time of day for zoloft, insomnia, mornings are tough

[livelaughlove]

Hi! i was wondering what time of day everyone takes zoloft? I am on my 22nd day of zoloft 50 mg, and i have been taking it at 8:00 at night. I was off zoloft for about 4-5 weeks then decided to go back on it. I used to always take it at night with no problems, but this time around has been different. I take the zoloft at 8, go to bed about an hour later, then every morning wake up like clockwork, around 4 or so, feeling really shaky, anxious, and have diarrhea. Also, i don't dream or feel rested. So, last night, i took the pill at 6 with dinner. I felt really tired an hour or so later. I went to bed at 8:30, and slept much better, actually had a dream, and was able to get into a deep sleep. I didn't wake up until 5, and i felt much more rested. I felt a little shaky when i woke up but not as bad as before. I still had to run to the bathroom for a bowel movement, but not as bad either. I am going to try to take it at 6 every night and see if that helps. I think i was getting a mild insomnia or something when i took it at 8. I am fine throughout the day now, no anxiety, it's just the mornings i seem to have problems with, with the shakiness, diarrhea, burping. Also, my doc prescribed 0.25 mg zanax which i was taking one once per day in the morning as soon as i woke up for a month, but this past week i have been scoring them and only taking half of one of those zanax pills. I don't want to take the zanax, but i thought i better slowly wean down. I think they are contributing to my stomach problems (belching and diarrhea). I did not take half the zanax pill yet this morning, i want to wait to see if i don't take it what happens. I do feel a little shaky but not as bad. Does anyone else experience this? Comments please!!!

[laineyk]

I take mine in the morning, ALWAYS with food, so I wont get too naseated. I think that no matter when you take it its going to cause increased anxiety

[kmwondering]

I can't speak to the Zoloft but mornings are the worst for me. I get shaky, my heart races and off to the bathroom I go. I think we are just hypersensitive to that morning burst of cortisol or something.

[insights]

I take mine in the morning, ALWAYS with food

Usually, taking it with and without food doesn't matter, however, it may do when first starting on Zoloft, or upping the dose. Taking it with food causes plasma levels to peak some 20-25% higher and about 2 hours earlier which may increase the severity of initial side-effects to some degree because of the faster rate of change. By how much varies from person to person.  Plasma levels reach a steady-state after about 7 days so this then no longer matters, but something to be aware of if you need to up the dose or restart Zoloft in the future.

Curiously, there is no increase in peak plasma levels when the liquid formulation is taken with food, but it takes about an hour longer to reach the peak.

Ian

[livelaughlove]

thanks for the replies everyone! I didn't take zanax at all yesterday and i had a really good day! Yay! I think the zanax, even at such a low dose, was giving me rebound anxiety or something, i just felt like in a fog or not my normal self on the days that i took it, which was almost every day, for about 5 weeks. So last night, i took the zoloft at 6 again with dinner. I went to bed and was asleep by 9. But i woke up at 3 and couldn't get back to sleep. So by 5 am i just got up and that's what time it is now. Also, had to run to the bathroom again this morning, went twice already, and my stomach was making all these gurgling sounds last night. Im just really tired right now, but can't sleep. I have work today UGGG! I didn't get the shaky feeling this morning though, thank God! Hopefully i will return to normal, maybe it's just the zanax was messing with me because i didn't take it yesterday, and i don't plan on taking it today. So we'll see what happens :)

[laineyk]

Ian, so do you think that by taking it without food I may have less anxiety...I am increasing my dose and find that within four hours of taking it I get trembling in my hands. I have anxiety most of the morning & into afternoon, but seem to settle down after 4ish.

I am trying to wean a little off the klonopin since it does nothing for me in the morning & I so dont want to increase the dose. so today & yesterday I decreased it from 1 1/2 mgs a day to 1mg.....it was a little rough this afternoon but I managed. I take .75mg in morning and then .25mgs at bed.

do you think that wean is to much at once? I just know that the klonopin doesnt do hooey for me in the morning unless I take a full mg. then it just settles me down.

whats your thoughts?

