What should a patient do who has been off sertraline (selective serotonin reuptake inhibitor) for 5 days and wants to stop taking it?

What to Do After 5 Days Off Sertraline

If you have already been off sertraline for 5 days and want to stop permanently, continue to stay off the medication and monitor for withdrawal symptoms over the next 2-3 weeks, as most discontinuation symptoms resolve within this timeframe. 1, 2, 3

Understanding Your Current Situation

After 5 days without sertraline, you are past the typical onset window for withdrawal symptoms, which usually begin within 24-48 hours of stopping the medication 3. However, you still need to remain vigilant:

• Withdrawal symptoms typically peak around day 5 and usually resolve within 2-3 weeks after stopping 3
• Since you're already at day 5, you may be experiencing peak symptoms now if they're going to occur 3
• The FDA label confirms that stopping sertraline can cause discontinuation symptoms including anxiety, irritability, mood changes, restlessness, sleep changes, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion 1

What to Monitor Going Forward

Watch specifically for these withdrawal symptoms over the next 2-3 weeks 1, 2, 3:

Somatic symptoms:

• Dizziness and light-headedness
• Nausea and vomiting
• Fatigue, lethargy, muscle aches, chills, flu-like symptoms
• Sensory disturbances (electric shock-like sensations)
• Sleep disturbances 2, 3

Psychological symptoms:

• Anxiety and/or agitation
• Crying spells
• Irritability
• Excessive dreaming
• Insomnia 2, 3

Critical Decision Point: When to Restart

If withdrawal symptoms are mild: Reassurance that they are transient is often sufficient, and you can continue staying off the medication 2

If withdrawal symptoms are severe or intolerable: You may need to reinstitute sertraline at your previous dose and then taper more gradually over several weeks to months 2, 4

The key distinction here is that severe symptoms warrant restarting and tapering properly, while mild symptoms can be managed with watchful waiting 2.

Important Caveats

Do not confuse withdrawal symptoms with relapse of depression 1, 2, 4. This is a common pitfall:

• Withdrawal symptoms include physical manifestations (dizziness, electric shocks, flu-like symptoms) that depression typically doesn't cause 2, 3
• Withdrawal symptoms should improve progressively over 2-3 weeks, while relapse would persist or worsen 3, 4
• If symptoms persist beyond 3 weeks or worsen after initial improvement, consider the possibility of depression relapse rather than withdrawal 3

Contact your healthcare provider immediately if you experience 1:

• Severe agitation or confusion
• Thoughts of self-harm
• Symptoms that significantly impair your daily functioning
• Symptoms that persist beyond 3 weeks

Why Abrupt Discontinuation May Have Been Problematic

Research shows that abrupt discontinuation (which is what happened in your case) carries higher risk of withdrawal symptoms compared to gradual tapering 2, 4, 5. Sertraline has a relatively short half-life of 22-36 hours, making withdrawal symptoms more likely with abrupt cessation 6. However, since you're already 5 days in, restarting just to taper may not be necessary unless symptoms are severe 2.

If You Need to Restart and Taper Properly

Should severe symptoms develop, the proper approach would be 2, 4:

• Restart sertraline at your previous dose
• Wait until symptoms stabilize (typically 1-2 weeks)
• Reduce dose by 10-20% every 1-2 weeks
• Extend tapering over several months if needed, as rapid tapers (4 weeks or less) may not adequately prevent withdrawal 4