Zoloft: getting worse before it gets better?

I hope someone here can help or offer some supportive words.

I have had a terrible past 3 weeks, full of ups and downs, the worst of which is insomnia and increased anxiety.

It all started three weeks ago, had a panic attack that kept me from sleeping, resorted to taking old lorazepam prescription several nights to sleep. Did NOT want to keep doing that, went to my PCP. I got put back on beta blockers (metoprolol) and sertraline (zoloft). This was 2 weeks ago. Since then, I have inconsistent sleep... when I sleep, I wake up every 90 minutes to 2 hours, then go back to sleep and repeat. I am actually okay with this as long as I can fall asleep early enough, but sometimes I can't fall asleep for HOURS. And it makes anxiety worse! My doctor started me right on 50mg on zoloft, rather than starting on 25mg and increasing.

This past week was slightly better than last week with sleep, although I had one very rough night (tuesday night) and the next night i took trazdone which the dr prescribed and slept more. I was able to go two nights with no sleep aid and got some sleep, and then last night my body was super wired when I went to lay down and I knew it was going to be tough. I went to see a naturopath too, who thinks this is about cortisol overproduction, so i am going to do testing for that and am going to do the saliva and urine tests tomorrow.

My "symptoms" that I have are not being able to sleep at night, when I do sleep, waking up every few hours, getting hot flash like feelings, and almost like adrenaline rush feelings sometimes when I'm laying down or awake. I also am feeling more anxious about these things, but not so much about other things. Today I feel VERY depressed all of a sudden. I thought my sleep was improving but I felt like last night was a setback. I feel like I want to go do things and enjoy myself again and enjoy the long weekend, but I feel so sad, frustrated, and hopeless about how the past few weeks have gone. Could this be side effects from the zoloft?? And when will it get better??

I have read it takes awhile to work, and people can have increased symptoms until it works. I thought maybe I was withdrawing from my temporary use of lorazepam, and maybe that was part of the problem, but I don't think it's the whole story. The naturopath wants me to take supplements, but I feel like I'm putting SO much crap into my body and I don't know what's working and what isn't, and not sleeping well is making everything worse.

I hope somebody out there has been through this and can tell me when it will get better! I hit two weeks on the zoloft just this past Friday. My sleep was semi improving up until last night. Most nights I get between 5-6 broken hours, at the very least I got 3, at the most I got 7. I used to get 7-8 consistently before hell broke out three weeks ago. Please help, I am so desperate and feel so alone. :'(

I sort of can relate. I had a terrible time getting on Zoloft but the side effects got better with time. I didn't sleep more than 2 hours every second night the first 14 days on it. I was put on it when it was newish and it was believed starting fast was the best so I started at 100 and upped to 200 after 3 days. I mostly felt nervous, weird and agitated but yes people can have other mental symptoms as well.

For me the worst stuff stopped after 2 weeks when I could sleep a little better and I felt "all better" after about 5 weeks.

Hi Jimi!
Thanks so much for your reply. It's so nice to know someone else has been here, too. After the first two weeks, how did your sleep improve? Was it a gradual progression or did it just all of a sudden get better? And did you have anxiety about the not sleeping on top of it? I'm pretty sure my anxiety/obsession with the sleep thing is making it worse, but it's hard to relax about it, LOL. I'm not sure if mine is improving, but if I do get to fall asleep within an hour of laying down, I sleep in two hour shifts and wake up every few hours but go back to sleep. It's been like this for weeks, but the first week it was worse and I was sleeping only 2 hours a few nights. Last night I could not fall asleep because my body felt fired up and adrenaline rushed, I tried taking an herbal supplement and after an hour or so I think I fell asleep, and did my usual wake up every 2-3 hours thing, and got like 5-6 hours. I really want to be able to sleep through the night, or at least get a sold 6 hour chunk!

It's good to know after a month you felt more settled. I hope it works that way for me, too!

Hi t11, I'm so sorry you're feeling along. Believe me, you're not alone.

I've been on Zoloft twice in my life. Neither time did I experience the negative side effects you've described. One exception to that: When I went from 150mg to 200mg I experienced anxiety, so I dropped the dose back down.

It seems to me that you should be feeling better by now, not worse. 3 weeks is a long time. Have you discussed the way you're feeling (from the Zoloft) with your doctor?

I'm thinking that starting out at 50mg was too much, too soon.

