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Mental Health Strange question about antidepressants... (SSRIs)

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raizanthelostone

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So I have a question that might sound a bit idiotic... But here goes... I believe I am my 10th week of sertraline (for anxiety/depression/panic attacks) , I started from week 1-4 50mg, 4-7 100mg, 7-10 (to this date) 150mg. And well I still have some really troubling thought and anxious thoughts, the thoughts get overwhelming and I find myself in a state where I can't focus properly at work, and I make mistakes because I lose concentration or I can't concentrate for long, then my boss gets pissed at me, and it seems like everyone in my life is always mad at me.

I feel really weird on antidepressants, like some days my anxiety is really bad, but a few days ago I had a couple days were I didn't really get anxious thoughts (still had some but not much). I have had a lot of suicide idealation through my course of sertraline and about a week and half ago called my doctors and asked them if I could taper down and maybe come off the antidepressants (due to them putting majorly intrusive thoughts in my head, like my hand hovering over a box cutter wanting to take it home and use it to slit my wrists), and it was greatly concerning me. Due to that my doctor booked me an appointment to see my normal doctor this saturday (under the impression I had reduced my dosage and wanted to come off sertraline), but I didn't actually drop my dosage, due to me backtracking on getting withdrawal symptoms . I haven't touched any recreational drugs for almost a month now (this saturday will be a month), I'm just wondering should I go ahead and ask my doctor to change my antidepressant ? And how effective are SSRIs, do they banish the anxiety and depression completely or is it like it banishes 80% and you're still left with 20% (as weird and strange and stupid as that may sound). As I'm not too sure what the course of action is, as I don't think my doctor wants to go up to 200mg of sertraline as she's under the impression 150mg is the max dosage for anxiety (What would I know I aint a doctor)... But yeah.. I'm not sure what to do.. Any advice would greatly help.
 
Hi there. Unfortunately many people have exactly the same symptoms as yourself on sertraline (and other SSRIs, SNRIs etc).

Although you're in your 10th week, it's possible the unpleasant side effects and intrusive thoughts will gradually diminish the longer you stay on. If you're getting some benefit, it might still be worth waiting out to the 4 month point before deciding if you should swap to another anti-depressant or anxiety medication.

As for whether they work 100%, that really depends on the person, but most still experience some of their former symptoms. The idea of most treatments is that they do enough to help you form the new habits, skills, thoughts and patterns of behaviour that will create a sustainable and permanent improvement, rather than simply 'blocking' the anxiety or depression outright.
 
Hey there,
I started sertraline at 50mg back in college twenty years ago, bumped it to 100 briefly before I lost coverage and went to zero. A decade later I was prescribed straight to 200mg (it was a rough time) for maybe three years, then abruptly dropped to 100mg (poor people coverage) where I've stayed for the last four years, with lots of abrupt stops and starts.

First, I was kind of shocked with the ideation that came on at 200mg. I had a different theory about what might be happening, but to experience it was disturbing. I did have two serious attempts during that time, too. So I think it is dose-dependent--it definitely is for me--and from what I read a long time ago, there isn't much added benefit for depression/anxiety above 100mg/day (but then, 200mg does benefit obsessive/compulsive disorders). But I haven't checked in a long time.

Now, does it work? It works, for me, to an extent. It depends on your goals, and your own personal risk/benefit math. One way that it works is removing the more subtle anxieties from your life, such that you do activities you had avoided or rarely done, without noticing that you're doing them. I think that is the main source of benefit for social anxieties, and it takes time to accomplish. You don't have to psych yourself up to go talk to strangers, you'll find in retrospect that you just have been. And that process changes your attitudes. It's a form of exposure therapy (don't like spiders? Here's a basket of them, I'm going to throw them at your face till you aren't scared anymore).

It reduces those anxieties by blunting your emotions generally, it seems like. So things that made you lock yourself away aren't as bad, but still troubling. And things that really made you joyful are just alright (including orgasms). It's subtle.

Some people on this board say that their problem is that they are unemotional and can't experience joy, and I think SSRIs would be a terrible choice for them. Me, I've always had too strong an emotional response, to everything (except a lot of happy things). The last several years have seen my life crater, and if I had to face the full brunt of my self-judgment, no one on the block would survive.

