How to Taper off Anxiety Meds Without Withdrawals
Stopping anxiety meds can trigger miserable withdrawal symptoms. I began taking Zoloft (sertraline) four years ago for anxiety. After one failed attempt to discontinue it I realized the powerful effects anxiety meds have on the brain. It took me over a year to get the courage to try again. If you suffer from anxiety, whether your medicated or not, I hope my story gives you hope that you can successfully taper off anxiety meds. At the very least I hope it prevents the hellish experience I had.
Anxiety Felt Like…
I’ve suffered from anxiety for about 10 years, probably longer if I’m being honest. As anyone who suffers from anxiety knows, it can take many forms. For me, anxiety felt like impatience, restlessness, and at times irritability. Generally, I just felt like the world was moving too slow for me and people were too laid back. While anxiety made me annoyed with the world around me, it also gave me tremendous energy. Sometimes productive energy, sometimes in the form of restlessness. When I was younger I purged that energy on the soccer field. In college, I make the dean’s list and worked full-time most semesters, while working out almost every day. That energy also helped me get my graduate degree while working full-time and raising two kids.
I was a workaholic and a proud supermom. I cooked from scratch, kept an immaculate house, worked full-time, hosted cookouts, kept myself in perfect shape, and managed the schedule of two competitive athletes (my kids). By society’s standards, I was winning. From breakfast to the moment my head hit the pillow, my brain was running a thousand miles an hour. I was doing more than most of my colleagues, many other moms, and anyone I was friends with at the time. My hyper-productivity was a source of pride and I was routinely confused why people didn’t get more done. Little did I know it would also be my downfall.
While my hyperproductive world looked amazing on the outside, the fortress was crumbling on the inside. Sleep became more and more fleeting. At first sleepless nights were occasional, maybe a few nights a month. After a few months, they became persistent. I started going two or three nights without sleeping at all. I was tired, but restless at the same time. I tried Ambien but it gave me super weird, vivid dreams.
Looking back now I think the insomnia was my warning shot. I didn’t realize it at the time and had no idea that things could get much worse.
It was at the peak of this insomnia that I began to lose vision in my left eye. It started with a dull aching sensation with movement. At first, I thought it was allergies but over the course of three days, my vision gradually deteriorated and I realized it was something more. By the fourth day, I had lost almost all vision in my eye which prompted me to schedule an appointment with an eye doctor.
It was a Friday afternoon and I only got a last minute appointment because my uncle is a prestigious eye surgeon. A quick exam resulted in an urgent MRI scan and a diagnosis of Optic Neuritis, an attack on my optic nerve. I left that evening with a prescription for Solu- Medrol (strong steroid) and a referral to a neurologist who specializes in Multiple Sclerosis. As I drove home through traffic that Friday night, barely able to see, I realized that my life was about to change forever.
A few weeks and dozens of tests later, I was diagnosed with Multiple Sclerosis. It turned out that my body had attacked my optic nerve. Even more concerning, there was evidence on the MRI of previous MS activity in my brain, in the form of lesions.
The neurologist who broke the news to me explained that the onset of MS often happens during stressful events or periods. She encouraged me to do everything possible to reduce stress to prevent further, and more serious progression of the disease.
After hearing about the insomnia, she insisted I see a sleep specialist and immediately begin immune-modulating therapy. Within weeks of the first vision disturbance, I was giving myself shots three times a week to prevent my immune system from attacking my nerves and taking potent sleep medication to sleep.
Although I eventually regained vision in my eye and got my sleep under control, the diagnosis was a wake-up call. I obviously needed to get a handle on my anxiety and take a break from the chaotic life I created.
That began a process of self-reflection and stress management that would take me a divorce, career change, and relocation with my kids to accomplish. It also took anxiety medication. My brain was like an untamed racehorse. It could outpace many people in my life but at the expense of my peace, sanity, and ultimately health. I began treatment with Zoloft.
Zoloft Feels Like…
For me, the Zoloft slowed my brain down. It numbed emotions slightly and helped me think through issues one at a time, rather than all at once. Along with improvements to my sleep habits, it also helped me sleep better. Overall it just calmed me down, a lot. In general, the highs of life were a little lower and the lows were less extreme.
