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Sertraline and co codamol
Hi, ive been on sertraline 50mg for 5 years now. After initially struggling to get on it, i managed and my life got pretty much back to normal...... untill now!
Basicly me and my long term girlfriend split up nearly 2 years ago now and since then i havent been as good as i was.
This summer i came off my mountain bike and broke my shoulder and was given co codamol 30/500 to take 4 times a day (which i did for 2 months) i then cut down over the next month then stopped completely about a month ago. Well since then ive been getting gradually worse anxiety and stomach aches and last week ive felt absolutely awful. Exactly like i did when i first started sertraline (nausea, shakes, sweats, waking up early, severe anxiety)
Could this be from stopping the co codamol? Although i stopped 4 weeks ago. I was surprised how well i coped being off work for 9 weeks and now im thinking it might have been the codene relaxing me?
Im really scared now that im slipping back to how i was 5 years ago which was pure hell
Thanks in advance, nick
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
Hi, ive been on sertraline 50mg for 5 years now.
...Basicly me and my long term girlfriend split up nearly 2 years ago now and since then i havent been as good as i was.
...Well since then ive been getting gradually worse anxiety and stomach aches and last week ive felt absolutely awful. Exactly like i did when i first started sertraline (nausea, shakes, sweats, waking up early, severe anxiety)
...Could this be from stopping the co codamol? Although i stopped 4 weeks ago.
I think there are several things converging, Nick. Firstly, 50mg sertraline is at the low end of the typical effective dose range. It may have been enough at the beginning, but it sounds like it became borderline when your stress levels increased when you split up with your girlfriend.
The second factor may be taking codeine for a relatively long time. As with most opiates, codeine can inhibit hippocampal neurogenesis, the mechanism by which ADs work. Anxiety and depression seem to be symptoms of hippocampal atrophy caused by high brain stress hormone levels killing brain cells in a part of the two hippocampal regions of the brain and inhibiting the growth of new cells. ADs (and therapy) stimulate the growth of new cells. See:
Depression and the Birth and Death of Brain Cells (
PDF)
While stopping the co codamol should have stopped neurogenesis inhibition, it takes weeks for the renewed neurogenesis to take effect. This is why ADs typically take 4-12 weeks to kick-in. Unfortunately, your stress levels may now have risen to the point of overpowering the positive affect of sertraline at the current dose.
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I was surprised how well i coped being off work for 9 weeks and now im thinking it might have been the codene relaxing me?
I think you're probably right. Some take opiates at least partly because the euphoria masks their anxiety/depression.
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Im really scared now that im slipping back to how i was 5 years ago which was pure hell
I think you need to talk to your GP/psychiatrist about increasing the sertraline dose. As per above, 50mg has probably been borderline since the breakup with your girlfriend and is definitely inadequate now. Most on sertraline are taking 100-150mg.
Ian
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Re: Sertraline and co codamol
When I read this I wondered whether it might be opoid withdrawal combined with an anxiety disorder? What I mean is that we are already struggling with physical & mental symptoms and tend to rect far stronger to them in a negative way than the non anxious (dependent on how bad your anxiety is). Therefore you get a period of shock to the system.
Maybe that's how it feels yet the true science behind it is what Ian has described? Would you believe that to be the case, Ian?
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Re: Sertraline and co codamol
Thanks for the reply ian. That does all sound about right. I have an appointment with my gp next week where im sure they will want me to increase my dose. Im dreading having to increase though as i already feel so awful and can see myself slipping back fast.
Living on my own doesnt help either
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Re: Sertraline and co codamol
Quote:
Originally Posted by
MyNameIsTerry
When I read this I wondered whether it might be opoid withdrawal combined with an anxiety disorder? What I mean is that we are already struggling with physical & mental symptoms and tend to rect far stronger to them in a negative way than the non anxious (dependent on how bad your anxiety is). Therefore you get a period of shock to the system.
Maybe that's how it feels yet the true science behind it is what Ian has described? Would you believe that to be the case, Ian?
