Sertraline diary (switching from citalopram to sertraline)

[Sparkle1984]

I went back on citalopram 20mg in December 2024 following a relapse of my anxiety. While some of my symptoms improved, I'm still experiencing persistent intrusive thoughts and a background feeling of dread. I felt like maybe the medication has lost effectiveness after being on it since 2012 (with a few breaks). Previously, citalopram was effective for both my depression and anxiety (including intrusive thoughts).


I had a doctor's appointment on Thursday last week to discuss changing my medication. The doctor agreed for me to switch from citalopram to sertraline 50mg, but to cut the tablets in half for the first week. I will have a review in 4 weeks' time. It seems he wants to try venlafaxine next if this doesn't work. I've also got a blood test in June to check for perimenopause and thyroid function.


I took my first Sertraline 25mg dose on Friday evening, and so far, I haven't noticed any side effects. Maybe I will once I move up to the full 50mg at the weekend?

[Sparkle1984]

It is now a week since I switched to sertraline. I haven't noticed any side effects apart from some drowsiness/tiredness since Wednesday. I had my first full 50mg tablet this evening.

It's still too early to tell whether sertraline is better for my anxiety and intrusive thoughts, but I have had several days already where the intrusive thoughts have felt more in the background than usual, and I don't ruminate on them as much. In the last couple of weeks, I've been doing self-guided ERP (Exposure and Response Prevention), and I think that has been helping a bit as well.

[Sparkle1984]

I am now nearly 4 weeks into the 50mg dose and although i have no physical anxiety symptoms, I can still feel the intrusive thoughts in the background, even when I'm not focusing on them. However, i still feel better overall on sertraline.

I had the results of my blood test this week, and it was all clear, so there are no physical medical issues contributing to my anxiety. I'm relieved about that, at least.

[BlueIris]

This is really interesting, thanks. I'm considering switching away from citalopram myself, and intrusive thoughts are a massive problem for me.

[Sparkle1984]

I'm glad you find it useful. How long have you been on citalopram for?

[BlueIris]

Years. Lots of years.

[Sparkle1984]

It's been a long time since I last updated this thread, but it's now been nearly 2 months since I switched to sertraline. I'm feeling quite a bit better than I did the last time I started citalopram, but the intrusive thoughts haven't gone completely. However, I can still lead a normal life, so I'm reasonably happy.

I have kind of accepted that this time around, the intrusive thoughts might never go completely, but as long as I live my life according to my values, that's the most important thing. (This approach is known as ACT - acceptance and commitment therapy). It's been quite tough to accept that, especially as the intrusive thoughts did disappear the previous times I was on medication. Yet, getting frustrated or feeling despair at the thoughts being there only made me feel worse. So when I get an intrusive thought, I try to catch it, acknowledge it and then gently refocus my attention to what I was doing at the time, instead of ruminating. This has been taking quite a lot of practise, and I'm still not quite there yet - sometimes when I'm doing a boring but important task, I still get drawn into the thoughts.

Since this episode has been quite long and drawn out, in the last couple of months I've taken a different approach. In my previous anxiety episodes I mainly used CBT (including thought challenging) and mindfulness. As that hasn't seemed to fully help this time around, I've been focusing more on ACT and also doing exposure and response prevention (ERP). This means I set aside 10 - 15 minutes a day to think about the worst case scenarios of my intrusive thoughts, while resisting the urge to ruminate on them or perform any compulsions such as reassurance seeking. I have to sit with the uncertainty and wait for the anxiety levels to gradually come down. Even though sometimes I feel a little sad that I might not fully get back to my pre-November 2024 self, apparently this sort of recovery could be more sustainable than my recoveries from previous episodes.

I think this approach is working somewhat. Even though it hasn't completely got rid of the thoughts, it has enabled me to prove to myself that I can tolerate the thoughts and the uncertainty, and that nothing terrible happens.

I'm currently on holiday in the Yorkshire Dales for 2 weeks (we arrived yesterday), so I'm feeling more relaxed, even though I can still feel the thoughts lurking sometimes. I reflect on how far I've come in the last 6 months - I'm feeling OK with travelling long distances from home and staying away overnight, including travelling for work. Back in January, I was feeling so awful that I had to cancel my participation in a work trip that would've involved travelling some 200 miles away from home and staying in a hotel for 2 nights. I was so disappointed but I just couldn't face it. If it had been a closer city, it wouldn't have been so bad. However, as of April I felt OK to travel for work again. And Christmas 2024 was a write-off as I was so anxious and depressed, so at least I know future holidays can only be better!

[Aleman200]

I hope you enjoy your holiday Sparkle, being away for 2 weeks in the Dales should help take your mind off things! I think you're rigght with the approach of having to learn to live in a bit of discomfort and challenging those thoughts, it's very tough though. It can be awful to look at the thoughts and convince yourself that they are just thoughts passing by.

I think it's very important to remember how far you have come for sure! Often reminding yourself of your progress and comparing it to when you were really bad often helps build up the self confidence that you're doing the right thing. How was the switch over to Sertraline from Citalopram? Did you experience any weird effects during the first couple of weeks or was it relatively quiet on that front? I'm thinking if it ever stops working for me i may ask my GP for a similar switch over!

[Sparkle1984]

Thank you! The switch from citalopram to sertraline was very smooth - I had hardly any physical side effects. I just remember my mental anxiety being slightly more intense for a couple of weeks or so.