Printable View
I've been on Sertraline now for a few weeks with a few dose increases. Last week Dr increased to 200mg from 150mg. My question is do you feel worse with every increase? My anxiety is totally debilitating one week in. Wake up with chronic anxiety and climbing the walls.
How many weeks and at what intervals was the dose increased?Quote:
Originally Posted by NWPower
Yes, heightened anxiety is common when first taking antidepressants (ADs) after dose increases. It is caused by increased serotonin activity triggered by the higher dose. Despite what is often claimed anxiety (also depression) isn't caused by low serotonin levels, nor do ADs work by raising brain serotonin levels, except for a few weeks after beginning to take them, and for a while after dose increases which is what causes the heightened anxiety. It usually diminishes after a couple of weeks as bio-feedback mechanisms kick-in to reduce serotonin synthesis and expression. See my: Serotonin - The 'chemical imbalance' mythQuote:
Last week Dr increased to 200mg from 150mg. My question is do you feel worse with every increase? My anxiety is totally debilitating one week in. Wake up with chronic anxiety and climbing the walls.
I suggest you discuss this with your GP as white-knuckling through the anxiety is counterproductive. Diazepam (Valium) and other benzodiazepines (BZDs) are usually very effective in the short-term, though imo they should be used only when needed as they inhibit the neurogenesis mechanism which creates the AD therapeutic response. The antihistamine *hydroxyzine has pretty good anti anxiety properties. It's not quite as potent as the BZDs, but is often potent enough to make a significant difference. Mirtazapine at low doses is another med which at low doses may ease the heightened anxiety.
* Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.
Thanks for your reply. I started on 50mg 13th Dec, 100mg 30th Dec. 150mg 13th Jan. 200mg 30rh Jan. So about a month.
I do take Lorazepam as I just can't function without whilst this anxiety is so chronic.
Why has the sertraline dose been increased from zero to the maximum recommended 200mg in only 2 months? ADs typically take 4-12 weeks to kick-in so there probably hasn't been enough time for a lower dose to be effective. You might indeed need to take 200mg/day, but I don't see how your GP could predict that. Most people do fine on 100-150mg.Quote:
Originally Posted by NWPower
By all means keep taking it if you need to as white-knuckling anxiety is counterproductive, but there is good evidence1 that BZDs inhibit the process by which ADs (also therapy) work. I'd be asking the GP for either hydroxyzine, or mirtazapine as a substitute.Quote:
I do take Lorazepam as I just can't function without whilst this anxiety is so chronic.
References:
[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)
Nochi R, Kaneko J, Okada N, et al. (2013)
Diazepam treatment blocks the elevation of hippocampal activity and the accelerated proliferation of hippocampal neural stem cells after focal cerebral ischemia in mice.
J Neurosci Res. Nov;91(11):1429-39 (Abstract)
Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)
Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)
Chen J, Cai F, Cao J, et al. (2009)
Long-term antiepileptic drug administration during early life inhibits hippocampal neurogenesis in the developing brain.
J Neurosci Res. Oct;87(13):2898-907 (Abstract)
Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)
See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly.
Managed to get an appt with GP earlier who confirmed his belief that I'm feeling worse because of the dose uppage. Funnily enough he mentioned Mirtazapine and will prescribe it in 2 weeks if Sertraline isnt helping
Did he offer an explanation for increasing the dose to the maximum without giving lower doses time to work?Quote:
Originally Posted by NWPower
Prescribe mirtazapine at a low dose in addition to sertraline to ease the anxiety until sertraline kicks-in, or to replace it?Quote:
Funnily enough he mentioned Mirtazapine and will prescribe it in 2 weeks if Sertraline isnt helping
He didn't offer an explanation and neither did I ask. I'm here now and have to deal with it.
I think he meant taking Mirtazapine as well as Sertraline. I hope I start feeling better in the next 2 weeks and won't need it 🤞🏻
It's up to you, but I would ask because this is outside the prescribing guidelines. There might be a reasonable explanation, but I'd want to be convinced. He isn't the one who's suffering.Quote:
Originally Posted by NWPower
Good, because I don't think there is a case yet for switching from sertraline. But I don't see why it wasn't prescribed now when it could make the biggest difference to your quality of life.Quote:
I think he meant taking Mirtazapine as well as Sertraline.