Could withdrawal have been part of it, sure. While there is nothing in Nick's description that shouts 'withdrawal' and he seems to have done everything to minimise it, when one is on the edge it doesn't take much to push you over. From what I've observed it is rare for a single event to trigger an anxiety disorder per se, it is more the corrosive effect of what such an event, or events can set in train in the deeper recesses of our minds which eventually brings us down, and I think that was also the case here. I don't think either taking the codeine, or withdrawal from it, was the cause of what he's now experiencing, just the final straw.
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
Im dreading having to increase though as i already feel so awful
The first order of business for your GP should be to ease your anxiety levels so you no longer "feel so awful" using short term meds such as mirtazapine - a sedating AD/antihistamine, a benzodiazepine, or maybe a beta-blocker. Raising the sertraline dose in small steps, no more than 25mg every 7-10 days should limit the severity of any side-effects, so clear that with the GP.
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and can see myself slipping back fast.
Done correctly it should prove easier than you fear, however, convince yourself you will suffer greatly and your mind may deliver your worst nightmare to you in widescreen Technicolor with Dolby surround sound.
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Re: Sertraline and co codamol
Ye i think an increase is defo on the cards, i was at my best when i was on 75mg a day for a couple of years, i have dropped to as little as 25mg over the years.
I think the split has really hit me to be honest, i was quite rough when we first split up but got alot better after a couple of months.
Ive got worse since buying my ex out and moving back into the house we used to share together, i regret buying her out a bit but it solved all the arguments and now we get on well which is good for the kids sake!
Like you say i dont think its a single thing, i think its a catalyst of things going wrong since the separation.
I just hope i can get back to the happy person i had been before we separated!
Thanks, nick
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
i was at my best when i was on 75mg a day for a couple of years, i have dropped to as little as 25mg over the years.
Probably not a good idea to stay on low, likely sub-therapeutic, doses for any length of time as this may increase the risk of poop-out. I'd be wary of taking less than 50mg/day.
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I just hope i can get back to the happy person i had been before we separated!
There is no reason why you shouldn't achieve this, Nick, though some patience will be required. There are no quick 'cures'. :sad:
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Re: Sertraline and co codamol
Does anyone think that the co codamol might have been cancelling the sertraline out because it feels exactly like when i first started on sertraline and when i used to increase the dose?
Thanks, nick
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
Does anyone think that the co codamol might have been cancelling the sertraline out
It may have been while you were taking it, along with the continuing stress which began with your relationship breakup and a consequent increase in brain stress hormone levels. That's what I meant by, "codeine can inhibit hippocampal neurogenesis, the mechanism by which ADs work", in an earlier post. Together the codeine and brain stress hormones may have effectively put your brain back to square one and it will take time, and likely a higher sertraline dose, for neurogenesis to restore order.
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Re: Sertraline and co codamol
Well i went to my gp today and had the results if my blood yest. Looks like i have an over active thyroid again and they have prescribed me propanalol 40mg to ease my symptoms (sweating, plapatations, on edge, shakes etc) and once that has settled in a couple of weeks i can think about upping my dose of sertraline. And ive asked to see a councillor to talk thru my issues and worries.
Fingers crossed the propanalol helps!!!
Nick
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Re: Sertraline and co codamol
Well the propranalol isnt really doing anything, spending most of the days with severe anxiety!
Really struggling at the moment so have decided to increase the sertraline slowly, started on 62.5 last week and will go to 75mg this week.
Fingers crossed the increase will help
Any words of advice??
Nick
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
Well the propranalol isnt really doing anything, spending most of the days with severe anxiety!
Not helping with the hyperthyroid symptoms, anxiety, or both, Nick? If for the symptoms then maybe the dose is inadequate.
Beta-blockers don't actually ease anxiety, per se, just block/reduce the adrenaline surge symptoms of the flight-or-fight response which can really spook people. This can sometimes be enough, but some need a med which directly address anxiety. Either way, I think you need to get back to the GP asap.
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Really struggling at the moment so have decided to increase the sertraline slowly, started on 62.5 last week and will go to 75mg this week.
Fingers crossed the increase will help
Any words of advice??
The increased dose should help, but be aware it may take some time for this to become apparent. ADs are not quick acting meds. Which is why I've suggested seeing your GP asap. The sooner your anxiety levels are bought under control the better.
