I've been struggling a bit (well documented on some of my other threads) with a depression that came about after weaning myself off of Zoloft which I had taken (200 mg) for 20 years with overall good results. This time around, partially through miscommunication with my doctor and curiosity on my part I agreed to try cipralex - It was as if the pharma salesman had just visited my GP that day and he couldn't say enough good things about it. I thought why not? Fewer side effects, a newer drug - it might work out better for me in the long run. To make a long story short, the 20 mg cipralex did lift my depression but I was constantly anxious and couldn't sleep without taking something else. By this time I had gone to a psychiatrist who agreed I should go back on Zoloft. I've transistioned back now and am back up to 200 MG but I'm still anxious as hell and starting to slip into depression again. My psychaitrist said it should be a relatively seamless transition as they are similar drugs and the antidepressant effect had already been established by the cipralex. I wonder about others experiences. My Psychaitrist said I should experience the same benefits with Zoloft that I experienced before. I've only been on the 200 mg for a couple of days but didn't expect my mood to drop so much.
- Thread starter OtterB
- Start date
David Baxter PhD
Late Founder
Your system is still adjusting to the medication change. It may well take a few weeks so bear with it and give it time.
forgetmenot
MVP
Although it is from the same family its make up is still different so as stated my Dr Baxter it will take time for your body to readjust Ihope you get back to feeling better soon if not make sure you doc knows ok hugs
I'm still struggling with the switch from Cipralex to Zoloft. I'm crazy nervous and went to a psychiatrist today and he said its sounded unusual but he suggested beta blockers to stop the trembling.
I really want to stick with Zoloft because I did so well for so long on it. I cut back the dose to 150 mm until the nervousness subsides but it's been 4 to 5 days of this. I expected maybe a little adjustment period. I was doing OK on the Cipralex except it wasn't handling anxiety that well and sleep was difficult. I'm wondering if I should have stuck with that. My wife is trying to assure me that all will work out and I'll get my old self back but this is really hell for both of us.
I'm going to stick with the Zoloft a few more days and if the nervousness doesn't improve (despite taking clonezapam) I think I'll check in to emerg. and see if they can help me ride this out.
I really want to stick with Zoloft because I did so well for so long on it. I cut back the dose to 150 mm until the nervousness subsides but it's been 4 to 5 days of this. I expected maybe a little adjustment period. I was doing OK on the Cipralex except it wasn't handling anxiety that well and sleep was difficult. I'm wondering if I should have stuck with that. My wife is trying to assure me that all will work out and I'll get my old self back but this is really hell for both of us.
I'm going to stick with the Zoloft a few more days and if the nervousness doesn't improve (despite taking clonezapam) I think I'll check in to emerg. and see if they can help me ride this out.
David Baxter PhD
Late Founder
Did you try the beta blockers as your doctor suggested? There is logic to that suggestion: What you're experiencing may be "pseudo anxiety", a physical jittery feeling like butterflies in the stomach, similar to what patients on Prozac or Wellbutrin sometimes experience.
David Baxter PhD
Late Founder
It may very well pass. If it doesn't, you still have a lot of other options.
Beta blockers can be a valuable therapeutic option for certain types of anxiety reactions, often used to treat the symptoms of "stage fright" which is that overall jittery feeling some people experience before facing an audience.
There are beta receptors throughout our body, and although originally indicated for cardiac indications, beta blockers have been found to relieve symptoms associated with various other disorders, such as "jittery anxiety"
The effect is an overall calming of the body, as though your "engine" rpm's are reduced from 5000 rpm to 2000 rpm or like a calming purr.
There is sometimes a period of adjustment over the first couple of weeks, where your body may feel absent of energy, but this usually passes.
Once the body adjusts to the new rhythm you'll feel like a different person....calm, slower paced and comfortable.
I was prescribed a beta blocker as a preventative medication for migraine for a while and it helped me feel a kind of bodily serenity I never felt before or since.
If your doctor thinks it might be right for you, I would say give it a try. You may be pleasantly relieved of your symptoms.
There are beta receptors throughout our body, and although originally indicated for cardiac indications, beta blockers have been found to relieve symptoms associated with various other disorders, such as "jittery anxiety"
The effect is an overall calming of the body, as though your "engine" rpm's are reduced from 5000 rpm to 2000 rpm or like a calming purr.
