Should I increase?

[Mongea]

Hello, I’m a mother of six who recently had a hysterectomy and now deals with anxiety and mild depression. I started Zoloft 5 weeks ago and have slowly worked my way to 75 mg. My doctor has given me the option of going to 100. I’ve noticed increased appetite and less anxiety although it’s not consistent. I have great days then a down day. Still have issues with racing heart every now and then and a lot of anxiety in the morning. I’m wondering if I need to go up to 100? Is 5 weeks enough to know if Zoloft is working?

[masa2333]

Hello. For any SSRI to work it takes 6-8 weeks. Increased appetite is common issue with those meds, I also experience it. I’m wondering, do you take any benzo? Doctors usually prescribe SSRI + benzo for the first couple of weeks until SSRI kicks in and to reduce side effects until your body adapts. I think you should not increase the dosage without talking to your doctor first. you should tell him how you feel and anything that bothers you so he finds you the best solution. Also, pills are not magical, you are still a human and will have ups and downs. I know I do. I have great days and then have a bad day. But it is all part of life. We are all here if you need to talk about it. 🙏

[Mongea in reply to masa2333]

I currently take Ativan three times a day for a total of 1.25mg. My doctor has approved the increase to 100 mg, I just haven’t pulled the trigger. I’ve been hopeful that maybe 75 mg would be enough, but the past day or two have been tough. Are you saying I still could see benefits at 6-8 weeks on the 75 if I hang in there a couple more weeks? And is an increase in appetite a sign the med is working or just something that happens.

[masa2333 in reply to Mongea]

Okay so benzos are there also. From my personal experience, I am taking Paroxetine 10mg and my doctor told me to increase to 20mg after first week but I haven’t done that. Dose of 10mg works for me to get through the day without crying and panicking all the time. I still have days when I am anxious but I try to do something that will make me happier or I cry all the day and by the end feel so relaxed and ready for sleep. If I feel that I need bigger dosage I will definitely increase it, but for now I can live like this. What I’m trying to say is that you know your body best and you know how you feel. You should honestly discuss everything that bothers you with your doctors, if this is your first time on therapy then maybe this meds combo doesn’t work for you and another will work better. I firstly took Prozac and Bromazepam and I felt horribly. Side effects were disastrous. I stopped and changed the meds. Now I feel more normal. It’s all trial and error.

[Mongea in reply to masa2333]

Is an increase in appetite a sign that the medication is working or stabilizing? Or is it just a side effect.

[masa2333 in reply to Mongea]

That’s just a side effect. My appetite is enormous too. People usually put on a few pounds from meds if they don’t watch what they eat

[Mongea in reply to masa2333]

So an improvement in appetite isn’t a signal that the medicine is working? The doctors have asked me that question as if it’s a benchmark of sorts.

[masa2333 in reply to Mongea]

Well you are not taking a medication for appetite improvement but rather mental health improvement. Improvement in mental health is the sign that the medication is working

[Mongea in reply to masa2333]

Very true. Something for me to consider. I am having a hard time knowing what signs to look for- I don’t feel like myself that’s for sure.

[Hidden in reply to Mongea]

Appetite improvement is a good sign because I know with anxiety you have no appetite!

[Indigojoe]

You have been through alot over the past many months.

Seems that you are an outstanding observer of your situation.

What would you think about asking your doc, who knows you personally to answer this question for you???

It's usually beneficial to form a team with people who can talk to you face to face. This way you can call at a moments notice if you need to talk to someone.

[Mongea in reply to Indigojoe]

I have a great team of doctors but no one seems to give me a straight answer. My psychiatrist told me it’s up to me if I want to increase the Zoloft. This is my first time on an antidepressant and it’s been very difficult to accept. The doctors keep saying 4-6 weeks, then 6-8 weeks and while I feel tiny baby steps I’m not feeling like I thought I would after 5 weeks.

[backup21an in reply to Mongea]

I get what you mean about taking antidepressants, it’s not that easy to accept is it. I have been on SSRIs for a few years, first Citalopram, then recently changed to Sertraline (Zoloft) now trying Fluoxetine (Prozac). From what I’ve read, and please remember I’m not medical, SSRIs of whatever type work for about 30%. Trying all variations moves that to about 66%. So there’s a good chance the first drug you try might not be right for you. Frustratingly it’s a slow process because not only do you need to get the right medication you need the right dosage. I thought that was the psychiatrists job to determine the right drug and dose? One thing I’m learning is that it’s very easy to be very self critical, feel full of guilt and on your own. Please try and be kinder to yourself, it’s an illness not understood by many, but it is an illness. Try doing a little thing everyday, it doesn’t have to be much, tidy a few clothes away, sort that kitchen cupboard out, anything, then give yourself credit for doing it. You are worth it.

[Want2BHappy3]

How old are your kids? Are you married? If so, is your husband helping? Tell your doctor what's going on and ask his opinion? I wouldn't want to advise you and be wrong? Take care

[Mongea in reply to Want2BHappy3]

Yes I’m married. Kids are 4,6,10,12,14 and 15. Doctor has approved the increase to 100 mg and I’m looking for advice or support as to when I can start seeing more improvements. I’ve been on the Zoloft for 5 weeks.

