Day 12 zoloft, working, but still have fast pulse upon waking

[livelaughlove]

Hi All! Last night at 8 pm was my 12th day i took zoloft 50 mg. I think it is working. Nearly all side effects are gone, except one annoying one. Every morning I wake up like clockwork, around 4:30 to 5 am feeling anxious and fast pulse 100-110 bpm, which is not considered harmful, but makes you not feel good. The only thing i can think of is that it's happening exactly 8 hrs after i take the pill, so the pill must be causing it. I am sure it will stop with time. Either that, or i read cortisol is naturally high upon waking. Maybe people with anxiety just have higher cortisol levels, i don't know.  Anyone else with this side effect? There is no point to lay in bed so i get up, eat a saltine cracker, and drink some gatorade. I read that when your blood sugar levels are low the pancreas reacts by stimulating 2 hormones, cortisol and epinephrine? That seems to help me, but then i let out a big burp. Actually, throughout my whole zoloft process i have been burping more when i eat. I think my stomach is a little irritated from the beginning stages of zoloft, having too much gastric acid, and that is why I've been burping. Anyone else with this? I know the brain-gut connection is closely related and if you are anxious, your brain will tell your body to produce more gastric acid and have more frequent bowel movements (loose stool or diarrhea) because it tells your intestines to contract more often than normal. Ahhhh, normal, i love that word. Can't wait to be "normal" again. lol

[insights]

The only thing i can think of is that it's happening exactly 8 hrs after i take the pill, so the pill must be causing it.

Zoloft hits peak plasma levels about 8 hours after it's taken which might account for the elevated anxiety levels that are bringing you awake. However, it usually achieves steady-state plasma levels after only a week at which point the amount of chemical in your blood stream doesn't vary greatly throughout the day so either your metabolism is slow, or it is a coincidence. My money would be on it being the latter. You could trying taking it in the morning.

The affect on your gut is probably a direct effect of the drug acting on serotonin receptors lining the intestines. The gut makes and uses far more serotonin than the brain, about 95% of all that's made in the body compared to just under 2%. Things should begin to settle down in a week or two, however, this is by no means a guarantee.

Ian

[livelaughlove]

Thanks for the reply! This morning has been better. I took the pill 8:00 last night again. Woke up around 4:30 am again, but not feeling as bad. A little shaky, pulse 100 bpm, but my attitude is "i don't care". So that's good for me. Helps me to keep calm. Right now I am at the 2 week mark of taking zoloft. And it must be working, too, because yesterday I found out my rheumatoid factor (i had labs done on friday but not all are back yet) is slightly elevated, and i really don't care. When all this started happening in OCtober, i was concerned it was not just anxiety but a health issue partly causing this. Now, I don't really care, it gives me a headache trying to figure out why i feel the way i feel, and i am not really interested in pursuing further testing. So it must be working! Last april i had an EGD, which showed moderate gastritis, negative H pylori. Mild esophagitis. Duodenal intraepithelial lymphocytosis. I had genetic testing for celiac disease (cause the increase IELS can mean either h pylori, celiac, autoimmune disease, or bacterial overgrowth, or Crohns). Negative for celiac. So i went on nexium from april to beginning of september. That helped, but then all of a sudden i was have severe watery diarrhea, flare ups of it, like 10 times a day. So i had a colonoscopy and biopsies were taken to rule out microscopic colitis, a type of inflammatory bowel disease, and they were negative. So negative celiac, colitis, h pylori so far. So i stopped taking the nexium, and the diarrhea stopped completely. My GI doc said the nexium was likely causing the diarrhea.  (when you take a PPI for a long time, it cuts down acid, so then you can get small bowel bacterial overgrowth, leading to diarrhea, in my opinion, as the gastric acid is important to keep flora in check. Flora is the amounts of good bacteria). So I also had CBC, CMP, TSH, T4, thyroid autoantibodies, and stool cultures and everything is normal and in range. Then in october i started to get these periodic weird feelings. Like a hot flush or weakness or something. So then i guess it was last week of november i weaned myself off zoloft after being on it for 10 years, cause i wondered if the zoloft was causing it. I weaned off too fast and had bad nausea, i think i got discontinuation syndrome from not going off it properly, so then 2 weeks ago i had enough and started taking it again. And that's where I'm at now. So, ive had all these tests and its frustrating when everything keeps coming back normal, yet you feel like crap. So, i kind of give up. Oh, and also, on my CBC with differential, my atypical lymphocytes are high. That and the slightly elevated rheum factor makes me guess maybe i have some autoimmune disease. But i dont' care, im not dying or anything. Atypical lymph can be high usually from mono, but i already had mono in high school. So my guess is that with the combo of duodenial IELS and rheum factor and atypical lymph, maybe it's some mild autoimmunity. But im not going to fret over it. Im only 34. My only symptoms are weight loss and fatigue, but that's prob mostly from the past month of my roller coaster with zoloft. Although, i did have this problem since october. So i don't know, don't care, and give up. Autoimmune diseases are so hard to diagnose. Just trying to get yourself diagnosed will make you crazy and frustrated, and it gives me a headache, so that's where I;m at now. Thoughts?

[insights]

Thoughts?

My guess, and I emphasis guess, is that you don't have an autoimmune, or indeed any other, organic disease. Were your stress levels higher than usual in October? If so, this might account for your initial symptoms, which have subsequently been exacerbated by stopping Zoloft. Certainly, stress is a 'good' fit with your symptoms. It can play havoc with the immune system to the point that anxiety/stress could be classed as immune system disorders as well as mental disorders.

Ian

[livelaughlove]

Yes my stress levels were very high in october, I was told my daughter might have a tumor and i think something snapped in my brain when i was told that. Waiting during that week period for her results had me a nervous wreck with vomiting and diarrhea, almost fainting, and coincidentally, that is also when the hot flushing sensations started. She is fine and nothing is wrong, but it made me ill thinking that she might have something serious. But now, my rheumatoid factor is high, so that means either rheumatoid arthritis, sjogrens, lupus, stuff like that. Normal people dont have elevated rheum levels. Only 4% of normal healthy people have elevated rheum levels. I have 3 tests pointing to possible autoimmune disease. I don't care anymore, though. I figure, whatever happens, happens. Take care :)

[livelaughlove]

well here i am again waking up at 4:30 am again ugg! It was not as bad this morning, but still felt like i had a fast pulse, maybe only around 95-100 bpm though. But as soon as i wake up i have to run to the bathroom and have a bowel movement, usually two. THat is really annoying. I have been taking one zanax every morning and that helps, lowest dose possible, 0.25 mg. I don't want to take it, but ive been taking them for the past 4 weeks and there were like 5 days where i didn't take it. I only take that one zanax. I don't want to take the zanax, for fear of my body having to rely on it and then i won't produce enough GABA and then when i stop im afraid of side effects. But it's such a low dose. I didn't take one today. I feel ok just a little anxious. Should i just start taking half of one of those low dose zanax for a little while and then stop altogether, or since it's just a low dose it wouldn't matter? I don't want to get side effects from not taking it. What should i do?

Also, i have been feeling weakness for the past week in my arms from my elbows to my hands. And my neck and back have been feeling a little sore. My knee hurts when i get up from a  sitting position, so i have better if i just move and stay active all day rather than sit because every time i get up from a sitting position it hurts. My knee has been like this for months. I have that high rheumatoid factor, haven't talked to the doc yet about it (i have access to the lab at my work and that's how i know my results, and my ANA was negative). So i wonder is the neck and back pains not really there but just there because i am wondering if i am in early stages of rheumatoid arthritis? It's weird, if i think of a disease, i develop symptoms of it, even though i dont have it. What would you put your guess on with that one? rheumatoid arthritis vs anxiety/hypochondria?

[laineyk]

 Hi, I am a veteran to zoloft been on and off it several xs. I am now on day 8 of 50mgs The burping was completely out of control had to take prilosec and/or Tums..last two days have been a little bit better but still my stomach is bothered by this drug everytime I have gone on it.

My anxiety has been so bad that I am taking klonopin 3xs a day, will wean off once I hit a therpeutic dose of zoloft which will probably be 150-200mgs.

each time I came off and went back on I had to increase the dose, eventually always going back down to 50mgs once I was stabalized.

I always am the worse in the morning & I take my zoloft in the morning so I would say its cortisol not the zoloft

[livelaughlove]

