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piccola

My 10 days on Zoloft Update.

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I posted before when I started taking this 1st ever SSRI, Sertraline. So I thought I would do an up-date now I am about to take my 11th dose at 25mg.

My original side effects were:

Fatigue, light-headed, nausea, dry mouth, no appetite, shaky, and "just strange"!! Also, a few days later I developed a pressure in my ears with a sort of whistling/humming noise.

After 1 week though, things changed. The dry mouth and Strange feeling disappeared.The ear problem also went away.  But anxiety started to get worse, especially in the mornings.

Then on Day 8 I woke with severe anxiety that turned into a Panic attack. I live completely alone, no family etc and was terrified. I phoned my GP who called me back later. She said this is a normal reaction in the beginning, and sometimes even an indicator that the drug will eventually work well. So she suggested I take 1/2 a diazepam if I needed to, and try to bear with it for a while longer, as she felt sure it would be good for me.

She also gave me a Crisis telephone number "just in case"

Its now 2 days later and here I am...still struggling but still trying to hang in there. I am Ultra-Tired. I cant seem to keep my eyes open at all. (Even though I take the med at night) Still light-headed to the point where I just want to lay in bed. Still very little appetite. The anxiety is there in the mornings, but goes away, and so far, no more panic attacks.

My dr is phoning me again on Tuesday (Day 14) to see how its going. I just hope by then the Fatigue has improved, as I literally cant do anything.

I dont know if this is of interest to anybody, or if anybody went through the same and has advice/reassurance for me.

I hope you are all coping well and having a good day.

 

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When SSRIs raise serotonin levels, these increased serotonin levels indiscriminately stimulate all serotonin receptor subtypes. That includes the 5-HT1A, 5-HT2A, 5-HT2C, and 5-HT3 receptors.

In short...

  • Stimulating the presynaptic 5-HT1A autoreceptor will block serotonin release (yes, initially SSRIs lower serotonin!)
  • Stimulating 5-HT2A receptors can cause a great deal of anxiety and sleeplessness and sexual side effects
  • Stimulating 5-HT2C receptors can block dopamine and norepinephrine release, blunting affect, and can also stifle appetite
  • Stimulating 5-HT3 receptors can cause nausea and vomiting.

That's just a little bit of the picture of what is going on. In postmortem brain examinations of people who had depression, anxiety, or bipolar disorder, they discovered that there was an abnormal abundance of 5-HT2A and 5-HT2C in a certain part of the brain (can't remember which). It's theorized that excessive 5-HT2A and 5-HT2C in part play into the role of symptomology of depression and anxiety.  

So over a period of about 2-4 weeks, these receptors begin to "downregulate," or decrease in density, after chronic exposure to a serotonergic substance, such as Zoloft or another SSRI/SNRI, so the serotonin has less receptors to bind to, which is when the therapeutic side effects are believed do set in.

  • The 5-HT1A presynaptic autoreceptors downregulate, disinhibiting serotonin release, as well as stimuates postsynaptic 5-HT1A receptors, causing a downstream release of dopamine.
  • The 5-HT2A receptors downregulate, reducing anxiety, sleep problems, and sexual side effects.
  • The 5-HT2C receptors downregulate, allowing dopamine and norepinephrine to flow again, as well as appetite to return.
  • The 5-HT3 receptors downregulate, causing the nausea and vomiting to cease.

Try to hang in there, it's tough I know.

If you need something for sleep, maybe ask your doctor if they can give you something like:

  • mirtazapine (Remeron): This would be a good medicine for you in a low dose (15 mg). It would help you with appetite and sleep at the same time, as well as anxiety. (very potent antihistamine with 5-HT2A/2C antagonism as well as α2A antagonism). This medicine can also block the negative side effects of SSRIs, what with antagonism of 5-HT2A/2C and 5-HT-3.
  • trazodone (Desyrel) (50 mg acts mostly as 5-HT2A antagonist and α1 antagonist, promotes sleep)
  • qutiapine (Seroquel) (low dose 25-100 mg mostly an antihistamine)
  • hydroxyzine pamoate (Vistaril) (antihistamine with slight 5-HT2A antagonism)
  • doxepin (Sinequan) (not Silenor, that's too expensive!) (The most potent antihistamine)
  • You said you have Valium right?
    • Valium might not be a good medicine for sleep because it's a very long-acting benzo and can stay in your system for a very long time, causing next day sedation. You would probably do better with a shorter acting benzo.
    • Something like:
      • temazepam (Restoril)
      • oxazepam (Serax)
      • lorazepam (Ativan)
      • estazolam (ProSom)
    • Z-drugs (nonbenzodiazepine sedatives)
      • eszopiclone (Lunesta)
      • zaleplon (Sonata)
      • zolpidem (Ambien/Ambien CR)

Some of these meds can be combined together, so long as their mechanism of action is different for an ultimate sleep cocktail...

