Been trying to manage without medication but is it time to give it a go?

[Lady Penelope]

Thank you once again.

I would like to stay on the lowest dose possible and I think that if I increase too quickly I might end up on a higher dose than I really need. I think I may try and stick it out at 50mg for 12 weeks and then decide. When I was on an SSRI a few years ago (Fluoxetine) I stayed on 20mg and found it fairly east to wean off from as the dose was not high. I am hoping that I will eventually be able to come off Sertraline and so the lower dose I am on the better.

I am worried about the side effects from increasing but not as much as I was at the start.

Had my first CBT sessions yesterday. It was an online assessment and I was diagnosed with panic disorder. I have been booked in for weekly sessions. starting next week. It was nice to speak to somebody about it and it felt good getting it all of my chest! I am hoping the combination of CBT and medication will do the trick.

I am also reading loads of books and listing to mediation and relaxation tapes which seem to help.

[panic_down_under]

I would like to stay on the lowest dose possible and I think that if I increase too quickly I might end up on a higher dose than I really need.

Because of the way ADs work it is better to take a bit too much than not enough. Any extra has little negative effect.

When I was on an SSRI a few years ago (Fluoxetine) I stayed on 20mg and found it fairly east to wean off from as the dose was not high. I am hoping that I will eventually be able to come off Sertraline and so the lower dose I am on the better.

It wouldn't have mattered much if you'd been on the maximum 80mg fluoxetine. It has a very long half-life, about 6 days, and that of its active metabolite norfluoxetine, which actually does most of the work is even longer, around 16 days, so it takes some 80-90 days to be completely metabolised which provides an automatic long, slow taper even if quitting it cold-turkey (which is not an endorsement, C-T withdrawal from any psych med, including fluoxetine, is a stupid move!).

Sertraline has a much shorter half-life, but the taper starting dose probably won't affect the withdrawal outcome by much. It is quitting the last few milligrams which generally produces any problems that may occur, not cutting back the higher doses. The trick is not to rush the process, but to slowly wean off over months, not weeks, by small steps.

Had my first CBT sessions yesterday.

That's very good news.

I am also reading loads of books and listing to mediation and relaxation tapes which seem to help.

That's great, but there can be a tendency to overload with information and end up doing several things which may not be compatible. Let the CBT therapist be your main guide.

[Lady Penelope]

Thank you for sharing your knowledge. It makes me feel a bit better about increasing. I I have been on Sertraline for 11 weeks now, starting at 25mg. I have been 50 for just over8 weeks. Review with G P Is December 23rd.
I am still feeling fairly anxious. Another ocular migrane yesterday and Face tingling. I am hoping it begins to settle down soon.

[panic_down_under]

am still feeling fairly anxious. Another ocular migrane yesterday and Face tingling. I am hoping it begins to settle down soon.

Do you have a past history of ocular migraines? If so, how frequent were they and did either an increase in anxiety, or face tingling accompany them?

[Lady Penelope]

I have a past history of migraine which started when I was about 25 and I had them for about 20 years. I’m 61 now. The ocular migraine started about 3 years ago and I would get one every few months.i have posterior vitreous detachment so have had my eyes checked frequently. They have got more frequent over the last six months or so and I would get one every month or two months. Since starting the sertraline I have had more. Once or twice a week.
The face tingling comes at random times - not connected with the ocular migraine. I have only had the face tingling since starting sertraline do am assuming it’s a side effect. I seem to get it when I am lying down relaxing. Tingling round my mouth and chin which lasts for 15 mins or so and then goes away.

[panic_down_under]

They have got more frequent over the last six months or so and I would get one every month or two months. Since starting the sertraline I have had more. Once or twice a week.

Interesting, as ADs are sometimes prescribed to prevent migraines of both types although they haven't affected the frequency of mine either way. Unfortunately, it's impossible to predict what effect increasing the sertraline dose will have on their frequency, if any.

Did you continue to have the migraines while on propranolol?

The face tingling comes at random times - not connected with the ocular migraine. I have only had the face tingling since starting sertraline do am assuming it’s a side effect.

It is a relatively common symptom of migraines too, but I think you're right about it being a med side-effect in your case.

While the increased migraine frequency and the face tingling are mostly likely just sertraline side-effects I suggest you raise them with your GP at the next consultation if you haven't already. He's in a much better position to judge whether they need investigating.

[Lady Penelope]

Hello again

Anxiety is ramping up again and I have two panic attacks in last 3 days.
I spoke to GP today for a review and she said I should increase to 100mg. I suggested going to 75mg for a week but she said that was not necessary.

No more migraines thankfully. GP thinks the tingling is side effect from Sertraline.

I have been on Sertraline for 12 weeks in total - 9 weeks at 50mg. Just thinking about whether to take her advice and go to 100mg straight away. I would have liked to have remained at 50mg for a few more weeks but I think I need to increase.

[Midnight-mouse]

I didn’t have any issues going from 50 to 100mg, maybe a little tired for a couple of days and a little icky sort of feeling in the stomach. I’ve definitely noticed big changes for me at this dose and might end up seeing what I’m like at 150mg soon.


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[Lady Penelope]

Thank you for the reply.

[panic_down_under]

Just thinking about whether to take her advice and go to 100mg straight away. I would have liked to have remained at 50mg for a few more weeks but I think I need to increase..

I think you're right. While 50mg may have some incremental improvement left to give you're unlikely to get a night turned to day moment from it.