Klonopin to help with SSRI side effects

Doc told me yesterday to move from 25mg Zoloft to 50mg, and might have to then move higher. But try 50mg. I told him I had side effects at 25mg and was afraid of more side effects (insomnia and very jittery) at increased dose. So he gave me Klonopin and said take that at the beginning, while getting used to the SSRI. Anyone else do that? Seems like a good idea. I do not want a benzo addiction, but the doc said small dose for a short period, while getting used to the SSRI, will not come close to causing addiction. But it will enable me to sleep and reduce the (very uncomfortable) morning jitters.

MV,

It is a very common and highly successful plan to use a benzo to offset the s/e's when initially starting an A/D.

...and yes the fact that you are taking a low dose for a definite amount of time...as well as the fact that your doctor considers you not at risk for dependency (no former issues with substance abuse) is telling that you will not have a problem with this regimen.

Wishing you the best with your increase. Let us know how you are doing soon, okay?

S,C,

The side effects from the increased Zoloft dose have been minor. Maybe that is because of the Klonopin. Can't tell. But not bad at all. On the other hand, the zoloft is not yet doing any good. And i will probably need a further increase in dose. Meanwhile every day I am plagued by anxiety. It is really miserable.

An update: I have now been on Zoloft 50mg for 11 days (after being on 25mg for about 9 days before that). The Zoloft may be having a modest positive impact on me -- or at least there are days I think that. There are other days I don't.

But it is really interrupting my sleep (unless it is the anxiety that is doing that -- who knows -- but I suspect the Zoloft is at least a substantial contributing factor). I can fall asleep only if I take some medication -- a low dose of Klonopin, or antihistimine or sleeping pill. Mostly I have been taking the Klonopin because that is what the p-doc suggested. He gave me .5 mg Klonopin. Told me to take a half of that pill if it is sufficient; if not I can take a whole pill.

When I take the half, I do fall asleep, after a while. But no matter what time I go to sleep, I wake up at about 5:15 am, feeling sort of wired/activated/agitated -- enough so that I cannot roll over and go back to sleep. I usually go out and get some exercise, but the result of all this is I am really tired every day.

The one time I took a whole Klonopin pill, the morning was better. But I am trying to minimize the Klonopin, since I don't want to get hooked. I do not have a history of addiction or an addictive personality, but still...

I plan to discuss this with my doc on Monday. But if anyone has insights or relevant experience, please let me know.

I know the sleep interruption may eventually disappear -- as a start up side effect. Or maybe it won't. I would have thought it might have disappeared already...

Thanks for your response, S. Cat. I will ask the doc about vistaril. I actually tried another first generation antihistamine, Doxylamine (which is OTC), as an alternative to the benzo, one night. I had used Doxylamine in the past, before I was on the Zoloft, on occasion, so I figured I would give it a try (and my doc said its OK to try it). It did put me to sleep but I was very drowsy the whole next day -- the so-called "hangover effect." Fortunately that was a Saturday, so did not interfere with work. But still.... Tonight I plan to experiment with half of a Doxylamine pill. I am thinking that might be enough to get me to sleep, but without the hangover effect the next day.

In addition to the difficulty falling asleep, I have been waking up very early (515 am or so) and with an uncomfortable activated/agitated/jittery feeling. Last night I tried taking .5mg of the Klonopin rather than .25mg, and I slept better and had much less of the jittery feeling in the morning. (Not zero, but less). The doc has approved that dose. But again I am trying to limit my use of the benzo.

Of course, none of this is a good long term solution. I need to be able to fall asleep without benzos or antihistimines or sleeping pills, and sleep through the night, and wake up without this very uncomfortable agitated feeling.

Time will tell whether these Zoloft sleep-related side effects will dissipate with time, or not. I guess they usually do. But usually is not the same as always, so we will see...

You also mentioned the possibility of increases in my Zoloft dose. That is not something I am going to be willing to do. It is true that many patients with OCD anxiety require a higher dose of Zoloft. (My doc put the odds that 50mg would be sufficient for me at around 50%). But I am just not willing to deal with the side effects of an increased dose. The cure can sometimes be worse than the disease. And I need to be able to function. So I will get whatever benefit I can get from the 50mg of Zoloft -- assuming I can resolve the sleep issues -- and then deal with the rest through the CBT/ERP I am doing.

I think that’s good advice Dan. I have been using Klonopin for the past two weeks, at a very low dose. Most nights only .25 mg. A couple of nights .5mg. But I’m going to transition to antihistamines. For now Doxylamine (OTC) and then I will ask my doc about Vistril. .