Been trying to manage without medication but is it time to give it a go?

[Lady Penelope]

Hello

I suffered with health anxiety a few year ago and was successfully treated with Fluoxetine and CBT. I weaned off the medication and everything was fine for about 18 months.

I felt the health anxiety creeping back about two years ago and went back to GP in Feb this year. I was referred for more CBT and prescribed Fluoxetine again. I had terrible side effects with it so stopped it after 6 days. I have to say I did get a lot of help and information from this forum at that time. I went back to GP and was prescribed Sertraline but I was to scared to take I because of the side effects I had experienced with the Fluoxetine.

Here we are now five months later and due to the pandemic I am still on the waiting list for CBT.
I have been managing with meditation, sometimes alcohol (not good I know) and Kalms tablets. I have been at home during the lockdown which I think has helped me manage. My health anxiety is still there and I now have more general anxiety well and feel anxious most of the time without any obvious reason. I seem to be incapable of making a simple decision and am stressing about every minor decision.

Now that lockdown is easing I find my anxiety getting worse and I have to go back to work next week. The wait for CBT is long so I am considering taking the anti-depressants. I don't find my
GP at all sympathetic and they just say take the anti depressant. I have the fluoxetine and the sertraline at home and keep getting the boxes out and looking at them and reading the leaflets.

I don't feel my anxiety is quite as bad as it was in Feb so I think could cope with side effects better then when I tried the Fluoxetine 10MG and they worked well for me a few years ago so am tempted to try them again. Then I change my mind and remember how horrendous the side effects were in Feb and look again at the Sertraline 50m and think at taking 25mg for a week to see how I get on. I know I have to make the decision myself but would be grateful for your thoughts please.

[panic_down_under]

I was referred for more CBT and prescribed Fluoxetine again. I had terrible side effects with it so stopped it after 6 days.

Unfortunately, ADs can produce more severe, and/or different side-effects the second time. They may also be less effective requiring a higher dose to achieve the previous level of control.


I have the fluoxetine and the sertraline at home and keep getting the boxes out and looking at them and reading the leaflets.

If someone created an AD that worked by simply staring at the box they would corner the AD market, especially for anxiety as many of us have not only the primary disorder but also severe pill phobia. Ime, reading the leaflet increases the risk of both not taking the med and experiencing all the side-effects listed when we do. :ohmy:


Then I change my mind and remember how horrendous the side effects were in Feb and look again at the Sertraline 50m and think at taking 25mg for a week to see how I get on. I know I have to make the decision myself but would be grateful for your thoughts please.

Fluoxetine is generally more activating at the beginning which probably contributed to the side-effects severity, plus as per above, you were taking it for the second time. Given your fears I suggest you take only 12.5mg sertraline for the first week and increase the dose by 12.5mg every 7 days until you're on 50mg (you should get your GP's okay to do this). Psychology is at least as important as chemistry and biology when it comes to side-effects. Expect to suffer greatly and the anxious mind is very capable of producing our worst nightmares in wide-screen technicolour. Most pharmacies sell pill-cutters which make dividing tablets more precise and less bloody. I can't remember how big 50mg sertraline tablets are. If they are too small to quarter then ask your GP to prescribe a box of 25mg tablets to get you started.

[Lady Penelope]

Thank you for your comprehensive reply. Very informative. Going back to GP to get 25mg Sertraline and will try 12.5.

[Lady Penelope]

Well I sent a message via email to my GP and explained in great detail how I was feeling about taking Sertraline and requesting 25mg tablets instead of 50mg I order that I could break them in half and start on 12.5. Anyway the GP obviously did not read it through and just sent another prescription for 50mg so now have two prescriptions! I phoned the surgery and explained all to the receptionist who understood what I was saying. She said she would print off my email and speak to the doctor about it. She called me back the next day and said he won’t do it as there is no point starting on 12.5 and to cut the 50mg in half and start on 25mg. I feel very cross about this and can’t understand why he said no. Needless to say I am still debating whether to try this or not. I should say the tablets are very small and scored so easy to half but impossible to quarter. Shall I just go for the 25mg? Sorry to be such a dithering idiot!

[panic_down_under]

he won’t do it as there is no point starting on 12.5 and to cut the 50mg in half and start on 25mg. I feel very cross about this and can’t understand why he said no.

Because he's a moron with all the empathy of a pet rock. :mad:


I should say the tablets are very small and scored so easy to half but impossible to quarter. Shall I just go for the 25mg?

You would probably do well starting on 25mg physically, but now that this has become an issue for you there is a risk of your mind increasing side-effects severity. Insist on 25mg tablets and tell him why. There are times we need to remind GPs of their true place in the scheme of things. They are not the minor gods some see themselves as, but the hired help who we pay directly, or indirectly through taxes.

[Lady Penelope]

Thank you (empathy of a pet rock! Made me ��).
i have very carefully cut the tablet into 2 and halved it again. I took what looked like a quarter yesterday and again today. I will probably do that for a few days and then up to 25mg.
i really could not face going back to GP again. I have had this prescription since February and been worrying about it since then and debating whether to take it or not. Once I had decided to give it a go I did not want to wait any longer.

I am on the waiting list for CBT and found the combination of anti depressants and CBT worked very well for me a few years ago. I feel now at least I am doing something to try and help myself while I wait for the CBT.
Thanks for all your help panic_down_under - it really does make a difference to get a reply from someone who has knowledge and is willing to share it.

[panic_down_under]

i have very carefully cut the tablet into 2 and halved it again. I took what looked like a quarter yesterday and again today. I will probably do that for a few days and then up to 25mg.

Pill-cutters available from most pharmacies make cutting pills much easier and much less bloody, ime.


i really could not face going back to GP again. I have had this prescription since February and been worrying about it since then and debating whether to take it or not. Once I had decided to give it a go I did not want to wait any longer.

I am on the waiting list for CBT and found the combination of anti depressants and CBT worked very well for me a few years ago. I feel now at least I am doing something to try and help myself while I wait for the CBT.

A good plan, imho. The sooner these disorders are treated the better.