Thanks so much for replying!!! I definitely am thinking about reaching out to my doctor. I have an appointment the week after next, but I feel like he's going to tell me to stick it out if I go in sooner so I will wait. It's actually only been two weeks on the Zoloft, but I agree that I should be feeling better! I'll give it another few days and see. I do have moments and periods of time where I feel better, but the not sleeping thing is the worst part. And I agree, he jumped up too quick especially because two days behind he put me back on another medicine..my body is probably in shock!

Definitely call your doctor.

It sounds to me, based on my experience with medication, that the 50mg was too too much, too soon. Better to go back to 25mg, take that for a week or two, then go up from there. Because the way it is, it sounds like the Zoloft is harming rather than helping. In my experience, Zoloft is a good medication, but it has to be taken slowly.

Thanks LauraBeth. I called and made an appointment to go in tomorrow.
My past few days have gotten worse, I think. I think I originally posted this on Sunday sometime when I was in a wave of anxiety/depression/hopelessness. That night, I had trouble sleeping again but did get to sleep eventually and felt okay. However, yesterday (Monday) even though the day was a relatively good day full of positive things (walking dog, brunch with friend, bbq with other friends, getting some work done and even a nap) at night the horror of insomnia came back. I tried taking one of these herbal supplements a naturopath prescribed for the past few days, doesn't seem to be doing much. Anyway, couldn't sleep, tried listening to meditations, sleep hypnosis, nature sounds (ocean), my husband eventually put on movie soundtracks to distract us because we BOTH were awake by some annoying repetitive noise in our neighbor's apt that was vibrating the ceiling. I am so overly sensitive to anything right now so the noise made it worse. I tossed and turned, got up several times, went to the living room, tried sleeping to the tv, more meditations, NOTHING. Finally gave up, and then around 4 was exhausted enough to sleep but that was pointless, I already knew I wouldn't be able to go to work... so I stayed home. I napped some this morning, and got some stuff done. The sad part, on top of not sleeping, is when I can't sleep (and even sometimes during the day) I get very upsetting thoughts that I never had before.. like thinking my husband will divorce me over this, my friends are all tired of me, and then I feel very lonely and blame myself. When my anxiety was at its worst before, I would get obsessive about stuff but never have these sorts of terrible, sad thoughts! I'm not having suicidal thoughts or anything like that, just very sad, hopeless, "this is never going to get better" thoughts. This does not seem like a normal side effect to me. I hope my doctor can help tomorrow and we can come up with a plan.

If anyone has gone through similar experiences on sertraline or zoloft, I am all ears. I started 50mg just over 2 weeks ago. I moved my dose to the morning so it would help with sleep, but doesn't seem to be making a difference.

Thanks for listening.

I had been on zoloft up to 100 for 3 yrs, bp1 never, had those side effects, first 2 weeks I had tiredness, they took me off due to mania, now the withdrawls, we're crazy for me.

I took Zoloft for years and I do remember things seeming bleak for a while. I think it took about a month for me to feel better. I was on 100mgs but started at 25. 50 sounds like too bit of a jump to me. Good luck I hope you feel better soon

Thanks so much, and thanks for everyone who responded!!

I'm seeing my doctor today and will try to figure out an action plan for how to deal with this and how much longer to stick it out.

You may want to try the atypical antidepressant Remeron (mirtazapine). It's called Remeron because it was designed to induce REM sleep.

I hope this helps.

I'm so glad you're going in. Let us know what your doctor says. And good luck!

Thanks so much, LauraBeth.

Well, I went in on Wednesday and my doctor basically tried suggesting I needed to "up" my dose to 100mg.. which I disagreed with and said "no no I'll stay on 50.." I was really hoping he would suggest going down or consider going off because of all this insomnia, which by the way, is still happening. Monday night I was up all night until 4am, and didn't go to work. Tuesday night I took Trazodone and did get to sleep at some point. Last night (wed night) i took a unisom and it worked great, I got about 7 hours. But tonight after trying to lay there after taking nothing (going sleep aid free) for over an hour, I decided I try unisom again. That was just before 10pm. It's now 11:50pm. I tried really hard to just lay there and rest, then I tried mindfully walking around. I just gave up because my brain will not shut off. It will be 3 weeks tomorrow that I've been on the zoloft. I am seriously considering going and switching doctors. Did anyone else have this sort of insomnia, and did it go away when you stopped the medication? I really am trying to figure out what to do.

I would like to maybe try that one, I've heard about it. My doctor prescribed trazodone, it works sometimes, but not super great.

