Need help to make a decision please

[Anxious Betty]

Hi everyone - this is my first post on this forum

I recently started on Sertraline for anxiety/agoraphobia.
I took 25mg for 10 days and then 50mg for 4 weeks.
I started low because I am very sensitive to a lot of medications I have tried previously.
My problem is that my anxiety does not seem to have improved at all and also my stomach has gradually got more upset. I have felt just generally 'off' and I'm not sure whether this is something that will go or not?
Also, surely it should have started helping by now?
I could really do with some advice from anyone who has had these experiences on Sertraline.

[panic_down_under]

Hi everyone - this is my first post on this forum

Welcome to No More Panic,

My problem is that my anxiety does not seem to have improved at all

Unfortunately, antidepressants do not begin working immediately in the way say aspirin, or benzodiazepines do, but typically take 3-12 weeks to kick-in.

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 stronger interconnections they forge, not the meds directly, and neurons take time to bud, grow and mature.

Also, 50mg is only the usual starting and minimum therapeutic dose. Most need to take 100-150mg for good results, some even more.

and also my stomach has gradually got more upset. I have felt just generally 'off' and I'm not sure whether this is something that will go or not?

Stomach issues are not uncommon at the beginning. The problem is serotonin is not just a brain neurotransmitter, but is used by most organs for a variety of purposes. The brain isn't even the biggest maker and user. The enteric nervous system, the mini brain which controls the gut, is, making and uses about 50 times as much and so SSRIs can affect it much more than the brain at the beginning. However, it will usually adapt to the heightened serotonin activity within a few weeks by reducing serotonin synthesis and expression, just as the brain does, and the side-effects should then diminish.

Anti acids should help with bloating, as usually will remedies containing loperamide such as Imodium for diarrhoea. OTOH, if constipation is an issue then drink more water and increase the amount of fibre in the diet. Stool softeners may also help.

[Anxious Betty]

Thanks Panic down under.
That all makes sense, so I should really give it longer to see if it helps?
I think my main worry is that the stomach issues are getting worse, when I would have thought they would be decreasing by now? My anxiety and agoraphobia originally stem from having stomach problems, so the side effects are also increasing my anxiety.

[panic_down_under]

I think my main worry is that the stomach issues are getting worse, when I would have thought they would be decreasing by now?

I'd give it another week or two. If this is still an issue then you should discuss it with your doctor.

Sertraline does tend to cause more G.I. issues at the beginning than the other SSRIs, plus SNRIs (except venlafaxine and desvenlafaxine) and TCAs are generally a better option than SSRIs when there are pre existing gut issues. However, as with every aspect of antidepressants, YMMV.

My anxiety and agoraphobia originally stem from having stomach problems, so the side effects are also increasing my anxiety.

It could also be the reverse, increased anxiety, which is quite common when first taking antidepressants, may be causing the stomach problems.

[Citydeer]

Hi Betty, i had similar issues on 50mg, that I felt no improvement to my anxiety. It's a very low dose my doctor said, and after 8 weeks I upped my dose. You may want to give it another few weeks and then talk to your dr about increasing. The way I see it, it won't be until I'm on a higher dose that I'll be able to assess whether sertraline is the right med for me or whether I need to change

[Anxious Betty]

Thanks Citydeer. Have you been on the increased dose for long? How have you found it regarding side effects/improvement?

[Citydeer]

I have only been on the increased dose of 75mg for 8 days. In terms of side effects, I have had an increase in anxiety which I am hoping will pass with another week or two. It is worth mentioning that I also had my period and a head cold this week, both of which mess with my emotions and hormones so could have contributed to my increased anxiety this week.

I'm taking a positive approach to the new week, and on Wednesday I'm going to up my dose again, to 100mg. If my anxiety hasn't improved a month after that, I'm throwing in the towel on Sertraline and trying a tricyclic anti depressant. I want to make sure I give Sertraline a good chance first though... but yeah 50mg was definitely not a high enough dose for me.

Good luck x

[Anxious Betty]

Thanks Citydeer - I hope the increase helps you soon x

[snowghost57]

It would be best to discuss it with your doctor and see what works for you. I tried Zoloft and I just couldn't hack it. Meds work for some, others it may not. I lost 4 lbs on this medication as I couldn't eat. The doctor offered to try something different and I declined. I will admit that when I came out of the fog of the medication, I felt that I was able to cope with my anxiety better. I now work on mindfulness, keeping my focus on my current task and rationalize my thinking.