[Lady Penelope]

Thank you. I do have a pill cutter which definitely helps. It’s great cutting in half as the tablet is scored - not so good on the second cut as the tablet is small but I will do for a few days. I will go to 25mg on Monday all being well.

[Lady Penelope]

I have now taken 12.5mg for two nights and plan to continue for 7 before increasing to 25mg. Feeling ok so far. I have been talked into throwing a birthday party for my son on Friday - what’s the deal with Sertraline and alcohol? I must admit to be drinking most days since lockdown -probably about half a bottle of wine every night but have not had any since I started Sertraline. Will I be ok to have a glass or two if wine or should I abstain completely? My family are not aware of my anxiety problem and don’t know I am on antidepressants . Any advice please?

[WiseMonkey]

Personally, I wouldn't have any alcohol until you find a stable dose of your AD and make sure it's working for you. Then try a small glass of wine if you wish. Alcohol mixed with AD's can magnify the side effects of them.

[panic_down_under]

I have now taken 12.5mg for two nights and plan to continue for 7 before increasing to 25mg.

The rule of thumb on this is to not increase med doses sooner than 5 times their half-life which is the point at which plasma levels usually stabilise to a steady-state. For sertraline this is 26 hours x 5 = 130 h/5 days. I usually recommend folk take an extra days or two as a confidence booster so increasing the dose ever 7 days is ideal. Doing it sooner may increase the severity of side-effects, but delaying it won't significantly lower their severity no matter how long the delay.


what’s the deal with Sertraline and alcohol? I must admit to be drinking most days since lockdown -probably about half a bottle of wine every night but have not had any since I started Sertraline. Will I be ok to have a glass or two if wine or should I abstain completely?

Sorry to be literally a party pooper, but ADs and alcohol are not a good mix. :weep: Firstly, the AD+alcohol combination can be unpredictable. Some days you may be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small glass of wine could turn legs to rubber. Plus, as WiseMonkey has already posted, alcohol may increase side-effects severity. Be extra cautious until you work out how the combination effects you.

The second issue is that alcohol can inhibit the mechanism by which ADs work. They stimulate the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels, mostly of cortisol (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)). The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly.

The problem is alcohol has the same effect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/) cell growth 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). This, and a few other factors, is why alcohol has never proven to be a anxiety/depression cure despite probably being the most (self)prescribed 'med' for these disorders. They mostly create a tag team downward spiral to rock bottom. :sad:

[Lady Penelope]

Thank you so much for the replies. Makes it very clear!

[Lady Penelope]

Hello
I have now started taking the Sertraline. I took for 25mg for two days back in July and then panicked and stopped as I was having a small family part for my son and I was afraid I would drink alcohol! I am now on day 9 of 25mg. My main side effect with it is increased anxiety but I really feel I need to stick with it and see if it works for me. I will post an update when I have been on it a bit longer in case it helps someone else just starting out. I had planned to start in 25mg and then group to 50mg after 7 days.
one of the problems I have had is that my heart rate has dropped and I wonder if 5is could be a side effect? My usual resting heart rate is about 62 and dropping to about 55 when I sleep. Since starting this my resting heart rate has gone to 54 dropping to 48 when I sleep. I am on propranalol 20mg twice a day and Amlodipine 5mg for blood pressure, along with a statin and baby aspirin. i called the GP and she said reduce the propanol to 10mg twice a day which I have but it has not made a difference and it’s still lower than usual. Does Sertraline lower blood pressure and heart rate? Or is it something else? My GP said to stay on 25mg Sertraline for another week.

[Lady Penelope]

I should also add GP has given me diazepam 2mg to help with side effects but I’m now frightened to take them in case they lower my heart rate even more! I have not taken any of them yet but was glad she had prescribed them in case it got too bad - I have managed without them since taking Sertraline but have an appointment at the hospital tomorrow which I am really anxious about.

[panic_down_under]

one of the problems I have had is that my heart rate has dropped and I wonder if 5is could be a side effect? My usual resting heart rate is about 62 and dropping to about 55 when I sleep. Since starting this my resting heart rate has gone to 54 dropping to 48 when I sleep. I am on propranalol 20mg twice a day and Amlodipine 5mg for blood pressure, along with a statin and baby aspirin. i called the GP and she said reduce the propanol to 10mg twice a day which I have but it has not made a difference and it’s still lower than usual. Does Sertraline lower blood pressure and heart rate?

One of the many roles serotonin has in the body is in mediating blood vessel tone, constriction and dilation which can see blood pressure either rise, or fall, when taking serotonergic ADs, especially at the beginning. SSRIs don't usually directly effect the pulse rate, however, it could vary in response to the drop in BP. This may resolve in a week or two as your body adjusts to the med. Fwiw, I've been on a BP med since having part of a lung removed nearly 15 years ago to keep my BP at the low end of the normal range and my resting heart rate hovers around 48 to 50 bpm. It has has no obvious consequences apart for occasional momentary dizziness if I get up quickly.

Are you taking the baby aspirin on doctor's orders? If not, I suggest you discuss this with your GP as serotonergic ADs are also mild anticoagulants.


GP has given me diazepam 2mg to help with side effects but I’m now frightened to take them in case they lower my heart rate even more!

Diazepam may reduce an anxiety triggered elevated heart rate by lowering anxiety levels, but doesn't usually do so otherwise at usually doses. One study (https://www.karger.com/Article/Abstract/481665) with healthy volunteers did find a slight increase in heart rate after one month of daily dosing at 5mg, but other studies have found no significant difference either way.

[Lady Penelope]

Thank you panic_down_under I can always rely on you to reply and give such a comprehensive answer.

i have phoned to docs and asked if I should stop propanalol completely and I’m waiting on a call back.