[insights]

Ian, so do you think that by taking it without food I may have less anxiety...I am increasing my dose and find that within four hours of taking it I get trembling in my hands.

Possibly as the drug will enter your bloodstream more slowly. However, this is a short lived effect. Seven days after each dose increase the amount of drug in your bloodstream reaches a stead-state of around 2.2-2.5 times what you'd get taking a one-off dose, and thereafter the amount varies only a little throughout the day.

I am trying to wean a little off the klonopin since it does nothing for me in the morning & I so dont want to increase the dose. so today & yesterday I decreased it from 1 1/2 mgs a day to 1mg.....it was a little rough this afternoon but I managed. I take .75mg in morning and then .25mgs at bed.

do you think that wean is to much at once?

I can't remember how long you've been taking Klonopin daily, but if it's been more than a couple of months, then a 33% drop is likely to be too much, 10% would be better. However, this might be hard to achieve, so drop by whatever minimum amount you can reliable divide the tablets by.

Switching to diazepam (Valium) would make it easier. Not only does it have an even longer half-life which tends to smooth withdrawal, but by getting the equivalent dose - 1.5mg Klonopin = ~30mg diazepam - in a mix of 2mg and 10mg tablets you can cut back in very small steps. Try dropping by 2mg initially, 1mg if it's too difficult and you may need to cut by a quarter of a 2mg tablet for the last few milligrams. Alternatively, Klonopin is available in liquid form which also allows fine dose adjustments. In both cases, don't taper any quicker than every 2 weeks.

Ian

[livelaughlove]

Hi all! update: so thursday i didn't take the half of the 0.25 mg xanax and i had a good day. Friday morning, i felt really shaky, i'm guessing it was from not taking xanax, so i took half of one and went to work and I felt crappy all day. Had loose stool like 4 times before i went into work and my stomach bothered me all day. Mentally I didn't feel as good either, just slow or uncreative or something. And my stomach bothered me all day. So yesterday, which was saturday, I didn't take any xanax again. I only went to the bathroom 2 times in the morning which is wonderful for me! I also felt really good mentally. Today, which is sunday, I woke up (it's 6 am) and only went to the bathroom one time so far but it wasn't as loose or light yellow in color. I plan on not taking zanax at all anymore. I hope i can do it! I am definitely noticing a pattern, with the days i take zanax i have upset stomach and mentally feel not good and a little depressed because of the fact that I don't feel good. I feel a little shaky right now, do you think it's because from not taking zanax? It's been 2 days since not taking it. Right now I have been on zoloft 3 1/2 weeks. The first time i took zoloft i was on 50 mg for quite some time, about 10 years. I didn't have these problems the first time i was on zoloft, but also, the first time i was on zoloft, i was not taking zanax or any other benzos. I think it is the zanax messing with me, i really do. Ian, do you think this is possible? I read that benzos can give people small bowel bacterial overgrowth. And, i fit the description of that, with the diarrhea and dyspepsia. I read because since zanax and benzos affect the CNS it messes up bowel motility and then that leads to stasis of bacteria in the small intestine, allowing it to overgrow, and then if you eat fructose and high carb diet the bacteria ferment upon that and give you the gas/bloat, belching, upset stomach, and diarrhea (steatorrhea) and the stools are usually yellowish in color and with mucous, which is all of my symptoms. Also, yesterday, i avoided fructose and i did much better. I work for a gastroenterologist and i fit the profile of small bowel bacterial overgrowth. My doc gave me stool cultures to get done and one of the tests will check for fecal fat, because with SIBO, the fat is very high in the stool. So i plan on dropping my stool cultures off tomorrow morning to see if i do have SIBO. Also, my rheumatoid factor is high, i have an appt with rheum on thursday. I also read that rheum disorders go hand in hand with SIBO, due to a motility dysfunction and parietal cell impairment in the intestines. Also, back in april , i had an EGD which showed duodenal lymphocytosis. That is rare, only like 3-5 % of the population gets this finding, and in my experience, they usually never get an answer as to the cause, but i am determined to get an answer. Duodenal IELS and i also had mild crypt hyperplasia, means the following : H pylori infection, NSAID use, celiac disease, autoimmune disease, lymphocytic colitis possibly or IBD, or small bowel overgrowth due to motility dysfunction. Well, i am negative h pylori, was not using any NSAIDS, i was negative celiac disease, negative inflammatory bowel disease. So all that's left is autoimmune disease or small bowel overgrowth from motility dysfunction. My rheum factor is high so it's possible i have an autoimmune disease. But, i think i have the small bowel overgrowth, and i have dieted in the past, once by doing a gluten free diet, but i ate grains (chick pea flour, tapioca, etc) for a month and i felt some relief but not totally. I didn't feel good until i did the paleo diet for about 2 months, avoided all grains, except one serving of grain a day which was white rice. I felt fine and had no problems on that diet. With the paleo diet, you are not eating anything unnatural and it is low carbs, which makes sence, because people with small bowel overgrowth are told to eat a low carb diet and avoid fructose as much as possible because that is what the bacteria ferments upon. I stopped this paleo diet back in october and have been having problems ever since. Ian, or anyone else, what do you guys think? Am i thinking too much about this? I probably am, but i want to feel better, and i will do whatever it takes to make these stomach issues stop. Anyone out there with any experience with this?

