off so long caused my mood and outlook, deteriorate along with my relationship.

My advice;

1) Check out this link regarding risks involved http://www.drugs.com/pregnancy/sertraline.html

2) Do not be pressured into coming off sertaline if you are not ready, look at the alternatives such reducing to 50mg and then reducing to nothing once pregnant. Alternative ask your doctor to prescribe a different drug, I can’t recall the name I tried another but it turned me into a zombie, you however may react differently.

3) Go to your doctor with a list of questions and make sure you get answers to them, so you can make an informed decision. My doctor got out books and we looked up certain information there and then. Better still, call your doctors and ask them to make you an appointment with somebody who knows about this stuff, I know there are 2 doctors at my surgery who have more experience in this area.

4) Get your boyfriend to go to the doctors with you so he can ask questions and get answers to any concerns. He needs to know what it is he asking you when he says he wants you to stop. You need to be working from the same page on this.

I hope I have made sense. Anything I have said should be checked with your doctor.

Best of luck!

I wish you well, fatigue is a big one as are the head aches, blurred vision, tingling in the arms etc.  After 8 months I thought I was going crazy, as my Dr. said it wasn't w.d.  I was so happy to have found the above site to verify what I was experiencing was in fact w.d.   These drugs affect our brain chemistry, thus takes many months to right itself apparently!

just a few thoughts from a pharmacist, if it helps!

sertraline should be gradually reduced over at least 4 weeks. 

Withdrawal symptoms include: dizziness, diarrhoea, nausea, headache, sweating, loss of appetite, electric shock sensation, anxiety and irritability. BUT these are often short-lived and minor so stay positive. Individuals differ in their responses, so one person's experience may be different to what you'll get. Remember, if it becomes intolerable, these symptoms go away if you restart the medication, but I undestand that's not the plan! speak to a pharmacist about what to take to remedy some of these problems if they become troublesome, eg paracetamol.

although 4 weeks is normally recommended, you can reduce slower if you'd prefer, and one source (the drugs and therapeutics bulletin) recommends taking 6-8 weeks. But I can find nothing specific on how to taper the dose. It sounds like you're doing ok with a few withdrawal symptoms on 100mg then 50mg alternate days, that's like 75mg daily. When you're ready, why not try 50mg daily for two weeks. Then 25mg daily for two weeks. Then 25mg alternate days (like 12.5mg daily).  Then see if you can stop. Just a note, these tablets are ok to split, there's no adverse effects of doing this (but always check with a pharmacist first as some tablets must not be split).

it is sensible to try and come off if you're planning a pregnancy (for obvious reasons) but I can assure you they do use sertraline in pregnancy sometimes. With any drug, you need to balance the risks and benefits. For some, the risks posed by untreated depression outweigh the potential harm to an unborn baby from the drug. Speak again to your doctor if you find you can't come off sertraline very easily and ask them more questions about the risks if you become pregnant. 

Focus on the reason for wanting to stop the sertraline and that might get you through the difficult symptoms! SSRIs zap your sex drive as you said, so that's a positive thought straight away. 

Best of luck  

i was in the same position as you, i'm actually 8 weeks pregnant now and still taking my medication. my partner was the same, didn't want to start trying until i'd come off them, but sertraline is the safesty antidepressant on the market to take at the same time as trying to get or already being pregnant. i've spoken to 2 doctors and my midwife about it as i was just as concerned as you and all 3 of them were happy for me to stay on them, i had my booking appt at the hospital yesterday and they confirmed the same, they had absolutely no worries about it at all.  in fact they said that due to the sertaline being in my system for a good year already, there is only ever a risk if you have just started taking them medication as your body isn't used to it and it can cause issues for you  and your baby, but they said as long as i'm coping ok emotionally then you're baby will be coping well emotionally too and that is very very important during pregnancy. i hope that helps :-)