Should I change antidepressants?

[random_woman]

I started Sertraline (Zoloft) 2 weeks ago because of derealization, anxiety and panic attacks. (First week 25 mg, second week at 50 mg, and today starting with 75 mg.) I have been absolutely shocked by how hard it has been starting with Sertraline, because of initial side effects of deperzonalisation and anxiety, but I have noticed a change for the better. It has had some effect on my anxiety and I have not had any panic attacks this past week. The derealization is unchanged, but I am not as scared by it any more, and that helps me to "feel normal".

I have gained about 3 pounds these 2 weeks and I am worried that I will continue to gain weight because my appetite is significantly increased and my energy is low. I have been bulimic and depressed in the past and Fluoxetine (Prozac) has been a great medication for me. It decreased my appetite and made me feel better about myself.

Should I ask to switch from Sertraline to Fluoxetine right away or should I stay on Sertraline for as long as I can manage and see how I feel even if it means gaining some pounds? I am concerned about gaining weight, but the most important thing is that I can function well enough to work, which I can do right now. I am very scared that changing medications will make my anxiety and derealization worse. But in the long run I can not possibly stay on a medication that increases appetite. I know that when I start to feel good again I will think about this a lot. I am scared that if I increase Sertraline to 100 mg in the following weeks tapering of it will be hell and that I will have to be on it for a long time, gaining weight, feeling tired and not being productive at work. I'm scared of my body getting used to it. Perhaps if I change now then it would be easier.

My favorite antidepressant is Bupropion (Voxra, Wellbutrin), but I understand that since I have developed anxiety it might not be working for me right now. It used to make me productive, positive, decrease my appetite and increase my libido. My pdoc had me stop it because she thought it might be causing the derealization and I miss it a lot, but since I stopped it I have developed anxiety and now I am to scared to try it again. Having panic attacks with persistent derealization is in lack of better words; a nightmare.

List of things that I am scared of:
In order of most to least scary

1. Panic attacks
2. Increased anxiety
3. Increased derealization
4. Gaining weight
5. Being tired and non-productive
6. Not feeling like doing anything

Any input would be greatly appreciated!
 

[saintalto]

You really need to give meds a lot longer than 2 weeks before you form an opinion about how effective they are.

[random_woman]

You really need to give meds a lot longer than 2 weeks before you form an opinion about how effective they are.

But don't you think my appetite will increase with dose? It's not that Sertraline doesn't work, it's this side effect that freaks me out.

[KnickNak]

Can i ask why you stopped the Prozac? i am currently on it right now.. 

[random_woman]

Can i ask why you stopped the Prozac? i am currently on it right now.. 

Decreased libido and ability to orgasm. My tdoc suspected that I might have adhd and my pdoc thought that Wellbutrin would benefit me because of my "adhd personality". It did. 

[melissaw72]

Is your pdoc working with you on changing meds?

Also, you won't know what will happen (side effects) until you try taking it again.  And if/when you do, I'd give the med 6-8 weeks to see if it is working or not.

[CirclesOfConfusion]

I've always been told by both docs and peers to give new meds at least 6-8 weeks to settle into a "steady state" blood/brain concentration before we can really evaluate what it is or is not doing.  The exception being obvious allergic reactions or other unquestionably severe problems.

2 weeks is not nearly enough time for your body chemistry to have adjusted to the presence of a new medication and allow any sustained benefits or side effects to clearly identify themselves.  If you want sustained benefits you also have to be patient with sustained trial periods.  A lot of meds are known to commonly produce temporary start-up side effects that can subside or even completely go away when given enough time to figure out and then settle into the most ideal dose for you as an individual.  If you don't give it a chance to get past that uncertain start-up period then you'll never really know enough about it's effects on you as an individual to make a fully informed decision about that med.

For example, there is one med that gave me a couple hours each day of brain zaps; which meant hours of lightheadedness and the sensation of electrical jolts to the head several times a minute.  It took a few months before that subsided to a less distracting, less alarming, and more easily tolerable level.  The brain zaps finally went away when an unrelated decision to change the dosage of a different medication happened several months later.  Eliminating brain zaps was an unexpected benefit of that change.  Now I have zero detectable side effects from the med that caused the daily brain zaps.  But it took over a year of uncertain fiddling and patience and some luck before that happened. 

We're all different.  We all experience each med differently from each other.  Unfortunately the reality we live in is that we are each our own personal beta-test guinea pig and apparently that will probably not be changing anytime soon.  The only way a med is guaranteed NOT to work is to never follow through with your doc's recommended trial period.  But nobody can guarantee what will work well for you.

You never know what will or will not work specifically for you until you give it an honest, good-faith try. 

[crazyguy]

I've always found Sertraline to be quite weight neutral -  it did make me crave sugar and carbs but I found I also had a reduced appetite so overall it balanced out.  

