Considering switching meds...

[BusuB]

I'm just so frustrated with my Zoloft right now.  I swear I have weeks/months where I feel great for the most part.  I have minor agitation as a SE but nothing I can't handle, but for the most part, the anxiety and depression is kept at bay.  However in the year I've taken it, it just seems so inconsistent.  I started at 100mg, did well for 5 months after startup, then plummetted.  Waited it out for a week and when I didn't improve, went up to 150mg.  The adjustment to 150 wasn't as smooth and began to experience more agitation but nothing I couldn't handle.  I did have to cut out my caffeine though as it just made me feel to jumpy.  At any rate, that change was made in August.  Been doing pretty good since then.  Had a couple rough days but for the most part but was feeling good up until about a month ago.  I posted here then about going through a rough patch due to the change in manufacturers (from Greenstone to Camber) and thought it resolved when I got back onto Greenstone.  I felt better after a couple weeks and had done pretty good until last Sunday.  I had a down day. Nothing horrible, and figured I'd be fine by the next day as usual.  Only now it's Thursday, and I feel worse.  I've started experiencing morning insomnia again and the agitation seems to be growing stronger where it becomes difficult to focus on work.  I'm not particularly feeling depressed (thank God), but I am certainly not enjoying life.  My lower back near my kidneys ache off and on.

I do have other things going on.  I just interviewed for another job on 2/14 and am still awaiting their decision.  I discussed this briefly with my pdoc over the phone who seems to think this spike might be related to that, but I don't think so.  It's not something that I ponder about so much and it's not a make or break type of deal.  If I don't get the job, I still have my current one.

At any rate... all of this has lead me to believe that the Zoloft is just not my drug.  I intend to discuss this with my pdoc at our appointment tomorrow, but I wanted to get some insight from some of you.  Am I jumping the gun?  Is it time for a change?  Is this the best I am to expect?  If I do make a change, I've been looking at the Celexa/Lexapro family.  How have you fared on that?  How will the change go?

So many questions.  This anxiety has me thinking at a 1000 miles a minute.

Thanks for listening to my ranting.

[insights]

Am I jumping the gun?  Is it time for a change?  Is this the best I am to expect?

No antidepressant is going to completely remove all anxiety or depression all the time. There will always be days when breakthroughs occur. This is life. Everyone bad days/weeks from time to time.

However, if it continues for more than a week or so then it could indicate that the antidepressant isn't up to the job at the current dose. Given that you do have good weeks too, I suggest you first try going to the maximum 200mg/day. Some need to be right at the dose limit to get a really good response, and a few need to go a bit beyond it. I've needed to be 10-25% over the maximum dose of nearly every effective antidepressant I've taken.

If Zoloft still doesn't work as well, as you'd like after 4-6 weeks at 200mg/day, the either Celexa or Lexapro would be at the top of my list. They have a proven record of working when other SSRIs have failed.

Ian

[BusuB]

Definitely something to discuss with the doctor.  After further discussion she suspected one of two things.  Strongly suspects that my body is just not tolerating that high a dose anymore or (much less likely) I'm exhibiting a sort of irritated hypomania.  She offered to write a rx for a mood stabilizer for the second possibility but I told her I'd wait as I don't particularly believe I have BPD, she did however give me the go ahead to reduce my dose to 75mg should I choose to to see if my condition improves.  Even if I don't improve this can also start a cross taper process should we choose to go another route.

[insights]

Strongly suspects that my body is just not tolerating that high a dose anymore

While it may be possible, I doubt it. I would have expected an intolerance to show up soon after you increased the dose and be continual. IMHO, your symptoms are more indicative of an inadequate dose, or the drug is beginning to pooping-out.  However, dropping back to 100mg should tell the tale. If you begin to feel better almost immediately and it keeps up for a few weeks then she's right. OTOH, if your anxiety goes through the roof, I might be.

Ian

[BusuB]

Saw the doc this morning and decided to make a switch to Lexapro and Neurontin if I think I need something to help with anxiety during the transition.  I had reduced my zoloft dose to 75mg last night with minimal positive effect.  Combine with the activating reaction I typically got from the zoloft any way lead us to this decision.  I start tonight, straight switch to 15mg/day. Wish me luck.

[insights]

and Neurontin if I think I need something to help with anxiety

A classic indicator of a benzophobic doctor.

Ian

[BusuB]

TBH, I have an atypical reaction to benzos.  My first dose of Xanax was actually precipitated my first-ever panic attack and there typically a dysphoric fallout afterwards.  Same happened with ativan anf klonopin.  She hasnt tried anything else except vistaril since.  Excessive alcohol does the same.