[insights]

Ian, or anyone else, what do you guys think? Am i thinking too much about this?

I think you are like the guy who is given a hammer and the his whole world becomes a nail. As you work in the field you're seeing everything from the gut point of view. The gastrointestinal tract, and particularly the enteric nervous system, does play a part in anxiety and depression, but it is probably not the most important part.

I doubt Xanax is causing your gut problems. Their are epileptics on the equivalent of 10-20mg/day of Xanax yet they don't appear to have more GI problems than the rest of us. Zoloft is much more likely to be causing them. The fact that it wasn't when you took Zoloft previously isn't significant. The initial antidepressant side-effects are often different than the first time and sometimes more severe.

Ian

[livelaughlove]

ok thanks Ian! that is so true! I'm a medical assistant and i prep charts all day and talk to patients all day so I see all this GI stuff and then i start to wonder, i guess wonder too much, that is true. I didn't take the zanax yesterday or the day before, I am done taking zanax. Funny thing was that I feel better, no more belching or burping. And I went to the bathroom twice yesterday morning and twice the morning before (not like 5 times like how it has been with the loose bowels). My stomach feels better without the zanax. So maybe I was just having upset stomach because i was worried about taking the zanax? Not sure. It's just weird the days I didn't take zanax i feel much better. But also, I am on nearly 4 weeks of zoloft so maybe it's also that the zoloft is finally working again, as i do feel better mentally. Also, i started taking zoloft with dinner instead of taking it at night before i go to bed, that seems to help. Thanks, it's good hearing from you, always good for me to hear everyone's thoughts cause sometimes I am my own worst enemy, i think too much!

[livelaughlove]