[Lady Penelope]

I had loads of heart tests done about 9 years ago just after my dad died. I thought I was having a heart attack but in hindsight I can see now that it was panic attacks. I have a great deal of heart disease in my family so I think that was why were being extra cautious. They said I had mild coronary artery disease so put me on 20mg simvastatin and baby aspirin.
then about five year ago I had slightly high blood press so got put on 5mg amlodipine. The propranolol was added a it later to help with the blood pressure and anxiety.

my husband thinks I don’t need any of these medications at all and always nagging me to stop. I suppose because I have heart related health anxiety I see the meds as a good preventative measure.My blood pressure is well controlled and often a little low.

i have been thinking all this over today and have booked to have a medication review in a couple of weeks time.

anyway thanks again panic_down_under. I think you are such a nice person to take the time to reply to so many on these boards.

[panic_down_under]

i have been thinking all this over today and have booked to have a medication review in a couple of weeks time.

Regular drug reviews are a good idea, imho.

I suggest you specifically ask about taking both sertraline and aspirin. There probably is no concern at your current sertraline dose, or at 50mg, but the combination will become increasingly problematic as the dose rises. However, please don't stop taking the aspirin without first discussing it with your GP.

If you discontinue the aspirin there may be a small drop in BP as this often increases a little when aspirin and amlodipine are taken together. You GP will likely have considered this when selecting the amlodipine dose so it shouldn't be an issue at the moment, but maybe get your BP checked again a week or two after you stop taking the aspirin.

[Lady Penelope]

Thank you panic_down_under
had call from G P who said to stop propranolol but keep an eye on blood pressure and heart rate . Review next Wednesday.

[Lady Penelope]

Now been on 25mg Sertraline for 12 days and have a review with GP tomorrow. Anxiety has been up and down this week and main side effect has been increased anxiety.. heart rate has been up and down and I have gone from 40mg propanol a day down to 20mg then none at all and back to 20! My health anxiety is centred around my heart so this has been difficult. I now have to decide whether to go up to 50mg or stay on 25mg. Does 25mg ever work for anyone? The side effects of 25mg have not been as bad as I feared and I am worried about increasing the dose. I am the sort of person who gets a big effect from medication- I only ever take 1 paracetamol instead of 2 if I have a headache.
I think I may feel marginally better than I did twelve days ago but not markedly so. Any thoughts please?

[panic_down_under]

I now have to decide whether to go up to 50mg or stay on 25mg. Does 25mg ever work for anyone?

25mg is a sub therapeutic dose for most. Taking sub therapeutic doses may increase the risk of the AD 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 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (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. For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

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 (https://www.ncbi.nlm.nih.gov/pubmed/27805299), 2016 and Amsterdam JD, 2009 (http://www.karger.com/Article/FullText/226611) found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007); Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002). Taking a low dose for months may create a similar situation as stopping and restarting it as plasma levels fluctuate. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.


The side effects of 25mg have not been as bad as I feared and I am worried about increasing the dose. I am the sort of person who gets a big effect from medication- I only ever take 1 paracetamol instead of 2 if I have a headache.

The side-effects will likely be not worse than at 25mg.

As per above, ADs have no direct effect on anxiety so experiences with other meds may not be a guide to AD dosing. Most serotonergic ADs need to be taken at doses high enough to saturate at least 80% (https://pubmed.ncbi.nlm.nih.gov/15121647/) of the serotonin transporters (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available diagnostic tests to determine the dose needed to achieve this for individuals.


I think I may feel marginally better than I did twelve days ago but not markedly so.

ADs typically take 5-12 weeks to kick-in. It takes about 7 weeks (http://cshperspectives.cshlp.org/content/7/9/a018812.full) for new cells to bud, grow and reach maturity, although some improvement may begin earlier.

[Lady Penelope]

Thank you panic_down_under for your reply.
Seems to me I will need to increase to 50mg.
I would like to do that slowly if possible by trying 37.5 for a week but have been told by a different GP that 25mg is not available in the UK.

At the moment I have 50mg and am splitting them in 2. I could try and split the tablet into 4 and take 3/4 of a tablet but it’s not very accurate even with a pill cutter.

or is there any point is splitting the 50 in 2 and taking 25mg morning and evening to spread it out?

or maybe I should just be brave and go for the 50!

Thanks for reading and I would appreciate your thoughts.

[panic_down_under]

At the moment I have 50mg and am splitting them in 2. I could try and split the tablet into 4 and take 3/4 of a tablet but it’s not very accurate even with a pill cutter.

I don't know if this will help as it depends on the tablet structure, but if it is scored try making the first cut at right angles to the score and then use the score to centre the blade for the second cut.


or is there any point is splitting the 50 in 2 and taking 25mg morning and evening to spread it out?

It may help for the first 2-3 days. Sertraline has a half-life of about 24 hours and plasma levels of most meds will stabilise to a steady-state at 5 times their elimination half-life. Once at a steady-state it doesn't matter much when and how the med is taken. At least that is the theory. In practice some, e.g. me, seem to do better taking ADs in 2-3 split doses, especially with those that have half-lives around 24 hours, or less. Doctors often discourage the practice as compliance frequently drops. We are contrary creatures and the more often a med needs to be taken the more likely we are to find it all too hard and give up.


or maybe I should just be brave and go for the 50!

It probably won't be that much harder. Side-effects tend to be less severe after a dose increase than they were when first taking the AD and to diminish sooner, but as with everything about ADs, there are no guarantees. They can be unpredictable meds. It pays to have a sense of humour. Cuts down on the tears. :ohmy:

[Lady Penelope]

Thank you again. Great tip about cutting the tablet!

i have just spoke to GP. She said you can stay on 25 or go up to 50 - it’s up to you! She said 25 is a very small dose. I have decided to try 37.5 for a week and see how I go.
panic_down_under your advice is much appreciated.

[panic_down_under]

I have decided to try 37.5 for a week and see how I go.

Cool. The rule of thumb on this is not to raise doses at less than 5 times the half-life of the AD, so for sertraline no sooner than 5 days from the last increase, though I recommend taking an extra day or two mostly for psychological reasons. Upping doses sooner may trigger more severe side-effects, however, delaying them usually won't significantly reduce any subsequent spike no matter how long the delay.

[Lady Penelope]

Been on 37.5 mg for 5 days now and anxiety has been so much worse than first two weeks. Panic attacks every day and I have had to resort to diazepam 3 times. Really hope this settles down soon -it’s horrendous and makes me regret starting this drug in the first place

[panic_down_under]

Been on 37.5 mg for 5 days now and anxiety has been so much worse than first two weeks. Panic attacks every day and I have had to resort to diazepam 3 times.

