Restarting sertraline

[wareing77]

Hi! I havent been on here in quite a while but unfortunately circumstances bring me back!!

I was on sertraline for approx 8 years as i had a major brakedown after my daughter was born and it helped me quite a bit for a while.

I decided to come off it at the end of last year as i was only on 25mg so thought it probably wasnt doing much and basicly just thought it was the right time!

Well ive had a few blips recently but theyve passed so let it be but these last few days the anxiety has gone through the roof and feels like its as bad as it was 8 years ago.

Im in major financial difficulty at the moment which i think may have contributed to the anxiety, this is in the process of getting sorted but the anxiety just wont go away.

Question is, should i start back on sertraline as i still have a couple of boxes in the cupboard! Or should i give it some more time? I think im going to get in touch with my doctor tomorrow to see what they say.

Thanks

Nick

[panic_down_under]

I decided to come off it at the end of last year as i was only on 25mg so thought it probably wasnt doing much and basicly just thought it was the right time!

back Nick,

It is not a good idea to take antidepressants ADs) at what are sub therapeutic doses (less than 50mg for setraline for most) for extended periods as this can increase the risk of the med failing to work.

ADs have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the interconnections they forge, not the meds directly and this requires a minimum level of the med in the system to initiate and sustain. Most ADs need to be taken at doses high enough to saturate 80% of the serotonin transporter molecules (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available test to determine the dose needed to achieve this for individuals so the minimum recommended dose has been set at levels that should ensure 80% transporter occupancy in almost all cases.

The problem with taking sub/borderline therapeutic doses is neurogenesis may be interrupted whenever AD plasma levels drop below the amount needed to sustain it which could lead to the second issue, the growing evidence antidepressants become progressively less effective every time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002). Taking a low dose for months may create a similar situation as stopping and restarting it. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.

Question is, should i start back on sertraline as i still have a couple of boxes in the cupboard! Or should i give it some more time? I think im going to get in touch with my doctor tomorrow to see what they say.

A couple of bad days isn't necessarily a cause for concern, but if they continued for more than a week then it is likely time to take action. However, this is something you should discuss with your GP as they know your history, Nick. It might be a good idea to have a comprehensive check up just to rule out other potential factors such as an infection. Anxiety disorders and depression are arguably expressions of a type of auto-immune disorder and they often worsen when our immune system ramps up.

[wareing77]

Hi and thanks for the reply, its funny you say about getting checked out as everytime i have anxiety bad enough to go to the doctors, they give me a blood test and it always comes back with high thyroid levels but they always put it down to the anxiety because when the anxiety has settled they test again and its back to normal.
Im going to book in this morning and see what they say

Nick

[panic_down_under]

they give me a blood test and it always comes back with high thyroid levels but they always put it down to the anxiety because when the anxiety has settled they test again and its back to normal

So they believe your anxiety is causing the elevated thyroid levels? They could be right. But it is equally possible that the high thyroid levels are causing the anxiety spike!

[wareing77]

Yes they usually say the increase in thyroid levels is probably due to the anxiety increase as it always goes back down after the repeat blood test.
I do cope fairly well with stress/anxiety these days but sometimes things that i normally take in my stride over bear me and trigger an episode which is why i believe it might be the thyroid levels causing me not to cope!
I may be completely wrong tho!!
I managed to get an appointment with a good doctor today and he has suggested going back on propranolol for a while to relieve some of the physical symptoms then think about going back on an anti depressant if it doesnt settle back down in a couple of weeks.
Also have a blood test booked for next week so will see what the results of that are.

Nick

[panic_down_under]

I managed to get an appointment with a good doctor today and he has suggested going back on propranolol for a while to relieve some of the physical symptoms then think about going back on an anti depressant if it doesnt settle back down in a couple of weeks

Sounds like a plan, Nick.

[wareing77]

Well after a good evening and waking up feeling rotten again ive decided to take the plunge and restart the sert! I kinda thought it was inevitable so would rather start sooner than later. Fingers crossed it was the right decision and the side effects arent as bad this time round

Nick

[panic_down_under]

Fingers crossed it was the right decision and the side effects arent as bad this time round

What is your starting dose, Nick? I'd start on no more than 25mg/day for the first week, maybe even drop it down to 12.5mg if the side-effects become too uncomfortable.

[wareing77]

Ive started back up on 25mg this time as i want to get the ball rolling, no side effects so far apart from feeling really cold and gut issues which i had with the anxiety anyway. When i first started on them years ago i started on 12.5mg and instantly had bad side effects so hopefully it wont be as bad.
Im sure alot of the side effects were and are created by my anxious mind but go when i get the stomach issues and nausea i just dont want to leave the house!!

Nick

[panic_down_under]

no side effects so far apart from feeling really cold and gut issues which i had with the anxiety anyway.

Serotonin mediates blood vessel tone - constriction and dilation - which is probably the cause of feeling cold and the gut and the enteric nervous system (ENS), the mini brain which controls it is by far the most serotonergic organ of the body. It produces about 95% of the serotonin used throughout the body, the brain accounts for less than 2%. Both should ease as bio-feedback mechanisms begin reducing serotonin synthesis and expression.

Im sure alot of the side effects were and are created by my anxious mind but go

I could be, unfortunately Nick. An anxious mind can be very adept at producing our worst side-effects nightmares if given half a chance.

when i get the stomach issues and nausea i just dont want to leave the house!!

Ginger and/or vitamin B6 supplements may ease the nausea. What are the stomach issues, Nick?