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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by PrettyLady on February 18, 2013, at 17:19:55
Hi all,
So I started 25 mg of Zoloft about a week and a half ago.
1st week: started to come out of depression, little addition of energy, little less anxiety
2nd week: upped to 50 mg and after a couple days, anxiety increased a lot.
I'm still not where I want to be with the depression, so I was wondering if the increased anxiety I am getting is a "startup symptom" ? Has anyone had this experience, will it go away? I don't talk to the doctor for another couple days.
Thanks everyone!
Posted by Phillipa on February 18, 2013, at 18:33:38
In reply to Zoloft Anxiety at first?, posted by PrettyLady on February 18, 2013, at 17:19:55
Sounds like maybe sticking at the 25mg for a while longer would help since you say it was helping both depression & anxiety? Phillipa
Posted by CamW on February 18, 2013, at 20:20:56
In reply to Zoloft Anxiety at first?, posted by PrettyLady on February 18, 2013, at 17:19:55
Yes, increased anxiety is a start-up side effect of all the SSRIs. Your body just has to adjust to the increase in availability of serotonin, by down regulating some of the extra post-synaptic serotonergic receptors.
People who take SSRIs for panic disorder almost always experience an increase in panic attacks when starting the SSRI. This is why many doctors give a week or two of benzodiazepines to help decrease the increased anxiety. After the couple of weeks, the incidence of panic attacks significantly decrease & even stop.
The anxiety usually last only a week or two, but seldom persists as long a 4 weeks.
Hang in there, the anxiety will pass.
I hope that this is of some help.
- Cam
Posted by PrettyLady on February 18, 2013, at 20:25:46
In reply to Re: Zoloft Anxiety at first? » PrettyLady, posted by CamW on February 18, 2013, at 20:20:56
Thank you both for your responses. I think I'm going to stick with the 50 mg dose and see how it goes. I still have a lot of room for improvement with both the anxiety and depression, and SSRIs have worked for me in the past. I will report back as things change.
I am also taking 7.5 of Remeron at night to sleep.
Hope this works!
Posted by jono_in_adelaide on February 18, 2013, at 20:38:17
In reply to Zoloft Anxiety at first?, posted by PrettyLady on February 18, 2013, at 17:19:55
This is very common
You have two options, one being grit your teeth and bare it till it passes, the other is to ask your doctor for a script for a benzo or some Atarax for a week or 10 days to cover the start up period.
Ativan 1mg twice a day, or Atarax 50mg three times a day would both be good choices.
Posted by PrettyLady on February 18, 2013, at 20:38:52
In reply to Re: Zoloft Anxiety at first? » PrettyLady, posted by CamW on February 18, 2013, at 20:20:56
p.s. Cam- could you explain this process a little more/why it makes you feel more anxious? I feel more amped up, it's weird. Is that the dopamine? Thanks!
Posted by SLS on February 18, 2013, at 21:05:13
In reply to Re: Zoloft Anxiety at first? » PrettyLady, posted by CamW on February 18, 2013, at 20:20:56
> Yes, increased anxiety is a start-up side effect of all the SSRIs. Your body just has to adjust to the increase in availability of serotonin, by down regulating some of the extra post-synaptic serotonergic receptors.
That's a very concise explanation. Very nice.
> People who take SSRIs for panic disorder almost always experience an increase in panic attacks when starting the SSRI. This is why many doctors give a week or two of benzodiazepines to help decrease the increased anxiety. After the couple of weeks, the incidence of panic attacks significantly decrease & even stop.
Which drugs do you feel are most effective for panic disorder? In another era, imipramine was considered to be the reference drug for this indication. Would Effexor be more effective than Zoloft? Is Paxil the most efficacious SSRI for panic disorder? How do you rate Lexapro for PD?
> The anxiety usually last only a week or two, but seldom persists as long a 4 weeks.
Interestingly, when used to treat depression, Lexapro often will not produce anxiety until day 14. Thereafter, anxiety can exist for 2 to 7 days before subsiding. Do you have any ideas as to why this might be?
I consider the information and insights you bring to Psycho-Babble to be invaluable. I have missed your contributions. You are in a unique position to observe real-world outcomes in the treatment of mental illness along with the prescribing practices of physicians. I particularly admire your ability to remain objective, even when fools like me challenge your conclusions. You have a gentle way about you that is particularly nurturing and accessible.
I have more questions for you. I hope you stick around for awhile.
- Scott
Posted by CamW on February 18, 2013, at 21:05:29
In reply to Re: Zoloft Anxiety at first? » CamW, posted by PrettyLady on February 18, 2013, at 20:38:52
> p.s. Cam- could you explain this process a little more/why it makes you feel more anxious? I feel more amped up, it's weird. Is that the dopamine? Thanks!
The following may not be the full story (I have been out of psychiatry for a decade), but here goes:
During certain forms of depression, a side effect of the depression is decreased serotonin neurotransmission, The post-synaptic neurone tries to adjust for this by producing more serotonin receptors, to try to bind as much serotonin as possible to trigger an action potential in the post-synaptic neurone, & keep the electrical signal going on to the next neurone.
Ingesting an SSRI blocks the re-uptake of serotonin into the presynaptic neurone, in essence increasing the amount of serotonin in the gap between neurones that can bind to the post-synaptic receptors. This flooding of serotonin & the resultant increase in serotonin neurotransmission may be a cause of the anxiety.
The body begins to down-regulate (get rid of) the excess post-synaptic receptors, which takes a couple weeks or so. This returns the serotonergic transmission to "normal" levels, thus getting rid of the SSRI-induced anxiety, as well.
Now, I would like Scott or Larry Hoover (or others) to comment on my answer, as the explanation may have changed over the years, & I'd hate to give erroneous or incomplete information.
I hope that this is of some help. - Cam
Posted by PrettyLady on February 18, 2013, at 21:12:33
In reply to Re: Zoloft Anxiety at first? » PrettyLady, posted by CamW on February 18, 2013, at 21:05:29
Cam: So, are you saying that the SSRI is causing some of my serotonin receptors to die off? Is this why, after 14 years of antidepressant use, durring the 8 month break I took from antidepressants I was more depressed than when I ever started them?
I'm not trying to be negative, I'm just trying to understand. The antidepressant will still work now, right? Or did I lose too many receptors from the past antidepressant use?
Posted by CamW on February 18, 2013, at 21:29:06
In reply to Re: Zoloft Anxiety at first? » CamW, posted by SLS on February 18, 2013, at 21:05:13
Scott - I have found that Paxil (paroxetine), with it's anticholinergic effects to be the most effect med for panic disorder. Unfortunately, the anticholinergic effect causes carbohydrate cravings, with it's resultant weight gain.
As for Lexapro (escitalopram), it is being prescribed quite extensively. While I think that it "may" be a more effective antidepressant than Celexa (citalopram), I would only recommend them being used for mild, "reactive" depressive disorders, unless used in combination with or mood modifiers. I find Lexapro & Celexa to be too "clean" as medications. They selectively bind to the serotonin re-uptake receptor & little else. I find that side effects (like the anticholinergic effects of Paxil), can be useful in treating various psychiatric disorders.
NOTE: The last paragraph is based on my "feelings" & "observations", I have NO scientific literature to back up my claims.
>Interestingly, when used to treat depression, Lexapro often will not produce anxiety until day 14. Thereafter, anxiety can exist for 2 to 7 days before subsiding. Do you have any ideas as to why this might be?
See, this throws out some of my answer in my second post to PrettyLady. There is probably a legitimate explanation & may have to do with secondary binding effects of the other SSRIs. These side effects may mask, or slow down, the turnover of the post-synaptic receptors, but again, I have to proof. This is just speculation.
Forgive me buddy, but I am not the font if knowledge that I once was.
As I once relayed to you in an email; you are one of the few people that I would trust with my life. Your opinions and critiques of my answers are much appreciated.- CamP.S. We will again get into some of those deep philosophical discussions regarding what depression really is (in our "opinions", of course). - C.
Posted by CamW on February 18, 2013, at 21:40:33
In reply to Re: Zoloft Anxiety at first? » CamW, posted by PrettyLady on February 18, 2013, at 21:12:33
> Cam: So, are you saying that the SSRI is causing some of my serotonin receptors to die off?
"Die off" may be too harsh a term. The post-synaptic serotonin receptors (those receiving the serotonin for the presynaptic (sending) neurone to carry the electrical signal on down the line of neurones. The excess post-synaptic receptors are no longer needed & just resorb into the body.
> Is this why, after 14 years of antidepressant use, durring the 8 month break I took from antidepressants I was more depressed than when I ever started them?
A couple of things could be happening. Fairly often, after stopping, then restarting an SSRI, the SSRI, for some reason, seems to take longer to elicit an antidepressant effect. In others, a change in SSRIs is required, as the original antidepressant no longer seems to work. I really do not know why this happens, but it does.
>
> I'm not trying to be negative, I'm just trying to understand. The antidepressant will still work now, right? Or did I lose too many receptors from the past antidepressant use?It is not the loss of receptors causing this phenomenon. The body can remake, or reduce. those receptors fairly easily, in most cases. It may take 4 to 6 weeks to see a significant antidepressant effect upon reintroduction of the old SSRI.
I hope that this is clear; I know I tried to put a lot of info into a limited space. - Cam
Posted by PrettyLady on February 18, 2013, at 21:45:46
In reply to Re: Zoloft Anxiety at first?, posted by CamW on February 18, 2013, at 21:40:33
Thanks a lot for taking the time to respond. I haven't taken this medication, Zoloft in, a few years, so I think it should work again. I had stopped it and restarted it before and it always worked, but in the past I had been also on an antipsychotic. This would explain why now I am feeling this startup anxiety that I never felt before. I'm on less stuff and more aware of the side effects. Thanks again.
Posted by CamW on February 18, 2013, at 21:51:48
In reply to Re: Zoloft Anxiety at first?, posted by PrettyLady on February 18, 2013, at 21:45:46
Posted by Phillipa on February 19, 2013, at 20:48:09
In reply to Re: Zoloft Anxiety at first?, posted by CamW on February 18, 2013, at 21:40:33
Cam correct me if wrong but I was a psych RN and gave the groups at night. We would discuss how the SSRI's worked. I used to compare it to a spaceship landing on the receptor and the receptor would keep it grounded so to spreak so the receptor would suck up the serotonin. When it was completed it the SSRI would then exit. So now there was a soaked in serotonin synapse of receptor site.
I did always feel that once the receptors got used to being "given" extra serotonin that the receptor didn't make as much on it's own. Hence why poop out might occurr. Am I close? Phillipa
Posted by CamW on February 20, 2013, at 11:18:19
In reply to Re: Zoloft Anxiety at first? » CamW, posted by Phillipa on February 19, 2013, at 20:48:09
> Cam correct me if wrong but I was a psych RN and gave the groups at night. We would discuss how the SSRI's worked. I used to compare it to a spaceship landing on the receptor and the receptor would keep it grounded so to spreak so the receptor would suck up the serotonin. When it was completed it the SSRI would then exit. So now there was a soaked in serotonin synapse of receptor site.
>
> I did always feel that once the receptors got used to being "given" extra serotonin that the receptor didn't make as much on it's own. Hence why poop out might occurr. Am I close? PhillipaPhillipa - I hadn't thought of it that way. I really had struggled as to why poop-out occurred. I do remember somewhere that serotonin levels were the same before & after poop-out. It could be that the post-synaptic receptors (which I believe also did not change in concentration) become less sensitive to the serotonin.
I'm sorry, I don't have an answer for that. Maybe Scott or Larry Hoover, or other brainiac here might know. I can't seem to recall any good explanation.
- Cam
Posted by Kenda Livingston on February 21, 2013, at 16:57:11
In reply to Zoloft Anxiety at first?, posted by PrettyLady on February 18, 2013, at 17:19:55
> Hi all,
> So I started 25 mg of Zoloft about a week and a half ago.
> 1st week: started to come out of depression, little addition of energy, little less anxiety
> 2nd week: upped to 50 mg and after a couple days, anxiety increased a lot.
> I'm still not where I want to be with the depression, so I was wondering if the increased anxiety I am getting is a "startup symptom" ? Has anyone had this experience, will it go away? I don't talk to the doctor for another couple days.
> Thanks everyone!******************
the first two weeks i took zoloft the anxiety was so bad i almost couldnt stand it. i couldnt eat and was beyond anxious/afraid-feeling. After about two weeks - voila! that went away and i never felt better. No antidepressant ever made me feel that well, but had I not been desperate for antidepressants to work I would have stopped taking it. I would take xanax with it the first two weeks if i had to do it again. good luck - you are almost to the good part
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