If diazepam gets you over this then that's okay. Unfortunately, there are no side-effect free ADs, although the more fortunate majority experience only mild ones. It all comes down to how individual biology meshes with the med.


Really hope this settles down soon -it’s horrendous and makes me regret starting this drug in the first place

Try and focus on the end result, not what is happening in the moment. Diversion can be effective. I read books pretty much from dawn to dusk my first time on an AD. 'Read' not being an accurate description, more concentrating on each word in turn without necessarily grasping what each sentence meant, let alone what the book was about. I've had to repeat this a couple more times since and still haven't a clue about the stories. But it did help get through some very dark days (mostly of my own making by insisting on ramping up doses quickly). One day I must sit down and begin really reading them.

[Lady Penelope]

Thank you. I am feeling awful today. Getting tingling all over my face and head, feeling dizzy and lightheaded. I keep telling myself it’s just the side effects and it will get better soon. So hard to get through each day. Terrible panic attack last night - the worst for about five years - I though I was having a stroke. I feel washed out now and fearing another one. Hate this anxiety. I know I have to stick with this and give it a try as I tried without meds for about 6 months and I was getting worse.
Thanks again panic_down_under. - I will try keeping busy and not dwell on it too much. I am planning on upping to 50mg in two days time.
The most difficult thing is not knowing when or if this will work for me

[panic_down_under]

Thank you. I am feeling awful today. Getting tingling all over my face and head, feeling dizzy and lightheaded. I keep telling myself it’s just the side effects and it will get better soon. So hard to get through each day. Terrible panic attack last night - the worst for about five years - I though I was having a stroke. I feel washed out now and fearing another one. Hate this anxiety.

Not all of what you're feeling may be down to the AD. An anxious mind is quite capable of delivering our worst nightmares given half a chance and severe med side-effects can give it a lot to play with.


I am planning on upping to 50mg in two days time.

Maybe give it an extra couple of days if things haven't calmed down for the side-effects to hopefully ease and to recharge the psychological 'batteries'. In the AD race there is much to be said for being a tortoise rather than hare.


The most difficult thing is not knowing when or if this will work for me

Unfortunately, this is the second biggest problem with ADs after the side-effects. Despite much effort there is still no reliable way of determining the most effective med for an individual. Gene tests have shown some promise, but aren't there yet and that has been the case for a while now. :sad:

[Lady Penelope]

I would be interested to know what the statistics are for Sertraline. Most things I read about SRRIs are negative and I wonder what percentage of people they help. It seems like they are a last resort for a a lot of people and many stop taking them within a few weeks due to the side effects. Also some people take them for a good few months and they don’t work so the have to start again with a different drug. I suppose people who have a positive experience are not posting looking for help and support.

[panic_down_under]

I would be interested to know what the statistics are for Sertraline. Most things I read about SRRIs are negative and I wonder what percentage of people they help.

Unfortunately, there is little data available for the effectiveness of ADs for anxiety as most of the research is into depression (which is curious given the prevalence of anxiety disorders is significantly higher). The other issues are studies are often too short lived, typically ending at 4 weeks, and almost none that go beyond 6 weeks, plus they rarely test up to the maximum recommended dose. In my case I've always needed to take the maximum, or above to get a good result. Based on study criteria my PD would have been classed as treatment-resistant and I would have spent the past 33 years imprisoned by agoraphobia. Instead with high AD doses I was able to continue with a very demanding job until retirement and travel the world.

For depression response rates are typically around 35-45% for the first SSRI tried, going to 60-70% on the second, or third. SSRIs tend to be more effective for anxiety than depression.


It seems like they are a last resort for a a lot of people and many stop taking them within a few weeks due to the side effects.

Yes, but not helped by many doctors treating their patients as mushrooms and not warning them about side-effects, prescribing either too high a starting dose, or ramping it up too quickly. Often they also tell patients that ADs will work within 2-4 weeks so people lose hope when they don't experience anything but side-effects during that time.


Also some people take them for a good few months and they don’t work so the have to start again with a different drug.

Depends on the med switched too. You won't go back to zero if changing to another SSRI, and would still retain some 'credit' when switching to most TCAs.


I suppose people who have a positive experience are not posting looking for help and support.

Support groups are not good guides to the effectiveness of any treatment and they is especially so with anxiety/depression groups and ADs. Most people have none to only mild side-effects from ADs and as you say, they aren't the ones you'll find posting here.

[Lady Penelope]

Thank you. Very interesting.
You are so right about the G P. Never said anything about side effects and said it will be a few weeks before you see any improvement. Very unrealistic.

Very good of you to share your knowledge. I will try and power on through.
i have been on Sertraline for almost three weeks now so I am hoping I am half way through to seeing some signs of improvement.
I initially thought once I get through two weeks it will start to get better but now I know that’s unrealistic.

How long before you know they are not going to work?

[Lady Penelope]

Today I have developed cold sores/blisters along my top lip. Could this be a side effect of Sertraline?

[panic_down_under]

How long before you know they are not going to work?

Imo, after at least 8 weeks on 200mg, because a few of us need to take high doses to get a response, but most GPs will want to pull the plug earlier.


Today I have developed cold sores/blisters along my top lip. Could this be a side effect of Sertraline?

It could be as Herpes simplex is a listed side-effect. Not sure how that is possible especially in the time frame, but... Presumably, it will respond to the usual treatments. Usually the main skin issue to be careful of with SSRIs is they may increase skin photo-sensitivity so apply sun block, and/or cover up if outdoors for any length of time, particularly in summer.

[Lady Penelope]

Thank you ��

[Lady Penelope]

Day 22 on Sertraline.
15 days on 25mg and 7 on 37.5
Week three has been harder than the first two weeks.
hoping this week will be better and I will see some improvement

[Lolalee1]

Hello pdu
Just wanting your thoughts on Pristiq my Psych changed my meds and I take 50mg of this drug in the morning i started it last Friday he didn’t tell me how long before I see or feel any changes.Thank you.

