More issues than I had originally

[stk149]

Hi everyone,

I never really post on this forum unless I'm really going through it, and right now I am really going through it.

I started taking sertraline in April 2018 for a particularly bad bout of health anxiety and OCD which I've suffered from for about 11 years now. I was having daily bouts of crying, depression, had a weird sensation down one side of my body and was probably the most anxious I'd ever been. It really was just that one symptom at the time that had me feeling the way I did however I do suffer from GAD too so pretty much every day there is something to worry about.

I started on 50mg daily and within a couple of weeks I couldn't believe the difference, it was working better than citalopram had for me a few years prior. Almost immediately the bodily sensation subsided and I was relieved knowing that it had been an anxiety issue all along, however I then started to notice some other worries creeping in: I started having difficulty swallowing food some times but I remembered I'd had this whilst on citalopram a few years before, so though it was annoying I didn't stress too much about it. Then I started worrying about anaphylactic shock in response to taking medications or eating foods I'd never tried before or those I hadn't ate in a while. I also developed this very strange paranoia around having my food tampered with (think rogue employee in the food manufacturers with poison), I started throwing food out if I suspected it was 'spiked'. There are a few more anxieties that arose and much like everyone else the past year and half of living through a global pandemic has not helped, but all in all I was managing ok and the things I was freaking out about were actually controllable - if I threw the food out, nothing would happen to me and I felt like I had control over those fears.

About 8 months in to my treatment I noticed the sertraline was starting to 'poop out' so booked a doctors appointment, she suggested going up to 100mg but of course with medication worries I was reluctant and told her that. In a few weeks I found myself improving anyway but was definitely emotionless and apathetic about most things - it was still better than anxiety though.

A few months after that I went back to see the "mental health specialist" (we've all been there, right?) - I expressed that I was considering going off the medication and he told me I'd only have to take 1 tablet every other day for a week then stop - I thought it sounded a bit sudden but kept it in mind as an option. He made a referral for me to see a therapist but it took about a year for me to actually get an appointment due to the waiting times. Though I was feeling ok, I decided to go anyway and while the therapist was very friendly and easy to talk to, I don't think her advice was all that great - by this stage I'd still decided to stay on my medication, it was October 2020 and I'd been on 50mg of sertraline for 2 and a half years. Therapy definitely unlocked a few things but I don't feel like I left with any real useful coping strategies (I do plan on going private to see a proper therapist soon by the way)

In April of this year, 3 years after starting sertraline and staying on the same dose for all that time, I decided I wanted to come off them. I felt like I was in a good place but the apathy and lack of excitement I felt on sertraline was holding me back. Of course on the very first day of stopping them, the fella I had spent 8 months building an emotional connection with decided he didn't want anything to do with me anymore and I found the whole situation very distressing. In saying that, the advice I had been given in therapy was to stop investing so much importance in relationships with others so I've been trying to get over it best I can.

So now I've been off sertraline completely for about 2 and a half months and here's where I'm at:

• Difficulty swallowing remains and is more pronounced at the moment. The other day I had one of those "oh god it's going down the wrong way" moments and now when I eat meat I feel my heart racing as I swallow and sometimes I bring it back up, it's really scary and it's really getting me down.
• Still scared of taking new medication and also now having vaccine worries (like most of the forum I'm sure) - I have had my first dose, awaiting second. Trying not to think about it.
• Still scared of eating certain foods in case I take an allergic reaction
• I still feel really badly depressed. I feel lonely and I feel like I have nothing look forward to. Even the things I do have planned I am not excited about. A lot of my friends are now in relationships and don't really have time for me anymore. I cry a lot again.
• Every time one health anxiety symptoms leaves, another one takes it's place and I'm finding it very very hard to cope with
• I feel overwhelmed and "stuck", and I feel like I spent the last 3 years on sertraline doing nothing and being unproductive.

I'm really struggling to see the light at the end of the tunnel this time. As usual I'm not really sure of what I'm trying to achieve with this post. Maybe if anyone's felt they developed new anxieties on sertraline did they have any success in getting rid of them and how long did it take? I don't know what to do anymore.

