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Author Topic: Zoloft.. Paxil... Zoloft.... OH MY!  (Read 514 times)

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Offline bbxjr

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Zoloft.. Paxil... Zoloft.... OH MY!
« on: December 26, 2013, 01:30:05 PM »
This is my first post, and could really use some help!

I got started on 25mg of Zoloft 15 years ago for mild depression and mild anxiety. After being on it for about 1 year I was increased to 50mg. I was feeling great! About 5 years ago I decided to stop taking it. 1 year later I started having panic attacks and severe anxiety. I immediately started back on Zoloft but after a couple weeks I gave up and decided to try something different. I started Paxil 20mg, and after a couple months my panic attacks and anxiety subsided. But I felt the Paxil was causing several side effects (depression, mental fog, jaw clenching, and lack of emotion and motivation) that progressively got worse the time I was on it. Exactly 2 months ago I had enough! My physician and I decided it would be good for me to try Zoloft again since it worked so well in the past. I started Zoloft 25mg 8 weeks ago and increased to Zoloft 50mg 4 weeks ago. The first 3 weeks on 25mg and 50mg I had really bad anxiety, nausea, and overall digestive upset. The Zoloft 25mg did very little for my anxiety and panic attacks. Today, after 4 weeks on Zoloft 50mg, I still feel very anxious but I'm able to control my panic attacks.

I have lots of questions!

1. Is Zoloft a good choice for my anxiety and panic issues?
2. Will the Zoloft work as good as it did in the past?
3. Should I give the Zoloft 50mg a couple more weeks?
4. Should I increase to Zoloft 75mg or 100mg?
5. Should I give up and try something different?

Thanks in advance to anyone who replies!

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #1 on: December 26, 2013, 06:31:19 PM »
I started Zoloft 25mg 8 weeks ago and increased to Zoloft 50mg 4 weeks ago. The first 3 weeks on 25mg and 50mg I had really bad anxiety, nausea, and overall digestive upset.

These side-effects are typical startup side-effects of most antidepressants that inhibit serotonin reuptake. They tend to become more severe the more often antidepressants are stopped and restarted.

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The Zoloft 25mg did very little for my anxiety and panic attacks. Today, after 4 weeks on Zoloft 50mg, I still feel very anxious but I'm able to control my panic attacks.

The usual minimum therapeutic Zoloft dose to initate and sustain the brain changes Zoloft makes is 50mg. Taking sub therapeutic doses for extended periods may increase the odds of antidepressants popping-out in the future.

Quote
I have lots of questions!

1. Is Zoloft a good choice for my anxiety and panic issues?

No antidepressants is intrinsically better than any other, either generally, or for a specific disorder (OCD is an exception). However, one or two will likely be for you, however, there is no way of determining which they are except by trial and error.

Quote
2. Will the Zoloft work as good as it did in the past?

This is hard to say. There is growing evidence that the more often antidepressants are stopped and restarted the less effective they become with each cycle reducing the odds of any antidepressant working by 20% according to one study. You may need to take a higher dose than before and the initial side-effects may be more severe.

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4. Should I increase to Zoloft 75mg or 100mg?

If you need to for good results then yes. Most people take 100-150mg.

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5. Should I give up and try something different?

There is a very good chance that a higher dose will be effective, and it is the easiest option. The maximum recommended dose is 200mg, or 300mg with regular medical supervision, but there are a few people taking 400mg/day.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline DeLellis123

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #2 on: December 26, 2013, 07:54:20 PM »
This is exactly what happened to me with me. I was on 150mg of effexor for 6 years and for some stupid reason I decided to get off it. We'll about a month after my last dose I jumped back on it and experienced the same thing, my anxiety was unbearable. After that I've tried citalopram, Zoloft, and am currently weaning off paxil cause all I wanna do is sleep on it. I'm gonna try the effexor again, I'm a little nervous to restart it but I have klonopin to help. I'd do anything to feel the way i did on the effexor. I'd give a anything to have my life back, to be myself.
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Offline bbxjr

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #3 on: December 27, 2013, 12:24:33 PM »
Thanks so much for the information!

I'm still on Zoloft 50mg but debating on whether or not to increase this weekend. Would Zoloft 75mg be my best option or should I go straight to Zoloft 100mg? Is it better to take it in the morning, even though it might be inconsistent, or in the evening? I'm thinking morning, only because I would have more food in my system and hoping for less chance of digestive upset?

Ugh!
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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #4 on: December 27, 2013, 06:46:13 PM »
Would Zoloft 75mg be my best option or should I go straight to Zoloft 100mg?

Yes, it would produce less severe side-effects, though at the expense of taking longer to get to your target dose. Go up to 100mg after 7-10 days.


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Is it better to take it in the morning, even though it might be inconsistent, or in the evening? I'm thinking morning, only because I would have more food in my system and hoping for less chance of digestive upset?

Consistency is more important than the time of day. Zoloft has a relatively short half-life - 24-26 hours - so I actually think it better to take it in 2 divided doses morning and night. Doctors prefer their patients take it only once per day because with multiple dosing compliance becomes an issue.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline bbxjr

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #5 on: December 28, 2013, 01:11:42 PM »
I have been taking Zoloft 25mg at night and this morning I swallowed 50mg. About 1 hour later I had a jolt of energy that I'm still trying to burn off.

I just feel stupid for coming off the Zoloft in the first place, and now I'm starting to feel stupid for coming off the Paxil. Whatever side effects I had on Paxil seemed better than dealing with all this! I just hope the Zoloft will work as good as it did in the past!

I read somewhere that Zoloft 50mg is equal to Paxil 10mg? I know that Paxil 10mg wasn't enough and Paxil 20mg may have been too much. So would that mean that Zoloft 75mg would be the amount that I need? Are they that similar?


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Offline Abraham2007

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #6 on: December 28, 2013, 01:43:08 PM »
I read somewhere that Zoloft 50mg is equal to Paxil 10mg? I know that Paxil 10mg wasn't enough and Paxil 20mg may have been too much. So would that mean that Zoloft 75mg would be the amount that I need? Are they that similar?

You should go up to 75mg on Zoloft(Setraline).  When you restarted at 50mg a year ago, after a five year break, the 50mg wasn't enough to manage your anxiety, as it did previously, so you will need a higher dose to get the previous effect.  Also when users start and stop antidepressant usage, the next attempt usually requires a higher dosage than before.

Quote
The first 3 weeks on 25mg and 50mg I had really bad anxiety, nausea, and overall digestive upset. The Zoloft 25mg did very little for my anxiety and panic attacks. Today, after 4 weeks on Zoloft 50mg, I still feel very anxious but I'm able to control my panic attacks.

Your body seems very sensitive to dosage increases.  If you jump from 50mg to 100mg, you maybe shocking your system, as if you were struck by lightning, so I don't recommend that big of a jump.  It may be too painful, until your brain adjusts.  If you go to 75, you'll feel an extra charge, but not quite as strong as 100mg.

Since I'm on Zoloft (Setraline) as well, and also have an anxiety disorder like you, I would take smaller increments at 12.5mg (half a 25mg pill)  with a jump every 7/10 days, until I get to the dose of 75mg.   I would stay at 75mg for a few weeks, and then decide if I should go up to 100mg, with the advice of my doctor.
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Offline bbxjr

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #7 on: December 28, 2013, 04:12:29 PM »
Thanks for the information!

I do feel that my body is very sensitive to these medications and takes longer than normal to adjust. At this point, I'm going to wait and see how the Zoloft 75mg treats me over the next couple weeks, but I'm thinking it might be where I need to be. I'm afraid Zoloft 100mg might produce similar side effects to the Paxil.

I was obviously younger 5 years ago and weighed probably 30 lbs less than I do now, would that have an affect on how many mg I need?

Do you find that Zoloft works well for your anxiety and what dose are you on?

 
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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #8 on: December 28, 2013, 10:06:41 PM »
I read somewhere that Zoloft 50mg is equal to Paxil 10mg?

No, Zoloft 50mg is generally about equivalent to 20mg Paxil, but some may require a little less or a little more due to invididual variations in how the meds are metabolized.

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I know that Paxil 10mg wasn't enough and Paxil 20mg may have been too much.

Paxil 10mg is a sub therapeutic dose, however, there is no such thing as too much of an antidepressant as long as it's within the recommended range. They have no direct effect, but work by encouraging the growth of new brain cells. This requires a certain amount of the drug to initiate and sustain, but taking, say, twice as much doesn't provide twice the response, though twice as much may be needed if stress levels greatly increase. The extra is simply ignored. In those without an anxiety disorder or depression antidepressants have no significant positive effects, though some side-effects may still occur.

Similarly, the effect of SSRIs on serotonin synthesis and expression only occurs if there is an excess of the neurotransmitter. SSRIs reduce serotonin levels in rats with a genetic susceptibility to anxiety to levels seen in untreated controls, but levels remain the same in treated controls. The same also occurs with norepinephrine and dopamine levels with tricyclic antidepressants and SNRIs (some SSRIs also marginally affect norepinephrine and dopamine indirectly) - Zangen A, 1997; Zangen A, 1999.

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I was obviously younger 5 years ago and weighed probably 30 lbs less than I do now, would that have an affect on how many mg I need?

No, weight makes little difference. Child doses are much the same as for adults. Age may become a factor late in life as the elderly tend to metabolize drugs more slowly.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Abraham2007

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #9 on: December 29, 2013, 10:27:28 AM »
I was obviously younger 5 years ago and weighed probably 30 lbs less than I do now, would that have an affect on how many mg I need?

Do you find that Zoloft works well for your anxiety and what dose are you on?

As Insights mentioned, weight does not affect Zoloft (Setraline)mg use. 

Excess weight, however, is often the result of a prolonged depression.  For anxiety disorder sufferers, like myself, the uncontrolled anxiety leads to depression, due to the feeling of powerlessness from the uncontrolled anxiety.  When stabilized on a SSRI/trycyclic, like Zoloft (Setraline), we can better control the anxiety, and feel more motivated to do things, such as go to the gym, exercise for 45 minutes at least three to four times a week, and choose healthier food choices, which would all lead to the reduction of the excess weight.

I take 175mg Setraline (Zoloft).  Without it, I would have a difficult time to manage my anxiety, since my life mandates a lot, such as working a full time job, paying off a mortgage/car, working a side business, pursuing a second degree, managing family. etc.  I've found it's easier to accomplish these things, with Zoloft(Setraline), than without.  I will probably raise my intake of Setraline (Zoloft), later, based on what my future psych doctor and I discuss, since I'm planning to change doctors.

Do note, 200mg is the recommended, max dosage level of Zoloft (Setraline), however this forum has mentioned that some have successfully went higher to 300mg, under the supervision of a doctor, but normally these people are the type who stay on antidepressants long term, instead of a temporary measure.  Also note that higher dosages do not imply that a person is emotionally challenged to need pills in order to live their lives, instead it's more to activate the brain for neurogenesis, since lower dosages may not force the brain to completely regenerate itself around the hippocampus.

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Offline bbxjr

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #10 on: January 07, 2014, 05:03:48 PM »
Ugh! I'm SO frustrated!

I'm at 11 days on Zoloft 75mg and still experiencing anxiety and panic attacks. The biggest annoyance right now is how "upset" my digestive system is. Does it get worse as you go higher in dose? Will it go away? Should I increase to Zoloft 100mg?

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #11 on: January 07, 2014, 06:36:41 PM »
Ugh! I'm SO frustrated!

