Sertraline reduced by nurse

[minianonymouse]

So I’ve been on sertraline 100mg for 9 years with no problems.
my latest review, the mental health nurse told me that the max I should have been on it is 2 years (even though I get a yearly review)
she cut me down to 50mg and said that like a diabetic that has to alter their diet, I need to learn to take responsibility 🙁 she also said I was at a greater risk of dementia which I’ve tried to research but there’s not much evidence of this.
she mentioned CBT (but didn’t actually offer this) which I’ve had in the past and it didn’t help.
that was a week ago and today my mood has really dipped-is this withdrawal and it might go away?
I can’t face going back to how I felt before I started sertraline, I’ve been bothered with mental health issues my whole adult life and I honestly thought I could stay on this medication forever 😞

Get a GP appointment, explain that 100mg is the dose that is effective for you and ask for it to be reinstated. The nurse was wrong to speak to you the way she did.

Please back to your normal dose snd speak to a GP, that’s a terrible way to talk to you and I suspect is acting in isolation, ignore, feel better and then report.

That seems a really strange thing for the MH nurse to say and do.
100mg isn’t even a high dose of Sertraline and it is used by millions of people so I doubt there is a proven increased risk of dementia.
Have you been struggling with your MH recently as it seems particularly strange to reduce the dose if you were stable on it?

It’s mostly nurses that carry out the medication reviews in my practice. There’s an asthma nurse, mental health nurse and so on

She’s out of line - just make an appt with your GP, get it put up - 100 is a normal dose.

It is of course a good idea you try CBT etc, but do that while you’re getting your dose, and then try reducing

There’s a study that suggests SSRs may speed up dementia once you have it (although it’s unclear - it might just been more people with dementia are on SSRs because they are depressed) but I don’t think there’s any link established so far with SSRs in earlier life and getting dementia later

I would also complain about her - this sounds beyond what a nurse practitioner should do.

I thought so too but I was so taken aback I agreed to reduce.
My MH has been stable for years, I’ve tried to reduce a few times in the past and it always ends up like this.
I thought maybe they had new guidelines about dementia risk but when I looked it up I couldn’t find anything.

Surely you don’t have to accept a medication alteration that’s not recommended by an actual psychiatrist, or at least at GP? Madness.

Also a reduction of 50mg in one go is too harsh, even if you should be reducing. 25mg increments up and down is much more normal when dealing with people who are actually qualified.

I think you need to go and have a conversation with your GP. I’m really sorry that you’re going through this

That's awful. I've had reviews with a nurse but they've been really sympathetic. I've thought of coming off occasionally but I still struggle with low mood and it helps enormously.
I hadn't heard about the dementia risk but I'm not too concerned. Some of my symptoms before starting the meds were as bad as I imagine early stages of dementia can be , severe brain fog, erratic moods, struggling with normal tasks so it considerably improves daily life for me. I guess it's worth it for me for now.

Loads of people are on Sertraline 100mg for years!

Plus withdrawing from SSRIs is difficult and needs support and careful thought and small increments - not just telling someone it's been two years and to get over it.

I had a medication review from a pharmacy technician at my surgery who wanted to change all sorts. I ended up hanging up on them and booking an appointment with an actual doctor who agreed the tech had been over-reaching and dealt with it.

You need to see your actual GP and have an informed, mutual conversation about this and go back on 100mg

Get a second opinion - see a GP. My Aunt was taken off some of her Parkinson’s medication once because a nurse thought she knew better than my Aunt’s consultant. As you can imagine - it did not go well and it took a while to get it sorted. Good luck.

Ask to see a GP, and do some research of your own. 9 years is a long time and she may have a point about reduction but it needs doing properly

I once had a doctor say I should come off meds because I'd been on them a long time (maybe 8 years at the time) I just said absolutely not and she dropped it. No other doctor has tried to have me come off, some even say some people need them for life.. I'd imagine I'm one of them. I did 15 years brilliantly on citalopram I'm only struggling now because they finally stopped working for me and I can't increase them anymore, so had to change ssri. In my mind I'd rather be stable and not crazy now, and take the risk later on!

Yeah, I think it’s likely you’ll need to go back to 100mg. 75mg might work, that’d be nice. But they do say that 100mg is, more often than not, the sweet spot with sertraline

I am not a GP or psychiatrist.

But:

1. BNF (UK formulary) says maintenance dose of Setraline is 50mg - a maximum of 200mg/ day. There is no statement in there about how long it can be taken for.

The NICE guidelines on Depression say that antidepressants should be continued to prevent relapse at the dose that was effective

They also say that medication should be tapered off especially after long durations of use to minimise withdrawal.

I don't think a sudden reduction from 100mg to 50mg meets this requirement.

If I were you I would in the first instance request an urgent appointment with a GP.

If you can't get one I would submit a complaint continuing the following points asking for answers and advice about best to move forwards as you believe yourself to be at high risk of your depression and due to the lack of tapering regime Sertraline withdrawal.

NICE resource is here: https://cks.nice.org.uk/topics/depression/management/ongoing-management/#:~:text=Possible%20risks%20of%20continuing%20antidepressants,of%20symptoms%2C%20to%20prevent%20relapse.

Thankyou so much for all the replies. I feel better already reading them.
im going to book an appointment with a GP and ask to be put back up.

I agree with everything that’s been said I was just so taken aback with the nurses words even though they were delivered in a kindly tone.
I could even understand if it was an expensive drug, but it’s not.

I’ve had CBT and psychiatric care in the past and this is the only thing that’s worked for me.
I was actually told by another nurse at a previous review that I could stay on it as long as I wanted and just let them know if I wanted to try and reduce so it was all very confusing.

I did think drawing a parallel between a diabetic reducing sugar and someone with mental health problems was unfair. Especially coming from a supposed mental health professional.

The diabetes analogy is bizarre. I actually think it's more like telling a type 1 diabetic to change their insulin regime so that their immune system can 'take responsibility'. Both clinically wrong and outright dangerous!

It also has echoes of the 'just pull yourself together' school of medicine.

Surely recognising that you need help, seeking it out/accepting it, taking your prescribed medication and maintaining good mental health IS taking responsibility?!

She sounds like she sees medication as a weakness, or a dependency you need to wean yourself off.

We're still a long way from parity of esteem if this remains the approach of some medical professionals.

I actually think you should make a complaint against this nurse as she is acting completely inappropriately and it is dangerous.
Whenever I mention my desire to come off my AD my psychiatrist is firmly against it and says why would you ever come off it if it is working,

Totally wrong! I was on 150mg for over 10 years. It eventually stopped working for me (sometimes it happens with SSRIs) and I got moved onto something else, but I was happy on the sertraline and quite keen to stay on it for life.

hope you get things sorted!

I’ve contacted the GP about going back up, I also checked and the nurse I spoke to is not a mental health nurse, she is an RGN. There are no RMN in the surgery at all

I think you need to write to the Practice Manager. This is really concerning and she needs urgent retraining (autocorrect tried to turn that into 'restraining', which may actually be more accurate!).