hello everyone, after my daughters suicide attempt a month ago, she has been taking Zoloft. The thoughts are still there and therapist and doctors alike are saying she is not improving, but I have seen improvement in her ability to talk to others, she is more upbeat and smiling again, and more engaged in conversations. Her Zoloft was increased yesterday to 250 mg after being on 200 mg for just a week. I have read everywhere that 200 mg is the maximum. Does anybody have experience taking 250 mg of Zoloft? Is it safe? So far the only side effect that she has experienced is insomnia -not getting enough sleep make her tired, which makes me wonder if going with the higher dose will increase her insomnia. Also, does anyone have any information regarding Zoloft and glaucoma.
As always, thank you so much for reading and responding. I appreciate this community so much.
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This is a question that should be answered by a psychiatrist who specializes in OCD. Your daughter’s medical and mental health histories can affect the answer. Dr. Steven Poskar is a psychiatrist who specializes in OCD. He has a video on YouTube that addresses OCD and medications for it. I think it’s about 30 minutes long.
I believe that many antidepressants are contraindicated for those with closed-angle glaucoma but not open-angle glaucoma. Please verify that with her doctor though instead of taking my word for it. I’m not a doctor.
Thank you. I’ll look for the video. I spoke with her psychiatrist today and he said that though her depression has lifted a bit, and they noticed that too (she doesn’t have suicide ideation, she is more forthcoming in her communication, participates in group therapy) is the fact that she still has those thoughts that requires the higher dosage. Doctor said that there are areas of the brain that need to be reached and that is why they want her in 250 mg for 3 months at least. If after that period of time they see results, she will be put back to 200 mg.
The goal of OCD treatment isn’t to get rid of intrusive thoughts. It’s to learn to respond differently to them in a way that is healthy and live life according to the person’s values instead of OCD’s lies and demands. It’s to learn to handle uncertainty and realize we are capable of dealing with whatever life throws at us. This usually brings down the intensity and frequency of the thoughts. We can get to the point where those thoughts don’t phase us and they don’t show up much. People without OCD have intrusive thoughts but can easily dismiss them because they don’t attach meaning to them or treat them as facts. OCD treatment teaches a person how to break the OCD cycle so it doesn’t keep going round and round.
Certainly! A lot of the group therapy that she is doing on the PHP is geared towards learning how to handle herself when a thought pops in, having coping mechanisms, relearning about values and believing in the true person she is and not the one OCD makes her believe she is. She will do one on one therapy with an OCD specialist once she is done with the partial inpatient program.
I would agree to get 2nd and 3rd opinions (or more) of doctors who specialize in OCD. Sleep is very important for physical and mental health. I would also encourage you to look into Spravato and ketamine. Both can be game changers for some people. Psilocybin is also being studied with promising results.
hi. Meds always have be high to address OCD. Is she doing ERP with an OCD specialist? That could be the missing piece of her puzzle if you did see improvement with medication alone. Insomnia can be addressed with melatonin (psychiatrist recommended it) and not taking meds too close to bedtime.
That’s what her psychiatrist told me today, that the higher dosis is needed to reach deeper parts of the brain that are responsible for the OCD symptoms. She is not doing ERP yet, once she is done with the PHP (partial hospitalization program ) she will start individual outpatient therapy with an OCD specialist. The PHP’s main focus is to get a diagnosis, manage medication, and start giving her the tool to engage in socialization, coping mechanisms, understanding what individual therapy will be like, and most importantly monitor her mental health progress or lack of.
I am concerned that you see changes in her but they don't and want to medicate her more. I would say get another opinion if you can and also see if how she is acting in the meetings are the same as how she is during her normal routines.
The thing is, if there had been no change then finding another SSRI seems like the better option, but you are also seeing positive changes.
Just be wary that the attempt is also fresh and so I am sure that you are keeping a close eye on her too for any signs. Some people can hide it quite well too.
So maybe chat with her about how the session went, let her know that you can be a listening ear, no matter what she may need to say.
They do see small changes, specifically the fact that she doesn’t have suicide ideation and she is a bit more active/participates in the group therapy. But what they don’t see improvement is in the thoughts that come so often. They explained to us that with the current dosis is like trying to catch a train by running behind it. With the higher dosis is like getting ahead of the train. She will be for only 3 months on that higher dosis, as the doctor feels confident that such dosis will reach the parts of the brain that are more related to the OCD symptoms.
