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Thread: Sertraline and co codamol

  1. #1
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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

  2. #2
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    Re: Sertraline and co codamol

    Quote Originally Posted by wareing77 View Post
    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.

    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.

    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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  3. #3
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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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  4. #4
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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 View Post
    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

    Quote Originally Posted by wareing77 View Post
    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.

    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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  7. #7
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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

    Quote Originally Posted by wareing77 View Post
    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.

    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'.
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  9. #9
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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

  10. #10
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    Re: Sertraline and co codamol

    Quote Originally Posted by wareing77 View Post
    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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