At the same time, I noticed in my last year as undergrad, my grades tanked, pretty hard. Sure, I was more social then, but I think it was because the sertraline took away some of the anxiety over my performance. I didn't care as much. That's good or bad, depending on which you think is worse. I worry that I haven't climbed out of the hole I'm in partly because of the drug, but when I quit for some time life was still too much.

And the other downside is that a lot depends on you engaging with the world and participating, so that you do become involved in new activities. That takes time, like months, and sometimes isn't possible. I know it was easier when I was an undergrad than as a 40yo broke hermit.

I haven't tried any others to compare. I don't really like being on the sertraline, but I'm not in much position to change given my healthcare situation. I can say that I saw a big change with my mother (a good one, imo) going from an SSRI for many years to venlafaxine, an SRI but with weak adrenergic effects. There are more options all the time, and don't be afraid to challenge your docs, who might prefer you start with "established safety profile" drugs like sertraline.

As for withdrawal, don't worry about it. There are strange horror stories of people straight losing their minds and their bodies falling apart out there, that I've never experienced with all my frequent stops, including 200mg to zero overnight (my guess is they're planted by class-action law firms). The long half-life means there shouldn't be any major physical problems, and the psych effects would be as subtle as they are when you start. I have had brain zaps after quitting, that are uncomfortable but apparently harmless, and those really only showed up after years of use. I do think the longer you're on these meds, the more potential problems you have quitting, but I'm talking many years of use.

Anyway, be open about everything with your docs, do some homework about what's available and the flavors of your complaints. Not all depression and anxiety is the same.
 
I used to be on these SSRI's until my doctor determined I was allergic to them. I was having serotonin-symptom like symptoms all the time and after I stopped taking them I felt a lot better. Your mileage may vary.
 
Zoloft didn’t work for me. The side effects were unbearable. I had foggy head and i had to switch to 10mg Lexapro. It worked a lot better for me even tho the beginning was tough. The whole “it will get worse before it gets better” rang true to me. I also was prescribed Hydroxyzine when needed and for sleep. Been taking them for 3 months. Getting tapered off. Now on 5mg. Recommend CBT therapy. Works for me which is great.
 
How long were you on the Zoloft?

I'm curious because Lexapro is also an SSRI.

Hydroxyzine is a whole 'nother character, and that one has some side effects.
 
I was on Zoloft for about 4 months in total. Strangely enough recently my Citalopram hasn't been as effective as it was when I first started taking it (2/3 months ago)... :(
 
I was on Zoloft for like over a week. I just couldn’t handle it and idk what it was that it hit me real fast. As soon as I stopped taking the unbearable side effects went away.
 
can I ask what the unbearable side effects were?

Because the only really noticeable effects I've experienced were sexual, and they mostly went away after a week.
 
I know for me with sertraline (although I know your questions wasn't directed at me) I got really bad anxiousness, and very bad panic attacks that were frequently occurring and a burning sensation in my body. I got loads of suicidal thoughts that I couldn't push out of my head as hard as I tried, I felt nauseous and didn't eat (lost 5kg being on sertraline), and when I did eat my stomach burned like hell and I had bad diarrhoea(that was explosive, as embarrassing as that is to admit). I had a really time understanding my consciousness, as weird as that sounds, like I kept feeling like I was outside of my body and had a bad sense of disattachment, but tbh that probably that probably relates to just the feelings of anxiety in general.

Anyone know why SSRI's can stop working and what to do when that happens? I've been having a heard time on the citalopram recently, its stopped working for me and I feel back to square one... I've been referenced to my local mental health service, but last time they turned me away and I doubt they will help me.
 
Those are some pretty extreme reactions.

Even at 200mg/day I didn't have any problems.

I've started and re-started sertraline more than a few times. Such that I'm used to it and can jump straight from zero to 200mg without any problems. The sensation I get when I first start is a weird tingle in spine, kind of intense when I yawn. The feeling is the same as "coming up" on LSD, so it's kinda weird. I find it pleasant.

Another side effect is the runs: serotonin is involved in absorbing food from your guts, and nausea, and a lot of people need some time to adjust (I take metformin and am always gassy and shitty, so I don't really notice anything).

And of course, libido tanks, and so do orgasms. That last big gets better after like a month for me.

At 200mg/day, suicidal ideation did occur, and was a bit scary. Other than that, it's a blunting of emotion, something I don't really "feel".

I really haven't had any other problems with it.

As for why people stop responding, I don't think anybody knows. In some cases, folks might just be non-responders, and it's a kind of placebo effect in the beginning, that just wears off after a while. There are theories about non-responders, but the answer is anybody's guess.

If it's not working for you, especially if you have suicidal thoughts, get a shrink however you can and hammer that home, that these drugs aren't helping. Use a crisis hotline if you have to.
 
Man I wish my reactions to the SSRIs were like that -_-. I had months of hell on sertraline -_- with just the increased anxiety and depression questioning whether anti depression meds actually work -_-. Out of curiosity what do you take sertraline for? Anxiety and depression, or a combination of the two?

I know exactly what you mean about the come up feeling on LSD and being on a SSRI. With both sertraline and citalopram I got that feeling, like you feeling it brewing inside of you for me normally it settled down in the evening (as I usually took my meds when I first wake up to avoid forgetting them). For me that sets off my anxiety sometimes due to the sensations of derealisation, also the fact that I had my worst ever life experience the last time I tripped on acid -__- probably why too.

Tbh sexually it made my orgasms more better and more stronger, although I do know a lot of people suffer with a lot of negative sexual side effects with SSRIs. For me one is becoming really turned on all the time (that can be really irritating).
 
Yeah the annoying thing is I took a year off of studying (university) to help try address my mental health issues and sought my life out and enjoy it. And me and my partner are going travelling to India for just over a month in January, and I was just worrying about the switching of medications (if my GP changed my medication or something) and me having a bad interaction potentially ruining the holiday (thinking of my experience with sertraline).

Oh yeah and another thing I forgot to mention, on the antidepressants its making me have more mood swings and get more hot tempered... Which has effected my personal relationships with people dearly :(

Also thanks for sharing the knowledge!
 
It is interesting. I really believe there are two major forms of depression going unacknowledged (but then, I'm not a shrink and up on their literature), and even some science to back it up.

OK, me, I think I feel too much most of the time. My first girlfriend said I was the most sensitive person she ever met. Boredom turns to depression and then intense anxiety. One small pointless memory can send me shooting down in a spiral. In fact I try to "derealise" to separate myself from the emotion, to tell myself it's not real. It's just a feeling, and that's not how things are. SSRIs blunt that, for me, and sort of "mute" any spirals of intensity that might start. I don't think that's necessarily the best way to deal, but it at least provides some benefit.

Some people seem to have a depression that is a total lack of feeling. They have no drive or energy, no will to live--they want to experience joy again, a reason to get out of bed. For them, SSRIs don't seem to help at all, and sometimes make things worse. After all, if you blunt emotions, you blunt the positive ones too.


(It helps that I've always had a good time on LSD, so the come up is more like the ride up the first hill in a roller coaster, and I get excited. And if I didn't mention before, when I went on sertraline on college 20 years ago, my grades tanked. Cause I stopped being anxious about them. So, there are always cons, depending on how you look at it.)
 
It was just 1 side effect. My head. It wasn’t necessary a headache or anything I tried googling and see what it can be called and what I kept getting was “foggy head” so that’s what I labeled as. It was unbearable and weird how it started happening as soon as I took the medicine. It wasn’t even a build up of weeks taking the medication, it was like a day or 2 after. As soon as I stopped taking it and switched to Lexapro it went away real quick. Obviously Lexapro had different side effects but they were bearable.
 
It's just unusual to me, because sertraline/Zoloft and escitalopram/Lexapro are identical in their mechanism-of-action, both being SSRIs. Sertraline has some more antagonism of sigma receptors, but so do lots of things, and no one knows what that means.

But people are different, and respond differently.
 
My first psychiatrist couldnt explain it either but he knew off the bat (i think its pretty obvious) that if i switched i wouldnt have the "foggy head" so thats what happened. I swtiched to lexapro and he just said with this i might experience bad stomach aches and he was right on the money with that. All well now.
 
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