Update on my situation: haven't taken xanax in 4 days, im done taking that, and i feel so much better. I will continue with the zoloft 50 mg, that is def doing it's job! But, I just wanted to say, through my own pushing, because i could not believe all this stomach upset with the passing of mucous in stool, light colored stool, and multiple times i go to the bathroom in the morning (though it's been down to only 2 or 3 times a day) I could not accept the fact that it's from the medicine or it's activity form irritable bowel, i don't believe in that. Not through the research i have done. It's not normal to wake up from sleep in the middle of the night to go to the bathroom, that is not an IBS symptom. So last friday, i pushed for a stool culture. Dropped it off yesterday morning. I have access to see my records, and the only test back is the one for where they check for WBCs in stool, which came back positive (it is never positive in people with just irritable bowel syndrome). Which means active, invasive inflammation. I KNEW IT! The other tests are not back yet. One of the docs i work with, i was telling him, after the other docs were all saying it's just diarrhea-predominant IBS and i said bull, i said this is not normal and i suspect small bowel bacterial overgrowth (and benzos can cause that to happen), so i was right. It's always good to listen to your gut. So it could be SIBO, but it could also be parasite/amebiasis, or inflammatory bowel, or bacterial infection. I have to wait for the other tests to see what happens. Also, i had my rheumatoid factor tested a few weeks ago and that came back positive. So that can mean rheumatoid arthritis, lupus, sjogrens, amongst some other things. But also, parasitic infection can cause RF levels to be high. This, along with the digestive upset, made me push for the stool culture. I also do have appt with rheumatology thursday. My theory is that it is small bowel bacterial overgrowth, causing me to have fructose malabsorption, which is causing the weight loss, and the bone pain, because i am not fully absorbing vitamins. Let's see if I'm right! Makes sense too when i was paleo, which is low carb diet, that i felt better. Bacteria like to ferment on carbs and cause major abd pain, gas/bloat/belching/dyspepsia. Also, people with SIBO do best when the only carb they eat is white rice, which is the only grain i ate while paelo. Since being off the paleo diet, since october, symptoms have worsened. This is all making sense now and i think i am on to something. But makes me mad because so many people, and i see it every day, suffer with symptoms similar to mine but they don't know what to do or what tests to push for. And doctors don't put the big picture together. I actually talk to patients and listen and get their perspective. Another thing i have found, that doctors I talk to have no idea about, is that a common indicator of autoimmune disorder is that almost everyone with autoimmune problems experience the skin peeling away in their mouth from time to time and aches and pains. I told my PCP a while back that i have this problem and he just said "I dont know, did you eat something hot?" No, i wasn't even eating and this happens to me, has been happening a while now. Why don't they put the bigger picture together??????????

[livelaughlove]

and also, when bacterial levels are off, anxiety/depression/insomnia will increase. There is a strong brain-gut connection with all of this. So that is why it is important to eat a healthy diet, avoid high fructose corn syryp, eat lots of vegetables and fiber (unless you have inflammatory bowel, then diet is different). But people that are told they prob just have irritable bowel syndrome or fibromyalgia, they are the ones that need a healthy diet and take a good probiotic and eat pre-biotic foods, avoid NSAID usage. I beleive in those people they have a motility issue in their intestines, and bacteria can overgrow because of this, and mess everything up. Then they are told they have IBS and anxiety. Whatever. I think it's a bacterial issue. Thoughts???

[insights]

It's not normal to wake up from sleep in the middle of the night to go to the bathroom,

It is if you've trained yourself to do so, or been trained by a temporary drug effect. The thing about the bowels is that the system is highly adaptable. The more often you go, the more often you end up needing to go. If you are going 2-3 times a day then I don't see how you can make the case for benzodiazepines affecting motility. If anything, I suspect a lot of your problem is down to everything having sped up to the point that the bowels don't have the time to process the food properly.

Ian

[laineyk]

LIVELAUGHLOVE> I am so happy for you...I wish I could say that the zoloft is working for me, Like Ian said sometimes the side effects are differant , well let me say I am in misery. I am up to 75mgs and my hands tremble I feel like I am waiting for the bottom to fall out of my world.
Klonopin is not helping and if I take it in larger doses it gives me more depression and restlessness?

Ian, can someone become bipolar at anytime? I read that SSRI;s will aggravate that & it just seems that I am a walking bundle of nerves.

I wanted to try to get to 150mg before I give up but its been HELL getting there

[insights]

Ian, can someone become bipolar at anytime? I read that SSRI;s will aggravate that & it just seems that I am a walking bundle of nerves.

They may expose unrecognized bipolar, but there is no evidence they cause it. I can't see anything in your post suggesting you have it.