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Re: Sertraline and co codamol
Well it seems to have stopped the sweatting and shakes n stuff but the anxiety is back constantly. Exactly like when i first started the sertraline and feels like side effects?
Had a phone appointment with the gp earlier and she wants me to go straight up to 100mg and has given me a couple of sleeping tablets just in case. She said to stick to the 40mg of propranalol and see how it goes. Seeing her again next week. Just really struggling in work at the mo but dont want to take any time off as its a slippery slope
Thanks
Nick.
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Re: Sertraline and co codamol
Quote:
Originally Posted by
wareing77
Well it seems to have stopped the sweatting and shakes n stuff but the anxiety is back constantly. Exactly like when i first started the sertraline and feels like side effects?
As per my previous post, the beta-blockers don't directly address anxiety, only block some of its effects. A small dose of mirtazapine might do the trick. It would also help with insomnia.
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Had a phone appointment with the gp earlier and she wants me to go straight up to 100mg and has given me a couple of sleeping tablets just in case.
Increasing the sertraline dose is your best/easiest option. Just be aware that it will take some weeks for the higher dose to become effective, and I suggest you ask your GP if you can only increase it by 25mg for the first week to limit a potential spike in side-effects.
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Re: Sertraline and co codamol
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Originally Posted by
panic_down_under
As per my previous post, the beta-blockers don't directly address anxiety, only block some of its effects. A small dose of mirtazapine might do the trick. It would also help with insomnia.
Im not sure mirtazapine is much good for me, i was on it before i started sertraline and i felt like a bit of a zombie on it. Im pretty sure my dr said i couldnt take them both at the same time either?
Quote:
Originally Posted by
panic_down_under
Increasing the sertraline dose is your best/easiest option. Just be aware that it will take some weeks for the higher dose to become effective, and I suggest you ask your GP if you can only increase it by 25mg for the first week to limit a potential spike in side-effects.
Ye ive started on 75 now so i hope this will start to work without too many side effects.
I take the sertraline first thing in the morning and am pretty rough all day but usually settle down a bit by the evening.
I slept ok last nite, quite a bit of waking and lots of wierd dreams but not too bad.
Nick
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Re: Sertraline and co codamol
Quote:
Originally Posted by
wareing77
Im not sure mirtazapine is much good for me, i was on it before i started sertraline and i felt like a bit of a zombie on it. Im pretty sure my dr said i couldnt take them both at the same time either?
I assume you were on a high dose as the primary med, but I'm suggesting a lower one, maybe 15mg just to sedate you a bit. That is pretty much how mirtazapine works, by sedation.
I'm guessing your GP is concerned about serotonin syndrome/toxicity because some medical literature claims this. It is wrong. Not my opinion, but that of arguably the world's leading SS/ST expert, Dr Ken Gillman:
As I have pointed out before, drugs like bupropion and mirtazapine, that have no significant serotonergic activity, are no more likely to cause ST than is vitamin C. This scenario has already been enacted, over a decade, with the antidepressant mirtazapine, which was claimed, erroneously, to have serotonergic activity. Many poor quality case reports of ST with mirtazapine were published. This probably led to misdirected treatment of overdoses, some of which may have caused morbidity. It took several reviews to correct this error and establish that mirtazapine cannot cause ST
PK Gillman, 2010
PDF
Moreover, mirtazapine is a serotonin 5-HT2a receptor antagonist (blocker) which can prevent the body temperature spike which does the damage in SS/ST although in humans the recommended treatments are the more potent 5-HT2a antagonists cyproheptadine and chlorpromazine.
Unfortunately, some drug interaction list compilers still haven't received the message. :mad:
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Ye ive started on 75 now so i hope this will start to work without too many side effects.
I take the sertraline first thing in the morning and am pretty rough all day but usually settle down a bit by the evening.
I slept ok last nite, quite a bit of waking and lots of wierd dreams but not too bad.