Hi! well i'm glad i'm not the only one! Last night was my 15th dose of zoloft. I am on 50 mg of zoloft and that is where i plan to stay, i am against increasing the dose, because i only have anxiety and not depression. It seems they want to increase it when people have depression, but for just anxiety, those doses are usually lower and have to be increased extremely slowly, because us anxiety-sufferers appear to be very sensitive. I also have been taking for the past month, minus a few days, one zanax every morning, low dose, 0.25 mg. But today, suddenly i feel i don't need it. I woke up again at 4:30 this morning. I didn't get that hot tingly shaky feeling, and my pulse was only 76 bpm. I did have to have a bowel movement right away, but finally it wasn't diarrhea. So my body must finally be adjusting! The hardest part is just getting through the first two weeks before things seem to settle down. The first week i was on it the nausea and burping was so severe i pretty much lived off tums and popsicles. Burping means gastritis, or stomach inflammation. Zoloft works great for anxiety sufferers, but it causes GI upset majorly in the beginning phases. More so than any other SSRI or SNRI. I work for gastroenterology and am very well knowledgable of all aspects of the field, and anxiety and GI upset majorly goes hand in hand. I don't like what i see in patients on mega-doses of SSRIs. That is why i don't want to increase. My theory is that anxiety sufferers have a real problem with cell communication, but technology is not advanced enough to test for that. What i think happens, is that something must be wrong with our cytokines and hormones and the hypothalamus gets mixed signals which messes up the brain-gut connection. I also think we have sensitivities in our amygdalas (another part of the brain). The hypothalamus tells your stomach how much gastric acid to produce, how fast to contract, controls peristaltic wave function and intestinal contractions. Too much acid causes gastritis and belching. It also controls the rate of stomach emptying, hence gastroparesis is also i believe high in anxiety patients. Diarrhea predominant IBS sufferers also have this problem, i believe their intestines are contracting too fast and pushing the stool through too fast. All this also messes up flora making it not homestatic, which in turn messes up leptin, a very important hormone that needs to cross the blood brain barrier. When flora is messed up, the fermenting bacteria mess up the cell wall of leptin, then it cannot cross the BBB (blood brain barrier) to get to the hypothalamus, so then the hypothalamus can't send out the proper signals to the gut and other parts of the body so sleep cycles get messed and GI issues ensue, as well as migraines, pains, and the like. But technology is not that advanced yet. I notice all anxiety sufferers all have the same problems, such as: migraines, ocular migraines, nausea, burping, weight loss or weight gain, constipation or diarrhea, fibromyalgia, difficulty sleeping, interstitial cystitis, pains in left upper quadrant, non-cardiac chest pain, and globus sensation (feels like a lump is in your throat). It's got to be all related! So they see a GI doctor. They get an EGD. The results are always the same, normal esophagus, mild to moderated chronic gastritis, usually H pylori infection negative, and negative bx of duodenum for celiac. They get a colonoscopy and random bxs are obtained for microscopic colitis, usually 95% of the time negative. If they are over 50 they have diverticulosis. That's cause they don't eat enough fiber and too many processed foods, so bowel movements are irregular and the sigmoid has to push harder, creating weak spots, that lead to little circular appearing pockets. Believe me, in america, every single person over age 50 has diverticulosis. Extremely common. So is the gastritis. It's very rare i see an EGD where someone doesn't have gastritis. But interesting theories i have, arent' they? Well, hang in there, it will get better soon but just takes time. :)

[insights]

It seems they want to increase it when people have depression, but for just anxiety, those doses are usually lower and have to be increased extremely slowly, because us anxiety-sufferers appear to be very sensitive.

In fact anxiety disorders, especially PD, PTSD and OCD, typically require higher doses despite SSRIs (and some other ADs) being generally more effective at controlling anxiety than depression. Even the weakest SNRI/TCA antidepressant, Effexor (venlafaxine), is usually much, much better at bringing the seriously depressed, bordering on catatonic back from the brink than any SSRI.

Zoloft is more likely to produce diarrhea than the other SSRIs initially.

Ian

[kmwondering]

I'm very interested in your theories. That morning jolt of cortisol is just too much for me when my anxiety is bad. I wake up with my heart pounding and right to the bathroom.

[livelaughlove]

thanks, i am reading about another theory, so i have positive rheumatoid factor, don't know yet if i have rheum arthritis cause i haven't seen a rheum doctor for more testing. But, on my egd, i did have duodenal intraepithelial lymphocytosis, which means inflammation from an increased amount of lymphocytes. So I am reading about the links between RA and duodenal IELs in negative celiac patients. There are like barely any studies at all on this. So the technology is not there yet. When i had my EGD, the causes of this increase in IELS can be from the following: celiac disease, inflammatory bowel disease, h pylori infection, NSAID use, and least likely, autoimmune disease. But what i am reading is that it appears to happen to a lot of rheumatoid disease patients, it has to do with 0372 RNA and cytokines and chemokines and interleukins causing this to happen and the cells build up in the gut. But there is hardly any research on this subject. But there should be because it appears to be pretty significant. Also, i am reading RA patients tend to get small bowel bacterial overgrowth from not producing enough stomach acid, which happened to me when i was taking nexium. Nobody puts this stuff together. I am not a doctor. I just work in a doctor's office prepping charts but i am really smart and follow patients and see what happens and i take notice of their symptoms and diseases and there is always a link. Maybe i am crazy for thinking this way. But i feel no one sees stuff the way i see it. I just don't like to see people suffer and never get answers.

[livelaughlove]

oops typo ^ should read MRNA, 0372 Rna. When i was having those bad bouts of diarrhea while on nexium, and it was like up to 10 times a day, i was the one that said to the gastro doc i think the nexium is causing it. I think it has decreased my stomach acid and now i am not breaking down food properly. I think i am getting small bowel bacterial overgrowth from not enough gastric acid to keep my flora normal. Gastro doc says thats possible, good theory, not likely, but def possible. So i stop the nexium and the diarrhea stops (this was back in september). Don't you know a few weeks letter the hospital sent out a study to all the GI docs about certain PPIS causing severe diarrhea and small bowel bacterial overgrowth from cutting down gastric acid too much and flora levels getting out of whack. So im not wrong im right. But i do wonder why i think so much about this stuff. I have an over active brain lol