[onionknight]

So, update on my experience with Zoloft.

I was back on after a few days off because the dose was too high at 100mg. I had much worse side effects this time around; bad headaches, jittery, nauseous. Unbearable suckiness!

I called my second doctor who I think I prefer to the original prescriber. I made it clear I wanted to change meds, but she wouldn't do anything over the phone, and I couldn't get an appointment right away. On Saturday, I didn't take any medicine because I was going to be with friends all day and didn't want to deal with headache and agitation. On Sunday, I knew I had to take it again, but I took 50mg, half the dose. Since then, I've taken 50mg and I feel fine, much fewer side effects and an improvement in mood, probably not related to dose decrease but still...it makes me question whether I want to change meds now. Oi. I don't know, but life is just a series of not knowing stuff

Now, I know the minimum theraputic dosage for Zoloft is 50mg. But I was only on 50mg for a week when I first began. My second doctor said you need to take a med for 6 weeks to see if the dose works. Does it make more sense to switch meds or see how I am in the next few weeks on 5omg of Zoloft? If I switched, I was wanting to go on Wellbutrin.

[mazing]

I would talk to your doctor about it. When is your appointment? I would see what they have to say but possibly try the 50mg zoloft first if your doc agrees. You may be right that the dose was just too high for you. I wouldn't rule it out before trying the lower dose if there is a chance it will help.

But you are right that it can take up to 6 weeks for the drugs to have any effect so the changes in mood may be due to environmental factors (or the rush of not having the headaches any more!). But if you aren't having the side-effects now it might be a possibility if your mood doesn't deteriorate.

[onionknight]

I don't currently have another appointment set up. They said on Friday that there was no avaiable appointment in the next week, but Monday they called and offered me a cancellation but of course, I go downtown on Mondays so that wasn't helpful at all. Now I'm waiting to hear back again. I HAVE NO IDEA WHAT TO DO! About what drug to be on, about how to make sure I'm doing what's best for me...

[SingDanceRunLife]

It's definitely possible that you need a lower dose. I was quite sensitive to Zoloft when I tried it, and a mere 25mg was effective. When I upped it to 50mg, I had side effects like you are describing, and also, became hypomanic.

I was also sensitive to Prozac and never went above 20mg.

[sunrise]

Originally Posted by onionknight

I called my second doctor who I think I prefer to the original prescriber. I made it clear I wanted to change meds, but she wouldn't do anything over the phone, and I couldn't get an appointment right away.

Can you pick one prescriber and stick with that person? You aren't helping yourself by going back and forth between two prescribers. One prescriber doesn't like to jump in and alter what another is doing unless there is a pretty significant problem. Prescribers have different philosophies. Maybe prescriber 1 had a strategy and by switching docs, it goes out the window and you have to start from scratch again with the new person. So I encourage you to decide which prescriber you want and go only to see that one, call only that one about your side effects, wanting to switch meds, etc. If your dose of Zoloft was too high, you should be calling the prescribing doctor.

[onionknight]

I am not switching back and forth between doctors. I decided I wanted to see a second psychiatrist because I didn't know how much I trust the first. I plan to continue seeing the second and so I'm talking to her about possible changes and my side effects. I haven't spoken ot original doc since before I went to second.

And they did have different philosophies! 1 just rose my dose whenever I said I wasn't feeling good still. 2 altered my med because I came to her and explained what led me there. She's more the wait and see type, wanting to keep dose as low as possible.

As a patient, I have a right to seek a treatment course I feel most comfortable with. Even if it takes me not only a few drugs but a few doctors to get a good relationship.

[mazing]

That's definitely true onionknight Sometimes it takes a while to find the doctor that you can connect with. I'm glad you have found someone that listens to your concerns.

[onionknight]

Honestly, I've been hearing about how antidepressants negatively affect the brain in the long run by reducing the brain's ability to produce the needed serotonin. I don't want to trigger chronic depression. What's a safe amount of time to take an antidepressant without risking this? I'm currently still taking the 50mg Zoloft. It's been a week on that dose, and I'm still feeling relatively good.

[mazing]

I would be talking to your doctor about your concerns It is true that some long-term antidepressants can have those kinds of side-effects, but as far as I know it is quite rare as long as your medications are managed well.

A small dose (such as 50mg zoloft) as far as I know is not going to cause a negative affect, especially in the early stages. What is more important currently is how it is helping you - if you are feeling good then I would suggest staying on it and talking to your doctor. They will know the most about potential consequences. Anti-depressants can be a great help to stabilise moods

[onionknight]

At my last appointment, my doctor made it pretty clear that she expect me to be on it for the rest of my life. She said I should stay on the same med at the same dose that got me well for maitence. I was upset when she told me this diagnosis because I had planned on going on a med for maybe a year tops to get me through a really (really!) rough patch. But she said that given that I have had three episodes of severe depression and something of a family history, if I go off the med, I have a 98% chance of relapse, which is why in her opinion, I better stay the hell on it.

Given that I do feel better now, and it is annoying to think that I can fall into more depressive episodes, I would stay on the med infinitely, if I knew I wasn't damaging my brain. But of course, I won't get a straight answer from my doctor even when I bring it up. A therapist told me prior to this psychiatrist that if I went on an antidepressant for 9-12 months that might be enough to alter my brain chemistry so that I wouldn't fall back into depression. She didn't think I'd need to be on a med for ever. So I don't know. I really don't know.