[panic_down_under]

Just wanting your thoughts on Pristiq

Desvenlafaxine is a slightly better option than its parent compound venlafaxine, imo.


my Psych changed my meds

What were you on before, at what dose and how long did you take that dose?


and I take 50mg of this drug in the morning i started it last Friday he didn’t tell me how long before I see or feel any changes.Thank you.

Were you switched directly from the previous AD, or did you wean off it and then start taking desvenlafaxine?

[Lady Penelope]

I am now almost four weeks into taking Sertraline. I took 25mg for 12 days, 37.5 for 9 days and I have been on 50mg for 5 days. I am pleased that I have got this far as I had stopped Fluoxetine earlier in the year after a few days due to side effects. I have been suffering with really bad anxiety since February.

It has been a rough few weeks and I am not really seeing any improvement yet. I am hoping that now I am on 50mg I will start to notice some good effects.

I have read so much about Sertraline and the time it takes to start working seems to vary from 4 weeks to 16 weeks! I am obviously hoping I am at the lower end of that scale. I am still on the waiting list for CBT as well.

[panic_down_under]

I am now almost four weeks into taking Sertraline. I took 25mg for 12 days, 37.5 for 9 days and I have been on 50mg for 5 days. I am pleased that I have got this far as I had stopped Fluoxetine earlier in the year after a few days due to side effects.

Well done!! :) It takes about 5 days for sertraline plasma levels to settle to a steady state after a dose increase (or decrease) and side-effects then usually begin to diminish so the worst is now probably behind you.


I have read so much about Sertraline and the time it takes to start working seems to vary from 4 weeks to 16 weeks! I am obviously hoping I am at the lower end of that scale.

The peak kick-in time is between 4-8 weeks, but as with everything about ADs, there are no guarantees. It all depends on individual biology and so far there is no way of accurately predicting a person's likely response to an AD.


I am still on the waiting list for CBT as well.

Have they given you a likely time frame?

[Lady Penelope]

Thanks panic_down_under. The timeframe for CBT was months from April but now with this pandemic who knows! They stopped all services for a while so I imagine much longer now. That was one of the reasons I felt I had to persist with the SSRI. I have been given access to online CBT but don’t find it that great. I am reading the Dare book and find that useful.

[panic_down_under]

The timeframe for CBT was months from April but now with this pandemic who knows! They stopped all services for a while so I imagine much longer now.

Yeah, 2020 should have been cancelled back in March!! :sad:


I am reading the Dare book and find that useful.

I'm not familiar with it, but the reviews seem positive. Fingers crossed it continues to help. :emot-nod:

[Lady Penelope]

I am now officially over the first four weeks on Sertraline. Over the last week I have had a couple of better days when I was slightly less anxious. I have been really anxious today and have had to take 1mg diazepam. I have only been on 50mg Sertraline for 10 days which I know is not long. I am feeling hopeful that I will get more good days and less anxious days as time goes by.

[panic_down_under]

I am now officially over the first four weeks on Sertraline. Over the last week I have had a couple of better days when I was slightly less anxious. I have been really anxious today and have had to take 1mg diazepam. I have only been on 50mg Sertraline for 10 days which I know is not long. I am feeling hopeful that I will get more good days and less anxious days as time goes by.

It is certainly looking promising. Long may that continue :emot-nod:

[Lady Penelope]

33 days on Sertraline- the last 14 days on 50mg. I have been feeling a bit better in the afternoons and evenings but much worse in the mornings. I have been waking up feeling anxious and shaky and this seems to lead to a daily panic attack. I have used the diazepam 1mg a few times. I am taking the Sertraline at bedtime. Any thoughts or suggestions please?

[panic_down_under]

33 days on Sertraline- the last 14 days on 50mg. I have been feeling a bit better in the afternoons and evenings but much worse in the mornings. I have been waking up feeling anxious and shaky and this seems to lead to a daily panic attack. I have used the diazepam 1mg a few times. I am taking the Sertraline at bedtime. Any thoughts or suggestions please?

Try taking it in the morning, or even splitting the dose taking half in the morning and the other at night. In theory neither should make any difference because about 5 days after a dose change sertraline plasma levels stabilise to a steady state and then don't vary much across the 24 hours, but in practice it often does.

[Lady Penelope]

Thank you panic_down_under. That’s definitely worth a try. Will let you know how it goes.

[Lady Penelope]

Ok just a quick update. I have now been on Sertraline for 6 weeks in total - started on 25mg and have been on 50mg for the last three weeks. Things are definitely improving slowly. My anxiety is definitely less although I still have anxious moments. I do feel I am more able to manage now. I am hoping this will continue to improve the longer I am on them. Spoke to GP today for follow up and she said stay on 50mg and she will review me in 3 months. I have heard it takes at least 12 weeks on a dose before it levels out and you know if you need to increase. Not sure that is correct though - doc said 4-6 weeks.
I have managed to avoid alcohol completely and intend on abstaining for a few more weeks. I do miss having the odd glass of wine or gin and tonic but I do feel scared about having a drink with these meds.
Since starting Sertraline I have reduced propranalol from 40mg per day to 20mg per day.
Special thanks to panic_down_under for all your help and information. It really does make a massive difference when starting out to have someone take the time and trouble to reply.

[panic_down_under]

I have heard it takes at least 12 weeks on a dose before it levels out and you know if you need to increase. Not sure that is correct though - doc said 4-6 weeks.

Most begin to improve at 4-8 weeks, but it can take longer for others. It all comes down to individual biology.


I have managed to avoid alcohol completely and intend on abstaining for a few more weeks. I do miss having the odd glass of wine or gin and tonic but I do feel scared about having a drink with these meds.

Once things settle down the odd glass probably won't hurt, but with an emphasis on 'odd' and don't drive or engage in other potential risky activity until you work out how the alcohol reacts with the med.


Special thanks to panic_down_under for all your help and information.