Indeed.Quote:
I hope I start feeling better in the next 2 weeks and won't need it 🤞🏻
Just as I was feeling the Sertraline is starting to do it's thing and I am feeling more positive, a Dr phoned to say I need to start cutting down the Lorazepam!!! I know it's addictive but this feels like a backward step. I tried to argue my case but he was having none of it. He's phoning again next week. I'm in an anxious spin again.
Probably not a bad thing as BZDs can reduce the effectiveness of ADs. At least he has you cutting down the dose, not quitting it abruptly.
How long have you been taking it and have you been taking it every day?
I've been taking it since November, 1mg twice a day. He did say he would prescribe something to take alongside reducing the Lorazepam.. maybe Mirtazapine 🤷🏼*♀️
7.5-15mg mirtazapine is should make it easier for you. What advice were you given for tapering off lorazepam?Quote:
Originally Posted by NWPower
Just to take half twice a day. I've tried that and it's just too much. Today I'm trying 1mg this morning and half this afternoon. Any advice would be appreciated.
It's worth a shot.Quote:
Originally Posted by NWPower
If it is still too hard try cutting back by a quarter of a dose if you can cut the tablets accurately enough. A pill-cutter from the chemist will make this easier, more accurate and less bloody than using a knife. So start by reducing the morning dose to 0.75mg for 4-5 days then the afternoon dose to 0.75mg again for 4-5 days followed by 0.5mg in the AM, 'rinsing and repeating' to zero. Some mirtazapine would help. A switched on GP would have prescribed it before ordering you to wean off the BZD! :mad:
Thanks. I have a pill cutter but these pills are soooo tiny. I'll ask Dr if I can have some .5mg that will cut easier. You definitely seem to think Mirtazapine will help so I'll go with that also. Now to put this all out of my mind till Thursday. Very tearful day of thinking this will never end :(
Good idea.Quote:
Originally Posted by NWPower
There are no guarantees, but a sedative to dampen the lorazepam withdrawal symptoms should make the process more bearable.Quote:
You definitely seem to think Mirtazapine will help so I'll go with that also.
It can often seem like that, but it almost always comes good in the end. These disorders are often a long time in the making and there are no shortcuts to recovery, unfortunately. :sad:Quote:
Very tearful day of thinking this will never end
Thank you for your kind replies.
So it's now week 5 of 200mg Sertraline and nothing much has changed. Some days I can think a bit more positive but the anxiety is still chronic. Does anyone know if the Sertraline needs longer to kill that? Desperate
It can take longer than 5 weeks for a dose increase to take effect. I'd give it at least another 2 weeks.
Do you have anything other than lorazepam to ease the anxiety?
I was given Quetiapine at the very beginning so still taking 2x100mg each day. No idea if they're doing any good other than help me sleep which I'm grateful for if nothing else.
Actually awaiting a telephone consultation with a Dr today.
So you've been on quetiapine since November last year?Quote:
Originally Posted by NWPower
Yes. Phone consultation with Dr yesterday where we decided to reduce Sertraline to 150mg and add in Mirtazapine. Took one last night and have to say that I woke less anxious this morning 🤞🏻
Is the mirtazapine replacing quetiapine, or in addition to? It is usually a more potent sedative than quetiapine.Quote:
Originally Posted by NWPower
In addition to, at least for now while it all seems to be heading in the right direction 🤞🏻Quote:
Originally Posted by panic_down_under
Some good news at last. :)
Yes indeed and thank you for your input. My next test will be tapering off the Lorazepam but I'm hoping they'll allow me to do that once Ive been stable for a while 🤞🏻Quote:
Originally Posted by panic_down_under
They should. Although getting off lorazepam is important as it will increase the AD's effectiveness doing so before anxiety is well controlled can be counterproductive. The other issue is that many GPs demand fast tapers, sometimes even an immediate stop. Madness! :mad: