Page 3 of 6 FirstFirst 12345 ... LastLast
Results 21 to 30 of 54

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

  1. #21
    Join Date
    Jan 2017
    Posts
    2,369

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

    Quote Originally Posted by Lady Penelope View Post
    I now have to decide whether to go up to 50mg or stay on 25mg. Does 25mg ever work for anyone?
    25mg is a sub therapeutic dose for most. Taking sub therapeutic doses may increase the risk of the AD failing to work.

    ADs have no direct effect on anxiety, or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly. For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.

    The problem with taking sub/borderline therapeutic doses is neurogenesis may be interrupted whenever AD plasma levels 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 are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002). Taking a low dose for months may create a similar situation as stopping and restarting it as plasma levels fluctuate. While the neurogenesis interruptions may only be of short duration, they will probably occur much more frequently.

    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.
    The side-effects will likely be not worse than at 25mg.

    As per above, ADs have no direct effect on anxiety so experiences with other meds may not be a guide to AD dosing. Most serotonergic ADs need to be taken at doses high enough to saturate at least 80% of the serotonin transporters (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available diagnostic tests to determine the dose needed to achieve this for individuals.

    I think I may feel marginally better than I did twelve days ago but not markedly so.
    ADs typically take 5-12 weeks to kick-in. It takes about 7 weeks for new cells to bud, grow and reach maturity, although some improvement may begin earlier.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  2. #22
    Join Date
    Apr 2016
    Posts
    160

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

    Thank you panic_down_under for your reply.
    Seems to me I will need to increase to 50mg.
    I would like to do that slowly if possible by trying 37.5 for a week but have been told by a different GP that 25mg is not available in the UK.

    At the moment I have 50mg and am splitting them in 2. I could try and split the tablet into 4 and take 3/4 of a tablet but it’s not very accurate even with a pill cutter.

    or is there any point is splitting the 50 in 2 and taking 25mg morning and evening to spread it out?

    or maybe I should just be brave and go for the 50!

    Thanks for reading and I would appreciate your thoughts.

  3. #23
    Join Date
    Jan 2017
    Posts
    2,369

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

    Quote Originally Posted by Lady Penelope View Post
    At the moment I have 50mg and am splitting them in 2. I could try and split the tablet into 4 and take 3/4 of a tablet but itís not very accurate even with a pill cutter.
    I don't know if this will help as it depends on the tablet structure, but if it is scored try making the first cut at right angles to the score and then use the score to centre the blade for the second cut.

    or is there any point is splitting the 50 in 2 and taking 25mg morning and evening to spread it out?
    It may help for the first 2-3 days. Sertraline has a half-life of about 24 hours and plasma levels of most meds will stabilise to a steady-state at 5 times their elimination half-life. Once at a steady-state it doesn't matter much when and how the med is taken. At least that is the theory. In practice some, e.g. me, seem to do better taking ADs in 2-3 split doses, especially with those that have half-lives around 24 hours, or less. Doctors often discourage the practice as compliance frequently drops. We are contrary creatures and the more often a med needs to be taken the more likely we are to find it all too hard and give up.

    or maybe I should just be brave and go for the 50!
    It probably won't be that much harder. Side-effects tend to be less severe after a dose increase than they were when first taking the AD and to diminish sooner, but as with everything about ADs, there are no guarantees. They can be unpredictable meds. It pays to have a sense of humour. Cuts down on the tears.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  4. #24
    Join Date
    Apr 2016
    Posts
    160

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

    Thank you again. Great tip about cutting the tablet!

    i have just spoke to GP. She said you can stay on 25 or go up to 50 - it’s up to you! She said 25 is a very small dose. I have decided to try 37.5 for a week and see how I go.
    panic_down_under your advice is much appreciated.