You could try switching to taking it at night. This seems to work for some. Weird dreams are not uncommon with most ADs. I suspect that they don't actually cause them, just lighten the dream state so they are more likely to be exposed to consciousness, i.e. most of our dreams are weird, we just don't usually remember them. I used to have some really great ones when on imipramine. The full Hollywood extravagancer in widescreen Technicolor. Even after about 25 years I still miss them (clearly I have no life). :sad:
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Re: Sertraline and co codamol
Sorry to hijack the post... so is it quite safe to take codein with likes of setralin/ Citalopram AD’s . I got mine prescribed for back pain and only take it when I m in agony, but since I have been on Citalopram didn’t dare to take any codein.
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Re: Sertraline and co codamol
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Originally Posted by
keta
Sorry to hijack the post... so is it quite safe to take codein with likes of setralin/ Citalopram AD’s . I got mine prescribed for back pain and only take it when I m in agony, but since I have been on Citalopram didn’t dare to take any codein.
Definately safe to take while on sertraline (not sure about citalopram) as id told the surgeon that i was on sertraline and he prescribed the co codamol. Think the only issue was with ibuprofen, i think every now and again is ok but not continuous use.
Check with your dr or pharmacist if you are unsure
Nick
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Re: Sertraline and co codamol
Well its been a week at 75mg now and still suffering. Not sure if im any better than i was or not, getting a bit annoyed with the continuous anxiety and bad guts!
I think the propranalol might actually be working because i seem to be better for the morning after i take 40mg but then get a bit worse towards the afternoon. Im wondering if i should be taking more than just the 1 dose in the morning?
Nick
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Re: Sertraline and co codamol
Quote:
Originally Posted by
wareing77
Well its been a week at 75mg now and still suffering. Not sure if im any better than i was or not, getting a bit annoyed with the continuous anxiety and bad guts!
You're unlikely to see any improvement for some time yet, except possibly from a placebo response. ADs are not fast acting meds. Nick.
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I think the propranalol might actually be working because i seem to be better for the morning after i take 40mg but then get a bit worse towards the afternoon. Im wondering if i should be taking more than just the 1 dose in the morning?
Propranolol has only a short half-life, some 4-5 hours, so immediate release formulations will typically run out of steam within 10 hours. It is usually taken in 2-3 divided doses. Extended/sustained/slow-release formulations are effective for about 24 hours.
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Re: Sertraline and co codamol
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Originally Posted by
panic_down_under
You're unlikely to see any improvement for some time yet, except possibly from a placebo response. ADs are not fast acting meds. Nick.
Ah ye i know they took a long time when i first started them, possibly 8 weeks or so! I just wish i could feel a bit better!
Quote:
Originally Posted by
panic_down_under
Propranolol has only a short half-life, some 4-5 hours, so immediate release formulations will typically run out of steam within 10 hours. It is usually taken in 2-3 divided doses. Extended/sustained/slow-release formulations are effective for about 24 hours.
Ah ok, that seems to make sense i suppose because i take 40mg first thing in the morning with the sertraline and by about lunch time i start getting anxious again with the shakes, sweats, etc. I have a follow up drs appointment tomorrow so will ask if i can take 40mg twice a day and see what they say.
Still managing to get to work but its a bloody struggle feeling as bad as i do!
The dr asked if i had been taking any supplements too and i have been taking apetamin for a long time to try and gain weight. The dr said its main ingredient is cyproheptadine which causes anxiety so ive had to stop taking that now too on the instructions of the dr.
Nick
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Re: Sertraline and co codamol
Quote:
Originally Posted by
wareing77
The dr asked if i had been taking any supplements too and i have been taking apetamin for a long time to try and gain weight. The dr said its main ingredient is cyproheptadine which causes anxiety so ive had to stop taking that now too on the instructions of the dr.
If you want to gain weight, Nick, then mirtazapine would be a better bet if you can convince your GP that it can be safely taken with sertraline. It's main side-effect is weight gain from the powerful carbohydrate craving it often induces. It may reduce your anxiety level too.
As for supplements, Omega-3 fatty acids/fish oil increase hippocampal neurogenesis just as ADs do, though to a milder degree (so does exercise, btw). Magnesium may also help. OTOH, many supplements promoted for anxiety/depression such as GABA, 5-HTP and L-Tryptophan are snake oil.