I always think that unless someone has intolerably severe side-effects it really is best to stick it out for 6 to 8 weeks; otherwise the risk is hopping from med to med and getting all those side-effects but never giving it enough of a chance to see if it has any benefits.  

Then again if Fluoxetine worked for you before it seems odd that you would not try that as the first line of attack? 

 

 

[random_woman]

Is your pdoc working with you on changing meds?

Also, you won't know what will happen (side effects) until you try taking it again.  And if/when you do, I'd give the med 6-8 weeks to see if it is working or not.

If I tell him that I want to change meds right now he would probably not recommend it.. When we spoke I was feeling hopeful and thought that it would be wise to give Sertraline a try, but then I came home and started freaking out. 

I've always been told by both docs and peers to give new meds at least 6-8 weeks to settle into a "steady state" blood/brain concentration before we can really evaluate what it is or is not doing.  The exception being obvious allergic reactions or other unquestionably severe problems.

2 weeks is not nearly enough time for your body chemistry to have adjusted to the presence of a new medication and allow any sustained benefits or side effects to clearly identify themselves.  If you want sustained benefits you also have to be patient with sustained trial periods.  A lot of meds are known to commonly produce temporary start-up side effects that can subside or even completely go away when given enough time to figure out and then settle into the most ideal dose for you as an individual.  If you don't give it a chance to get past that uncertain start-up period then you'll never really know enough about it's effects on you as an individual to make a fully informed decision about that med.

For example, there is one med that gave me a couple hours each day of brain zaps; which meant hours of lightheadedness and the sensation of electrical jolts to the head several times a minute.  It took a few months before that subsided to a less distracting, less alarming, and more easily tolerable level.  The brain zaps finally went away when an unrelated decision to change the dosage of a different medication happened several months later.  Eliminating brain zaps was an unexpected benefit of that change.  Now I have zero detectable side effects from the med that caused the daily brain zaps.  But it took over a year of uncertain fiddling and patience and some luck before that happened. 

We're all different.  We all experience each med differently from each other.  Unfortunately the reality we live in is that we are each our own personal beta-test guinea pig and apparently that will probably not be changing anytime soon.  The only way a med is guaranteed NOT to work is to never follow through with your doc's recommended trial period.  But nobody can guarantee what will work well for you.

You never know what will or will not work specifically for you until you give it an honest, good-faith try. 

Thank you VERY much for your answer. I do want to make a fully informed decision! But is it 6-8 weeks from starting at 25 mg or is it 6-8 weeks from when I reach 100 mg?

I've always found Sertraline to be quite weight neutral -  it did make me crave sugar and carbs but I found I also had a reduced appetite so overall it balanced out.  

I always think that unless someone has intolerably severe side-effects it really is best to stick it out for 6 to 8 weeks; otherwise the risk is hopping from med to med and getting all those side-effects but never giving it enough of a chance to see if it has any benefits.  

Then again if Fluoxetine worked for you before it seems odd that you would not try that as the first line of attack? 

I hope that it will be weight neutral for me as well. I find that thinking of food makes me salivate even though I just had dinner, but hopefully this will subside.  I used to take fluoxetine for depression, but these days my problems are anxiety, anxiety attacks and derealization so that's why I'm on a new med now. 

[CirclesOfConfusion]

I've been told the bare minimum is 6-8 weeks of just taking the med in the first place, but might still feel transition-y and still fluctuating if at that point the dose is still in the process of being increased/adjusted.  It seems like enough time to at least find out if it is worth continuing to spend time and effort refining stuff like dose quantity, dosing schedule, version of the med (some have several formats like instant release, extended release, liquid, etc.) or if it has just become an obvious dud and maybe it is time to move on to something else.  In my experience, getting to 6-8 solid weeks at the actual target dose and dosing schedule is really the better time for making decisions with more informed insight into what the longer term experience might be like with that particular med.

Understanding that side effects often subside once the adjustment period is over is one thing that helped me be patient with months of dizziness and brain zaps.  Really, the most constructive thing to do is just observe yourself as fairly and objectively as possible and then take those observations to pdoc.  For me, brain zaps are certainly an unpleasantly disruptive side effect but not a start-up period deal-breaker.  I consulted with my pdoc to get her opinion on things like whether the zaps were damaging in any way and she said they were not, as far as she knows thus far.  So I just continued to put up with them as we made various adjustments to see if we could find me a sweet spot where the dose was helpful but produced less side effects.

Also keep in mind that at any given moment there are so many internal and external variables at play besides the meds that can affect how we feel and act.  Whenever I talk with my pdoc about my observations of the effects of my meds, I also let her know if there are any new/changed situational variables that may have a particularly complicating effect on how much we attribute how I feel to the med or to other things happening in my life or to my body.  There have been times when we put off making decisions about med changes until after a major work deadline stressor or a lingering physical illness (like bronchitis, etc.) have passed.