Sertraline 50mg

[panic_down_under]

II've found it improves my sleep no end (although it can sometimes be harder to get up in the morning).

If your GP will prescribe it consider switching to trazodone. The problem with mirtazapine as a sleeping aid is its long half-life, 20-40 hours, which can cause sedation to continue into the morning. At high doses, 200+ mg, trazodone is a pretty good AD, but these days it is mostly prescribed for SSRI induced insomnia at doses of 25-100mg. Its half-life is 10-12 hours.

I’ve got Zopiclone but try and give it a break so as not to become dependent.

Dependence may occur if you take Zopiclone (eszopiclone) daily for some weeks to months so it would need to be tapered off rather than quitting it abruptly. This is also true of the sertraline.

Unlike the related benzodiazepines, eszopiclone enhances hippocampal neurogenesis, the mechanism by which AD work, by increasing the survival rate of new hippocampal neurons by 40-50% which may speed up kick-in a little (Methippara M, 2010; Su XW 2009; Pollack M, 2008).

Mirtazipan takes 5 weeks, so I guess I will just push through with Sert

Mirtazapine should aid sleep immediately as it is mostly a very sedating antihistamine, not a true antidepressant. However, as per my reply to ServerError above, trazodone would be a better option if your GP will prescribe it.

[Rad1]

Thanks so much PDU
Very good to have your thoughts.

I will keep in mind as an alternative. I take it it can’t go together with sertraline and it’s just a switch, effectively starting over.

Is it easy to come off gradually as Sertraline is?

And any recommendations for a stand alone sleeping med that are ok with sertraline? That I won’t become dependent on? I seem to need something every night. Using zopiclone works, but as the week goes on it worries me.

Sorry this message is a bit over the place, I’m going through a wave of anxiety.

Rad

[panic_down_under]

I take it it can’t go together with sertraline and it’s just a switch, effectively starting over.

No. Both mirtazapine and trazodone would be taken in low doses as required to aid sleep, not as ADs. You'd remain on sertraline.

Some drug interaction sites flag a possibility of serotonin syndrome/toxicity (SS/ST) if either is taken with SSRIs. They are wrong. That isn't my opinion, but that of Dr Ken Gillman who is one of the two leading authorities on the syndrome who spends much of his semi retirement correcting false claims as for example:

A substantial proportion of the cases in their supplementary list do not meet the criteria for ST, because they do not even involve drugs with serotonin elevating properties (e.g., triptans, ‘setrons’, trazodone, mirtazapine etc.). Those are, without question, false positives — ingestion of a drug known to produce substantial elevation of 5-HT is a sine qua non. Update on Recent Case Reports and Reviews of Serotonin Toxicity

And any recommendations for a stand alone sleeping med that are ok with sertraline? That I won’t become dependent on?

You will become dependent to some degree on all these meds if you take them continually for some weeks to months. It means you should wean off them slowly when the time comes to stop. Eszopiclone, mirtazapine and trazodone all have different modes of action so rotating between two of them (I doubt your GP would prescribe all 3) will significantly reduce the likelihood of dependence.

Sorry this message is a bit over the place, I’m going through a wave of anxiety.

No problem, Rad. Been there all too often and got the t-shirt.

[Rad1]

PDU, thanks, really appreciated

[Rad1]

Well my GP seemed to think trazodone would be an alternative to Sert (true), and nit taken with it (I’m sure your knowledge is broader). Although I expressed your opinion. So she was not willing to prescribe it. Then she suggested antihistamine for drowsiness.
I hope to speak to the mental health nurse on Monday. She may know more.

Rad

[panic_down_under]

Well my GP seemed to think trazodone would be an alternative to Sert (true), and nit taken with it (I’m sure your knowledge is broader). Although I expressed your opinion. So she was not willing to prescribe it. Then she suggested antihistamine for drowsiness.

Although trazodone is an effective AD usually without some of the ongoing side-effects which really bug people such as sexual dysfunction it is rarely prescribed as an AD these days. Instead it has found a niche as a very effective treatment for SSRI/SNRI induced insomnia. So much so that while I don't have the sales data I suspect it probably outsells most other ADs, except maybe amitriptyline, because of this. Unfortunately, many UK GPs haven't cottoned onto this yet. But at least it's available through the NHS. It isn't through the Australian PBS. However, our vets frequently prescribe it for their patients (memo to self: next time come back as a dog, or even better, a cat! )

I hope to speak to the mental health nurse on Monday. She may know more

I would hope so, Rad. GPs really need more education about psych disorders and their treatment. It is amazing how little they get during their initial training. Psych disorders seem to be more an afterthought. They are often better equipped to treat rare tropical diseases that many will never see during their career while a quarter or more of their patients will have a psych disorder, diagnosed or not. </soapbox>