I was able to think very pragmatically about decisions and put myself and my kids’ best interests ahead of anything else. I could evaluate one problem at a time, rather than thinking about a thousand things at once. In many ways, the correction was very helpful in making the necessary changes.
Why I decided to Taper off Anxiety Meds
You might wonder why I wanted to come off Zoloft if it helped me in so many ways. The truth is, after three years and a lot of changes, I just wanted to feel again. I missed the highs of life and felt strong enough to handle the lows. I wanted the energy and stamina I had before Zoloft. My life looked completely different and many of the previous stressors had been resolved. I truly felt that the challenges that remained were manageable.
I had changed my diet completely, was living in a beautiful place, working at a great job, and overall happier and healthier than I’d been since I could remember. I lost 15 lbs and was eating almost purely keto, fasting most days until lunch, working out regularly, and practicing Yoga.
I began toying with the idea of quitting Zoloft based on how balanced and healthy I felt. I had no idea it would be such an ordeal. A week later I was in the throes of full-blown withdrawal.
My First Try at Stopping Zoloft
The first time I tried to quit Zoloft was after two days of forgetting to take it. Once I realized I’d forgotten two days in a row, I decided I would just stop taking it for good. I figured I would have some effects from stopping it, but I assumed the worst case would be a return of the anxiety symptoms. I was very wrong.
Little did I know, the first two days were the easiest and the symptoms would rapidly and furiously ramp up over several weeks far beyond anything I’d experienced before.
What does Withdrawal Feel Like?
By the third day without any Zoloft, I was feeling tearful all day, even though that wasn’t a symptom that I’d had before. I was experiencing weird electric shock sensations, also described as ‘brain zaps’. By day four they were nearly continuous. I also felt so off-balance that I almost tripped several times a day. I wasn’t sleeping and felt both restless and exhausted all day.
Although I felt defeated, I was relieved that my symptoms, which had become overwhelming, would go away. I wrongly assumed that once I resumed taking the medication I would go back to normal. After a week the withdrawal symptoms were still there. They were less profound but still persistent throughout the day and I was tearful all the time.
Realizing I was in over my head and desperate for relief, I scheduled an appointment with my doctor. I sat in the exam room nearly in tears explaining what I was experiencing. The medical student who did the first interview explained that gradual tapering is required to stop Zoloft and abrupt discontinuation is dangerous.
When the doctor came in he confirmed that I was experiencing discontinuation syndrome. Worse yet, he said it might take a few weeks for the medication to fully take effect. Since the symptoms were so severe, he recommended we actually increase the dose to get things under control sooner.
That’s how I ended up increasing from a 25mg dose to a 50 mg dose. It was the exact opposite of what I hoped would happen when I tried to stop taper off anxiety meds in the first place.
Although I felt defeated, I was grateful when the fog started to lift, the symptoms gradually receded and within a week I felt back to normal. I felt like I failed. I also felt dependent on the medication long term. It was such an awful experience it would be a full year before I even considered coming off again.
Stopping Zoloft Safely
While there are many different protocols, one thing everyone agrees on is you need to taper off anxiety meds gradually. I wish I’d know that the first time I tried.
Tapering is a gradual reduction of medication over time. The process is designed to reduce withdrawal effects and give your brain time to adjust. Without proper tapering, withdrawal symptoms can include:
- Insomnia or vivid dreams
- Flu-like symptoms, including achy muscles and chills
- Electric shock sensations
- Return of depression symptoms
New Doctor, New Perspective
A full year later I was seeing a new doctor. During my routine annual exam, she did a thorough history and ordered pretty extensive bloodwork. She asked about the Zoloft and I explained the anxiety and how I’d tried to come of it once, unsuccessfully. She then went on to explain how and why she thought I could consider stopping it again. She raised some interesting points
- Gene Variant. I may have a gene variant that makes me more predisposed to anxiety. With proper adjustments to diet and supplements, I could reduce that effect. I would have to take ownership of my tendency towards anxiety and develop other coping strategies.
