Tapering Imipramine

[DebK]

I am going off 100 mg Imipramine to then try Sertraline @ 25mg to start.  My doc has me doing every other day for tapering and I have only done this for one week and feel some anxiety side effects.  Eventually I will do 50 mg and she really is wanting this to be very very slow.  I guess I want to hear experiences from others on getting off Imipramine for an SSRI.  Thanks.

[mikl_pls]

I've gone to and from TCAs and SSRIs/SNRIs before. It seems like you may need a cross-taper schedule for the imipramine and sertraline. For example, start low on sertraline while at the same time taking a slightly lower dose of imipramine.

An example would be something like this (please note that I am not a doctor and this is just an example of what could be done):

• Weeks 1-2: imipramine 75 mg + sertraline 25 mg
• Weeks 3-4: imipramine 50 mg + sertraline 50 mg
• Weeks 5-6: imipramine 25 mg + sertraline 75 mg
• Week 7 and on: discontinue imipramine + sertraline 100 mg

That would be something along the lines of what my pdoc would do for me.

[DebK]

Thanks for your reply and suggestions.  At this time,, after finally speaking to my pdoc who is marginally helpful, I am off the Imipramine and on the Sertraline.  Not feeling particularly well, some headache and nausea, but thankfully the Sertraline is low dose.  I even decided on my own to cut in half and take 12mg for a week then up to the 25mg. I very likely feeling some withdrawal from Imipramine,  it this is hard to decipher.  I am trying to move forward and hope for good results with Sertraline.  Pdoc has given me no idea when or if I will take a larger dose.  I think it is time to find another doctor.

[mikl_pls]

4 hours ago, DebK said:

Thanks for your reply and suggestions.  At this time,, after finally speaking to my pdoc who is marginally helpful, I am off the Imipramine and on the Sertraline.  Not feeling particularly well, some headache and nausea, but thankfully the Sertraline is low dose.  I even decided on my own to cut in half and take 12mg for a week then up to the 25mg. I very likely feeling some withdrawal from Imipramine,  it this is hard to decipher.  I am trying to move forward and hope for good results with Sertraline.  Pdoc has given me no idea when or if I will take a larger dose.  I think it is time to find another doctor.

Glad to hear that you successfully transitioned to sertraline! Sorry for the late response, I thought I'd go ahead and respond anyway since no one else had.

That was a good idea to split the 25 mg tablet in half at first, that's very often what needs to be done at first if it can be done (i.e., sometimes you can't what with the medicine being in capsules, like with Cymbalta or Effexor, so you have to be prescribed twice as much of a smaller dose in case there's tolerance issues at the intended starting dose). I loved Zoloft, it worked very well for me for a few years, but as with all antidepressants for me, it kinda pooped out. I know that I can go back to it though if I need to try something I know will work, but I suppose I need to give it a good break before I go back to it.

Yes, that does sound like imipramine withdrawal to me, very similar to side effects I've experienced withdrawing from similar antidepressants.

I think your pdoc may be trying to establish the lowest effective dose for you. You may not need to go up in dosage right away, but if those withdrawal effects last for a while, you may wish to increase your sertraline (which of course you should always discuss with your pdoc first before doing). If you get to a high dosage acutely, and then start feeling better, sometimes they will cut the dosage down towards a lower maintenance dose. For example, if you made it to 150 mg acutely, you may be able to get by with 75-100 mg for maintenance, or even lower. Everyone is different.

Typically sertraline is dosed in the morning; however, for some, it is sedating and thus should be dosed at bedtime. When I took sertraline, it felt very stimulating, so I took it in the AM.

[DebK]

This is helping me.  I have taken the Sertraline at night, but it could be interfering with my REM.  I am waking up and not feeling very rested. That only adds to my yuckiness. Maybe I will start tomorrow in a.m. as it is too late in the day now to switch over now.

[mikl_pls]

2 hours ago, DebK said:

This is helping me.  I have taken the Sertraline at night, but it could be interfering with my REM.  I am waking up and not feeling very rested. That only adds to my yuckiness. Maybe I will start tomorrow in a.m. as it is too late in the day now to switch over now.

It might be best to ask your pdoc about when to take it before switching over.

Yes, almost all antidepressants can decrease REM sleep, but this occurs regardless of whether you take it in the AM or PM.

If you have issues with sleeping, there's an antidepressant that they can add to your regimen called trazodone (Desyrel) which can help improve quality of sleep.