[mazing]

I don't know a lot about anti-depressants but I know that a lot of people do need them ongoing. Think of it like any other physical illness. If you had diabetes you would need ongoing insulin to stay well. When you feel better if you stop the insulin then you will become unwell again. The drug has side-effects at times but the alternatives of not having insulin are worse.

Many medications used for severe depression are similar. Many individuals with depression have physical issues with serotonin and chemical functioning. The medications help to increase that functioning and that is why you feel better. Going off the medications however can cause a relapse in symptoms as the medication is no longer assisting your brain. If you have already had a few events and a family history this is what she would be worried about. It may be partly a physical condition which medications can help. Yes it may mean medication daily for the rest of your life, but is that a decent price to pay to avoid the depression that is very likely if you stop?

[onionknight]

Full disclosure: I don't really buy into the medical model of depression, not completely anyway. I do acknowledge my mind is hardwired toward a propensity to be come overwhelmed by stress and depression, whether it is purely genetic or a combination of past abuse, biological influences and just my personality. I am someone who is suseptible to depression. That's the given here; it is what comes next that is where I waver.

Your thoughts and actions can change your brain. I know this works for me because I used to be a lot more uncomfortable with my own existence than I am now. I suppose I hold on to the hope that one day I will get myself into a situation where I will no longer fall into the same patterns of severe depression. I have had previous incidents, but they were inspired by environment. When I was in high school, things were rough at school and at home. If it didn't trigger some dsyphoria and depression, it might have been a bigger problem. But I got well from that by just focusing on being happy, on not hurting myself, on making better choices, etc. It got my to feeling happy. But I didn't stay happy. After graduating high school, I got very (very!) depressed again, and it really only got resolved because I finally left the abusive home that was stifling my life. I went off to college and slowly grew and healed. Then I left college and was completely disembedd in the life I had grown dependent upon. That's where I am now, that's what caused this lastest bout of depression.

I actually do suffer from other chronic illeness, and I don't really take all the required medication. I have labile blood sugar (essentially diabetic) which I correct with meds, but I also have bad asthma and screwy hormones that both cause me suffering and annoyance. I don't weight the side effects greater than the benefits.

I'm torn.

[onionknight]

I think I'm going to try to get off the med all together. The side effects are better at 50mg. But I don't experience please like I should. I think the Zoloft is supressing the production of Dopamine, or if my brain isn't producing enough naturally, I should be on a different medication. Sure, I feel more adjusted to daily life because of the Zoloft but the lack of pleasure, of deep emotion isn't worth it. I will risk the relapse, in order to not feel like my mind is slow and unfeeling.

[metamorphosis12]

Yeah, it's always important to consult your doc or pdoc. Hopefully, you feel comfortable with and is competent. a couple of things about SSRI's and other psychotropics in general. Regarding Zoloft (sertraline), generally the therapeutic dose can range from 50-150mg. Though some people do go as high as 250mg. Of course the lower dose you can use with positive effects the better. Side effects are often dose dependent, so the higher you go= more side effects. Everyone's physiology is different, so one person can find a beneficial response at even 25 mg, while another may need 100 mg. You also have to take into account any other meds, especially psychotropics, that you also use. As the combination can work in a synergistic fashion and a lower amount of Lexapro may be possible.

Also, with these meds. it is always important to titrate up slowly, 25mg for 4-7 days then 50mg and so on. The same goes for lowering the dose or stopping the med. 100 down to 50 to 25 to 0. this will avoid most psychological or physiological `withdrawal. Though compared to other classes of psych. meds withdrawal is usually relatively easy. Zoloft can be one of the more stimulating SSRI's along with prozac. One of the main reasons why people stop taking SSRI's is because of the side effects, which include sexual dysfunction, lethargy, weight gain, anxiousness, to insomnia to name a few.

Generally it takes about 4-6 weeks to give them a fair trial. Some of the initial side effects can subside as your brain adapts. Doctors usually err on the side of caution with psych meds. SSRI's are considered a safe class of meds., as overdose rarely causes death and coming of them is relatively easy. Serotonin syndrome is the one issue you need to be careful of and that can happen when taking another serotonergic med. or supplement ( 5-HTP, tryptophan, yohimbe and others). The increase of to much serotonin in the brain can cause rapid HR,, shivering, sweating, hyperthermia, hypertension, agitation, hypomania, and possible trip to the hospital, as severe cases cause coma. It is pretty easy to avoid the issue by avoiding the handful supplements and the meds TCA's, MAOI's, SNRI's. Your doctor should explain this to you and will steer clear of any possible meds that interact. I have been on Lexapro (escitalopram), for over a yr and take supplements and a few other meds. I have never had a problem. SSRI's are usually being used as the first line of treatment fo depression, anxiety , in certain cases, OCD etc. So the typical protocol for doc or pdocs with patients that cannot tolerate one SSRI is to try 1-2 others before changing up classes of meds. If a patient has issues with trialing 2- 3 SSRI's, then the doc/pdoc should jump to another line of treatment. Certain meds. like Wellbutrin (bupropion) is often used as an adjunct to SSRI's. It is a stong NE and DA reuptake inhibitor. It also can offset the side effects os Zoloft. It can decrease appetite, increase libido, and can increase energy levels with the NE uptake inhibition. Though, I am not into using polypharmacy unless needed.