Glad my scribblings have helped. :)

[Lady Penelope]

Just a quick update which might help someone thinking about taking Sertraline. I have now been on Sertraline for 8 weeks - starting at 25mg and increasing to 50mg six weeks ago. I had the prescription since February and it took me until 13th August to pluck up the courage to take it. My main problem is health anxiety.

I am now feeling so much better. I still get the odd flash of anxiety but I can manage it. If I had know how much better it has made me feel I would have taken it much sooner. I would say I am 80% better than I was earlier in the year. My anxiety was so bad in February that I missed a family holiday. So I would encourage anyone to give this medication a try.

[panic_down_under]

I am now feeling so much better. I still get the odd flash of anxiety but I can manage it. If I had know how much better it has made me feel I would have taken it much sooner

That's good to hear. :emot-nod: Thanks for letting us know. Six weeks is still early days. There should be further improvement over the next weeks as the brain changes triggered by the med consolidate.

[Lady Penelope]

Thanks panic_down_under.
I have now had two bad days - I must have jinxed myself! Been feeling anxious and jittery. Ocular migraine two days running and tingly face. It this normal with Sertraline? How long does this medication take to be level? And when do you know if you need to increase?

[panic_down_under]

I have now had two bad days - I must have jinxed myself! Been feeling anxious and jittery. Ocular migraine two days running and tingly face. It this normal with Sertraline?

Migraines are a relatively common side-effect. They tend to occur more often when there is a past history. Tingly skin is a common initial SSRI side-effect produced by constriction of the fine blood vessels of the skin. Serotonin isn't only a brain neurotransmitter. It has many roles in the body including in blood vessel tone, constriction and dilation, and SSRIs can effect this, especially at the beginning.


How long does this medication take to be level?

This is difficult to answer as the med doesn't have a direct effect. ADs stimulate the growth of new brain cells (neurogenesis) which produce the therapeutic response and their growth can be affected by other factors too. It can take up to 12 weeks to achieve the maximum response from a dose. However, even when working at maximum efficiency there can be the occasional bad day. They are part of the human condition.


And when do you know if you need to increase?

If the bad days become more frequent then a dose increase should be considered. Most on sertraline take 100-150mg/day.

[Lady Penelope]

Thank you

[Lady Penelope]

I have finally had a call to say I can start CBT after being on waiting list since February. It starts tomorrow and will be delivered online. I was prescribed SSRI in Feb but did not start taking them until august as I was holding out for CBT. I am so glad I started taking them now. I will be on 8 weeks on 50mg tomorrow and I am feeling a little better. I still have anxiety every day but it is more manageable now.

when all this started it was health anxiety that triggered it but it has now developed into general anxiety as well.

I did have a major panic a couple of days ago when I woke with chest pain. It only lasted a minute but I am always convinced I am about to drop down dead with a heart attack or Stoke.

this is what I hope to address with the CBT. I have tried the online CBT and did not find it great. I find it hard to stop worrying about the future and thinking about dying all the time. I am hoping the combination of CBT and Sertraline will do the trick. I have a review with docs in 4 weeks to decide whether to increase dose or stay at 50mg.

my question today is how does everyone go about their daily lives without worrying so much that it curtails their life. I cannot imagine going back to being that person who just gets on and enjoys their days.

I have been reading a lot of books about anxiety such as Claire Weekes and Dr Harry Barry and I can understand what they are saying and it makes sense but I don’t seem to be able to apply their advice very well. I always think to myself ‘how do you know that this time it is not something other than anxiety’
Have a good day everyone and thanks in advance for any replies.

[panic_down_under]

I find it hard to stop worrying about the future and thinking about dying all the time.

...my question today is how does everyone go about their daily lives without worrying so much that it curtails their life.

The Reaper will get us all in the end and no amount of worrying about this will add a nanosecond to our existence. Will probably shorten it as stress is humanity's leading cause of premature death. My observation is the young are much more preoccupied with death than oldies like me. We tend to gradually come to terms with it the closer it gets and for some it can be a blessing. It's not the years in your life that count; it's the life in your years.

Life is about the journey, not the destination, and this is true irrespective of what you believe that destination is. You can either half live in the shadow of death, or out in the sunshine fully embracing life. Be so busy living that you don't have time to brood about journey's end. There is a differenced between existing and living. They shouldn't be confused, but often are. Everyone dies, but not everyone really lives. The secret to a well lived life is not being one of the latter.


"Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a ride!"

Hunter S. Thompson


I cannot imagine going back to being that person who just gets on and enjoys their days.

And yet when they work well, both therapy and/or meds can return your life to pretty much nearly the way it was. Not exactly the same, which is a good thing because look where that got you, but hopefully a better, more resilient version of the former you. It won't happen overnight, but there is a very good chance it will happen.


‘how do you know that this time it is not something other than anxiety’


You don't, and one day it won't be, but how many times has it been "something other than anxiety" until now? The odds are greatly in favour of it not being. The 'funny' part is that those overwhelmed by every minor twinge, convinced that this time it really is the end, almost invariably cope magnificently with real trauma, often far better than the 'heroes'. The imagined is almost always far, far worse than the actual.

[Lady Penelope]

Thank you.that makes so much sense!
I am just feeling bad as I have had a bad coupled days with anxiety and panic. Another ocular migraine last night and woke up at 5am this morning with panic attack and had another one an hour later. Feel totally drained and nauseous now.
I have been on 50mg for 8 weeks now so it makes me think the medication is not going to work. Or is this usual with Sertraline to have these blips before it levels?
have first CBT today.

[panic_down_under]

I have been on 50mg for 8 weeks now so it makes me think the medication is not going to work. Or is this usual with Sertraline to have these blips before it levels?

Blips do happen, but I think you will probably need a higher dose. Most take 100-150mg sertraline for optimum results.

[Lady Penelope]

Thank you. I will leave it until the end of this week and see how I go. It seems to be a bit of a roller coaster with this medication. I have had some really good moments and some awful but I am definitely better overall. I have read that some people take 3-4 months to level on one dose. I don’t want to increase unless I really have to. Thanks again panic_down_under it really is helpful to have a reply. Makes me feel a lot less alone with this.

[panic_down_under]

I have read that some people take 3-4 months to level on one dose.

