Sertraline 50mg

[Paul84]

After 8 weeks of on and off anxiety and low mood, I went back onto Sertraline 50mg on Tuesday.
Monday, I was feeling better than I have done for a while as I've started to come down to Earth but, after 2 doses of Sert, I feel awful. Disturbed sleep, elongated yawning, Dry Mouth, lower mood, loose stools...
Has anyone taken meds, had 2nd thoughts and stopped? After 2 doses, would it still be case of weaning off them?

[ServerError]

You wouldn't have to wean off sertraline after just two doses, unless you've been taking an SSRI prior to that and moved straight over to sertraline. Then a taper would be needed. There's a user on here who knows way more than me about these medications who will hopefully be able to offer you better advice than I can, but what I will say is that 50mg is quite a low dose of sertraline. When I was on it, I was on 100mg and had the option to go higher still. Also, two doses is not enough to really make much difference, good or bad. I don't know enough to say whether two doses could trigger the side effects you experienced, but I do know that it isn't anywhere near enough to say whether it is helping or not. When I took it, I experienced very difficult side effects that kicked in after about a week, but once those side effects went away, it really helped me, but I think I'd been on it about six weeks before I noticed it beginning to work for me.

[Paul84]

You wouldn't have to wean off sertraline after just two doses, unless you've been taking an SSRI prior to that and moved straight over to sertraline. Then a taper would be needed. There's a user on here who knows way more than me about these medications who will hopefully be able to offer you better advice than I can, but what I will say is that 50mg is quite a low dose of sertraline. When I was on it, I was on 100mg and had the option to go higher still. Also, two doses is not enough to really make much difference, good or bad. I don't know enough to say whether two doses could trigger the side effects you experienced, but I do know that it isn't anywhere near enough to say whether it is helping or not. When I took it, I experienced very difficult side effects that kicked in after about a week, but once those side effects went away, it really helped me, but I think I'd been on it about six weeks before I noticed it beginning to work for me.

Thanks for your reply. I recognise the strange yawning from my previous time on setraline. I have IBS which has been kicking off during the last couple of weeks so that probably hasn't settled.

It's definitely affecting my sleep as I'd been sleeping well before taking the meds.

[panic_down_under]

after 2 doses of Sert, I feel awful. Disturbed sleep, elongated yawning, Dry Mouth, lower mood, loose stools...

These are all fairly typical initial SSRI side-effects, Paul. They will usually diminish within a few weeks.

Has anyone taken meds, had 2nd thoughts and stopped?

Unfortunately, many people prescribed ADs stop taking them within days because of side-effects. Has their GPs warned them about side-effects and prescribed a small starting dose most would probably have continued taking them.

After 2 doses, would it still be case of weaning off them?

No. Dependence doesn't develop that quickly. It would be an issue after a couple of months.

There are a couple of things to be aware of. Firstly, the initial side-effects can be more severe and/or different the second time on an AD. You might also need to take a higher dose than the last time to achieve the same outcome.

Also, 50mg is too high a starting dose for most with anxiety disorders so most treatment guidelines, including BNF-NICE's, recommend taking 25mg for the first week to ease onto the AD. I suggest you then up it by the same amount at weekly intervals until you reach the full 50mg. However, given this is your second time on the sertraline merry-go-round, 12.5mg would likely given you an even easier ride. But you should clear taking a lower dose with the prescribing physician first (and maybe ask for a prescription for 25mg tablets if you have trouble quartering the 50mg tablets). Cutting tablets with a pill-cutter is both more accurate and often less bloody, ime, than trying to cut them with a knife. Your chemist/pharmacist should stock them.

Most side-effects can be diminished. Insomnia is that most common SSRI side-effect. Let your GP know if you still have trouble sleeping at the lower doses as it is relatively easily controlled with a small dose of mirtazapine, or a sedating antihistamine. For dry-mouth sip water to keep the mouth irrigated and if that isn't enough most chemists stock a range of gels, oral sprays, toothpastes and other products for dry-mouth. Loperamide (Imodium) is usually effective for SSRI induced diarrhoea. Not sure what the situation is in the UK, but supermarkets stock it here.

[Rad1]

These are all fairly typical initial SSRI side-effects, Paul. They will usually diminish within a few weeks.



Unfortunately, many people prescribed ADs stop taking them within days because of side-effects. Has their GPs warned them about side-effects and prescribed a small starting dose most would probably have continued taking them.



No. Dependence doesn't develop that quickly. It would be an issue after a couple of months.

There are a couple of things to be aware of. Firstly, the initial side-effects can be more severe and/or different the second time on an AD. You might also need to take a higher dose than the last time to achieve the same outcome.

Also, 50mg is too high a starting dose for most with anxiety disorders so most treatment guidelines, including BNF-NICE's, recommend taking 25mg for the first week to ease onto the AD. I suggest you then up it by the same amount at weekly intervals until you reach the full 50mg. However, given this is your second time on the sertraline merry-go-round, 12.5mg would likely given you an even easier ride. But you should clear taking a lower dose with the prescribing physician first (and maybe ask for a prescription for 25mg tablets if you have trouble quartering the 50mg tablets). Cutting tablets with a pill-cutter is both more accurate and often less bloody, ime, than trying to cut them with a knife. Your chemist/pharmacist should stock them.

Most side-effects can be diminished. Insomnia is that most common SSRI side-effect. Let your GP know if you still have trouble sleeping at the lower doses as it is relatively easily controlled with a small dose of mirtazapine, or a sedating antihistamine. For dry-mouth sip water to keep the mouth irrigated and if that isn't enough most chemists stock a range of gels, oral sprays, toothpastes and other products for dry-mouth. Loperamide (Imodium) is usually effective for SSRI induced diarrhoea. Not sure what the situation is in the UK, but supermarkets stock it here.

That’s great advice. I’ve just started back on Sertraline and am on 25mg, day 4. I got IBS day 2, I already had insomnia and I felt anxiety increase. I suffered badly last time with all the above, for 4 to 6 weeks. Then it cleared except IBS and I felt my old self. I went up 25, 50, 75, 100. Increase every 5 to 7 days.
Rad

[panic_down_under]

Then it cleared except IBS

Sertraline tends to be harder on the gut than the other SSRIs. I don't know why. All you can do is treat the symptoms, or if it becomes intolerable switch to another AD. Fluoxetine (Prozac) seems to be the least likely to cause ongoing gastrointestinal issues, though, as with everything about ADs, this isn't guaranteed.

[Rad1]

PDU, Do you know the AntiD with the least impact on insomnia and heightened anxiety? Rad

[panic_down_under]

As a generalisation all the SSRIs are likely to be similar, however, it is possible that one or two may be less so for you. It all comes down to how each meshes with your individual biology. Unfortunately, there is no way of determining the best one/s other than by trial and error (despite the claims gene tests haven't been that useful so far).

The older serotonergic TCA meds, other than maybe clomipramine (Anafranil), are generally a little less likely to induce insomnia because they are also reasonably potent sedating antihistamines. They also tend to be a little less likely to heighten anxiety than the SSRIs/SNRIs at the beginning. However, YMMV on both.

[ServerError]

If the concern is about insomnia being induced by the medication, would mirtazipine be a good option to consider? I obviously don't have the professional expertise, but I know it can be quite sedating and I've found it improves my sleep no end (although it can sometimes be harder to get up in the morning).

[Rad1]

Thanks Server error and Panic DU.
I hate the insomnia and waves of anxiety at the outset, I’m 5 days in and only 25mg! I’m meant to be returning to work soon after several weeks off. I had 3 hrs sleep a couple of nights ago. That’s primarily down to financial worries, but starting up the Sertraline again (after a 6 month break) has worsened it. I’ve got Zopiclone but try and give it a break so as not to become dependent. Mirtazipan takes 5 weeks, so I guess I will just push through with Sert.

I wish I could be put in a sleep 💤 for a week and let the meds be introduced more rapidly! Wake up and feel refreshed and my former self.
Cheers
Rad