Like Remeron + trazodone + [benzo/nonbenzo]

Hope this helps you! Best of luck!

Edited by mikl_pls
left something out

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I think I have replied on your previous post but here is how I look at it which is by far medical advice but from my own personal experience.

When starting a new medicine which I used to take zoloft our anxiety seems that it can get a little worse before it gets better, and anxiety and the effects of your body tensing up so much for periods of time has to wear it out, physically and mentally, and depending on how long you have suffered from it your body is just worn out and needs to relax which means 'feeling tired'. 

I also relate this to when my son had seizures, I asked the doctor why he would sleep for so long after them, and this is what he told me. When you're body goes through things like this it causes the entire body and every muscle and your mind to go through something very strenuous, almost like running a marathon and when its stopped and relaxed your body needs rest/sleep. I find that very similar with anxiety, and panic attacks, that afterwards you just feel drained. 

Hopefully you start to feeling even better and get some energy back very soon! Sounds like you are on your way! 🙂  

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Thank you for all your replies. They meant a lot to me.

Here I am on week 7 and still on 25mg of Sertraline.

After all the initial problems I had, as detailed above, suddenly....after about 18 days, it all changed. For the better!!

The anxiety/panic just disappeared. No nausea or dizziness either. I suddenly just began to feel well. By the end of week 3 I really noticed the difference. I began to live again!!!

The fatigue/sleeping was still a problem. And it is sometimes even now. But to be honest, I have always had that problem, so I dont think its to do with Sertraline. I tried taking it at different times of the day, but sometimes I sleep great and others not at all. So that seems to be my normal, and not the meds.

I didnt have to increase my dose at all. If, and I hope never, I do need to go up to 50mg, then I will.

So my advice would be to just hang in there if you can. I didnt believe it was helping me. I thought I was just getting worse and the panic was awful. But I only ever needed to take Diazepam twice (when the panic got too bad) and now they are put away in a safe place, where I hope I will never need them.

Its hard to believe the anxiety/panic will go away, when this med does seem to make it worse at the start. But it DOES get better. My dr was right to ask me to persevere, as I haven't felt this good in years.

So,please, give it long enough to help you before you decide to give up and try something else. 

Best wishes to everybody reading this post.

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On 12/9/2018 at 5:32 AM, piccola said:

Thank you for all your replies. They meant a lot to me.

Here I am on week 7 and still on 25mg of Sertraline.

After all the initial problems I had, as detailed above, suddenly....after about 18 days, it all changed. For the better!!

The anxiety/panic just disappeared. No nausea or dizziness either. I suddenly just began to feel well. By the end of week 3 I really noticed the difference. I began to live again!!!

The fatigue/sleeping was still a problem. And it is sometimes even now. But to be honest, I have always had that problem, so I dont think its to do with Sertraline. I tried taking it at different times of the day, but sometimes I sleep great and others not at all. So that seems to be my normal, and not the meds.

I didnt have to increase my dose at all. If, and I hope never, I do need to go up to 50mg, then I will.

So my advice would be to just hang in there if you can. I didnt believe it was helping me. I thought I was just getting worse and the panic was awful. But I only ever needed to take Diazepam twice (when the panic got too bad) and now they are put away in a safe place, where I hope I will never need them.

Its hard to believe the anxiety/panic will go away, when this med does seem to make it worse at the start. But it DOES get better. My dr was right to ask me to persevere, as I haven't felt this good in years.

So,please, give it long enough to help you before you decide to give up and try something else. 

Best wishes to everybody reading this post.

That is great news! I am so glad its working for you and that you are starting to feel good again. 🙂 

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47 minutes ago, Grounded said:

That is great news! I am so glad its working for you and that you are starting to feel good again. 🙂 

I’m so happy for you my friend now go live the best life you can 

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