Re: Restarting sertraline
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Originally Posted by
wareing77
I decided to come off it at the end of last year as i was only on 25mg so thought it probably wasnt doing much and basicly just thought it was the right time!
:welcome: back Nick,
It is not a good idea to take antidepressants ADs) at what are sub therapeutic doses (less than 50mg for setraline for most) for extended periods as this can increase the risk of the med 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 (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 interconnections they forge, not the meds directly and this requires a minimum level of the med in the system to initiate and sustain. Most ADs need to be taken at doses high enough to saturate 80% of the serotonin transporter molecules (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available test to determine the dose needed to achieve this for individuals so the minimum recommended dose has been set at levels that should ensure 80% transporter occupancy in almost all cases.
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, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002). Taking a low dose for months may create a similar situation as stopping and restarting it. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.
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Question is, should i start back on sertraline as i still have a couple of boxes in the cupboard! Or should i give it some more time? I think im going to get in touch with my doctor tomorrow to see what they say.
A couple of bad days isn't necessarily a cause for concern, but if they continued for more than a week then it is likely time to take action. However, this is something you should discuss with your GP as they know your history, Nick. It might be a good idea to have a comprehensive check up just to rule out other potential factors such as an infection. Anxiety disorders and depression are arguably expressions of a type of auto-immune disorder and they often worsen when our immune system ramps up.
Re: Restarting sertraline
Hi and thanks for the reply, its funny you say about getting checked out as everytime i have anxiety bad enough to go to the doctors, they give me a blood test and it always comes back with high thyroid levels but they always put it down to the anxiety because when the anxiety has settled they test again and its back to normal.
Im going to book in this morning and see what they say
Nick
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
they give me a blood test and it always comes back with high thyroid levels but they always put it down to the anxiety because when the anxiety has settled they test again and its back to normal
So they believe your anxiety is causing the elevated thyroid levels? They could be right. But it is equally possible that the high thyroid levels are causing the anxiety spike! :unsure:
Re: Restarting sertraline
Yes they usually say the increase in thyroid levels is probably due to the anxiety increase as it always goes back down after the repeat blood test.
I do cope fairly well with stress/anxiety these days but sometimes things that i normally take in my stride over bear me and trigger an episode which is why i believe it might be the thyroid levels causing me not to cope!
I may be completely wrong tho!!
I managed to get an appointment with a good doctor today and he has suggested going back on propranolol for a while to relieve some of the physical symptoms then think about going back on an anti depressant if it doesnt settle back down in a couple of weeks.
Also have a blood test booked for next week so will see what the results of that are.
Nick
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
I managed to get an appointment with a good doctor today and he has suggested going back on propranolol for a while to relieve some of the physical symptoms then think about going back on an anti depressant if it doesnt settle back down in a couple of weeks
Sounds like a plan, Nick.
Re: Restarting sertraline
Well after a good evening and waking up feeling rotten again ive decided to take the plunge and restart the sert! I kinda thought it was inevitable so would rather start sooner than later. Fingers crossed it was the right decision and the side effects arent as bad this time round
Nick
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
Fingers crossed it was the right decision and the side effects arent as bad this time round
What is your starting dose, Nick? I'd start on no more than 25mg/day for the first week, maybe even drop it down to 12.5mg if the side-effects become too uncomfortable.
Re: Restarting sertraline
Ive started back up on 25mg this time as i want to get the ball rolling, no side effects so far apart from feeling really cold and gut issues which i had with the anxiety anyway. When i first started on them years ago i started on 12.5mg and instantly had bad side effects so hopefully it wont be as bad.
Im sure alot of the side effects were and are created by my anxious mind but go when i get the stomach issues and nausea i just dont want to leave the house!!
Nick
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
no side effects so far apart from feeling really cold and gut issues which i had with the anxiety anyway.
