14 weeks on zoloft 50 mg

[Comoso2]

I'm 14 weeks on zoloft 50 mg. I have good and bad days. The mornings are bad almost always. Somedays it doesn't last long some days it eats the day.

I've been prescribed .5 MG clonazepam twice daily but I've read so many horror stories I'm scared to take it. Last week, I took. 25mg in the am Monday through Thursday and felt pretty good. I didn't take Friday and still felt good. Saturday so so and Sunday not so good. Iv went back to the. 25 MG this morning. Should I just stick with the. 25 or am I playing with fire and I'll eventually need increasing doses?

When I first got hit with anxiety I took it for a little over a year and weaned off through much pain believing the Ashton manual and that my problem was my klonopin. I put up with the hell, was med free for 15 months with tons of panic attacks and high anxiety.

It's just now sinking in that maybe anxiety came back because I want talking the med...I guess... it's so hard to decide what to do. Life right now, is definitely not fun so...

[panic_down_under]

I'm 14 weeks on zoloft 50 mg. I have good and bad days. The mornings are bad almost always.

After 14 weeks you are getting pretty much all you will out of the 50mg dose. To achieve better results you will need to increase it. I know higher doses have triggered tinnitus in the past, but there is no point taking a med at ineffective doses, imho.


Last week, I took. 25mg in the am Monday through Thursday and felt pretty good. I didn't take Friday and still felt good. Saturday so so and Sunday not so good. Iv went back to the. 25 MG this morning.

Clonazepam has a longish half-life, around 40 hours which is why you continued to get some benefit days after the last dose.


Should I just stick with the. 25 or am I playing with fire and I'll eventually need increasing doses?

I think you'd be better either increasing the Zoloft dose, or switching to another antidepressant if tinnitus again becomes a problem with Zoloft.


When I first got hit with anxiety I took it for a little over a year and weaned off through much pain believing the Ashton manual and that my problem was my klonopin.

Ashton's manual can be useful for weaning off benzodiazepines, but her scaremongering about these meds seems based more on ideology, not medicine, imho. I've heard she has recently also begun demonizing antidepressants. Having reviewed her testimony in a notorious British legal case, I have very little regard for her.


It's just now sinking in that maybe anxiety came back because I want talking the med

It almost certainly came back because anxiety disorders can be chronic conditions which wax and wane but don't completely go away, though remissions lasting months to several years are relatively common.

[Comoso2]

So is the clonazepam at that low of a dose a bad idea? I honestly think it's helping tinnitus too... I'm prescribed 60 pills per month. I have enough pills to take for several years at .25 per day so a Dr saying I can't have more, I'd have a couple of years back log...

[panic_down_under]

So is the clonazepam at that low of a dose a bad idea? I honestly think it's helping tinnitus too... I'm prescribed 60 pills per month. I have enough pills to take for several years at .25 per day so a Dr saying I can't have more, I'd have a couple of years back log...

Yes. Firstly, because you're taking them without your doctor apparently being aware of it. This is never a good idea, but especially not with drugs like the benzodiazepines (BZDs) which doctors are becoming increasing unwilling to prescribe.

Secondly because of you take clonazepam daily for more than a month or two you will almost certainly become dependent and be in trouble once your stash runs out if you then can't find a doctor willing to prescribe it.

BZDs have also been shown to interfere with the neurogenesis mechanism by which antidepressants work. Given you're on only the usual minimum effective Zoloft dose you really shouldn't be doing anything which reduces its effectiveness, imho.

I believe your best bet is to either raise the Zoloft dose to an effective amount, or if you can't because of tinnitus switch to another antidepressant. I have previously elsewhere suggested some which rarely, if ever trigger it.

[Comoso2]

Yes, you have, and thank you. I think I'll try to up my zoloft to 75 for a week and see how it goes.

My pdoc actually practically begged me to take daily clonazepam last time I was there, 2 weeks ago, it was his talk that got me to try the. 25 for a few days after taking none for 2 months.

[Phill2]

I'm 14 weeks on zoloft 50 mg. I have good and bad days. The mornings are bad almost always. Somedays it doesn't last long some days it eats the day.

I've been prescribed .5 MG clonazepam twice daily but I've read so many horror stories I'm scared to take it. Last week, I took. 25mg in the am Monday through Thursday and felt pretty good. I didn't take Friday and still felt good. Saturday so so and Sunday not so good. Iv went back to the. 25 MG this morning. Should I just stick with the. 25 or am I playing with fire and I'll eventually need increasing doses?

When I first got hit with anxiety I took it for a little over a year and weaned off through much pain believing the Ashton manual and that my problem was my klonopin. I put up with the hell, was med free for 15 months with tons of panic attacks and high anxiety.

It's just now sinking in that maybe anxiety came back because I want talking the med...I guess... it's so hard to decide what to do. Life right now, is definitely not fun so...

I've been on 50mg for nearly 2 years now and it works great
Just follow your Drs advice and you'll be fine :yesyes:

[Comoso2]

Thanks, Phil, was it working well for you by week 14? I think I'm improved, but morning retching and anxiety can still be pretty rough most days. By evening I'm anxiety free but restart the mess the next day...

[Phill2]

Thanks, Phil, was it working well for you by week 14? I think I'm improved, but morning retching and anxiety can still be pretty rough most days. By evening I'm anxiety free but restart the mess the next day...

It was working well for me by 6 weeks but everyone is different that's why it's better to listen to your doctor than others who may have had a different experience.
I was going through a very rough patch and they've proved to be a godsend.

[Comoso2]

Panic, I went to 75 mg at bed time last night, woke up in a panic and retching at 6 am. I had to take .25 klonopin. Well, I didn't have to, I'm just tired of having panic attacks so I did. Nauseated, definite tinnitus increase, ears popping like crazy. 75 mg might be one and done.

[panic_down_under]

Panic, I went to 75 mg at bed time last night, woke up in a panic and retching at 6 am.

This isn't unusual after dose increases. And it may not have just been the med. Anxious minds are very adept at producing the whole catastrophe of side-efects if given half a chance.



Nauseated, definite tinnitus increase, ears popping like crazy. 75 mg might be one and done.

As hard as it is, I'd stick with it a little longer using the clonazepam to ease the increase in anxiety/panic.

But if you're still having issues after a week or two then to reiterate my previous advice to you, I think your best alternatives are norepinephrine, aka noradrenaline (NE) reuptake inhibiting antidepressants as none of the serotonergic antidepressants you've tried have been a success. The meds which fit the bill are the SNRIs Savella (milnacipran) and Fetzima (levomilnacipran) and the older TCAs Pamelor (nortriptyline) and Norpramin (desipramine).

Savella and Fetzima are essentially the same med, the difference is the newer Fetzima only contains the active isomer of the chemical, its basically the same patent extending deal as Celexa (citalopram) and Lexapro (escitalopram), so it probably won't matter much which is chosen, however, Fetzima is still in patent so may be more expensive. But your doctor may prefer it because Savella isn't FDA approved for anxiety and depression (this doesn't mean it won't work, just that it hasn't gone through the expensive approval process). Although this is a moot point, some doctors can be sticklers, especially when they are unfamiliar with the meds. Savella and Fetzima inhibit NE and 5-HT (serotonin) in a ~3:1 and ~2:1 ratio respectively.

Pamelor is pretty much a straight NE reuptake inhibitor having little affect on the serotonin transporters. Norpramin is also mainly a NE inhibitor with a NE:5-HT blocking ratio of about 35:1. It also has very little impact on histamine and acetylcholine muscarinic receptors which produce many of the typical TCA constipation, dry-mouth and sedation side-effects so would be my pick of the 4 meds, with Pamelor my second choice. Both TCAs are on the American Tinnitus Association's list of recommended meds to treat this condition (I can't yet post links so Google: "Drug Therapies" "American Tinnitus Association").

[Comoso2]

I think I'm going to stick it out at 75 mg for a few days then and see how it goes. I called my pdoc today, but no return call so... I've taken klonopin 6 out of 9 days now, though so it'll have to be really bad before I take more.

[Comoso2]

Dadgummit, I went to my post office and got my mail this evening. There was a letter telling me my pdoc was closing his office. I now really don't know what to do.

I can't really stay at 75 after all, I was using my 50s and the 25s he prescribed me when starting up. Man, what an incredible bummer. I need to realize I had many good days on 50.

Panic, I know you say I'm getting all I'll get out of it at 14 weeks, but what's wrong with the thinking of I'm just one of those that gets some benefit but not anxiety elimination? 50 mg, meditation, relaxing, .25 MG klonopin once or twice a month when I have big events????

I don't know, just kind of hurt and confused tonight. I guess that explains why he didn't call me back today...

[panic_down_under]

There was a letter telling me my pdoc was closing his office. I now really don't know what to do.

I can't really stay at 75 after all, I was using my 50s and the 25s he prescribed me when starting up.

Can't your PCP/GP prescribe it for you? Is this the only psychiatrist in your area?


Panic, I know you say I'm getting all I'll get out of it at 14 weeks, but what's wrong with the thinking of I'm just one of those that gets some benefit but not anxiety elimination?

You can stay on 50mg if you want, but i think you'd be selling yourself short. Unfortunately, the only way of knowing whether Zoloft might give you a better result is to take it up to its dose, or tolerance limit, maybe beyond.