It sounds to me like your doctor thinks the insomnia is due to depression, so he raised your Zoloft dose. Maybe try the 100mg. Zoloft and use an OTC sleep aid (Unisom or ZZZquil) for a few nights - or even for a week - and see how you're doing?

Thanks all, again!! I didn't start the 100 because it seems too much of a jump to me at this point, and I wasn't depressed before I started the Zoloft. I'm not feeling super depressed now, but only when I don't sleep. I definitely tried the unisom, it worked one night and did not work the next. I'm going to keep sticking it out, next week I'm seeing a hypnotist so maybe that will help. The other X factor is I also take beta blockers which also have insomnia as a side effect, but it didn't do that to me before, either.

If you weren't depressed when you started taking the Zoloft, did your doctor tell you why he was prescribing it?

For anxiety and health anxiety. Those are my main concerns. Sometimes I get bummed out from being anxious and drained, but I never really struggled with depression.

Your Dr. put you on beta blockers for anxiety or is that for another health condition?

If I was in your situation, I'd probably be looking for a new doctor. But in the meantime....I'd ask the Dr. about quitting the beta blocker if prescribed for anxiety and not a health condition and take Ambien while waiting for the AD to take effect. If that didn't help, I'd reduce the Zoloft to 25. If that doesn't work, I might increase the Ambien and keep on 50 mg of Zoloft for a couple of weeks. If I still had problems, Celexa, Lexapro, or Prozac might be worth trying.

Zoloft isn't a bad option for anxiety-unless it doesn't work. If your anxiety skyrocketed after the Zoloft, it seems really odd that a Dr. would increase it just yet, by that much especially.

Magnesium at bedtime can really help, too, but probably not for anxiety to the extent you are experiencing (but think of it for long term issues). Lack of sleep is a catalyst for that kind of anxiety; unfortunately. It sounds like you are in a cycle. I wouldn't take Trazadone if sleep is that bad--that drug is known to be unreliable for some. I wouldn't go that route until it's under control. Low dose Amitriptlyine can be good for long-term sleep issues if Trazadone doesn't work.

Some anti-depressants actually disrupt your sleep architecture, making you worse off. Zoloft, I think, is one of the better ones.

I personally think beta blockers for anxiety is a horrible, horrible idea. For anxiety and insomnia that is this out of control, starting with Ambien or Lunesta until your leveled out enough for another long-term option seems so much more reasonable. I think you are right to question the 100 mg Zoloft. I wonder if your Dr. has a schedule IV Rx phobia, or did you have problems with addiction in the past?

I've had insomnia all my life. I'm sorry it is so horrible for you.

I was really distrubed by your post, so I looked something up:

Drug Interaction Tool | University of Maryland Medical Center

I don't know what beta blocker you take, so I only checked 2, but they both had medium interactions with zoloft, but if you smoke, the interaction was severe and potentially dangerous.

Removing the smoking but adding Trazadone, the interaction is labeled as severe, and this only between Trazodone and Zoloft-it won't evaluate all 3 together.

Quote:
PROPRANOLOL - Propranolol (Injection)
TRAZODONE HYDROCHLORIDE - Trazodone (By mouth)
ZOLOFT - Sertraline (By mouth)

High Interaction Potential
Drug-to-Drug

TRAZODONE HYDROCHLORIDE (TRAZODONE HYDROCHLORIDE) and ZOLOFT (SERTRALINE HYDROCHLORIDE)
Taking sertraline together with trazodone may increase the risk of adverse effects, including problems with your blood pressure, body temperature, muscles, and thinking. Using sertraline together with trazodone is usually not recommended, but may be required in some cases. If you are using both medicines together, your doctor may change the dose or how often you use one or both of the medicines. It is important to tell your doctor and pharmacist about all other medicines that you are using. Call your doctor if you feel weak, have a rapid or fast heart beat, feel unusually restless, have a fever, or have trouble moving your arms and legs. Do not stop using your medicines without talking to your doctor first.

Those interaction tools are not necessarily followed to the T, but it's a good way to see if your doctor knows what he is doing and to keep yourself safe.

Beta blockers can also cause Hyponatremia and hyperkalaemia, some of which may mimic anxiety symptoms, and hyperkalaemia can wake you up at night with cardiac event and and metabolic acidosis causing heart palpitations.

Cardiovascular medications - beta-blockers | University of Maryland Medical Center

And here are nutrients depleted by beta blockers:

Cardiovascular medications - beta-blockers | University of Maryland Medical Center

Well, I was given Propanolol when I was having extremely severe anxiety and it did help lessen my anxiety enough so I could function. After that, it didn't do much so I stopped taking it.