- Alcohol. I shouldn’t be drinking alcohol while taking Zoloft… oops. I love a glass of red wine now and then, this was almost enough of a reason to try again reason by itself 😉
- Tolerance. It probably isn’t doing much to impact the anxiety after 4 years.
Sure enough, when the blood work came back, her instincts were confirmed, I was homozygous for the MTHFR gene variant. Read more about MTHFR and how common it is in my recent article, New Data, MTHFR Gene Variant May Increase Sensitivity to Toxins.
I decided in that moment, that with this doctor, her tough love, and this new information I could successfully taper off my anxiety meds, once and for all. That appointment changed everything. I felt like a teenager who lost their car keys four years ago for speeding but was about to get them back.
My doctor emphasized the need for tapering slowly. She prescribed 25mg pills so I could split them easily at home. The tapering protocol she recommended is below along with another method, and what I actually ended up doing.
I have to emphasize how important it is to work with a doctor on this. I’m stubborn, and impatient and have an inflated confidence in my ability to endure discomfort. That said, discontinuation syndrome is real and can be dangerous for some people.
3 Ways to Taper off Anxiety Meds
I’m going to give you three scenarios here with a strong emphasis on seeking medical advice with this process. Factors like how long you’ve been taking the medications, other medications you’re taking, original symptoms, genetics, and lifestyle can all play a factor in the recommendation. This isn’t something to play with or take personal liberty with… it can be very scary when the withdrawal symptoms get out of control. To successfully taper off anxiety meds you need a (1) doctor, (2) supportive strategies, and a (3) proper tapering protocol.
Doctor Advised Zoloft Tapering Protocol
My new doctor recommended I wait until after the holidays when life was a little less stressful and more routine to taper off my anxiety meds. Based on my previous discontinuation symptoms, she recommended the following slow, 4-month tapering schedule with a re-evaluation at month 3.
- Month 1 – Alternate 25mg with 50 mg tablet daily
- Month 2 – 25 mg daily
- Month 3 – Alternate 25mg with 12.5mg daily
While I trust my new doctor, I was still scared of the withdrawal symptoms so I did a little more research. I found a company out of the Netherlands, Tapering Strips Worldwide, that’s done extensive research on discontinuation syndrome from a variety of medications.
This company recommends a very specific protocol to taper off anxiety meds with slight and very gradual dosage reductions over time. These gradual reductions are smaller and more specific than what you can do at home by splitting pills. They have ‘tapering strips’ with each pill labeled by day. According to their protocol, tapering of 50mg dose of Zoloft would take only 28 days.
Tapering Strips require a prescription from your doctor but can ship worldwide. As it’s an international company, my doctor wasn’t familiar and also didn’t know what insurance coverage would look like. She agreed to review the information I shared and get back to me after the holidays when my tapering should begin. I was interested if I could really taper off in 28 days… which sounded amazing. Little did I know I would taper down on my own before she had a chance.
My Tapering Plan
It was Christmas break and I was psyched about a long-awaited trip to the mountains with my boyfriend. A few days before we were set to leave we got notice that there had been a terrible storm that knocked out power and access to the Airbnb we booked. No hot tub, no mountains… no vacation.
We debated going somewhere else, but as total pragmatists, we decided a staycation would be better than a last-minute, hastily planned trip during COVID.
I discussed it with my boyfriend and although it was literally the opposite of a weeklong relaxing vacation, he agreed that it would be a good time since we were together, without kiddos, off work and we had very little responsibility. We decided that after the kids left on Christmas we would start the process.
I’m going to share with you how I did it, how long it took and how it felt with the reminder that YOU NEED MEDICAL SUPPORT AND ADVICE for this process. I had an incredibly supportive boyfriend willing to walk with me through it, but I took a risk. This is not meant to be a recommendation for how YOU should taper off anxiety meds. It could be something you share with your doctor for discussion.