Serotonin mediates blood vessel tone - constriction and dilation - which is probably the cause of feeling cold and the gut and the enteric nervous system (ENS), the mini brain which controls it is by far the most serotonergic organ of the body. It produces about 95% of the serotonin used throughout the body, the brain accounts for less than 2%. Both should ease as bio-feedback mechanisms begin reducing serotonin synthesis and expression.
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Im sure alot of the side effects were and are created by my anxious mind but go
I could be, unfortunately Nick. :sad: An anxious mind can be very adept at producing our worst side-effects nightmares if given half a chance. :weep:
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when i get the stomach issues and nausea i just dont want to leave the house!!
Ginger and/or vitamin B6 supplements may ease the nausea. What are the stomach issues, Nick?
Re: Restarting sertraline
Quote:
Originally Posted by
panic_down_under
Ginger and/or vitamin B6 supplements may ease the nausea. What are the stomach issues, Nick?
Um slight nausea but nothing severe yet, but im getting sort of cramping, bubbling, loose stools etc! I pretty much had this before i started so not too worried as i knew sertraline would probably make this worse!!
Its always the morning thats worse, and since restarting the sert im back waking 3 or 4 hours after i fall asleep so lots of time to think about it in bed
Stomach issues and lack of appetite are always the 1st to show when im suffering anxiety, it doesnt help that im already skinny!!
Oh and eating is very difficult, i just seem to chew and chew but my body doesnt want me to swallow!!!! Again this normal for me when im feeling like this!!
Nick
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
Um slight nausea but nothing severe yet, but im getting sort of cramping, bubbling, loose stools etc!
Loperamide (Imodium) can be very effective in easing these side-effects, but discuss its suitability with your GP or pharmacist before taking it and don't exceed the daily dose.
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since restarting the sert im back waking 3 or 4 hours after i fall asleep so lots of time to think about it in bed
Stomach issues and lack of appetite are always the 1st to show when im suffering anxiety, it doesnt help that im already skinny!!
A small dose of mirtazapine could help you sleep and possibly stack on a few pounds too as it often induces carbohydrate cravings. It might also calm the gut.
Re: Restarting sertraline
Quote:
Originally Posted by
panic_down_under
Loperamide (Imodium) can be very effective in easing these side-effects, but discuss its suitability with your GP or pharmacist before taking it and don't exceed the daily dose.
A small dose of mirtazapine could help you sleep and possibly stack on a few pounds too as it often induces carbohydrate cravings. It might also calm the gut.
Ye not sure about mirtazapine as when i first started sert years ago i was coming off mirt and the side effects were horrendous though now i think that might have been not so much the start up side effects of the sert but withdrawing from the mirtazapine.
Im only on day 3 this time but the side effects arent anywhere near as bad as the first time so far!! I can feel it ramping up a bit though
Nick
Re: Restarting sertraline
So day 6 on 50mg and the side effects are in full swing! Had a real bad couple of days, been given some diazepam but dont wanna get addicted altho i took it for weeks last time and was fine once the sert kicked in!
Re: Restarting sertraline
Quote:
Originally Posted by
wareing77
been given some diazepam but dont wanna get addicted altho i took it for weeks last time and was fine once the sert kicked in!
The bad news is that you are already dependent - not addicted - on diazepam and its metabolites, plus lorazepam (Ativan) as these are a natural constituent of all foods. While the amount is small, it is not insignificant and can reach harmful levels in the blood plasma of some with impaired liver function.
The better news is that you are very unlikely to develop dependence to the high doses from the prescribed diazepam in the couple of weeks you may be on it to ease you through the initial sertraline side-effects, just as you didn't the last time.
What's the difference between dependence and addiction? This study about aspirin provides a clue: Intractable upper gastrointestinal ulceration due to aspirin in patients who have undergone surgery for peptic ulcer.
I doubt many taking BZDs would continue to take them in the face of repeated surgeries and the certainty of imminent death.
(No, this does not mean aspirin shouldn't be taken if needed. There's a difference between therapeutic use and long term abuse.)