There is sometimes a period of adjustment over the first couple of weeks, where your body may feel absent of energy, but this usually passes.
Once the body adjusts to the new rhythm you'll feel like a different person....calm, slower paced and comfortable.
I was prescribed a beta blocker as a preventative medication for migraine for a while and it helped me feel a kind of bodily serenity I never felt before or since.
If your doctor thinks it might be right for you, I would say give it a try. You may be pleasantly relieved of your symptoms.
It looks like beta blockers have a ton of side effects. I'm not so much jittery it have that uncontrollable feeling of dread in my chest that is totally paralyzing. But I have noticed a glimmer of hope today where my anxiety isn't as extreme and I may be getting into the start of the therapeutic benefits of Zoloft. So much for the "seamless" transition from cipralex to Zoloft. But for the first time I'm starting to feel like I did when I was on it for 20 years. I see all the scare mongering from certain sites warning that people often don't experience the same benefits the second time they go on an AD. I know I've got a couple more weeks before this settles down but I'm confident I'll be my old self.
David Baxter PhD
Late Founder
My advice is to avoid those sites like the plague. At best, they are one-sided: You only hear from the people who are unhappy, not all the people who had good results. Additionally, a lot of things get attributed to medications via superstitious "cause-effect" links when in reality there are usually numerous uncontrolled factors that are at least equally likely to have produced whatever effect the individual is complaining about.
According to my understanding of the mechanism of action of SSRI SNRI medications and their propensity for tolerance, I don't know the science supports the notion that returning to a discontinued compound might lessen effectiveness.
On the contrary, I think physicians look for successful history with this class of medications, sometimes even in siblings or parents previously successfully treated, to zero in on the compound that might work for the patient at hand.
Follow your doctor's advice and rely on your doctor's expertise and clinical judgement in selecting your medication options.
More on beta blockers. Steve, I appreciated your perspective - I was just a little spooked by the information sheet saying they can worsen depression and interfere with certain SSRIs amongst a host of other unpleasant interactions. My Psychaitrist explained that the dosage for my purposes is so low that there was little risk in taking them. He said they calm the body which can lead to a calmer mind. I'll try them as I continue to work through my readjustment to Zoloft. I went up to 200 mg last night and was a little apprehensive given what happened last week but I awoke at 5:30 AM feeling great. I should have got up then but went back to sleep and woke 3 hrs later feeling anxious and a little down. Anyway I'm encouraged that the Zoloft seems to be finally having a positive effect.
---------- Post Merged at 04:19 PM ---------- Previous Post was at 11:55 AM ----------
Is there any truth in the efficacy of generic Sertraline vs Zoloft. Our family doctor told us th generics do not have to measure up to the same standard. I've taken the Sertraline since it became available and it worked fine for me.
---------- Post Merged at 04:19 PM ---------- Previous Post was at 11:55 AM ----------
Is there any truth in the efficacy of generic Sertraline vs Zoloft. Our family doctor told us th generics do not have to measure up to the same standard. I've taken the Sertraline since it became available and it worked fine for me.
David Baxter PhD
Late Founder
For the vast majority of people and the vast majority of medications, generics work just as well as the brand names.
All generics MUST contain the same active ingredients but some of the stabilizers, etc., may be different. In a few cases, the non-active ingredients may mean that a medication is absorbed less quickly or less completely, or it may be metabolized more quickly, and for some individuals this can occasionally make a difference. For most people, the difference will be nil or negligible.
Steve, The sheet provided by the pharmacy for propranolol was 5 pages long. I won't quote it all to you but a few of the paragraphs that caught my attention. It states it's mainly for treating high blood pressure, irregular heartbeats, shaking (tremors), migraine headaches, angina and after heart attacks to improve survival. Under Other Uses: it states that it has also been used to control symptoms of anxiety or overactive thyroid. There was the usual list of side effects including nausea, vision changes, unusual dreams, reduced blood flow to the hand and feet. Unlikely side effects are mental mood changes, swelling ankles and feet, very slow heartbeat, fainting, etc. The part that worried me most was the Precautions section where they mentioned certain types of heart rhythm problems (which I've had), bronchitis (which I've had quite a lot), mental mood disorders. Then there is a very long list of drug interactions including diazepam, certain SSRI antidepressants including fluoxetine, paroxetine, fluvozamine and trycyclic antidepressants. Here's a link to another site on this drug. Propranolol (Inderal)
As a start, I wou drecommend reading this article http://forum.psychlinks.ca/prescrip...-making-sense-of-medication-side-effects.html posted by David a few days ago.
With regard to your pre existing conditions, and concerns about how they might be affected, if at all, by the medications your doctor is prescribing, I would suggest arranging a follow up visit with your doctor to address these legitimate concerns.
Your doctor knows your medical history, your symptoms and you are entitled to understand the prescribing rationale being used in your situation.
The drug interactions being cited in the patient information brochure refer to interaction at the metabolic level, where the liver enzymes called Cytochrome P-450 2D6 are involved in metabolizing certain medications. When two or more medications requiring this pathway compete, one of the medications may be affected in the amount that is either absorbed into the body, or in the amount that is eliminated.
Not all medications (even those within the same class of medications) use this pathway and your doctor should be aware which one do and which ones don't and how to manage any potential conflicts.
Sometimes all that's needed is a dosage modification of one of the medications, to compensate for the interaction, while at other times, the doctor may select another compound in the same class of meds to avoid the interaction.
So if you have concerns, take the information you have learned, have a look at the Forum section on Drug Interactions where we have posted some resources among the "Sticky" posts on this very question, and ask your doctor for clarification for your own situation.
With regard to your pre existing conditions, and concerns about how they might be affected, if at all, by the medications your doctor is prescribing, I would suggest arranging a follow up visit with your doctor to address these legitimate concerns.
Your doctor knows your medical history, your symptoms and you are entitled to understand the prescribing rationale being used in your situation.
The drug interactions being cited in the patient information brochure refer to interaction at the metabolic level, where the liver enzymes called Cytochrome P-450 2D6 are involved in metabolizing certain medications. When two or more medications requiring this pathway compete, one of the medications may be affected in the amount that is either absorbed into the body, or in the amount that is eliminated.
Not all medications (even those within the same class of medications) use this pathway and your doctor should be aware which one do and which ones don't and how to manage any potential conflicts.
Sometimes all that's needed is a dosage modification of one of the medications, to compensate for the interaction, while at other times, the doctor may select another compound in the same class of meds to avoid the interaction.
So if you have concerns, take the information you have learned, have a look at the Forum section on Drug Interactions where we have posted some resources among the "Sticky" posts on this very question, and ask your doctor for clarification for your own situation.
David Baxter PhD
Late Founder
To add to what Steve has posted, OtterB, the use of beta blockers to treat anxiety is not uncommon. They don't work for everyone but for some they work quite well.
The caution about increasing depression is really an alert about (a) depressed individuals who are not already taking an anti-depressant and/or (b) people with depression but WITHOUT concomitant anxiety.
To put it into perspective, many individuals with concomitant anxiety and depression take both an antiudepressant and a low dose tranquilizer such as clonazepam or lorazepam. If you look at the literature on those medications you'll see the same cautions and the same comments I made above would apply to those medications.
The caution about increasing depression is really an alert about (a) depressed individuals who are not already taking an anti-depressant and/or (b) people with depression but WITHOUT concomitant anxiety.
To put it into perspective, many individuals with concomitant anxiety and depression take both an antiudepressant and a low dose tranquilizer such as clonazepam or lorazepam. If you look at the literature on those medications you'll see the same cautions and the same comments I made above would apply to those medications.
Still struggling with Zoloft switch. We decided to go down to 150 mg today as the anxiety side effect was not abating and I was up to 2 mg of clonesapam to control it. Although I was on 200 mg for most of the last 20 years I tapered to 100 mg for the last 3 years so maybe the 200 is just too much. Hopefully this reduction will work and I can cut down the clonezapam. I was feeling pretty hopeless today - fortunately the pdoc said he hasn't given up by far. I might consider going back to the cipralex after all this.
Looks like I'm sticking with Zoloft for another couple of weeks after meeting my pdoc today. He is confident that the Zoloft will kick in on the anxiety. I forgot to mention to him some slight itching. Hopefully this clears up but can't figure out after using the drug all these years I would get a reaction now. Any ideas?
David Baxter PhD
Late Founder
That's a (slight) possibility but it's also quite possible that you are hyper-alert to possible side-effects and imagining that as a result.
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