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Taking sertraline. Feeling dizzines, nauseous, vomiting, suicidal and no concept of time, place or space. What can be done?

Dec 2014
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Practicing since : 2007
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For countless years I have been taking Sertraline 150mg in AM and again 150mg in PM. Due to accidental screw-up at Pharmacy 5 weeks ago, I have been out of Sertraline and completely off it for 4.5 weeks. Dizzines, nauseous, vomiting, suicidal, no concept of time, place or space; can't mobilitate in a straight line; constantly falling and bashing my head. no coherence, cognitive skills, no memory. all the signs of suicidal ideation. have several psych problems. was on 12 heavy duty psych meds at high doses for long time - walking zombie. then got gorgeous long coat German Shepherd (3 years old at the time) and with a little professional help trained her to be my Psychiatric Service Dog. She is priceless - took completely away almost ALL of my psych problems, and is able to mitagate the remaining few before they actually occur. XXXXXXX is doing all she can to stay by my side where I can touch her back to help stay upright and walking in straight line. gained 20 pounds in that 4.5 week period. no energy to do anything physical. have to put Kota on treadmill cause i can't walk. can't drive in this condition. should i go back on the Sertraline or since I've been off it 4.5 weeks, am I thru the worst of the symptoms? (from those original 12 psych meds at high doses, since I got Kota, I am down to only 3 - and the Sertraline is the only 1 at a high dose. feel like going crazy - no concept of time, place, space. can't remember anything. am totally useless. without Kota, I'd have eaten the metal meal 2 weeks ago...oh, never mind, i just saw that this is a pay for service site - Kota & I live hand to mouth on Social Security Disability. Sorry to have wasted your time Dr Grief, but am glad you are there for people who can afford this site...

I have been experiencing MANY falls in my home - usually smashing my head on something hard, but only knocked out twice. Assuming this is due to the dizziness of the Sertraline withdrawal. I know a couple of these would be considered concussions like the one 2 days ago. My Psychiatric Service Dog is always right there - she paws at me to wake me up, then helps me get up and over to the sofa to lie down. She does this on her own. There have been several times when I remember falling, but don't remember HOW I got to the sofa. My magnificent Partner is incredible at what she figures out to do for me. Without her, and with my extensive Army & Law Enforcement background, I would have had the metal meal in a second. She is the only reason I am here. I just want to know if I should ask my Doc if I should continue this withdrawal to the end, or have to go back on the Sertraline.
Posted Tue, 4 Jun 2013 in Mental Health
Answered by Dr. Seikhoo Bishnoi 6 hours later
Welcome to Health Care Magic

First of all I would like to summarize your history and clinical situation. You are a 60 year old female and you are having history of breakdown in 1998 followed by development of PTSD, Severe depression, agoraphobia and social phobia. You are currently on Topiramate 50 mg, Dextroamphetamine 20 mg, Narco 10-325 for pain, clonazepam 2 mg daily, seroquel xr 800, temazepam 300, levothyroxine 100 umg, atenolol 100 mg per day. There is no significant known allergy.

You were taking Sertaline 150x2 mg per day but due to some situation at pharmacy you failed to get it and this resulted in symptoms like nausea, vomiting, dizziness, suicidal ideation, restlessness, loss of orientation to time and place, repeated falls, episodes of unconsciousness etc. Then you brought a German Shepherd and after that you started feeling better.

Now coming to management part. You have suffered severe serotonin withdrawal syndrome. It is a condition which occurred after SSRI antidepressants are stopped abruptly. You have mentioned that even now there is a lot of cognitive difficulties and episodes of fall. These are nothing but due to withdrawal only.
XXXXXXX is able to elevate your low mood, she is the reason that your psychiatric symptoms have improved but still cognitive and nervous symptoms are persisting and these symptoms should not be ignored. I would like to advise you to please visit your Psychiatrist again and take opinion regarding the episodes of falls. Get your BP checked to rule out any hypotension. Second thing, get your EEG done to rule out any seizure episode.

You are on multiple medicines for possible Bipolar disorder and abrupt discontinuation of a SSRI may just precipitate withdrawal in acute stage but it can result in relapse of severe depressive symptoms. Second thing as you are in withdrawal you can start Sertaline again with 50 mg twice a day and then after about 2 weeks you can start gradually tapering it.

Hope it helps you, you can ask again for any follow up questions.

Dr. Seikhoo Bishnoi, MD
Above answer was peer-reviewed by
Follow-up: Taking sertraline. Feeling dizzines, nauseous, vomiting, suicidal and no concept of time, place or space. What can be done? 10 hours later
Dr. Bishnoi,
Just to clarify: I have never been Dx'd as Bi-Polar, just the other things I mentioned (PTSD/MST/Severe Social Phobia/Chronic Severe Depression/ Agoraphobia) plus a couple minor others like nightmares & night terrors. And I got my wonderful XXXXXXX 3 years ago and she turned out to be one of those rare dogs that can sense chemical changes not only in the body but in the brain - thus she can take what were originally her natural actions to those changes and then I shaped them into behaviors that best suited me, especially for out in public. XXXXXXX has/had removed every psych issue I had, except PTSD/MST (for which there is really no cure) - all the rest were gone due to her. Some of them have returned - as a result of the Sertraline withdrawal as you pointed out. Now I know what the problem is - I'm not going crazy! Having gone thru such horrid withdrawal symptoms for this long, and now your reassuring me that my symptoms are indeed from the withdrawal, I believe that with Kota at my side I can get thru the rest of the symptoms until they end. It was incredibly reassuring to know that I was NOT going crazy, and that all the weird things that were happening to me were due to the withdrawal. Taking Seroquel XR should be able to fill in the gap of my staying off Sertraline - maybe - I will ask my doctors.

