Zoloft increase

[ezratti]

Hi all - Short version of the story... OCD and depression (on and off) since childhood, added panic attacks to the mix in 1999. Self-medicated for about 4 years after that, then got sober. Since then been taking Zoloft 150 mg (100 in am, 50 in pm) and Seroquel 75 mg (25 three times daily). Been virtually symptom-free for eight years, save for a brief period when I went off the meds. Two weeks ago had a panic attack and subsequent anxiety/depression, which brought me right back to how I felt all those years ago. Went to PCP, who increased Zoloft to 200 mg (100 and 100) and Seroquel to 150 (50 three times daily). After four days, I felt better, and by last weekend was back to normal. Then yesterday, panic attack out of the blue, and today everything is surreal again and I am a mess. I know SSRIs can increase anxiety and depression before they improve them, but I figured I was past that point since I started to feel better. I am worried that Zoloft may have pooped out on me, and I'm dreading having to try something else. Just looking for anyone to share their experience with similar. Thanks.

[insights]

I am worried that Zoloft may have pooped out on me, and I'm dreading having to try something else.

While it may have, you've only been at the higher dose for 2 weeks so it is way too early to draw any conclusions. Give it al least another 2-3 weeks before hitting the panic button (no pun intended).

If Zoloft has quit then you could try adding a small dose of Buspar (buspirone) which will sometimes restore the effectiveness of pooped SSRIs, or switch to another antidepressant. Celexa (citalopram) and Lexapro (escitalopram) have gained a reputation as the SSRIs most likely to work after another has quit. I'd go with Celexa, mostly because of the wider dose range (they are essentially the same drug).

Alternatively, you could switch to a SNRI or tricyclic antidepressant (TCA). Both are less likely to poop-out than SSRIs. My recommendation would be the TCA imipramine. The TCAs are usually easier to get started on, and also to discontinue than the SNRIs, although this isn't guaranteed. Their downside is more potential ongoing side-effects such as dry mouth and constipation. These can be a nuisance but are manageable.

Ian

[ezratti]

Thanks for the reply, Ian.

Saw MD today. He feels that, given how long I've been on Zoloft, and the fact that I felt better and THEN worse after the increase, that it might be time to switch meds. I expressed my reservations about giving up on Zoloft too soon, before the dosage change was fully effected, which he said was valid, but he feels we would be having the same conversation in a year or two even if the increase worked for now. So we both agreed to do a change to Paxil. No tapering, just swapping them out and bearing through whatever side effects.

[ezratti]

I actually had some anxiety-free moments today, so I'm considering giving the higher dose of Zoloft a little longer. Curious for feedback from anyone with experience increasing dosages and typical timeframes for results. Thanks.