True, even longer, but by 12 weeks you'll be getting most of what the dose is capable of. After that any further improvement is usually minor, although there is considerable room for psychological improvement if the med has eliminated most of the anxiety.


I don’t want to increase unless I really have to.

Why, because the side-effects may return? If so, they might, but they are usually less severe than at the beginning and don't last as long. However, I do recommend sertraline dose increases be no greater than 25mg at a time with at least 7 days between each increase.

[Lady Penelope]

Thank you once again.

I would like to stay on the lowest dose possible and I think that if I increase too quickly I might end up on a higher dose than I really need. I think I may try and stick it out at 50mg for 12 weeks and then decide. When I was on an SSRI a few years ago (Fluoxetine) I stayed on 20mg and found it fairly east to wean off from as the dose was not high. I am hoping that I will eventually be able to come off Sertraline and so the lower dose I am on the better.

I am worried about the side effects from increasing but not as much as I was at the start.

Had my first CBT sessions yesterday. It was an online assessment and I was diagnosed with panic disorder. I have been booked in for weekly sessions. starting next week. It was nice to speak to somebody about it and it felt good getting it all of my chest! I am hoping the combination of CBT and medication will do the trick.

I am also reading loads of books and listing to mediation and relaxation tapes which seem to help.

[panic_down_under]

I would like to stay on the lowest dose possible and I think that if I increase too quickly I might end up on a higher dose than I really need.

Because of the way ADs work it is better to take a bit too much than not enough. Any extra has little negative effect.


When I was on an SSRI a few years ago (Fluoxetine) I stayed on 20mg and found it fairly east to wean off from as the dose was not high. I am hoping that I will eventually be able to come off Sertraline and so the lower dose I am on the better.

It wouldn't have mattered much if you'd been on the maximum 80mg fluoxetine. It has a very long half-life, about 6 days, and that of its active metabolite norfluoxetine, which actually does most of the work is even longer, around 16 days, so it takes some 80-90 days to be completely metabolised which provides an automatic long, slow taper even if quitting it cold-turkey (which is not an endorsement, C-T withdrawal from any psych med, including fluoxetine, is a stupid move!).

Sertraline has a much shorter half-life, but the taper starting dose probably won't affect the withdrawal outcome by much. It is quitting the last few milligrams which generally produces any problems that may occur, not cutting back the higher doses. The trick is not to rush the process, but to slowly wean off over months, not weeks, by small steps.


Had my first CBT sessions yesterday.

That's very good news. :emot-nod:


I am also reading loads of books and listing to mediation and relaxation tapes which seem to help.

That's great, but there can be a tendency to overload with information and end up doing several things which may not be compatible. Let the CBT therapist be your main guide.

[Lady Penelope]

Thank you for sharing your knowledge. It makes me feel a bit better about increasing. I I have been on Sertraline for 11 weeks now, starting at 25mg. I have been 50 for just over8 weeks. Review with G P Is December 23rd.
I am still feeling fairly anxious. Another ocular migrane yesterday and Face tingling. I am hoping it begins to settle down soon.

[panic_down_under]

am still feeling fairly anxious. Another ocular migrane yesterday and Face tingling. I am hoping it begins to settle down soon.

Do you have a past history of ocular migraines? If so, how frequent were they and did either an increase in anxiety, or face tingling accompany them?

[Lady Penelope]

I have a past history of migraine which started when I was about 25 and I had them for about 20 years. I’m 61 now. The ocular migraine started about 3 years ago and I would get one every few months.i have posterior vitreous detachment so have had my eyes checked frequently. They have got more frequent over the last six months or so and I would get one every month or two months. Since starting the sertraline I have had more. Once or twice a week.
The face tingling comes at random times - not connected with the ocular migraine. I have only had the face tingling since starting sertraline do am assuming it’s a side effect. I seem to get it when I am lying down relaxing. Tingling round my mouth and chin which lasts for 15 mins or so and then goes away.

[panic_down_under]

They have got more frequent over the last six months or so and I would get one every month or two months. Since starting the sertraline I have had more. Once or twice a week.

Interesting, as ADs are sometimes prescribed to prevent migraines of both types although they haven't affected the frequency of mine either way. Unfortunately, it's impossible to predict what effect increasing the sertraline dose will have on their frequency, if any.

Did you continue to have the migraines while on propranolol?


The face tingling comes at random times - not connected with the ocular migraine. I have only had the face tingling since starting sertraline do am assuming it’s a side effect.

It is a relatively common symptom of migraines too, but I think you're right about it being a med side-effect in your case.

While the increased migraine frequency and the face tingling are mostly likely just sertraline side-effects I suggest you raise them with your GP at the next consultation if you haven't already. He's in a much better position to judge whether they need investigating.

[Lady Penelope]

Hello again

Anxiety is ramping up again and I have two panic attacks in last 3 days.
I spoke to GP today for a review and she said I should increase to 100mg. I suggested going to 75mg for a week but she said that was not necessary.

No more migraines thankfully. GP thinks the tingling is side effect from Sertraline.

I have been on Sertraline for 12 weeks in total - 9 weeks at 50mg. Just thinking about whether to take her advice and go to 100mg straight away. I would have liked to have remained at 50mg for a few more weeks but I think I need to increase.

[Midnight-mouse]

I didn’t have any issues going from 50 to 100mg, maybe a little tired for a couple of days and a little icky sort of feeling in the stomach. I’ve definitely noticed big changes for me at this dose and might end up seeing what I’m like at 150mg soon.


Sent from my iPhone using Tapatalk

[Lady Penelope]

Thank you for the reply.

[panic_down_under]

Just thinking about whether to take her advice and go to 100mg straight away. I would have liked to have remained at 50mg for a few more weeks but I think I need to increase..

I think you're right. While 50mg may have some incremental improvement left to give you're unlikely to get a night turned to day moment from it.

[Lady Penelope]

Thank you. I decided to go up to 75 for a week and see how I go. Started last night.