Ian

[livelaughlove]

Hi LaineyK! Don't give up! I think, personally, you are having problems because you are still in the process of going up on your doses. So just when your body gets used to a particular dose, you then are having to "up" it and then it increases anxiety all over again. So you probably won't feel normal until when you are at just one dose for a while. I agree with you the klonopin is messing with you. I stopped the zanax last friday, today is wednesday. I feel much better. Every time i took zanax, i would actually feel more depressed because it made me kind of foggy and no energy, also gave me more diarrhea. The days i did not take zanax, i felt better mentally, and the stomach upset wasn't as bad, but remember, I might also have some health issues going on that is irritating my bowel. All i know is my stool culture is positive WBCs, which means either inflammation or active infection (like a bacterial infection, parasite, or inflammatory bowel disease). Giardia is negative. The other cultures are not back yet. And remember, my rheum factor is high so i might have something going on with that as well. I once had amebiasis about 3 years ago i got from mexico while on vacation, had to take metronidazole and that killed the infection. And i work in a hospital, in a GI practice, so it is possible i picked up some infection at work, or from food from eating out. Whatever it is, I feel i am going to get an answer soon as to what is making me not feel well. I actually hope it is an infection and not autoimmune disease, because infection you can treat, autoimmune disorder you live with forever. But i feel strong enough that i can manage through :) Some days lately are tough, i get bad joint pains, and feel weak, have to take a nap. At work, i go out to my car on my lunch break and nap. I wish LaineyK i could help you. I know what you are going through and it is really tough. The biggest enemy is our own mind and trying to change how we perceive things and how we think. Breathing exercises help me. Also, if i have to do something, I don't put it off. If i put things off, I think about all the what if's that don't always make sense so that gives me anxiety. So if i do things right away then i don't have to think about them because it's done. Also, diet is big. I take a probiotic every day. I take multivitamins every day. I also take vitamin B-12 SL 1000 mcgs every day. I try to eat lots of healthy unprocessed foods and avoid carbs and fructose, and anything processed. That helps. I am trying to restore a normal flora level in my bowel. I don't feel strong enough to start exercising again just yet (and I don't want to lose any more weight). Do you have any hobbies? Like something that can keep you pre-occupied like sewing or something? that would be helpful. Also, just talking out loud to someone helps. Because for me, thoughts i have in my head actually don't sound so bad when I talk about them out loud to someone. Are you avoiding caffeine? And no alcohol, right? Yoga is good, too. Or, even if you just stretch, hold the pose, slowly inhale through your nose, exhale through your mouth, that helps. Stay active. Pick situations where you can go out in public and do things so that way you can prove to yourself you can do it. Like, sometimes i get anxiety waiting in line waiting to get to the cashier. But then i do it, and talk to the cashier, and then when i leave the store now i think "wow, i did it. Go me!!!". The zoloft helps with that. Takes the edge off. I wish i could offer more advice of things that help me so you can apply them. But it is a work in progress, you really have to work on it, even when you don't feel like it and have self-doubt. And remember, that's all it is, is self-doubt. So think of yourself like you are training yourself. Kind of like if you have a pet and you want to teach them tricks, you have to be your own trainer. I hope this helps! Let me know your progress through all of this, and i hope you have a better day today!!!

[livelaughlove]

and PS. yes, benzos can cause small bowel bacterial overgrowth in people susceptible. There is emerging research but does not appear to be in practice as of yet. I talk to so many patients every day, and the ones with a lot of bowel troubles, they are all on benzos and anti-depressants. If they go off their meds, they get dizziness and nausea and no one is telling them, it's a side effect of the medications. The more meds people are on, the more problems they seem to have. In the small bowel, it should not have bacteria. The bacteria (both good and bad) should only be in the large intestine, referred to as the colon. The small bowel is the duodenum, jejunum, and ileum. The small bowel is where nutrients are absorbed. If you have active inflammation, you get damage and don't absorb nutrients. If you take benzos, in people susceptible, it will slow the movements of the intestine and allow for possible stasis bacterial overgrowth, or motility dysfunction where bacteria that lives in the colon can get pushed back up in the small intestine where it should not live. I think a lot of people with insomnia, depression, nausea, belching, irritable bowel, anxiety, i think they have improper flora levels in their intestines and that is affecting them. It has to do with how the hypothalamus in the brain tells the intestines to move, and the brain-gut connection. I truly believe in this. I talk to so many people every day and based upon their symptoms, my theory just makes sense. It's better than just being told "take miralax and eat more fiber". I think people want specifics. And they want to be heard. My thoughts anyway, but i tend to think out of the box a lot LOL