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Re: Sertraline and co codamol
Well still suffering quite a bit, possibly a bit better than a few weeks ago. Im pretty sure the propranalol is doing its job relieving some of the symptoms. Im just over 2 weeks at 75mg of sertraline now and not sure if i should go to 100mg? 75 worked quite well last time i was bad, and i was way worse than i am this time. Maybe i should give it a couple more weeks to kick in?
Had 3 or 4 really good days last week along with a couple of bad days so hopefully the good days will come more often
Coincidentally last time i was really bad i also had hyperthyroidism so i dont know if it causes the anxiety or the anxiety causes it?! Is it just a case of riding they symptoms out untill my thyroid settles down again?
Nick
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Re: Sertraline and co codamol
Quote:
Originally Posted by
wareing77
Im just over 2 weeks at 75mg of sertraline now and not sure if i should go to 100mg? 75 worked quite well last time i was bad, and i was way worse than i am this time. Maybe i should give it a couple more weeks to kick in?
It may take up to 12 weeks to kick-in, Nick.
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Had 3 or 4 really good days last week along with a couple of bad days so hopefully the good days will come more often
Which is a positive sign, though it is still early days.
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Coincidentally last time i was really bad i also had hyperthyroidism so i dont know if it causes the anxiety or the anxiety causes it?! Is it just a case of riding they symptoms out untill my thyroid settles down again
An overactive thyroid can certainly trigger anxiety. Whether just controlling the gland will resolve the anxiety I can't say because anxiety can take on a 'life' of its own independent of the initial trigger after a while and thus needs to be treated in its own right. My panic disorder was initially almost certainly a response to chronic, low-level chemical exposure, but it didn't end once that exposure ceased and the toxins were excreted.
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Re: Sertraline and co codamol
Yuk..... 12 weeks!!!!
As you say, it may have triggered it but so many other things may have too! Im just going to have to stick to the sertraline and propranalol till i start improving. Hopefully if my thyroid goes back to normal i want need the propranalol and more. And i may possibly increase to 100mg sertraline in a couple of weeks anyway.
Going to get some omega 3 and magnesium supplements later...... there are so many different types/makes though!!
Nick
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Re: Sertraline and co codamol
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Originally Posted by
wareing77
Yuk..... 12 weeks!!!!
These meds work by growing new brain cells and rewiring some parts of the brain and that isn't a quick process, Nick.
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Going to get some omega 3 and magnesium supplements later...... there are so many different types/makes though!!
I just buy the cheapest fish oil brand at the time. But I cut open a capsule instore whenever I buy a different brand to check whether the oil is fresh. I've occasional found ones that are rancid and has a strong odor.
Of the two main fatty acids in fish oil, eicosapentaenoic acid (EPA) seems to be more important than docosahexaenoic acid (DHA) for easing anxiety and depression so if the cost is about the same choose the brand with the highest EPA-DHA ratio (Liao Y, 2019; Mocking RJ, 2016; Grosso G, 2014; Samieri C, 2012; Sublette ME, 2011; Martins JG, 2009).
Terry (MyNameIsTerry) is the magnesium guru so he will hopefully chime in. PM him if he doesn't in the next day or two.
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Re: Sertraline and co codamol
Quote:
Originally Posted by
panic_down_under
These meds work by growing new brain cells and rewiring some parts of the brain and that isn't a quick process, Nick.
I just buy the cheapest fish oil brand at the time. But I cut open a capsule instore whenever I buy a different brand to check whether the oil is fresh. I've occasional found ones that are rancid and has a strong odor.
Of the two main fatty acids in fish oil, eicosapentaenoic acid (EPA) seems to be more important than docosahexaenoic acid (DHA) for easing anxiety and depression so if the cost is about the same choose the brand with the highest EPA-DHA ratio (
Liao Y, 2019;
Mocking RJ, 2016;
Grosso G, 2014;
Samieri C, 2012;
Sublette ME, 2011;
Martins JG, 2009).
Terry (MyNameIsTerry) is the magnesium guru so he will hopefully chime in.
PM him if he doesn't in the next day or two.
Sorry, only just seen this.
Let me know if you need some info on magnesium. Some useful threads here:
