Sertraline - help

[jayke]

Hi there.

Had anxiety disorder since a kid - I'm 47 now.

In day 3 of Sertraline. Felt okay until today. Feel anxious. Had mini panic attack. Agitated now. Getting waves of cold chills.

Just looking for anybody to relate to, if you can help?

[nomorepanic]

Hi

This is just a courtesy reply to let you know that your post was moved from its original place to a sub-forum that is more relevant to your issue.

This is nothing personal - it just enables us to keep posts about the same problems in the relevant forums so other members with any experience with the issues can find them more easily.

Please also read this post:

http://www.nomorepanic.co.uk/showthread.php?t=213239

[Scissel]

I'm also on Sertraline, and yes, this does happen once and a while especially when you first start it. However, of all that I've been on (ADs) I find it to be lesser on this one. Cold Chills and that feeling can be anxiety. Hang in there and stick with it. Try to use meditation music on YT to get through these attacks.

Good luck!

[jayke]

Thank you

[panic_down_under]

In day 3 of Sertraline. Felt okay until today. Feel anxious. Had mini panic attack. Agitated now. Getting waves of cold chills.

Just looking for anybody to relate to, if you can help?

These are all typical initial side-effects of serotonergic antidepressants caused by the initial increase in serotonin activity. Despite the oft repeated claims serotonin is not a 'feel good' neurotransmitter (nor are anxiety and depression caused by too little serotonin in the brain). They usually diminish within a couple of weeks as bio-feedback mechanisms kick-in to reduce serotonin synthesis and expression.

I'm guessing you were prescribed 50mg tablets to start with. That is the usual starting dose for depression, but is too high for most with anxiety disorders, especially PD, as recommended by NICE. Starting at 25mg for the first week would have been better, or even 12.5mg if extra sensitive. However, there probably is no point to dropping the dose now. Just keep reminding yourself that what you're feeling is 'normal' and not a sign of harm.

You will likely need to increase the dose to 100-150mg for optimum results. I suggest you do so in 25mg steps, not 50mg, at weekly intervals. But you should get the prescribing GP's okay to do it that way.

[jayke]

Thanks for this! I'm day 15 now. Feeling so tired. In and out of anxiety - feeling 'edgy' as I call it. GO said they can't get less than 50mg so said to start on that. Would rather not go up any more but of course will if needed. I'll see how this week goes. Felt okay today until an hour or so after the meds. I have been taking at lunchtime so going to start taking in the evening to see if that helps.

[panic_down_under]

Feeling so tired. In and out of anxiety - feeling 'edgy' as I call it.

Sertraline tends to be activating for many initially often triggering insomnia, while it can be sedating for others. Given the choice I'd take the sedation.

It is still early days so don't expect much change in mood. It takes about 7 weeks for the new med boosted brain cells which create the therapeutic response to grow and mature which is when most people begin to notice an easing of anxiety, although it may occur 2-3 weeks earlier. However, it can sometimes take up to 12 weeks for ADs to kick-in. It all comes down to individual biology and how this meshes with the med.

GO said they can't get less than 50mg so said to start on that.

According to the NHS, sertraline should be available in 25mg, 50mg and 100mg tablets.
https://www.nhs.uk/medicines/sertral...ke-sertraline/

Would rather not go up any more but of course will if needed.

Take as much as you need to get the best result. There is no point taking any medication at ineffective doses. With ADs it is better to be slightly over medicated than under as it's important to maintain plasma levels in the therapeutic range. Unfortunately, unlike for the TCAs, there is not a commercially available blood test to measure SSRI and SNRI plasma levels.

I'll see how this week goes. Felt okay today until an hour or so after the meds. I have been taking at lunchtime so going to start taking in the evening to see if that helps.

In theory it shouldn't make a difference what time of day sertraline is taken as plasma levels usually settle to a steady state within 5-6 days and then don't vary much across the 24 hours, but in practice it sometimes does so taking it at night may help.