I'm at 11 days on Zoloft 75mg and still experiencing anxiety and panic attacks.

Unfortunately, it may be a few weeks yet before the Zoloft kicks-in. There isn't really any way of speeding this up. Discuss this with your doctor and ask for a benzodiazepine to ease you through this rough patch. If /she's a benzophobic, the antihistamine hydroxyzine is usually a reasonably effective alternative.

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The biggest annoyance right now is how "upset" my digestive system is. Does it get worse as you go higher in dose? Will it go away? Should I increase to Zoloft 100mg?

In most cases the impact on the GI tract is temporary, however, it may return for a while each time you increase the dose. Personally, I would go up to 100mg, but you need to discuss this with your doctor.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline bbxjr

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #12 on: January 13, 2014, 02:18:41 PM »
I'm still taking 75mg. The anxiety has gotten better, but it's still there in certain situations. My digestive system is still "upset" and I'm starting to experience some similar side effects that I had while on Paxil 20mg, such as jaw clenching and just an overall feeling of not feeling well. I'm afraid if I increase to the Zoloft 100mg the side effects are going to be the same as Paxil 20mg. I felt "normal" on Zoloft 25mg and 50mg, and also on Paxil 10mg. But, my anxiety was out of control. My question is, can I go back to Zoloft 50mg and take another "daily" medication to treat the anxiety level from reaching a certain point? I have Xanax .25mg, but I don't want to be on that everyday! My primary doctor mentioned to me "beta-blockers" at some point, but I don't have that racing feeling when I'm in a panic attack. It's mainly just the feeling of not being able to catch my breath, dizziness, and nausea.

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Offline Abraham2007

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Re: Zoloft.. Paxil... Zoloft.... OH MY!
« Reply #13 on: January 13, 2014, 05:32:48 PM »
I'm still taking 75mg. The anxiety has gotten better, but it's still there in certain situations. My digestive system is still "upset" and I'm starting to experience some similar side effects that I had while on Paxil 20mg, such as jaw clenching and just an overall feeling of not feeling well. I'm afraid if I increase to the Zoloft 100mg the side effects are going to be the same as Paxil 20mg. I felt "normal" on Zoloft 25mg and 50mg, and also on Paxil 10mg. But, my anxiety was out of control. My question is, can I go back to Zoloft 50mg and take another "daily" medication to treat the anxiety level from reaching a certain point? I have Xanax .25mg, but I don't want to be on that everyday!
My advice would be No.  If you go back to 50mg, you will be at a very low therapeutic dose for Zoloft (Setraline).  For someone with an anxiety disorder, especially for someone like yourself who's been getting frequent panic attacks, you should be on a dose between 100mg to 150mg.  If you go lower (like 50mg) than the average mean, you won't get the full effect of the medication.

If you want to take another "daily" medication, a doctor would recommend a benzodiazepine, such as Xanax.  The daily dosage for Xanax is about .5mg, and you could take two(.25mg) in order to get that dosage amount, while your body adjusts to the Zoloft, and gets jittery.  The Xanax will calm you down, during this jittery phase. 

Do note, that Xanax has a very short half life, and that is why it works faster and quicker than the other benzodiazepines.  If you want to be on a benzodiazepine that lasts in your system longer, without a need to take Xanax regularly during your day, you may want to swtich to a benzodiazepine like Klonopin (Clonazepam), with your doctor's approval, due to it's longer half life.  You could then develop a more adaptable tolerance to any anxiety symptoms, since you have the Klonopin to calm you down, while the Zoloft is still working in your system.

You'll be able to wean yourself off the Xanax, once the Zoloft gets more settled in your system, so don't feel you'll be on Xanax the rest of your life.  You're only taking it temporarily.

Beta blockers control the physical symptoms of anxiety, like higher heart palpitations, however it's better to be on a antidepressant long term, since the antidepressant medication rebuilds your brain from its previous atrophy due to psychological stress, which beta blockers don't .


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