Advice with Zoloft and Klonopin, long story...

[MamaDon08]

Hi everyone,

I'm new to AnxietyZone, although I've read many posts looking for information over the years. I feel it's time to jump in and put myself in the conversation and look for advice and knowledge from other people with experience on these meds, and also experience with the life that is one of an anxiety sufferer.

My story is a bit long, but hopefully someone takes the time to read it. I started Zoloft for the first time in October 2009 during my first pregnancy at 19 weeks. I had been taking klonopin 0.5mg once or twice a day prior to getting pregnant, and quit it cold turkey when I found out I was pregnant. I have been off an on klonopin since my first panic attack in 2004. My OB put me on Zoloft 50mg during this pregnancy because I literally was losing it. I even asked to have myself committed. It was horrible. My anxiety was debilitating and I was borderline agoraphobic. I could not bear to be alone at times and could not even walk to the back of the grocery store. The first 4/5 days on Zoloft were terrible with nausea and panic, but I was able to take Zofran and low dose Klonopin to counteract these symptoms and eventually the Zoloft did kick in and help. I continued on the Zoloft at 50mg and klonopin 0.25mg as needed through my pregnancy and after (Yes, my son is perfectly fine. The benefits of taking the Klonopin definitely outweighed the risks and I was closely monitored by my specialist as I was already high risk. He just turned 3 and is brilliant!) until I got pregnant again in November 2010. My first son was 9.5 months old. I immediately stopped the Klonopin again, and eventually stopped the Zoloft too. My OB said maybe my hormones swung the other way during my second pregnancy because I was the polar opposite of the first time. I did take klonopin maybe 3 or 4 times in my last trimester of that pregnancy but didnt start the Zoloft back. My 2nd son was delivered early at 36 weeks due to placenta complications and it was an emergency c-section and a very traumatic experience where I was quite ill afterwards. I was sick and dizzy and felt like I was "out of my head" and miserable for my first 6 weeks postpartum and even though I was back taking my klonopin twice a day I finally realized my misery was anxiety and I started the Zoloft at 50mg again. I honestly don't remember if I had the same start up side effects that time or not, but I also had a 17 month old and 6 week old and husband who, as much as he tries, doesn't really understand anxiety and psychosomatic symptoms. When my youngest was about 4 months old I asked my Dr to up my dosage because I just felt like I was not coping like I should be, too irritable with my kids, etc. He moved me up to the 100mg dose and again I don't recall the side effects but do know that the dose increase seemed to be my perfect dose. I was able to back off the Klonopin to just 1/2mg every 3 to 7 days, or less. The Zoloft was doing the trick. And then we found out in July of 2012 that I was pregnant for the 3rd time. Again, off the Klonopin totally, and ended up off the Zoloft again too. I did really well managing my anxiety again without meds. It seemed my hormones were in my favor again this time.

And here is where it gets complicated and difficult to even talk about. All of my pregnancies were high risk from the beginning and this one was no different, except this was our baby girl! We had a scare at 20 weeks when we were referred to another specialist because they thought she might have a chromosomal abnormality, but everything turned out fine. Then she wasn't growing at quite the right rate and I was closely monitored twice a week throughout the pregnancy due to her growth and other complications. I can't go into details due to possible pending legal action, but our daughter was stillborn on February 22, 2013 at 36 weeks and 3 days. She was absolutely perfect, 4lbs 12oz and 17.5 inches. That was a Friday afternoon. Needless to say my dr started me back on Zoloft and Klonopin by Sunday night, the 24th. I started Zoloft at 25mgs at bedtime and Klonopin 0.5mg twice a day. I did have some pretty serious nausea and diarrhea and increased anxiety for the first week or so, and then I increased on March 8 to 50mg at bedtime. I was doing great at this dose until about 3 days ago. I did miss one dose because I actually ended up admitted back to the hospital for a D&C last Wednesday. I actually had the procedure Thursday morning and was back home Friday afternoon. I have noticed since Saturday that my anxiety has been over the top, even with taking the Klonopin 0.5mg two or three times a day. I don't know if the Zoloft at 50mg just isn't enough or if the side effects of increasing the dose are just hitting me 7/8 days after the increase or what? I am miserable.