As for Zoloft, it is often used for anxiety and OCD. Sometimes depression does manifest as anxiety, or accompanies anxiety...I cannot tell the difference between my depression and my anxiety; they are intertwined.

My thinking is that the 50mg. wasn't enough to knock out your anxiety, so your doctor increased the Zoloft dose to 100mg. This is where meds always get tricky...is it the Zoloft causing worse anxiety OR is it that the dose of Zoloft isn't high enough to be combating your already-present anxiety?

Thank you so much for your thoughtful reply! I am starting to wonder if the beta blocker can be causing the insomnia, although it didn't the last time I was on it. I actually am looking for another doctor sorta, lol! The beta blocker is prescribed for occasional heart palpitations, which happen with panic. I was on them originally for a month and a half, and then stopped and I was okay until this all started again. I agree that I'm in a cycle- low sleep = more anxiety = worse sleep because I obsess over it. When I get enough sleep (at least 5-6 hours, more is better of course) I am okay the following day and sorta think the Zoloft is working. Recently I had a bad night of no sleep (Thursday night, got like 2.5-3 hours) but the next day, I forced myself to function and I was as human as possible. And I wasn't as worried as I have been when this happens, which I attributed to the Zoloft. This is why I think jumping to 100mg is a bad idea. I am certain my doctor would not prescribe any z drugs like lunesta or ambien because of their addictive nature, he shamed me for taking lorazepam that I had from an ER doctor for a week when this all started and I couldn't sleep. It was the only thing that helped. He made me think I got dependent on it and I'm still worried that was part of the problem - that maybe I'm withdrawing from it. I took it 6 times across two weeks, and it's been almost three weeks, so who knows. Anyway moral of the story is, still trying to figure out!

P.s. I used to take magnesium for my worries about my random heart palpitations (PVCs). It helped a lot! I took it before bed because it was supposed to be absorbed better that way. I never noticed if it helped sleep or anxiety but i always thought it helped. I'm sorta experimenting now because I don't know what works and what doesn't.

I think I am finally noticing that 50mg is doing some good. I'm not sure if it's worsening sleep, but it takes the edge off worries. I had a bad night of sleep two days ago, and the next day I wasn't as keyed up as I have been about insomnia. Then today I had a half marathon race, and in the past I would get nervous before races and then worry about my heart rate during the races themselves. Today I didn't worry about either thing, I had a lot of fun actually. I am having trouble sleeping again tonight and debating taking another sleep aid but I'm not getting worked up. So I think I'm good on 50mg! I just need to fix my sleep.

Thank you for your thorough response! What disturbed you about my post? I hope it didn't upset or trigger you! I appreciate your research. I too was worried about doing Zoloft + trazodone because of the serotonin syndrome. I was reassured by my doctor and the pharmacist that I would be okay and lots of people do this. I typically take these meds many hours apart when I do use trazodone for sleep. I am not a fan of the beta blockers, either. I did not want to go on them to begin with in May. I was originally only on them for a month or two and went off, and after panic week 2016 I went back on. I am worried they maybe affecting my melatonin! It's hard to say since they didn't before and my sleep problems started before I went back on, but who knows. Maybe I need to try taking all my meds in the morning. Right now I space it out- beta blockers (metoprolol ER 25mg) at lunchtime, losartan 50mg (blood pressure med) at dinner, sertraline 50mg in evening. I changed sertraline from morning to evening to see if it would help with sleep. Thought a reboot might work. I really hate being on all these meds. Two years ago, I only took sertraline 50mg and I was doing super well. Last year my stress exploded, started with high blood pressure then random health issues which made health anxiety surge. I wish my doctor had tried to figure out why my blood pressure was high (maybe anxiety!) instead of starting this with the losartan script. My husband and I think the losartan affected me badly and triggered some off things, but we don't know for sure. Anyway, I am looking for a new doc! The other thing Is my husband and I have the same dr and my husband has to take blood thinners because he had a PE (pulmonary embolism) last year. No one ever figured out why this happened, but now he's on these blood thinners that make him bleed and other side effects and this is another thing that worries me. I think my doc is big on symptom management and not figuring out underlying causes. Maybe I sound obsessive but I wish doctors thought more about wellness and not "lack of symptoms." My therapist suggested my husband see a hematologist and I'm trying to get him to go. Anyway just another thing I am unhappy with about my dr! Sorry this was so long! you guys are really helpful though!