SSRI question

Another question about SSRIs, as I struggle to figure out what to do.

I started Zoloft at 25mg. That is almost surely not a therapeutic dose, but I wanted to start low to deal with side effects, since the only prior time I tried an SSRI (8 years ago), I had trouble tolerating even a pretty low dose (of Lexapro)..

I took the 25mg for 9 days and then switched to 50 mg. I am on day 18 at 50mg. I cannot tell whether it is doing any good, since I do not know what I would be like if I were not taking it. But I don't think it is doing much good.

It is, however, messing with my sleep. (Maybe to some extent the anxiety is messing with my sleep, but I think the Zoloft is mostly to blame). For the first two weeks, I took a low dose of Klonopin every night, to help fall asleep. But I stopped doing that because I don't want to take any risk of getting hooked on Klonopin or any other benzo.

Now I can fall asleep on my own, without a pill, so I guess that is progress -- but I wake up too early (like 530 am or so) and with a very uncomfortable jittery/agitated feeling.

The p-doc suggested I try taking the Zoloft pill a little bit later in the morning (I was taking it around 8; now switched to 1030 am or so). He said early morning jitters might be a sort of withdrawal symptom, as the amount of Zoloft in my body is reduced. So if I take the Zoloft a bit later in the morning, the jittery feeling might happen a few hours later the next day -- like 8 am instead of 530 am-- but by that time I will be up and going so it won't impact me much and I might not even feel it.

I tried that yesterday for the first time. I had a very interrupted night of sleep. I slept very lightly and was up a lot during the night. And still woke pretty early - though to be fair I also went to sleep pretty early. I will try this again today, taking the pill around 1030 am, and see how it goes.

The doctor also said if this does not work, I could try splitting the dose and taking half in the morning and half late afternoon, in an effort to keep a more steady amount of the medication in me. It seems like there's no way to predict what will work, so they just make up every different option to see what might work. I feel like a lab rat.

The doc also said he thinks I probably need a higher dose than 50mg of Zoloft, since 50mg does not seem to be doing much for me. But he understands that I will not go above 50mg until I can address the sleep issue that I am having with 50mg, because I have to assume that increasing the dose will only exacerbate the sleep problem.

At the same time, he said we may conclude that Zoloft is not the right med for me and maybe switch -- as I mentioned in a prior post -- to Paxil. But I think Paxil might have worse side effects than Zoloft, and the cross taper can create its own side effects, and Paxil is reportedly harder to get off of too. So I am not sure I would do the switch. I would probably instead just throw in the towel. so to speak -- stop taking meds, and instead try to address my situation solely through therapy (I have a very capable therapist).

I don't know how people deal with all the medication side effects, and sleep deprivation, agitation and jitters, and switching from med to med, etc, all without any assurance that any of it will do any good. It sometimes seems like the cure is worse than the disease!

I would welcome any advice you might have. Thank you.

Thanks for your response, Keller. What dose of Zoloft were you on? Did you have to slowly taper off it after 6-8 months? How was that? Did you switch to another SSRI, or just go without meds?

You may be right that I will have to give it another couple of weeks to see how it goes. I am luck that, thus far, I have not had other side effects (GI, sexual, etc.). But the sleep interference is pretty challenging to deal with.

Thanks Keller. If the Zoloft does not help me (or if the side effects do not abate), I am considering doing the same thing you are doing -- go off SSRIs, take a Klonopin on rare occasion when I really need it, and try to deal with my anxiety through therapy and personal effort. I just cannot tolerate all the trial and error and side effects, while doctors make wild guesses about what might help. In particular I find the sleep deprivation hard to tolerate. I agree with you that exercise helps. I never much enjoyed exercise, and particularly when I am feeling sleep deprived. But I am doing it every day. I ran at 6 am today. It does burn off excess energy.

Wow, Karen, you tried a lot of meds. I don't think I could tolerate all of that, knowing each time that the med you try might not work, and dealing with all of the effects of withdrawal, or cross tapering, and the start-up side effects, etc. You must be pretty strong...

i sometimes think something more "sedating" might be OK for me, since I sometimes have trouble sleeping. So it might help with that and also calm down my anxiety. But of course I would not want to be, or feel, sedated during the day. (One night a week or two ago I took a Unisom Sleep Tab at night and I was drowsy the whole next day).

The p-doc said he would suggest Paxil if we conclude that Zoloft does not work for me. But after reading some about Paxil, I don't think I would do that. Too many side effects and difficult withdrawal.

I asked my doc about Buspar and he said it usually does not work for his patients. I also asked a friend who is a psychiatrist and she said the same thing.

I think I am going to stick with the Zoloft 50mg for another couple of weeks and see if it helps -- and also whether the side effects -- which for me are mostly sleep disturbance / morning agitation -- subside. Then I will figure out what to do. Maybe go off all meds, or maybe stay on Zoloft 50mg, or maybe increase to Zoloft 75mg, or maybe switch to a different med, though I am not sure I can deal with that...

Thanks Karen. Your experience and insights are very valuable. I did mention the possibility of splitting the dose. My doctor suggested that I alter the time of the dose first, and try that for some days, to see if it helps with the sleep and the morning agitation. If not then I would try the split dose.

Of course, a separate issue is whether this medication is working for me at all. That is hard for me to tell because I do not know what I would be like without it. I am still quite anxious, much of the time, but maybe slightly that a month ago. It is hard for me to tell whether that is because of the passage of time, therapy or medication or all of the above. The doctor thinks there is a likelihood that I will need to increase my dose to at least 75 mg. But I do not think I want to do that — and especially I do not want to do it until the current side effects including the interference with my sleep resolves.

I have tried meditation and it is helpful. I do on unguided meditations during the day And I often do a guided meditation to help me fall asleep.

Thanks Memar. It is helpful, though as you say reactions can vary. Did you take the Zoloft for anxiety or for depression or something else? Are you taking something else in addition to the Zoloft?

Did you feel any different when you increased the dose to 75 mg?

I could deal better with the side effects if I knew it would work. But that seems to be a guess...

Post Edited (medved) : 8/8/2019 5:17:36 PM (GMT-6)