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

[panic_down_under]

I have now taken 12.5mg for two nights and plan to continue for 7 before increasing to 25mg.

The rule of thumb on this is to not increase med doses sooner than 5 times their half-life which is the point at which plasma levels usually stabilise to a steady-state. For sertraline this is 26 hours x 5 = 130 h/5 days. I usually recommend folk take an extra days or two as a confidence booster so increasing the dose ever 7 days is ideal. Doing it sooner may increase the severity of side-effects, but delaying it won't significantly lower their severity no matter how long the delay.

what’s the deal with Sertraline and alcohol? I must admit to be drinking most days since lockdown -probably about half a bottle of wine every night but have not had any since I started Sertraline. Will I be ok to have a glass or two if wine or should I abstain completely?

Sorry to be literally a party pooper, but ADs and alcohol are not a good mix. Firstly, the AD+alcohol combination can be unpredictable. Some days you may be able to drink a herd of alcoholic elephants under the table without raising a sweat, on others a small glass of wine could turn legs to rubber. Plus, as WiseMonkey has already posted, alcohol may increase side-effects severity. Be extra cautious until you work out how the combination effects you.

The second issue is that alcohol can inhibit the mechanism by which ADs work. They stimulate the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels, mostly of cortisol (PDF). The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly.

The problem is alcohol has the same effect on hippocampal neurogenesis as cortisol. Even moderate drinking can reduce cell growth by nearly half (see also: Morris SA, 2010; Crews FT, 2003). This, and a few other factors, is why alcohol has never proven to be a anxiety/depression cure despite probably being the most (self)prescribed 'med' for these disorders. They mostly create a tag team downward spiral to rock bottom.

[Lady Penelope]

Thank you so much for the replies. Makes it very clear!

[Lady Penelope]

Hello
I have now started taking the Sertraline. I took for 25mg for two days back in July and then panicked and stopped as I was having a small family part for my son and I was afraid I would drink alcohol! I am now on day 9 of 25mg. My main side effect with it is increased anxiety but I really feel I need to stick with it and see if it works for me. I will post an update when I have been on it a bit longer in case it helps someone else just starting out. I had planned to start in 25mg and then group to 50mg after 7 days.
one of the problems I have had is that my heart rate has dropped and I wonder if 5is could be a side effect? My usual resting heart rate is about 62 and dropping to about 55 when I sleep. Since starting this my resting heart rate has gone to 54 dropping to 48 when I sleep. I am on propranalol 20mg twice a day and Amlodipine 5mg for blood pressure, along with a statin and baby aspirin. i called the GP and she said reduce the propanol to 10mg twice a day which I have but it has not made a difference and it’s still lower than usual. Does Sertraline lower blood pressure and heart rate? Or is it something else? My GP said to stay on 25mg Sertraline for another week.

[Lady Penelope]

I should also add GP has given me diazepam 2mg to help with side effects but I’m now frightened to take them in case they lower my heart rate even more! I have not taken any of them yet but was glad she had prescribed them in case it got too bad - I have managed without them since taking Sertraline but have an appointment at the hospital tomorrow which I am really anxious about.

[panic_down_under]

one of the problems I have had is that my heart rate has dropped and I wonder if 5is could be a side effect? My usual resting heart rate is about 62 and dropping to about 55 when I sleep. Since starting this my resting heart rate has gone to 54 dropping to 48 when I sleep. I am on propranalol 20mg twice a day and Amlodipine 5mg for blood pressure, along with a statin and baby aspirin. i called the GP and she said reduce the propanol to 10mg twice a day which I have but it has not made a difference and it’s still lower than usual. Does Sertraline lower blood pressure and heart rate?

One of the many roles serotonin has in the body is in mediating blood vessel tone, constriction and dilation which can see blood pressure either rise, or fall, when taking serotonergic ADs, especially at the beginning. SSRIs don't usually directly effect the pulse rate, however, it could vary in response to the drop in BP. This may resolve in a week or two as your body adjusts to the med. Fwiw, I've been on a BP med since having part of a lung removed nearly 15 years ago to keep my BP at the low end of the normal range and my resting heart rate hovers around 48 to 50 bpm. It has has no obvious consequences apart for occasional momentary dizziness if I get up quickly.

Are you taking the baby aspirin on doctor's orders? If not, I suggest you discuss this with your GP as serotonergic ADs are also mild anticoagulants.

GP has given me diazepam 2mg to help with side effects but I’m now frightened to take them in case they lower my heart rate even more!

Diazepam may reduce an anxiety triggered elevated heart rate by lowering anxiety levels, but doesn't usually do so otherwise at usually doses. One study with healthy volunteers did find a slight increase in heart rate after one month of daily dosing at 5mg, but other studies have found no significant difference either way.

[Lady Penelope]

Thank you panic_down_under I can always rely on you to reply and give such a comprehensive answer.

i have phoned to docs and asked if I should stop propanalol completely and I’m waiting on a call back.

[Lady Penelope]

I had loads of heart tests done about 9 years ago just after my dad died. I thought I was having a heart attack but in hindsight I can see now that it was panic attacks. I have a great deal of heart disease in my family so I think that was why were being extra cautious. They said I had mild coronary artery disease so put me on 20mg simvastatin and baby aspirin.
then about five year ago I had slightly high blood press so got put on 5mg amlodipine. The propranolol was added a it later to help with the blood pressure and anxiety.

my husband thinks I don’t need any of these medications at all and always nagging me to stop. I suppose because I have heart related health anxiety I see the meds as a good preventative measure.My blood pressure is well controlled and often a little low.

i have been thinking all this over today and have booked to have a medication review in a couple of weeks time.

anyway thanks again panic_down_under. I think you are such a nice person to take the time to reply to so many on these boards.

[panic_down_under]

i have been thinking all this over today and have booked to have a medication review in a couple of weeks time.

Regular drug reviews are a good idea, imho.

I suggest you specifically ask about taking both sertraline and aspirin. There probably is no concern at your current sertraline dose, or at 50mg, but the combination will become increasingly problematic as the dose rises. However, please don't stop taking the aspirin without first discussing it with your GP.

If you discontinue the aspirin there may be a small drop in BP as this often increases a little when aspirin and amlodipine are taken together. You GP will likely have considered this when selecting the amlodipine dose so it shouldn't be an issue at the moment, but maybe get your BP checked again a week or two after you stop taking the aspirin.

[Lady Penelope]

Thank you panic_down_under
had call from G P who said to stop propranolol but keep an eye on blood pressure and heart rate . Review next Wednesday.

[Lady Penelope]

Now been on 25mg Sertraline for 12 days and have a review with GP tomorrow. Anxiety has been up and down this week and main side effect has been increased anxiety.. heart rate has been up and down and I have gone from 40mg propanol a day down to 20mg then none at all and back to 20! My health anxiety is centred around my heart so this has been difficult. I now have to decide whether to go up to 50mg or stay on 25mg. Does 25mg ever work for anyone? The side effects of 25mg have not been as bad as I feared and I am worried about increasing the dose. I am the sort of person who gets a big effect from medication- I only ever take 1 paracetamol instead of 2 if I have a headache.
I think I may feel marginally better than I did twelve days ago but not markedly so. Any thoughts please?