Major Anxiety Crash - Looking for Answers as I restart Sertraline with Some Major Side Effects

[Peregrin3]

Hi all,

I'm new here. I first had a panic attack after losing my job 6 years back when I was newly married. I was put on 25mg sertraline and never looked back. Had minimal side effects and managed to go through having several kids, buying a house, and thriving at a fast-paced job. I went off the sertraline with my doc's permission in late 2016 and did great for 2017. Fast forward to 2018, and I had a full blown panic attack in the back of a truck in rural Ethiopia. Fun stuff. I had several months supply of sertraline left over and went on it without a doctor's advice. It stabilized me, but mid-2018 I felt I needed a new prescription. Went on that and was fine for a month until I started getting dizziness and headaches that lasted all day by October. I was convinced I had some sinus infection, but everything was clean. My doc said it was anxiety and upped my dose to 50mg.

Within a day, everything went sideways. It was like I was on speed mixed with gasoline. I would wake up shaking and feeling like someone was constantly shocking me with a wire. Five days later, I had had enough and my doctor said I needed to quite cold turkey. The first few weeks of November were a haze of black thoughts and fatigue from the withdrawal. Then, everything got better. That is, until it wasn't.

I felt my anxiety coming back on at the beginning of December, but I had been practicing CBT, was exercising, eating healthy, and was taking time to be mindful. On December 5, I crashed hard. I realized I had lost the ability to fall asleep. Every time I'd nod off, I'd get a surge of adrenaline and I'd wake up with my heart pounding. I spent two weeks in a hellish fog of using really old Xanax pills and antihistamines to just try to get to sleep. I saw my doctor and he prescribed Ambien for sleep, but the two nights I took it I woke up to the most excruciating burning nerve pain I've ever felt in my life. I finally, at my wife's request, admitted myself to a partial hospitalization program at a local mental health hospital. I thought I had lost it. The psychiatrist there gave me Trazodone, which knocked me out cold at night the first month. He then prescribed Lexapro 5mg. I made some great progress over a few weeks — I stopped jumping at small noises, I started doing hobbies again, felt able to play with my kids without feeling panicked, and could focus on my job, but at my 1 month consult this week, my psychiatrist wanted me to stop the Lexapro as it was not working as efficiently as hoped and it was giving me burning/aching pains in my extremities and mild gut pain.

This brought us full circle to sertraline. I'd been on it for years at a low dose successfully. It was just a part of my daily routine I never thought about. When we started doing a bit of research and contacting a local pharmacist, we discovered I had spent years on an officially licensed generic sold by the brand name's owner, but when I had restarted the meds in August, I had been switched to a generic made in India (Aurobindo). My doctor and pharmacist discussed the possibility that the Aurobindo generic may have had other additives or that my body didn't process it as well, leading to the headaches, dizziness, and eventual reaction to the upped dose back in October. The theory now is that the crash I experienced was from coming off the meds too suddenly, and restarting the original SSRI will allow the brain to readjust and heal quicker.

Today is day 3 back on beloved sertraline/Zoloft. I took the first dose two nights ago and felt my brain relax and my body tingle just a bit, but in an almost therapeutic way. Then last night, the opposite happened. It was like hell all over again. I couldn't fall asleep at all and had horrible panicky and burning/shooting nerve sensations all over my body. I can't tell if this is from the sertraline or withdrawal from Lexapro (escitalopram), but it could be both. I've found that my Xanax is near useless against these symptoms, but it does abate them enough to where I could get an hour of sleep every time I took .25mg.

My question for anyone here is if they've experienced anything like my journey, and secondly, if anyone has found relief in a long-acting benzo (Valium, etc) while they were transitioning medicines. I miss the person I used to be. I know I'm still here and am so excited for some much in life, but the daily pain makes it so hard. If I could go back to August and skip reintroducing the meds, I would. Yet, here we are, and planning for the future is the only hope I've got. I know there's a day out there when I won't feel shaky or on fire for a whole day. That's my dream.

[guynfl2chat]

Everyone reacts differently to meds. I had on success with Zoloft. It actually made my conditions worse. The one thing that is tricky with anxiety is that may find its way back into your life even if you think you have it well managed. The first thing to do is to accept it and work with your doctors (as you have) to manage it. I wouldnt worry too much about the past as it sounds like you did have a full panic episode. Stay the course on the meds you are prescribed and notice if you are feeling better. Personally, I take xanax as needed-- that works for me. Sometimes I need it for a few days and sometimes I fine for a period of time without it. I tried different anti-depressants and they just made me feel disconnected and foggy. There is no 1 cure for everyone.. so you have to find what works for you.