[Lady Penelope]

Ok just a quick update. Now been on Sertraline for 13 weeks and still feeling anxious every day. I started on 25mg for two weeks and then 9 weeks on 50mg.
Been taking 75mg for two weeks and don’t know if I need to just be patient and give it time to kick in or up to 100?
Any thoughts please?

[panic_down_under]

Been taking 75mg for two weeks and don’t know if I need to just be patient and give it time to kick in or up to 100?

It is going to take longer than 2 weeks for the dose increase to begin having an impact, but I'd go up to 100mg as most need to take 100-150mg for optimum results.

[Lady Penelope]

Hello
now been on Sertraline for 19/weeks starting at 25mg. The last 5 weeks on 75mg. It finally beginning to work and I’m having much better days. Also 5 weeks into CBT.
I have two worries about Sertraline- I am loosing a lot of hair. I can see my hair is becoming thinner and keep finding hairs in the bath and on the floor. I understand this can be a side effect of Sertraline. Is this likely to stop.?
I am also getting more frequent ocular migraines. I used to get one every few months but it now twice a week. My GP thinks this is a side effect of Sertraline.
Also I am feeling a bit emotionally numb. I don’t seem to be able to feel any emotion. My son left home this week and I have not even shed a tear. When my daughter left I cried for weeks! I don’t want to stop Sertraline as it is helping my anxiety a lot but should I consider tapering down to 50mg? I am not sure I gave it enough time of 50mg to level and may have gone up too soon. I have read it can take 12-18 weeks for a dose to become fully effective. I would be grateful for your thoughts.

[panic_down_under]

Hello
now been on Sertraline for 19/weeks starting at 25mg. The last 5 weeks on 75mg. It finally beginning to work and I’m having much better days. Also 5 weeks into CBT.

This is very good news! :)


I have two worries about Sertraline- I am loosing a lot of hair. I can see my hair is becoming thinner and keep finding hairs in the bath and on the floor. I understand this can be a side effect of Sertraline. Is this likely to stop.?

Hair loss is an uncommon side-effect of many meds, including SSRIs. Often the only remedy is switching to another AD, however, there are a few case reports of zinc or omega-3 fatty acid/fish oil supplements being effective so one, or both may be worth a shot.


I am also getting more frequent ocular migraines. I used to get one every few months but it now twice a week. My GP thinks this is a side effect of Sertraline.

It probably is. It is one of those side-effects which could go either way, some have more migraines, in others the SSRI stops them. A small dose of one of the beta-blockers may help. If not the only option is switching to another AD.


Also I am feeling a bit emotionally numb. I don’t seem to be able to feel any emotion. My son left home this week and I have not even shed a tear. When my daughter left I cried for weeks!

Sadly, as with the migraines, this can go either way, some experience emotional blunting, others the opposite. It sometimes resolves after a while, but there are no guarantees. If it doesn't again the only option is switching to another med.


I don’t want to stop Sertraline as it is helping my anxiety a lot but should I consider tapering down to 50mg? I am not sure I gave it enough time of 50mg to level and may have gone up too soon. I have read it can take 12-18 weeks for a dose to become fully effective. I would be grateful for your thoughts.

Not many do well on only 50mg, but the only way of knowing if you will is to try it.

[Lady Penelope]

Thank you so much for you informative reply. I will definitely try the supplements for hair loss.
when you say switching to another med do you mean another SSRI or a different type of anti depressant?
also I don’t want to loose any benefits I have - how does this work when switching?

[panic_down_under]

when you say switching to another med do you mean another SSRI or a different type of anti depressant?
also I don’t want to loose any benefits I have - how does this work when switching?

There is a good chance that switching to another SSRI will work. While they all inhibit serotonin reuptake the same way, each affects other receptors differently and it is those other interactions that mostly cause side-effects. Most can handle a straight overnight switch from one SSRI to an equivalent dose of another with none to only mild symptoms, but some GPs prefer to do it with a short cross taper. AD dose equivalence isn't an exact science so there may need to be some fine tuning over the following weeks, but there shouldn't be any significant loss of efficacy. You definitely won't be going back to square one.

If you and your GP decide switching is the best option then citalopram would be my choice as it generally produces fewer/less severe side-effects than the other SSRIs.

[Lady Penelope]

Thank you so much.

[Lady Penelope]

Hello everyone
I had been doing ok on 75mg apart from the hair loss. I had a review with GP and she suggested dropping dose to 50mg. I did this 8 weeks ago but I don’t think it’s made any difference to hair loss. I was feeling ok on 50mg and was planning on staying on that dose. I have finished my 12 week CBT course which has also really helped.

However I am now thinking of coming off it all together. I spent the day in A & E yesterday with a strange headache and pins and needles. Docs suspected TIA and I had loads of tests. They think it was a return of migraines. I had an ECG which resulted in them organising more heart tests. The doctor I saw said I really should be on Aspirin. I had come off it when I started the Sertraline on the advice of my GP but the hospital are very keen for me to return to it. I am thinking of tapering off the Sertraline so I can take the Aspirin. I still have some anxiety every day so don’t really want to come off. Would another anti depressants be better if I’m taking aspirin? Any advice please? I have another appointment with GP on Tuesday. I like to be informed before I speak to GP as I find that none of them in my practice know a great deal about SSRI’s. Thanks for any advice

[panic_down_under]

I was feeling ok on 50mg and was planning on staying on that dose. I have finished my 12 week CBT course which has also really helped.

I still have some anxiety every day so don’t really want to come off.

If you're still having some anxiety then a higher dose is warranted. The aim should be to eliminate all anxiety if possible because it reinforces itself.


Would another anti depressants be better if I’m taking aspirin? Any advice please?

All the SSRIs and SNRIs, plus the TCAs clomipramine and imipramine may be strong enough anticoagulants to perhaps being risky with aspirin and other NSAIDs, although whether this significant at the low 50-75mg doses I can't say. I'd seek advice from a cardiovascular specialist. The other TCAs should be okay, at least on coagulation, however, they may not be a good choice if you have significant heart issues, and especially not if the problem/s is electrical conductance related, atrial fibrillation, for example. The SSRIs citalopram and escitalopram are possibly also unsuitable for the same reason.