OCD usually requires a higher dosage of SSRIs than is given for Clinical Depression. It is very rare for medication alone to be sufficient to treat OCD since OCD is part biology and part learning (negative reinforcement). ERP with an OCD specialist is the gold standard treatment for OCD, often supplemented with the front-line medications for it.
May I ask what kind of thoughts torment your daughter?
According to google (because I’m no expert in meditations), 200 mg is the maximum dose for Zoloft. If that dose doesn’t help, it is safe to say they might want to try to switch to another medication.
She has been tormented by taboo thoughts for about three years. She was hiding this from us and living in absolute misery, with shame and fear. The psychiatrist that sees her now considers that the higher dosis is required to reach the parts of the brain responsible for the OCD symptoms. I spoke with him today and he says that the higher dosis will be for three months and if they see the expected results, then she will be brought back to 200 mg.
Interesting. I had two psychiatrists so far and non of them was open to changing the doses so fast. From my experience one should stay on the working dose for them for at least a year.
Honestly I’ve never reached a point to be on a highest dose. I will be on a mid dose and if it doesn’t help, they would switch the meds. That’s just my experience. Is your daughter in ERP therapy. The gold standard for OCD is SSRIs combined with ERP
Maximum dosage levels are normally the ones set by the FDA for the condition(s) that it originally approved the medication for but often medications are found beneficial for other conditions as well and the dosage ranges can differ for other conditions. Google isn’t a reliable source of accurate medical information. The person’s medical history and their current medications that they’re taking can also affect what is considered a safe dosage.
Yes, Google may not be right a lot of times, but it is a great source of educating yourself and standing up for yourself. I was told by my immunologist that doctors are generally afraid of people like me that read and educate themselves. I take it as a compliment.
I didn’t mean anything personal by my response. I’m sorry if it was taken that way. You may handle your googling of medical information just fine, I don’t know. Through insider information I have, doctors like it if their patients have accurate information and understand how it applies to them specifically. A lot of patients though google information and end up believing misinformation, disinformation and even conspiracy theories. It doesn’t help when some doctors promote such information too but they are usually sanctioned and sometimes they lose their license. Sometimes patients come across accurate information but take it out of context or misapply it because they don’t have the medical education to properly understand and apply it. These are the things doctors are “afraid” of with patients. Doctors already aren’t allowed to spend much time with their patients and when they have to take time to explain how their patients Google search results are inaccurate or misinterpreted inappropriately, it takes away from the time they are allowed to spend with the patient. Unfortunately, this is just going to get worse as government officials have deleted medical information from government sites that goes against their ideology even though it’s backed by rigorous scientific study.
Again, I’m not saying you’re doing this and I apologize if it was taken that way.
This is from a presentation on the pharmacotherapy for OCD- First-line Agents by Dr. Saxena. Dr. Saxena is a psychiatrist who specializes in OCD and related disorders . Sertraline (Zoloft) 150-300 mg/day usual daily dose. Maximum dose is 400 mg/day.
I have been on high levels of Zoloft before. Everyone is different, but 250 was certainly safe for me. Typically OCD requires a higher dosage to combat than depression. Hopefully, this will give both of you the relief you desperately need.
I started on sertraline some years ago, after having been on clomipramine for quite a long time.
Initially my dose was 200 mg daily, but I had a four month stay on an OCD ward in a hospital here in England, where my dose was put up to 300 mg a day.
Normally the maximum dose is 200 mg, and most doctors are not allowed to prescribe above that amount. But some OCD prescribers have been given licence to prescribe up to 400 mg. Big doses are often needed with OCD.
The doctors and therapists only know what your daughter is like during appointments, but if you have noticed an improvement in her state of mind, then your perception is likely to be more accurate! It can be a slow road to recovery, but simply smiling again and being able to hold a conversation is progress.
I've been so incapacitated by OCD in the past that I've barely been able to move from the sofa, but sertraline and CBT have made a real difference.
But I too am concerned with the long term consequences of medication. I'm thinking of trying inositol. It currently isn't prescribed or recommended as a front line treatment, but limited studies have been promising with reducing OCD.
I do have insomnia, but don't know if that is down to the sertraline or not. To be honest, it hadn't occurred to me. There are CBT techniques that can help with insomnia, and I've had some success with these.
Don't be discouraged if your daughter has the occasional setback or spike - it's often two steps forward one step back with OCD. Each little step forward can make a big difference.
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