200mg dosage

I began sertraline on the 29th of May initially on 50mg and gradually increased to 150mg but now the GP wants me to try the last hurdle to 200mg and I’ve become really scared to do it. I rang the doctor back today after I consented yesterday. Anyway she reassured me but I’m still apprehensive. A) because this is the max dosage and what if it doesn’t help? However the 150mg has made the biggest difference. B) I’ve never met anyone on max dosage? C) I’m scared of serotonin syndrome?!? Anyone had any experience of this dosage and any advice? Thank you.
PH xx


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Originally Posted by Phoenixess

I began sertraline on the 29th of May initially on 50mg and gradually increased to 150mg but now the GP wants me to try the last hurdle to 200mg and I’ve become really scared to do it.

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How long have you been on 150mg and how are your anxiety levels?

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I rang the doctor back today after I consented yesterday. Anyway she reassured me but I’m still apprehensive. A) because this is the max dosage and what if it doesn’t help? However the 150mg has made the biggest difference.

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Some of us need to take around the maximum dose to get good results from antidepressants, perhaps because we're fast metabolisers. I've always needed large doses, 50% above the recommended maximum dose for the first AD, currently 12% above the max for the one I've been taking for about 25 years.

Unfortunately, the only way to know if 200mg will do the trick is by trying it. There's not much point in taking a med which isn't effective when something else probably will be. One option to consider is adding the noradrenaline, aka norepinephrine reuptake inhibiting AD nortriptyline if sertraline is falling short of full effectiveness to essentially create a bespoke SNRI. This was a very popular combination back in the day before SNRIs became readily available and many of the old time psychiatrists still rate it a better option than taking a SNRI. Given some of the issues with SNRIs they have a point, imho.

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B) I’ve never met anyone on max dosage?

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It isn't unheard off, especially for depression as SSRIs are less effective for it.

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C) I’m scared of serotonin syndrome?!?

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Serotonin syndrome is rarely an issue when taking a single serotonergic AD. It can be when taking two, or more, but most serious problems only arise when one of them is a MAOI class AD which are rarely prescribed these days, though they probably should be.

I’ve been on the 150mg for four weeks and I wish still having panic attacks and limited panic attack symptoms daily on the 50mg and the 100mg the 150mg has really stopped all these and the befits have been amazing. Alongside these I have been on diazepam three times a day regular but now I only need the diazepam as and when. However I still have moment of being over whelmed and have had five significant panic attacks in the last four weeks in comparison to 3 a day on 50mg and in a depersonalised state prior to all the meds. Just finding the shift difficult. Whereas previously I have been too scared to take any medication hence why I got to the state I was in.


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Originally Posted by Phoenixess

I’ve been on the 150mg for four weeks and I wish still having panic attacks and limited panic attack symptoms daily on the 50mg and the 100mg the 150mg has really stopped all these and the befits have been amazing.

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Which suggests that 150mg should be given more time to show what it can do. That said, going to 200mg shouldn't harm your progress. Maybe meet your GP half way and go to 175mg. You can always drop back to 150mg once you're stable.

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Alongside these I have been on diazepam three times a day regular but now I only need the diazepam as and when.

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That's good because diazepam and other benzodiazepines inhibit antidepressant effectiveness. However, this doesn't mean you shouldn't take it if you need to. White-knuckle through severe anxiety is even worse as it reinforces the anxiety/panic.

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However I still have moment of being over whelmed and have had five significant panic attacks in the last four weeks in comparison to 3 a day on 50mg

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50mg was probably never going to cut it. Most need to take 100-150mg. Plus ADs often make anxiety worse in the beginning. It is just part of how they work. As long as the panic attacks are diminishing in number and intensity you're on the right track. These disorders are often years, sometimes decades in the making and they don't often surrender easily.

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and in a depersonalised state prior to all the meds. Just finding the shift difficult. Whereas previously I have been too scared to take any medication hence why I got to the state I was in.

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For many of us the hardest thing we've ever done is taking the first AD and then continuing to do so despite the side-effects which often hit us where we're most vulnerable. You deserve a lot of credit for sticking with it. :yesyes:

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Originally Posted by panic_down_under

Which suggests that 150mg should be given more time to show what it can do. That said, going to 200mg shouldn't harm your progress. Maybe meet your GP half way and go to 175mg. You can always drop back to 150mg once you're stable.



That's good because diazepam and other benzodiazepines inhibit antidepressant effectiveness. However, this doesn't mean you shouldn't take it if you need to. White-knuckle through severe anxiety is even worse as it reinforces the anxiety/panic.



50mg was probably never going to cut it. Most need to take 100-150mg. Plus ADs often make anxiety worse in the beginning. It is just part of how they work. As long as the panic attacks are diminishing in number and intensity you're on the right track. These disorders are often years, sometimes decades in the making and they don't often surrender easily.



For many of us the hardest thing we've ever done is taking the first AD and then continuing to do so despite the side-effects which often hit us where we're most vulnerable. You deserve a lot of credit for sticking with it. :yesyes:

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Thank you that’s very kind of you. We will see what happens. Xx


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Tried 175mg today fell asleep for four hours I do when my dosage increases. But overall my evening anxiety session has dissipated and I’ve only had one diazepam today.
Fingers crossed [emoji1696]


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Originally Posted by Phoenixess

I’ve only had one diazepam today. Fingers crossed [emoji1696]

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Sounds like you're on the right track . :)

Getting headaches not sure the 175mg is a good move? Any advice xxx


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Originally Posted by Phoenixess

Getting headaches not sure the 175mg is a good move? Any advice xxx

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Headaches are a relatively common side-effect when first taking SSRIs, or increasing their dose. Serotonin isn't only a brain neurotransmitter. It has many roles in the body including mediating blood vessel tone, constriction and dilation and ADs may affect this for a short while. Paracetamol, aka acetaminophen, is usually effective and preferred to NSAIDs like aspirin, ibuprofen and naproxen because SSRIs are also mild anticoagulants.

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Originally Posted by panic_down_under

Headaches are a relatively common side-effect when first taking SSRIs, or increasing their dose. Serotonin isn't only a brain neurotransmitter. It has many roles in the body including mediating blood vessel tone, constriction and dilation and ADs may affect this for a short while. Paracetamol, aka acetaminophen, is usually effective and preferred to NSAIDs like aspirin, ibuprofen and naproxen because SSRIs are also mild anticoagulants.

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Really had a difficult time on the 175mg not only headaches and drowsiness but like complete paranoia and spaced out yesterday. I’ve gone back to the 150mg dose and I feel back to normal. Going to phone my GP tomorrow to discuss because that was too much for me. Xx


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