[Speranza]

HI, I've not been on this drug but I just wanted to say well done for posting and hanging in there. I suspect some of the answers you are after will come through therapy. I wonder if you need to try a different drug? x

[stk149]

Thank you for your reply 💖 I think they will too, I hope I don’t have as long to wait this time going private. Maybe I do, but I hate being so dependent on them. There’s nothing wrong with being on antidepressants for all of your life I just personally don’t like how eventually they end up making me so emotionless. Well done to you for going on it and getting help, I hope your journey is a pleasant one and I hope they help you! They definitely helped for me initially

[panic_down_under]

I started on 50mg daily and within a couple of weeks I couldn't believe the difference, it was working better than citalopram had for me a few years prior. Almost immediately the bodily sensation subsided and I was relieved knowing that it had been an anxiety issue all along, however I then started to notice some other worries creeping in:

If you improved that much in only 2-3 weeks then I suspect this owed more to the placebo effect than the med. Antidepressants don't have a direct effect on anxiety, or depression in the way say aspirin does on a headache. These disorders are the emotional expression of a brain deficit, the atrophy of parts of the hippocampal regions caused by high stress hormone levels *killing brain cells and inhibiting the growth of new ones. Both ADs and the CBT/REBT/mindfulness therapies work by stimulating the growth of new hippocampal cells. These cells and the connections they form produce the therapeutic response, not the ADs directly. It takes about 7 weeks for neurons to grow and mature, however, improvements in mood may begin a few weeks earlier with kick-in usually occurring in the 4-12 week range.

*See: Depression, antidepressants, and the shrinking hippocampus; Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act: A primer.... As per above, therapy also works through hippocampal neurogenesis too, as do Omega-3 fatty acids/fish oil and exercise to lesser degrees though they can make a significant difference in mild cases.

I started having difficulty swallowing food some times but I remembered I'd had this whilst on citalopram a few years before, so though it was annoying I didn't stress too much about it. Then I started worrying about anaphylactic shock in response to taking medications or eating foods I'd never tried before or those I hadn't ate in a while.

I suspect you never took a dose high enough to get a positive response. Most on sertraline take 100-150mg/day to achieve a good outcome, and those with health anxiety often need to take high doses as OCD spectrum disorders such as HA are often the most difficult to bring under control.

About 8 months in to my treatment I noticed the sertraline was starting to 'poop out' so booked a doctors appointment, she suggested going up to 100mg but of course with medication worries I was reluctant and told her that. In a few weeks I found myself improving anyway but was definitely emotionless and apathetic about most things - it was still better than anxiety though.

All ADs may potentially affect emotions, but not all will for an individual so there is a good chance you won't have this problem with another AD.

A few months after that I went back to see the "mental health specialist" (we've all been there, right?) - I expressed that I was considering going off the medication and he told me I'd only have to take 1 tablet every other day for a week then stop - I thought it sounded a bit sudden

Many have few problems quitting SSRIs (except paroxetine), but I think that's too quick, plus I'm not a fan of doing so by skipping doses, especially with relatively short half-life ADs like sertraline as in can create a roller-coaster effect as the med drops in and out of the system at low doses which can be very disturbing. Better to cut the dose in half for a week, or two and then halve it again for another week before stopping.

Therapy definitely unlocked a few things but I don't feel like I left with any real useful coping strategies (I do plan on going private to see a proper therapist soon by the way)

Learning coping strategies is one of the pillars of CBT, REBT, mindfulness.

So now I've been off sertraline completely for about 2 and a half months and here's where I'm at:

• Difficulty swallowing remains and is more pronounced at the moment. The other day I had one of those "oh god it's going down the wrong way" moments and now when I eat meat I feel my heart racing as I swallow and sometimes I bring it back up, it's really scary and it's really getting me down.
• Still scared of taking new medication and also now having vaccine worries (like most of the forum I'm sure) - I have had my first dose, awaiting second. Trying not to think about it.
• Still scared of eating certain foods in case I take an allergic reaction
• I still feel really badly depressed. I feel lonely and I feel like I have nothing look forward to. Even the things I do have planned I am not excited about. A lot of my friends are now in relationships and don't really have time for me anymore. I cry a lot again.
• Every time one health anxiety symptoms leaves, another one takes it's place and I'm finding it very very hard to cope with
• I feel overwhelmed and "stuck", and I feel like I spent the last 3 years on sertraline doing nothing and being unproductive.

Maybe if anyone's felt they developed new anxieties on sertraline did they have any success in getting rid of them and how long did it take? I don't know what to do anymore.

I think these have more to do with anxiety than sertraline. They will likely resolve if treatment is resumed, be it ADs, or therapy. If you decide to take an AD then consider trying the TCA clomipramine (Anafranil), or the SSRI fluvoxamine (Luvox). While no AD is intrinsically more effective than the others either generally, or for a specific disorder, clomipramine and fluvoxamine seem to have a slightly better track record for OCD spectrum disorders. IMO, clomipramine is the better of the two as fluvoxamine interacts with many meds which may be an issue if you're taking meds for other conditions.