Do I Increase?

[kd40]

Hi all

I'm 8 weeks in on 50mg and I feel like I've gone back to square one in some respects. My anxiety is creeping back in and a little OCD too - I'm not sure whether to stick with it and I don't feel exactly as before but I know I'm not happy or to increase.

I am worried about weight gain - I have put on since starting but I know this is my own fault through too much wine and no exercise as I'm very unmotivated at the moment.

I know I'm relatively still early to be levelling out - but I'm worried this downward trend may continue :(

[panic_down_under]

I'm 8 weeks in on 50mg and I feel like I've gone back to square one in some respects. My anxiety is creeping back in and a little OCD too - I'm not sure whether to stick with it and I don't feel exactly as before but I know I'm not happy or to increase.

50mg is the low end of the therapeutic range. Most need to take 100-150mg sertraline to achieve optimum results.


I am worried about weight gain - I have put on since starting but I know this is my own fault through

Weight gain is a potential issue with most antidepressants (ADs). Unfortunately, the ones that generally don't cause it tend not to be effective for anxiety, e.g. bupropion (Wellbutrin, Zyban), or are not readily available in the UK, e.g. trazodone (Desyrel, Oleptro).

There are several hypotheses to why ADs cause weight gain, but few definitive answers, however, affecting the metabolism is certainly one of them, possibly mediated by, among other factors, how ADs affect the enteric nervous system (http://www.scientificamerican.com/article/gut-second-brain) (ENS), the mini brain which controls the gut and the influence they could have on the gut biome. The ENS is by far the most serotonergic organ (https://www.apa.org/monitor/2012/09/gut-feeling) of the body, making about 95% of the serotonin produced compared to less than 2% for the brain, so it can be more affected by serotonergic ADs than the brain is. It is known that the gut bacteria can affect weight (https://www.bbc.com/future/article/20190212-could-gut-bacteria-microbes-make-you-fat) and the mix of gut flora may change (https://www.medicalnewstoday.com/articles/326299.php) due the the impact of ADs. Another factor seems to be that people simply enjoy eating more when they are no longer anxious and/or depressed.


too much wine and no exercise as I'm very unmotivated at the moment.

Take it easy with the wine. ADs work by stimulating the growth of new brain cells (neurogenesis) in the two hippocampal regions of the brain to replace cells killed (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/), or prevented from growing by high brain stress hormone levels, particularly of cortisol. Unfortunately, alcohol has the same affect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/) hippocampal neurogenesis by nearly half (see also: Morris SA (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861155/), 2010; Crews FT (https://pubs.niaaa.nih.gov/publications/arh27-2/197-204.htm), 2003).

Exercise would certainly help, not only with weight, but also anxiety as it also stimulates neurogenesis (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413959/) in the hippocampi. You don't need to run a daily marathon, a steady 30 minute walk 3-5 times a week can work wonders.