[Phill2]

Dadgummit, I went to my post office and got my mail this evening. There was a letter telling me my pdoc was closing his office. I now really don't know what to do.

I can't really stay at 75 after all, I was using my 50s and the 25s he prescribed me when starting up. Man, what an incredible bummer. I need to realize I had many good days on 50.

Panic, I know you say I'm getting all I'll get out of it at 14 weeks, but what's wrong with the thinking of I'm just one of those that gets some benefit but not anxiety elimination? 50 mg, meditation, relaxing, .25 MG klonopin once or twice a month when I have big events????

I don't know, just kind of hurt and confused tonight. I guess that explains why he didn't call me back today...

I've found that many doctors up the dose far too quickly rather than wait to see what happens on the lower one.
If you say you've had good days on 50 then stay there

[Comoso2]

My PCP has told me he doesn't like giving out psych meds. I think he honestly believes everyone can beat it med free. Yes, he was the only pdoc within 40 miles of here. I went back to 50 last night and feel better today, crazy stuff...

[panic_down_under]

My PCP has told me he doesn't like giving out psych meds. I think he honestly believes everyone can beat it med free.

Might be time to get a new PCP if there are nearby alternatives. This one doesn't seem worth feeding. :mad:

Ian

[Phill2]

My PCP has told me he doesn't like giving out psych meds. I think he honestly believes everyone can beat it med free. Yes, he was the only pdoc within 40 miles of here. I went back to 50 last night and feel better today, crazy stuff...
Unfortunately if they've never experienced it they can never fully understand.
I was lucky in having a GP who had suffered both anxiety and depression.

[Comoso2]

Called new pdoc. They quickly told me they don't prescribe clonazepam. I told them I barely take it so no problem. 75 mg increase is crushing me. I woke up to a panic and cried for am hour or so. I guess I stick with it, this stuff sucks so bad.

[panic_down_under]

Called new pdoc. They quickly told me they don't prescribe clonazepam.

Unfortunately, this is often the case these days. It is based mostly on ideology, hysteria and hypocrisy/. The leading anti BZD crusaders now increasingly have antidepressants in their sights too. Fanaticism is not confined to religion.


75 mg increase is crushing me.

When do you see the new psychiatrist?


I woke up to a panic and cried for am hour or so. I guess I stick with it, this stuff sucks so bad.

It isn't necessarily all the dose increase. The anxious mind is very adept at kicking us when we're at our most vulnerable.

[Comoso2]

I hear you, I'm believing that it's just my mind. I'm going to tough the increase out but man its not easy. I was awfully tempted to take .25 clonazepam this morning when I was hyperventilating and crying, but I refrained and it eventually passed. I'm still dizzy and nervous from it though.

---------- Post added at 16:23 ---------- Previous post was at 16:21 ----------

I don't even have a date for setting new pdoc, they're supposed to cask me esky next week. I still have my final one with my guy that's closing on February 1.

[panic_down_under]

I was awfully tempted to take .25 clonazepam this morning


Maybe ask your current psychiatrist to prescribe a small dose of hydroxyzine (Vistaril) to take instead of the clonazepam. It's a prescription antihistamine with pretty good anti anxiety properties. While not as potent as the BZDs, it is often potent enough.

*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is supposedly the more effective anxiolytic, but just how true this is is a matter of debate.

[Comoso2]

I have generic Vistaril and propranolol that I tried before I went on sertraline, I guess I could try that tomorrow if it's tough. More than anything I need to quit feeding fear into my amygdala and making it bigger...

---------- Post added at 19:17 ---------- Previous post was at 18:51 ----------

But Vistaril and sertraline show a moderate interaction on drugs.com so I've stayed away.

[panic_down_under]

But Vistaril and sertraline show a moderate interaction on drugs.com so I've stayed away.

And if you check sertraline and clonazepam you will find exactly the same warning, almost word for word. The difference is hydroxyzine doesn't block hippocampal neurogenesis, the mechanism by which antidepressants work, whereas benzodiazepines may (Boldrini M (https://www.ncbi.nlm.nih.gov/pubmed/24969726), 2014; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Chen J (https://www.ncbi.nlm.nih.gov/pubmed/19437554), 2009).

Many drugs interact. This doesn't mean they shouldn't be taken together, just that doses may need to be adjusted to compensate, or potential side-effects noted and precautions taken if necessary. This is the principle reason most medications are only available on prescription.

BTW, neither my prefered drug interaction checker at Medscape (http://reference.medscape.com/drug-interactionchecker), or at the University of Maryland Medical Center (http://umm.edu/health/medical/drug-interaction-tool) and WebMD (http://www.webmd.com/interaction-checker/) list any interactions.