Both my BP & thyroid are under control with Atenolol & Levothyroxine & are checked regularly. On May 23, I am scheduled for: Stroke/Carotid Artery Screening; Heart Rhythm Screening (Atrial Fibrillation); Peripheral Arterial Disease Screening; and a 6-pack that includes measuring risk for Stroke, Diabetes, Coronary Heart Disease, Congestive Heart Failure, COPD, lung cancer, good/bad cholesterol, glucose levels, and body mass index.

I am scheduled to see my PCP in a month for my yearly physical where she always refers me for an extensive blood work-up, along with the blood tests my psych Doc requests & those my Oncologist needs, but she only prescribes the Atenolol. I am next scheduled to see the Doc that handles my psych issues and meds in 2 weeks. It is almost impossible to get ahold of him outside of an appointment, and there are none available prior to the one I have.

So armed with your information, I am going to attempt contact with both of them by email ASAP and see if they also agree about having to go back on the Sertraline. Dr. Bishnoi, I am tired of putting pills & chemicals in my body. Some, like the Seroquel XR that help me relax enough to sleep & stay asleep, the Clonazepam for emergencies, and the Atenolol & Levothyroxine, I know are needed. But XXXXXXX has mitigated the use of all the others & I want off them - like currently tapering off the Topiramate from 200mg AM/PM to currently 50mg AM only & tomorrow I stop it completely. (This is with Doctor approval & oversight - XXXXXXX alerts to my oncoming migraines - so that I can prepare a dark room and my music & lie down with her for about 30 minutes, then I can get up & go, migraine free.) I have only had 2 horrible migraines in 2 years, thanks to Kota's warnings, where before, I would have them a couple times a week, many lasting several days. That's why I was put on the Topiramate in the first place. It did help cut down the # of migraines I had a little, but was basically useless.

Dr. Bishnoi, with this extra info, what is your opinion now of my staying OFF Sertraline? The less chemicals I have in my body, the better I feel, and along with Kota's actions, I function MUCH better in all areas of my life. I don't want to be a walking zombie when I truly believe that I don't have to. That's why I got and trained XXXXXXX for in the first place. Her actions in front of my Doc had caused him to slowly wean me off many meds. But then I had the spinal problems and more meds were added & others had their dosages upped.

Yeah, I may be 60, but act like I'm 16. After the first spinal procedure, an awesome amount of indescribable pain was taken away that I had lived with for years and had kept escalating. I got to start walking XXXXXXX every day, twice a day, regardless of weather (yay California!) for a minimum of 1 1/2 miles each time. Now I can barely walk at all. But I am strong INSIDE & know I can handle this withdrawal with Dakota's help, now that I KNOW just WHY/WHAT is happening. (Poor Kota is quite confused - she KNOWS there is something wrong with my body, by the changes in my physiology and brain chemistry. But she hasn't yet ever dealt with this type of radical change and the only thing she can think of right now is to force me to the sofa, lie along side me, and keep me safe & pain-free there.)

I hope you don't mind reading this additional info. I know my mind is really messed up right now and I probably am not making a lot of sense. But I really do want to get off the Sertraline since I've come this far & would like to know if anything here changes your mind about my restarting to take it.

Thank you SO MUCH Dr. Bishnoi, for your participation in this website to help people like me. Your services are invaluable, and I am taking your advice to heart. Thanks again Doctor for helping me - things are better already now that I KNOW what' happening to my body. Dr. Bishnoi, I send to you & your loved ones love, XXXXXXX peace, health, wealth, and all you need as you so richly deserve.
Deb & Kota
"A true friend is someone who sees the pain in your eyes,
while everyone else believes the SMILE on your face"

(PS: A personal question Doctor. Are you Muslim? The reason I ask is that when I am complimenting you on the doctor review thingie, I would want to refer to you/your name properly.)
Answered by Dr. Seikhoo Bishnoi 43 minutes later
Hello again

I have read your history again and I want to tell you that the serotonin withdrawal syndrome is not a minor thing. It is considered as medical emergency but as few weeks have passed already so there is no need to panic because acute stage has passed. You are having problems of imbalance, not able to walk properly, disturbed daily routine and these may impart long term effects on your health. You have mentioned earlier also, you were doing good in terms of behavior and mood and you want to come off medicines, so if you dont want to take sertaline then there is no harm. But you are having history of falls and dizziness so I would like to advise you again that, most likely they are due to serotonin withdrawal but we have to rule out other possibilities also like seizure or syncope (though chances are rare). This is the reason I was advising you to consult your Psychiatrist.

On the basis of medicines I assumed that probably it was bipolar as not detailed medical history was there. It was mistake on my part.

For PTSD, I want to tell you that though it is difficult to treat with medicines but with non-medicinal treatment like Progressive Muscle Relaxation Exercise, Breathing Exercises followed by Behavior Therapy. The relaxation exercises will help you to remain calm and relaxed. Once you learn to relax yourself then under controlled condition you can control your PTSD symptoms. You have to visit a Psychologist for that. In my experience these methods have proven results.

Try to get on your daily routine as soon as possible.
You dont want to take medicines so you can try Omega-3 Fatty Acid XXXXXXX foods like Walnuts, flax seeds, fish as Sardine, Salmon etc. These substances help in improving mood.
Regarding your question I am not from Muslim religion, but want to say you that a doctor always wants to help his/her patient regardless to any religion. :)

Hope it helps you, if you have more question you can ask again.
Wish you a good health
Dr. Seikhoo Bishnoi, MD
Above answer was peer-reviewed by
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