The past 3 1/2 weeks have been the hardest of my life. My precious daughter was stillborn, I hemorrhaged and had to have a D&C, and I'm struggling to feel mentally same enough to even be able to start grieving and processing my loss. I've had to focus so much on my physical health and trying to get healthy again after the complications from delivery, and I'm battling hormones that don't realize I don't have my baby and anxiety that seems uncontrollable at times. I was really, really starting to feel "better" on the meds until I got home from the hospital this last time. I honestly think the trauma and terror of the hemorrhage and then having the D&C set off my anxiety to a whole new level. I live an hour from the hospital, so I think the fear of something else happening definitely contributes to my anxiety, plus I'm a stay at home mom with my two boys and I worry what would happen to them if something happened to me, and I find myself now obsessing over crazy things like what if I got a blood clot from surgery or what if I have a clotting disorder...a million thoughts a minute that I can't turn off. It's horrible. I'm OCD as well, so that helps none.

My big question is what to do about my medications. I know I'll never be the same again emotionally. I can never have my daughter back, and I've had to endure things like final arrangements and giving birth to my sweet girl who never breathed, and so much more. I don't expect to be happy or normal. I just really need help getting to a point where I can function and have such debilitating anxiety and obsessive thoughts. Do I need to give the Zoloft more time at 50mg, or go ahead and up to the 75mg, which my dr has given me the ok to do? The past 3/4 days I've woken up jittery and literally shaking at times, my head feels full and heavy, I get bouts of tingling in my feet and legs, hands, face, I have waves of pure terror hit me out of nowhere, hot flashes, nausea, diarrhea, cold chills, feeling like my heart is racing, slight headaches, obsessing over small details about my health- the works. Even with the Klonopin. And my long term goal is to be basically off the Klonopin with the right Zoloft dose, but right now there's no way I can go off the Klonopin. Also, I'm taking Zantac 150 twice a day now because the Zoloft is causing me stomach pain and excess acid, but I'll deal with that if I can get my anxiety under control.

I really need to get my life back because I have two little boys to care for and a daughter to mourn and so many hard things to come that I know I can't face on my own, like taking down her nursery and canceling Easter pictures and seeing friends give birth to their little girls. I know there's no miracle drug for these things but I'll take all the help I can get right now. I don't understand because I remember Zoloft being such a wonder drug the last two times I started it, and I really need that now too. Any advice is greatly appreciated. I just need to know that it will get better again like it did before so I can be "normal" enough to start dealing with my life instead of obsessing over things I can't control and being in a constant state of panic.

Thank you for reading my very long history and thank you for any experience or advice you can share.

[insights]

My condolences on the loss of your daughter. That is tough. 

As you needed to go to 100mg once before this is probably going to be your lowest effective dose. But you may need more. There is growing evidence that the more often an antidepressant is stopped and restarted the less effective it becomes. The startup side-effects can also be more severe and/or different each time too. You are also almost certainly under far more stress than you have ever been before so may require a stronger dose to regain adequate control. My guess, and I stress the guess, is that you will probably need 150mg for a while, plus the Klonopin at least for the next month or so. 

You could try supplementing the Zoloft with Buspar (buspirone). It is an anxiety drug that frankly doesn't do much for most, however, it has been found to sometimes restore the effectiveness of SSRIs which have stopped working. I'm not suggesting Zoloft has, but the Buspar may give it an extra boost. It has few if any side-effects and takes 1-2 weeks to kick-in.

Final point, losing a baby must be the most painful thing a mother could ever go through, but don't despair. You will be happy again. It is going to take time and there will always be moments when the loss will hit you again, but it does get better and you can and will have a happy, contented life.

Best wishes

Ian