Sertraline first timer

[Becbec27]

Hi new here, been suffering along time with anxiety and intrusive thoughts to the point where I’m sometimes scared to be alone, was on 10mg citalopram For 4 years and was doing great until lockdown Went to the docs they decided to switch my meds to sertraline and just swapping straight over. I started sert 15 days ago 50mg, the side effects were awful as many know but after 2 weeks I am starting to feel more myself not completely but a little, started to eat a bit more sleep is still only 6 hours I’d love a lay in. My doctor has suggested that I up to 75mg as the thoughts were still there not as plaguing but still there I took my first 75 yesterday felt really tired and had headache most of the day, I just don’t know whether to carry on taking the 75 or just stick on 50 as I am improving slightly, if anyone can give me insight on wat to do I’m stuck in a single parent of 2 children have lots of support from family and friends.

Please any info would be appreciated
Thanks Becky

[Sparkle1984]

It is normal to have increased side effects when you increase the dose of medication. I have experienced the same (although I'm on citalopram rather than sertraline). It should settle down again in a few days or so.

[Becbec27]

Thankyou for replying took my second dose of 75mg this morning, it’s just a scary place to be in your own head all the time only time I get a break is wen I’m at work or asleep, I was on cit for years and just stopped working for me hopefully sert is as good if not better xxx

[Sparkle1984]

Yes I can relate to how you feel - I restarted citalopram 10 days ago after suffering a relapse of my generalised anxiety disorder, so I'm still going through the early side effects and heightened anxiety. I also feel like I only really get a break from the anxious thoughts when I'm sleeping! Hopefully you'll get some relief soon.

[panic_down_under]

Hi new here,

:welcome: to NMP, Becky


been suffering along time with anxiety and intrusive thoughts to the point where I’m sometimes scared to be alone, was on 10mg citalopram For 4 years and was doing great until lockdown Went to the docs they decided to switch my meds to sertraline and just swapping straight over.

Given you had been on what is usually a sub therapeutic dose of citalopram was any thought given to simply upping it?


I started sert 15 days ago 50mg, the side effects were awful as many know

It would have been kinder to have been started on 25mg for the first week as this is about equivalent to 10mg citalopram. At 50mg you were being hit by both the effects from the med switch, plus around a doubling of the effective dose.


but after 2 weeks I am starting to feel more myself not completely but a little, started to eat a bit more sleep is still only 6 hours I’d love a lay in.

SSRI induced insomnia is a fairly common initial side-effect. You could try the over-the-counter antihistamine diphenhydramine which is the active chemical in Nytol tablets and liquid. If that isn't effective ask your GP to prescribe a small dose <=15mg of mirtazapine which is marketed as an antidepressant (AD) but is mostly a potent antihistamine. Small doses of another AD, trazodone, would be even better as it has a shorter half-life than mirtazapine so you'd be less likely to be groggy the next morning, but my understanding is the NHS makes prescribing it for that purpose difficult. Still, there's no harm in asking.



My doctor has suggested that I up to 75mg as the thoughts were still there not as plaguing but still there

It would usually take more than 2 weeks for an AD to begin having an effect even when switching from another, but going to 75mg is probably not a bad idea. Most take 100-150mg for optimum results.


I took my first 75 yesterday felt really tired and had headache most of the day, I just don’t know whether to carry on taking the 75 or just stick on 50 as I am improving slightly, if anyone can give me insight on wat to do I’m stuck in a single parent of 2 children have lots of support from family and friends.

Side-effects will often spike after a dose increase due to the initial surge in serotonin activity. They should drop back as biofeedback mechanisms kick in and reduces serotonin synthesis and expression after a week, or two.


I was on cit for years and just stopped working for me

Probably in large part because of being on such a low dose for so long. Antidepressants 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, and they take time to bud, grow and mature. 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, 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. While the neurogenesis interruptions may only be of short duration, they occur much more frequently.

[Becbec27]

THanks for all in the info, had a fairly good day no increased side effects so far from taking the 75mg, appetite has come back with a vengeance though not stopped eating all day,
I hope you are all well and ok xx

[Becbec27]

Well feel bit any how this morning, didn’t sleep to well vivid dreams there awful, I no we all get good and bad days but you forget when you have a good day how the bad days feel, I hate the process of these meds, also my jaw is constantly clenched when I realise I’m doing it I stop does anyone else do this? Xxx

[panic_down_under]

didn’t sleep to well vivid dreams there awful,

Insomnia and broken sleep are a relatively common SSRI side-effect. Vivid dreams also sometimes happen. I don't think they are any different than what we normally dream, but ADs may shorten and/or lighten the depth of REM sleep which can allow the dreams to bleed into conscious awareness. I used to love the ones I had when on imipramine. Full widescreen Technicolor extravaganzas and often really weird. I haven't taken imipramine for nearly 25 years but I still miss them. :sad:


also my jaw is constantly clenched when I realise I’m doing it I stop does anyone else do this? Xxx

Jaw clenching is another common SSRI side-effect. It is usually temporary.

