Starting Sertraline question

[tom1984]

I am on my third day of starting the med.
This morning I increased my dose from 12.5 =1/4th to about 18mg. On sunday my dose will be 25mg.

I woke up very anxious because my intrusive thoughts in regard to suicide worsened again. I had them pretty much under control.

Is it possible for them to get worse because of the meds and heightened anxiety or should I stop the meds?

I know 100% sure that I want to live and I want to be here for my kids and wife but some spontaneous thoughts make me very anxious.

I tend to start ruminating on them which is bad but I am so scared of losing control or something would happen that I do something I don´t want. So therefore I ruminate and check with myself to feel sure about myself never doing such things.

I hope this gets better soon!

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[apm]

Hi Tom,

Any SSRI will take time to work, probably 4-6 weeks for the full therapeutic effect to be felt.

In the time before this, they will tend to, ironically, make the symptoms worse that they will ultimately make better.

I have a couple of suggestions- first, speak to your GP- they might be able to prescribe something to take the edge off these effects. Second, try mindfullness & meditation, they can help to calm the mind. Thirdly, make sure you have a crisis plan for times when things are bad- particularly a number like the samaritans (not sure what the Canadian version is called).

Mainly, stick with it- it's a horrible drug to come onto, but great when it's stabilised and working: https://www.drugs.com/comments/sertr...ty-stress.html

Keep the faith!

[panic_down_under]

I woke up very anxious because my intrusive thoughts in regard to suicide worsened again. I had them pretty much under control.

Is it possible for them to get worse because of the meds and heightened anxiety or should I stop the meds?

Unfortunately, yes. The biggest problem with antidepressants, especially SSRI, SNRIs and other serotoninergic ADs is they often make anxiety worse because of an initial spike in serotonin activity. Bio-feedback mechanisms usually kick-in after a week or two at a steady dose to reduce both serotonin synthesis and expression in some brain areas to less than half pretreatment levels (despite what is often claimed anxiety and depression are not caused by too little serotonin, nor do ADs work by increasing it in the brain, they actually reduce it).

You should tell your doctor about the thoughts you're having and ask for something to ease them.

[tom1984]

I am now on 25mg since yesterday. Anxiety was high again yesterday but better today.
Also my toughts are calmer today. I am still tensed up and have high blood pressure as a result as well :-(.

The doc said I have to increase up to 50mg but does that mean an increase in anxiety and tension or will the symptoms remain more or less the same as now?

I don´t think I can cope with even more severe tension and anxiety.

I can also remain on 25mg for a week but then I risk that my symptoms will not improve and only get the side effects. Or is 25mg also a good dose to try on for a while?

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[panic_down_under]

I am now on 25mg since yesterday. Anxiety was high again yesterday but better today.
Also my toughts are calmer today. I am still tensed up and have high blood pressure as a result as well :-(.

The doc said I have to increase up to 50mg but does that mean an increase in anxiety and tension or will the symptoms remain more or less the same as now?

...I can also remain on 25mg for a week but then I risk that my symptoms will not improve and only get the side effects.

While 50mg is the recommended starting dose for depression it is often too high for those with anxiety so 25mg is the better initial dose. Increasing a medication's dose at intervals of less than 5 times its half-life may significantly increase the severity of any side-effects, but delaying it won't significantly reduce their severity no matter how long the delay. Sertraline has a half-life of about 24 hours so ideally doses should be only increased (or decreased) no earlier than 5 days from the previous one. I usually suggest a week between increases, but no longer. A few extra days won't significantly slow your recovery.

Or is 25mg also a good dose to try on for a while?

Most SSRIs need to be taken at a dose high enough for the med to saturate ~80% of the serotonin transporter molecules in regions of the brain which manifest anxiety and recommended minimum doses have been calculated to achieve this. Slow metabolizers may do well on lower doses, but there is no readily available diagnostic test to determine who they are. Also, most people end up taking 100-150mg/day of sertraline for optimum results.

[tom1984]

Ok so I will stick to 25mg for 3 more days and see from there.

I find this medication thing very hard because I feel so low and bad. I wish I had some relief already.

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[panic_down_under]

I wish I had some relief already.

Have you asked your doctor for something you help you until the sertraline begins to work?

[tom1984]

Have you asked your doctor for something you help you until the sertraline begins to work?

I have an appointment tonight.
My bloodpressure is very high. Around 160/10. Yesterday 170/11. Probably due to tension and anxiety.

Today the sertraline is better.

However the faster heart rate and high blood pressure are still there. Don't know what do do at the moment to be honest.

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[tom1984]

Ok, I visited my gp and we have come to the conclusion that my sudden high bloodpressure is a side effect from sertraline.

Tomorrow I have ro call my psichiatrist for a different med again. Tis is the 3rd in 3 weeks.

This is taking way to long to my liking.

Again all the side effects and starting from zero.

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[panic_down_under]

Ok, I visited my gp and we have come to the conclusion that my sudden high bloodpressure is a side effect from sertraline.

Tomorrow I have ro call my psichiatrist for a different med again. Tis is the 3rd in 3 weeks.

I wouldn't panic over one or two readings unless they are off the chart. Serotonin has many roles in the body apart from being a brain neurotransmitter including in the regulation of blood vessel tone, constriction and dilation and serotonergic ADs can interfere with this particularly in the first few weeks. They can either raise or lower blood pressure depending on individual responses though lower BP is the more common. They are also mild anticoagulants so may offer some protection against heart attack and ischaemic (blocking) stroke, but slightly increase the risk of the much less common haemorrhagic (bleeding) stroke. Plus, anxiety can also significantly raise BP.

This is taking way to long to my liking.

Unfortunately, there are no quick fixes. These disorders are often a long time in the making and they cannot be resolved in a few days or weeks.

Again all the side effects and starting from zero.

If you switch overnight to another AD you will retain some of the benefit gained so far. Unless switching to/from a MAOI class AD there is no need for a 'washout' period.