  5. #25
    Join Date
    Jan 2017
    Posts
    2,369

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

    Quote Originally Posted by Lady Penelope View Post
    I have decided to try 37.5 for a week and see how I go.
    Cool. The rule of thumb on this is not to raise doses at less than 5 times the half-life of the AD, so for sertraline no sooner than 5 days from the last increase, though I recommend taking an extra day or two mostly for psychological reasons. Upping doses sooner may trigger more severe side-effects, however, delaying them usually won't significantly reduce any subsequent spike no matter how long the delay.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  6. #26
    Join Date
    Apr 2016
    Posts
    160

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

    Been on 37.5 mg for 5 days now and anxiety has been so much worse than first two weeks. Panic attacks every day and I have had to resort to diazepam 3 times. Really hope this settles down soon -it’s horrendous and makes me regret starting this drug in the first place

  7. #27
    Join Date
    Jan 2017
    Posts
    2,369

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

    Quote Originally Posted by Lady Penelope View Post
    Been on 37.5 mg for 5 days now and anxiety has been so much worse than first two weeks. Panic attacks every day and I have had to resort to diazepam 3 times.
    If diazepam gets you over this then that's okay. Unfortunately, there are no side-effect free ADs, although the more fortunate majority experience only mild ones. It all comes down to how individual biology meshes with the med.

    Really hope this settles down soon -itís horrendous and makes me regret starting this drug in the first place
    Try and focus on the end result, not what is happening in the moment. Diversion can be effective. I read books pretty much from dawn to dusk my first time on an AD. 'Read' not being an accurate description, more concentrating on each word in turn without necessarily grasping what each sentence meant, let alone what the book was about. I've had to repeat this a couple more times since and still haven't a clue about the stories. But it did help get through some very dark days (mostly of my own making by insisting on ramping up doses quickly). One day I must sit down and begin really reading them.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  8. #28
    Join Date
    Apr 2016
    Posts
    160

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

    Thank you. I am feeling awful today. Getting tingling all over my face and head, feeling dizzy and lightheaded. I keep telling myself it’s just the side effects and it will get better soon. So hard to get through each day. Terrible panic attack last night - the worst for about five years - I though I was having a stroke. I feel washed out now and fearing another one. Hate this anxiety. I know I have to stick with this and give it a try as I tried without meds for about 6 months and I was getting worse.
    Thanks again panic_down_under. - I will try keeping busy and not dwell on it too much. I am planning on upping to 50mg in two days time.
    The most difficult thing is not knowing when or if this will work for me
    Last edited by Lady Penelope; 30-08-20 at 11:06. Reason: Typo

  9. #29
    Join Date
    Jan 2017
    Posts
    2,369

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

    Quote Originally Posted by Lady Penelope View Post
    Thank you. I am feeling awful today. Getting tingling all over my face and head, feeling dizzy and lightheaded. I keep telling myself itís just the side effects and it will get better soon. So hard to get through each day. Terrible panic attack last night - the worst for about five years - I though I was having a stroke. I feel washed out now and fearing another one. Hate this anxiety.
    Not all of what you're feeling may be down to the AD. An anxious mind is quite capable of delivering our worst nightmares given half a chance and severe med side-effects can give it a lot to play with.

    I am planning on upping to 50mg in two days time.
    Maybe give it an extra couple of days if things haven't calmed down for the side-effects to hopefully ease and to recharge the psychological 'batteries'. In the AD race there is much to be said for being a tortoise rather than hare.

    The most difficult thing is not knowing when or if this will work for me
    Unfortunately, this is the second biggest problem with ADs after the side-effects. Despite much effort there is still no reliable way of determining the most effective med for an individual. Gene tests have shown some promise, but aren't there yet and that has been the case for a while now.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #30
    Join Date
    Apr 2016
    Posts
    160

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

    I would be interested to know what the statistics are for Sertraline. Most things I read about SRRIs are negative and I wonder what percentage of people they help. It seems like they are a last resort for a a lot of people and many stop taking them within a few weeks due to the side effects. Also some people take them for a good few months and they don’t work so the have to start again with a different drug. I suppose people who have a positive experience are not posting looking for help and support.

Page 3 of 6 FirstFirst 12345 ... LastLast

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Do I just give up and take the medication?
    By Kb97 in forum Panic / Panic Attacks
    Replies: 15
    Last Post: 26-04-17, 02:04
  2. Medication, when do you give in and try it?
    By Tela44 in forum General Anxiety / Generalised anxiety disorder (GAD)
    Replies: 4
    Last Post: 12-03-15, 09:08
  3. Should I give up on this medication?
    By Catherine84 in forum Pregabalin / Lyrica
    Replies: 7
    Last Post: 09-09-14, 13:25
  4. Time to give up?
    By kingmuma in forum Fluoxetine / Prozac
    Replies: 2
    Last Post: 28-11-09, 22:35
  5. Does this Medication give you chest pains
    By Chardless in forum Citalopram / Celexa
    Replies: 0
    Last Post: 09-10-09, 18:44

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •