To high of a dose years ago, starting on low dose?

[Jakemje]

After talking to my pdoc about my medications I had been on in the past, we came to the conclusion that my old pdoc might have been starting me on to high of a dose of meds and it was amping up my anxiety and never could "break the cycle".

My old pdoc started me on 100mg of Zoloft and upped it to 125mg within 2 weeks. I had always responded to low doses of meds (5mg-10mg of lexapro worked wonders for almost a decade, and I only ever need half of a .25mg Xanax to stop a panic attack)
I feel that my size, 6' 250lbs makes a lot of people think "Oh he is a big guy and needs a big dose"

The problem I had with Zoloft years ago was that it made my feel mad all the time and the littlest thing would just piss me off, but this was at 100-125mg.

My new doc believes that me giving Zoloft another try, but starting at 25mg and going from there.

Does this make sense? I know everyone reacts differently to meds, but could it be that small amounts of meds are the answer instead of the normal range (50-150mg)? That, just a minute amount could correct the chemical imbalance? I know they have "therapeutic doses" for all meds, but I have read all over the net, along with my doc telling me from patients she has, that some respond to small doses better than the "normal dose". She even has one patient that takes Zoloft every other day on a low dose and it stopped his anxiety.

I'm just curious as if this seems plausible

Thank you for any input

[panic_down_under]

My old pdoc started me on 100mg of Zoloft and upped it to 125mg within 2 weeks

Has Kellogg's been putting junior psychiatrist degrees in their cornflakes packets again? SIGH!!

I feel that my size, 6' 250lbs makes a lot of people think "Oh he is a big guy and needs a big dose"

Size has little to do with it. It comes down to how fast or slow you metabolize meds and that is mostly determined by DNA.

The problem I had with Zoloft years ago was that it made my feel mad all the time and the littlest thing would just piss me off, but this was at 100-125mg.

Aggression can be an antidepressant side-effect independent of dose.

That, just a minute amount could correct the chemical imbalance?

SSRIs do reduce high brain serotonin levels, but this isn't what produces the therapeutic response. Antidepressants stimulate the growth of new brain cells (neurogenesis) and it is these neurons and they create the response.

but I have read all over the net, along with my doc telling me from patients she has, that some respond to small doses better than the "normal dose".

Maybe, but there is a potential big trap with this and I'd be wary of taking less than 50mg Zoloft. The problem with sub/borderline therapeutic doses is neurogenesis may be interrupted whenever plasma levels of the med 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're stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007). This applies whether returning to a previously taken antidepressant or a different one. 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.

She even has one patient that takes Zoloft every other day on a low dose and it stopped his anxiety.

I suspect this is mostly the placebo effect in action.