[jessiejakes]

Hi I started on citalopram 20 mg last night and don't know if it was because I have been super anxious but slept for about 4 hours only.I did take half a 2 mg diazepam to relax me .I asked chemist if I could take diazepam whilst on citalopram and she said YES just leave hour in between the citalopram and diazepam.hope this helps you ? She did say I can take 2 mg of diazepam if needed instead of just half as this would help me to sleep.

[Thicks75]

Hi, I take 50 mg of sertraline I been on this dose for almost 3years now. I also take 2 mg of lorazepam at night to sleep. It helps me a lot. They tried upping my sertraline to 75 mg and I got sick so I went back to 50. Idk if this would help you.

[designguy]

I was on zoloft (sertraline) for years, worked up to 200mg/day, later added buspar which enables the zoloft to be more effective for anxiety. Both of these helped me cope better and manage my anxiety but they did not eliminate my anxiety, which i have since found is quite common for a lot of people. At one point my anxiety got extreme and I was prescribed klonopin which really helped in slowing down the ruminating and decreased my anxiety. Of the three meds, it made the most difference in reducing the anxiety. But again, it did not eliminate my anxiety. I recently read that klonopin is also typically prescribed for insomnia and sleep issues. I tapered off all three meds last October but was having some thyroid/sleep issues in January. I started taking the klonpin again at night (low dose) and it really helped in resetting my sleep pattern.

[Pearwig]

I am slowly reducing my Sertraline dose from a self-inflicted blip last summer. I have no anxiety symptoms now and hope to be back on 50mg per day in a couple of months. I find that a tricyclic anti-depressant such as Amitryptilline (sp?) or Mirtazapine (sp?) at night helps sleep, but does not knock me out in the mornings, and is not addictive as some sleeping pills are. Hope this helps and that you re-stabilise on Sertraline, which I find great. I was ok on Citalopram as well, which I took for a time, hoping it would help with my ED (sadly, it didn't!).

[Tamzeali]

Hi, switching meds is not easy and sometimes the dose needs to be adjusted to bring back a balance in brain. With SSRI, the stabilisation can take upto 6 weeks. For me Sertaline didn't work. Citalopram worked very well. I have been on a high dose for long time, 6 years. but then it stopped working, tolerance may be, some articles mentioned it. My journey has been through paroxetine, then Sertaline and then citalopram over a period of almost 15 years. Now they recommend Mirtazapine. See you need to experiment what works best for you and give your body time to adjust. But having said that, it's a hell to go through. What you are going through can be difficult. You yourself don't know who you are or was that a different person you know.

[unblocktheplane]

Although Aurobindo is a very reliable generic provider, many patients react differently to drugs from different companies. It can be the manufacture of the active ingredient or the filling components of the pill. When you find one that works for you, stick with it! Use the same pharmacy and make sure they order the same supply every time.

You didn’t say so but it sounds like you discontinued sertraline cold turkey. All these meds require weaning off. If you just dropped it, could be the restart if your problems. And did you wean yourself off the escitalopram?

It takes 0.5mg Xanax have much effect for sleep. I trust you are aware of addiction. One poster receommended taking it as needed—good advice. Don’t develop an unnecessary daily habit. It’s a rough one to get off. 50mg Trazodone works great for sleep when added to your SSRI regime. Sounds like the shrink was giving you more than this.

Take control of your health. Do your own research. Start doing yoga & breathing. Get out in nature (maybe not Africa!) at least half an hour every day, slow, mindful walking.

Were I having these symptoms, I’d look at thyroid & adrenals first. Take 25mcg levothyroxine (T4) daily for three weeks. If you feel better, it’s your thyroid. DON’T worry about lab tests. Depend on how you feel and your body temp, not below 98°.

IMNSHO, docs put patients on SSRIs because it’s easy rather than doing a deep investigation into biochemical imbalances with hormones. If you don’t feel right, you’re not right, no matter any labwork. Until you can find a doc who will agree to that approach, you’re fishing in the dark.

Feel better…