How I did It
I already had 25 mg pills instead of my 50 mg pills in preparation to taper after the holidays per my doctor’s plan. That made it easier to decrease the dose since cutting a 50 mg pill into tiny doses would have been difficult. Here’s what I did…
Day 1 – approx 37.5 mg (one 25mg pill, one half 25 mg pill I cut in half)
Day 2 – 25 mg
Day 3 – 12.5 mg (one 25 mg dose cut in half)
Day 4 – approx 6mg (rough estimate, I tried to get about 1/4 of the 25mg pill)
Day 5- approx 4 mg (rough estimate, cut off just the very edge of the 25 mg pill)
Day 6 – nothing
During the tapering process, my withdrawal symptoms ramped up and were the worst on days 5-10. The primary symptoms I experienced during the tapering period were brain zaps, mild anxiousness, irritability, and some balance issues.
I never felt tearful, overwhelmed, or like I couldn’t handle it. That said a few days were rough and thanks to my BF I just endured them and didn’t get discouraged.
Today, on day 11 I woke up full of almost boundless energy, and other than a few passing brain zap sensations, I feel free of the withdrawal effects.
I truly attribute my success to the secret weapons I list below. I was off work, with a trusted partner and neither of my kids was home which reduced my normal responsibilities dramatically. Without these unique circumstances, I’m not sure I could have done it so much quicker than either of the other tapering protocols recommended.
My Secret Weapons for Tapering of Zoloft
Several things fell into place beautifully the week of Christmas. Please don’t beat yourself up if you can’t do all of these things, just figure out what you can do. Whatever you decide, the goal is to reduce stress and increase comfort during the transition.
Loosen up on things requiring willpower – I’m normally pretty rigid on my keto diet, fasting, exercise routine, and alcohol consumption. During the tapering period, I ate whenever and whatever my body was craving. I enjoyed a glass of wine or two each night. Basically, I cut myself some slack and didn’t hold myself to my normal high standards of diet and exercise.
When my body is under stress, things requiring willpower can trigger me to feel anxious. By releasing that pressure I was able to relax and use some of these things for comfort. **BTW, my doctor explicitly told me not to drink while taking Zoloft, please note that it may not be a healthy choice:)
Exercise with moderation – For the most part, exercise is relaxing to me. I’ve always used it as a stress reliever. When I felt up to it I went to the gym or worked out at home. I kept the workouts short and focused more on movement and stretching than heavy lifting.
Lean on Supportive People – I have never felt ashamed of taking Zoloft for anxiety but it wasn’t something I shared with many people. That said, having someone like my boyfriend who expressed unconditional support and zero judgment during this period was so important.
He was patient and allowed me to work through the symptoms without over-analyzing each one… just letting them pass like labor pains in childbirth. That chill, supportive approach made me totally at peace with sharing the symptoms as they arose and celebrating when they ended. I’ll always be thankful that he was there with me throughout this process 💕
Sauna and cold pool – Many of you already know I’m a huge fan of cold therapy and sauna. Spending time in these environments during the week was calming and helped interrupt symptoms when they were near-continuous.
The sauna also helped me sweat out the wine 😅 🍷
The cold pool stopped the brain ‘zaps’ immediately. I would spend 15-20 mins in there any by the time I got out my brain was reset and calm. The effect lasted a few hours. I used my box breathing app in there which probably contributed to the calming effects of the cold water.
Reduce Responsibilities – It sounds like a terrible reason to take time off work but it can be super helpful. Not having the mental burdens of work while my brain was adjusting was key.
It gradually builds up over several days and can peak around the end of the first week for some people. Time off to taper off anxiety meds can really be classified as sick time if you’re trying to bank vacation days:)
Supplements – As part of my first evaluation with my new doctor, she identified a gene variant that might be contributing to my anxiety. She then recommended specific supplements to support that mutation.
I was diligent about taking them during the transition. Keep in mind, these were prescribed for me, by my doctor. Talk with your doctor about which supplements might be helpful to you, based on your blood work and needs.
I believe they were essential support to taper off my anxiety meds, especially the magnesium.
Box Breathing – I’m a huge fan of the box breathing technique. During times where my symptoms were particularly intense, I used this breathing app to reset my autonomic responses and regain control of my breathing, heart rate, and mental state. It’s a technique used by Navy Seals and surprisingly easy to learn.