[Mongea in reply to Mongea]

Oh and my husband has been amazing with supporting me during this time!

[Want2BHappy3 in reply to Mongea]

WOW, you've got a full plate, my poor mom had 9 and my dad who was mentally ill. She eventally had to commit him. Everybodys different, I'm on Mirtazapine my doctor told me about 2 months for it to kick in. I told her I needed something Now. I'm good, but still don't like going outside

[Kkimm]

Hi Mongea

You are doing really well and making good progress for 5 weeks in. It took me 4 months and 2 increases to really gain the benefit. I was still feeling horrendous after 5 weeks but hung on in there and did an increase around 6 weeks and felt a little bit better then another increase around 12 weeks and felt a huge improvement and was almost back to normal. Around 18 months on I am still feeling great with a few minor symptoms only and do not intend to reduce or stop in the near future. You will have good days and bad days all the way through. I now find the bad days hardly bad at all.

You are doing so well to manage anxiety when you have young children, my daughter is grown up and has been a great support, I cannot imagine having dealt with it when she was young.

Very best wishes, I think you are well on the way to recovery.

Kim

[Mongea in reply to Kkimm]

Thank you for your kind words. I’m very hard on myself- I feel like I should be farther along after five weeks. Currently I’m attending an intensive 10 day outpatient mood clinic at the Mayo Clinic. They’re giving us tools and skills to work through our anxiety and depression for the future beyond medication if we choose that path. One symptom I’m still struggling with is feeling a little disconnected from my spouse and children. Almost like I’m living life in the “third person”. I’m not sure if that’s the anxiety or the medication. If it is the med, I hope it’s a symptom that goes away with time.

[Kkimm in reply to Mongea]

Hi Mongea

I think feeling detached from your family is more likely to be caused by anxiety than the medication. I believe your doctor also gave this view. If however it is the medication it could be the early period in which most people feel worse before they feel better. In a way it is actually your anxiety causing it but the medication could be temporarily making it feel worse.

Either way it will pass given time. I certainly did feel similar in my early stages and do not feel at all like that now. I would have described mine as more like feeling spaced out or outside my body. It was very unpleasant. It went after a month or two and an increase in medication, Venlafaxine in my case.

Your mood clinic at the Mayo clinic sounds very interesting. How are you finding it affecting you? The benefits may take some time to take effect.

Are you based in the USA?

Very best wishes

Kim

[Mongea in reply to Kkimm]

Hi Kkimm,

The mood clinic at the Mayo has been very helpful. I’ve learned new techniques to deal with my anxiety that I wouldn’t have had before this experience. It’s also been helpful to have group therapy during the clinic. It’s nice to connect with others who are going through the same things.

Throughout the week I’ve experienced a lot of disconnect however... I’m learning about behavioral activation and doing things even if you don’t feel like it. When I’m in the moment of disconnect, my anxiety peaks and I find it hard to do anything. But I’m forcing myself to move forward despite my mood.

I’m hoping that these feelings will go away completely over time or as the medication continues to do its job. Im currently at 100 mg of Zoloft for a total of 6.5 weeks. Selfishly, I’d like to see more improvement in areas.

[Kkimm in reply to Mongea]

Hi Mongea

You sound as if you have gained alot from attending the Mayo clinic. Behavioural activation will be an incredibly valuable tool if you are able to use it. At first it is very hard to continue to do everything and set yourself more challenges but gradually it becomes easier and you will make real gains. As well as starting to enjoy what you do your anxiety will decrease.

I used to find it really difficult to go out walking in the country after I became ill. It had been the most enjoyable and stress-free activity I did either with my partner, my daughter or friends but it became my most feared activity which took the longest to overcome. Eating out, once again something I loved became impossible. It was almost as if my anxiety sort out the things which had been most pleasurable and meant the most to me to hurt me the most. Sounds really weird but that is what happened. When l tried to do those things I had a growing feeling of light headedness, sickness and dread. At first almost as if I was going to die. At first I avoided the activities but as I felt strong enough I began to do them again and again until very very gradually over a few months the feelings faded and finally disappeared completely only now returning very rarely and in a very mild way, often if I am unusually hungry or tired.

I would think your disconnect feelings could be the same sort of thing and may fade in the same way. Unfortunately there seems to be no quick fix for anxiety we just have to work through it with two steps forward and one step back. We should all be really proud of ourselves when we do achieve a step forward however tiny.

The other thing I wanted to tell you was that I have remembered that I had lots of unpleasant feelings that only started after I began medication for example a pain in my stomach which went on for weeks then just suddenly stopped one day. I am sure they were all anxiety and not caused by the medication and I am so pleased that I didn't stop taking it when they occurred.

Gradually you will get there , it is not selfish to want to improve quickly but it is counter productive. Trying to forget about it, carrying on as normal, setting yourself new challenges and realising you are doing so well to have got this far are the things that will help.

Kim