[Becbec27]

Evening all, I’ve currently been on 50mg sert for 4 weeks and upgraded to 75 mg on Friday, absolute life saver these meds are I’m already on the right path no anxiety in sight (touch wood),
I’m planning a weekend away soon and would like to know if anyone drinks alcohol while on sert? I haven’t had a drop in 7 weeks, Any advice would be appreciated xxx

[panic_down_under]

I’m planning a weekend away soon and would like to know if anyone drinks alcohol while on sert? I haven’t had a drop in 7 weeks, Any advice would be appreciated xxx

There at two issues to be aware of. Firstly, ADs and alcohol can be an unpredictable combination. Some days you may be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small drink might turn legs to rubber so be extra cautious until you work out how you're effected and definitely don't drink and drive.

The other problem is alcohol inhibits the way ADs work. Anxiety disorders and depression are the emotional symptoms of atrophy (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) of part of the two hippocampi regions of the brain caused by high brain stress hormone levels killing brain cells and preventing the growth of replacements. ADs stimulated the growth of new cells and the therapeutic response comes from those new cells and the connections they form (see also: 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/)).

Even moderate drinking can reduce (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/) hippocampus 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). An occasional drink or two shouldn't harm, but daily drinking, or getting hammered is not a good idea. Sorry :weep:

[Phill2]

Evening all, I’ve currently been on 50mg sert for 4 weeks and upgraded to 75 mg on Friday, absolute life saver these meds are I’m already on the right path no anxiety in sight (touch wood),
I’m planning a weekend away soon and would like to know if anyone drinks alcohol while on sert? I haven’t had a drop in 7 weeks, Any advice would be appreciated xxx

I have my Sert in the morning and 3 Bourbons in the afternoon with no problems.
Been doing it for years.

[Becbec27]

Hi all hope everyone is ok,
Been in 75mg off sert now for 4 weeks 50 before that for 3, been ok but these past couple of days I feel like I’m really down and can’t snap out of it.
I’m thinking of upping to 100mg as I’ve heard it’s the therapeutic dose and most are in this, really knocked me as I was going on well just can’t shake this feeling of emptiness and morbidness, I’m carrying on with work and my anxiety is ok just the depressed feeling I can’t shake
Any advice plz xxx

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your thread was merged with another of your threads.

Please when posting on similar topics add it onto your previous post rather than starting a new one.

It is nothing personal it is just to make it easier for people to follow your story and to give you advice as a whole.

[panic_down_under]

Been in 75mg off sert now for 4 weeks 50 before that for 3, been ok but these past couple of days I feel like I’m really down and can’t snap out of it.
I’m thinking of upping to 100mg as I’ve heard it’s the therapeutic dose and most are in this, really knocked me as I was going on well just can’t shake this feeling of emptiness and morbidness, I’m carrying on with work and my anxiety is ok just the depressed feeling I can’t shake

The therapeutic dose range for sertraline is 50-200mg/day, with most taking 100-150mg. SSRIs tend to be slightly more effective for anxiety than depression and depression can take longer to respond. That said, you've only been on it for 7 weeks and 4 at 75mg so there is likely to be significant improvement to come from the current dose. Your GP is in a better position to make the call on a dose increase.

[cry]

Hi Becbec,

How are you getting on now? Xx

[Becbec27]

Hey, I’m actually not to bad I’ve now been on 100mg sert for 12 days upped from 75mg had no side effects upping the dose, I would say I’m feeling 70% better than I was 8 weeks ago, these pills have done wonders in a short space of time. Don’t get me wrong I still have a way to go and I still have a few bad days, they are becoming less and less as the weeks go on I’m keeping myself busy with work and the kids,
Thanks for messaging, how are you getting on xx

[Becbec27]

Good morning,
So decided to go out for a few drinks over the weekend had a really good night but drank far too much, woke up yesterday morning jd a panic attack first one in about 7 weeks, seemed to feel slightly calmer throughout the day, woke this morning feeling down and anxious, do you think it will be the alcohol and will I feel good again xx

[panic_down_under]

do you think it will be the alcohol and will I feel good again xx

It is almost certainly the alcohol. Heavy alcohol consumption depletes levels of the neurotransmitters dopamine, GABA, serotonin and endorphins by 30-50% within the amygdalas, the twin brain areas thought to be the control centres for fear and anxiety. To make matters worse the brain tries to compensate by releasing Corticotrophin - releasing factor CRF which prompts the pituitary gland to release ACTH, a hormone which stimulates the adrenal glands to hyper-secrete the stress hormone cortisol. Chronic alcohol abusers develop not only enlarged livers, but also swollen adrenal and pituitary glands.

Getting plastered once in a blue moon probably won't have any long term effects, but make it a habit and that cortisol will start killing brain cells in the hippocampal regions of the brain which is the physical cause (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) of anxiety and depression. ADs work by stimulating the growth of new brain cells. The new cells and the connections they forge produce the therapeutic response, not the meds directly. Even moderate drinking can result in significant hippocampal atrophy (https://www.popsci.com/moderate-drinking-bad/) (Topiwala A (https://www.bmj.com/content/357/bmj.j2353), 2017; - see also: Anderson ML (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568748/), 2012; 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).

Also, ADs and alcohol can be an unpredictable combination. Some days you might be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a pint of shandy may turn legs to rubber. Definitely do not drink and drive while on ADs!

[USER12]

Btw are you taking 75mg tablets or cutting a 50mg tab in half and making it up to 75mg that way?