Sleep Support – The one withdrawal symptom I was the most concerned about was insomnia since I’ve suffered from chronic insomnia in the past. To help make sure I was sleeping I had a few tools on deck…
- Lunesta – I’ve taken Lunesta occasionally in the past for sleepless nights. Fearful of dependence I only take it very rarely. That said, during this period my bottle of Lunesta sat on my nightstand. I never needed it but I was glad it was there just in case.
- Essential Oil Diffuser – I use this daily anyway, but it was especially calming transitioning into a more relaxed state each night. The diffuser I have isn’t fancy, I think I got it at my local grocery store. The essential oil was from Target and it worked just as good as some of the more expensive oils I’ve used in the past.
- Weighted Eye Pillow – This is another staple in my sleep routine. It puts just enough pressure on my eyes, which ache when I’m tired, and blocks out all light. It’s lavender scented and has a washable cover on it.
Fidget toys – In a past life, I was a teacher and kept these little toys close by for my ADHD students. When you’re anxious they’re super calming. Here’s my favorite one… we all fight over it:)
Short term vs Long Term Weapons
I had this article written and ready to publish yesterday when my boyfriend asked me a very good question,
‘How are you planning on handling stress and anxiety without the medication?’
Damn it, hadn’t really thought that far ahead. I was so concerned with avoiding discontinuation symptoms that I hadn’t thought about life after the tapering process.
I hadn’t thought much about a recurrence of the anxiety and hyper energy issues I’d had in the past. More energy seemed great, but knowing that it had gotten out of control in the past was something that hit me light a ton of bricks.
After giving it some thought I realized that basically, I want the benefits of the extra energy without the restlessness, sleeplessness, and other symptoms. In order to do that, I had to give some thought to supportive, long-term strategies that calm the brain and allow the body to purge energy when needed.
Things to Keep doing…
Some of the strategies I used during the tapering period are useful long term. Other things like my keto diet are already well established and endorsed by my doctor as helpful. I guess you could consider this list a ‘keep doing’ list…
- Box Breathing
- Sleep Support (as needed)
- Sauna and cold pool
- Keto Carnivore-ish diet
Some things are new strategies that I think would be helpful in managing my anxiety. A few are new, others are just things I need to tweak like what time I exercise each day.
- Exercise first thing in the morning. I already have a really consistent exercise routine and usually exercise in the morning, but not always. I’ve found that a good sweat purges some of the restless energy and excitement that hits me in the face every morning. My normal routine is 20 mins strength training, 5 min cardio burst, 10 mins abs and core, 5 mins stretching. Read about my workouts.
- Resume Yoga. I used to teach Yoga actually. I’m a long way removed from those days but even a short Yoga practice one a week calms my mind and body for days. My favorite Yoga apps are Down Dog and Yoga Studio but I’m sure there are others. It’s been a while since I’ve practiced and the apps change quickly. I think all of them have free trials now. I can say that Down Dog gave me a scholarship years ago when I couldn’t justify such luxuries… I’ll never forget that gesture:)
- Marinate in a New Perspective. This book came to me through my IG feed… and it’s been the best book I’ve read on stress or mindfulness. I totally geek out on new perspectives on old challenges and this book doesn’t disappoint.
Before I leave the topic of how to taper off anxiety meds, I want to share with you my general, heartfelt sentiments about anti-anxiety and anti-depressant medications. I want to be very clear… when I was prescribed these medications I was in need of support. I didn’t have the ‘secret weapons’ in place and it was a very stressful time in my life, for a lot of reasons.
I’m grateful they were there when I needed them and I’m even more grateful that some of the other coping strategies I’ve learned over the last 4 years may reduce my dependence on them.
That said, if there comes a point where my anxiety is overwhelming again I would consider medications again. At the end of the day, it’s about being a great mom, a great partner, and a great colleague at work. I’m not too proud to admit when I need help or too arrogant to think my limited understanding of the human body supersedes a physician’s expertise. I think that together, modern medicine and functional medicine can co-exist.
Don’t feel ashamed for need medication, don’t try to taper off anxiety meds without (1) talking to your doctor, (2) putting supportive strategies in place, and (3) making sure you’re open to resuming them if you’re not ok. There is no judgment here. Love you guys!