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300.3

Zoloft dosage question and other zoloft questions

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According to what my pdoc said about Zoloft, it's best to take in the morning as it tends to be stimulating, but some people can and prefer to take it at night. So I would say it's probably worth a try at least, the most harm that would be done is likely just sleep disturbance, which could be remedied by just taking it in the morning again. I have a friend who takes Zoloft at 150 mg, and he takes it all at night without a problem, and in fact, his doctor told him to take it at night (his doctor isn't a pdoc though).

If you continue to have eye pain, I remember you mentioned considering going back to Luvox, but expressing doubt about it. I also seem to remember the dose you were on was rather low for someone with OCD to be on Luvox. The max dose of Luvox is 300 mg, and like many SSRIs/SNRIs, some may even be prescribed beyond the max dose if the pdoc deems it necessary. The reason I bring up switching back to Luvox is because I'm wondering if this eye pain of yours is related to Zoloft's anticholinergic properties, which aren't that strong at all, but relative to Luvox, it's a stronger anticholinergic (Luvox is negligibly anticholinergic). So switching back to Luvox could be a solution to your eye pain, and you could try a higher dose to see if you get the results you need. Other agents that would benefit OCD, like Paxil and Anafranil, would be much more anticholinergic than Zoloft, especially Anafranil (TCA). Lexapro and Celexa, which may or may not have good results for OCD and may require higher than max dose dosing, which can only be done with Lexapro due to Celexa's effects on heart rhythm in high doses, would be slightly less anticholinergic than Zoloft, but still anticholinergic nevertheless. Effexor XR can be beneficial for OCD in some people, and I think it may potentially be a good alternative for you because it is also negligibly anticholinergic, like Luvox. The only thing is its stimulating properties might be a bit overwhelming at first, but they're temporary and will pass with time. I have OCD as well, and am on the max dose of Effexor XR, 375 mg, and it has helped my anxiety immensely and my OCD a pretty good bit. YMMV though. Cymbalta could be used too, since its serotonergic properties are pretty strong, but its noradrenergic properties are pretty hefty too, which might undermine the benefits of the serotonergic properties. I took Cymbalta for a long time and had great results with it though, but again YMMV. There were some case reports on Cymbalta in the treatment of OCD. In one, a man tried clomipramine (Anafranil) initially, then paroxetine (Paxil), but discontinued due to side effects. Them he tried mirtazapine (Remeron) with some improvement, but experienced symptom exacerbation and eventually switched to escitalopram (Lexapro), which he was stable on for 12 months and then became symptomatic again, after which he was switched to duloxetine (Cymbalta) at a final dose of 120 mg/day (max dose). An Italian case report exists in which four patients were treated for OCD with duloxetine. All patients had been partial or nonresponders of previous medications. Duloxetine dosages were up to 120 mg/day and patients were followed for 12 weeks. Three patients (75%) experienced improvement. A Taiwanese report described a man with OCD who was treatment-refractory with severel SSRIs and venlafaxine (Effexor), who achieved full remission after 12 weeks of monotherapy with high-dose (180 mg/day) duloxetine (60 mg over max dose).

There are other agents they use for adjuvant agents for OCD that may help you, but given some of the side effects of them, I wonder if you'd fixate on that and obsess over the possibility of developing a deadly skin rash to the point where you break out in hives and then panic and stop taking the drug before it can have a beneficial effect (believe me, I totally understand where you're coming from with obsessing over side effects of medications, I'm not by any means poking fun at you or anything). There is a theory that folks with OCD have a dysfunction with glutamate in their brain. They've been doing research with a lot of meds that affect the glutamate system (mostly those that lower glutamate release I think), like riluzole (a drug for ALS), memantine (Namenda) (an Alzheimer's drug), gabapentin (Neurontin) (an anticonvulsant and α2δ ligand), N-acetyl-L-cysteine (NAC) (an OTC supplement and prescription drug used to help clear bronchial airways I think), topiramate (Topamax) (anticonvulsant), lamotrigine (Lamictal) (anticonvulsant), and zonisamide (Zonegran) (anticonvulsant). High-dose Levetiracetam (Keppra) (another anticonvulsant) is another med they've done studies with for OCD. Just figured I'd mention those as possibilities just in case you might be interested in having a little extra help. It might help you require a lower dose of an SSRI/SNRI.

One of the hardest things to do when one has OCD like we have, is to stop obsessing about the medicine, whether it's working or not, whether we're getting side effects from them, etc., and just let the meds do their job. The more we interfere with them by tweaking the dose down due to side effects or getting ourselves all up in a big bother about side effects just makes things worse, and gives the meds more to overcome. It is for this reason that my pdoc has on occasions had to give me regularly dosed Klonopin, like anywhere from 0.5 mg three times a day to 1 mg twice a day. Do you take any benzos, have you taken any benzos, or do you object to taking any benzos? They could potentially help hasten the progress of the Zoloft, and there's a small possibility that your eye pain could go away as well, because it could be a symptom with a psychosomatic origin rather than a physiological origin (I'm not a doctor, so I'm not claiming to know this, I'm just offering an alternative speculation on the situation at hand).

I hope you can get relief soon and be symptom and side effect free as soon as possible! I understand completely where you're coming from. I share this manifestation of OCD with you, and it's so annoying because I always have so many questions for my doctors and keep asking and asking and eventually some of them just sort of decide they can't answer any more questions and say "see you next time!" and leave. I have to pay my pdoc extra money because I spend so long with her asking questions and discussing my treatment plan, and also have to be the last patient of her day, which ends up being pretty late in the evening, and the wait time is often extremely long, but she doesn't cut me off which I like, and she's even giving me some psychotherapy on the side since I'm currently without a therapist. My LPC whom I had been seeing since the age of 9 or 10 (I'm 28 now) I think is trying to retire, but she's being all hush-hush about it and won't give anyone a straight answer about it, and instead just seems to be dodging phone calls, so I've been procrastinating looking for a new therapist because it would feel almost wrong to be with any other counselor other than my first one. Anyway, best of luck to you!

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I will write more through out the day as I'm currently at work.

When I was in luvox my Ocd/depression were 98 % gone. I was taking 125mg at the time. If I knew then what I knew now I would have went up on the dosage instead of abanding it because it did stop working completely. I had a perfect 15 years on the Luvox

I currently take xanax as needed .25  which is usually once a day.

My thoughts were maybe I could sleep through the eye issue if I took zoloft at night. 

Inot addition to nac I have been reading up on inositol and the results are promising at the high dosage required. I'm surprised I haven't read stories on people trying it.

I'll be speaking with my psych today and he has told me 2 times he wants to try me on 100mg zoloft to see if there is definitely a correlation of dosage to my eye pain. I think it is because as I go up it gets worse. We have spoke about this before.

Im extremely hesitant in doing this as I have improved dramaticlly .

I know everyone is different but the odds of Luvox working again are?  This would be a 5 week experiment which could be for the worse. 

Edited by 300.3

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Just got back from Dr

First thing he wants to do is try taking Zoloft at night.

After that maybe go down in dosage

He brought up the option to try Riluzole. I'm scared to even read about it and what the side effects could be. 

Option of trying Lexapro

 

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I'm slowly transitioning to taking Zoloft at night. Dr wants to see if that changes anything with my eyes.

I see him on Tuesday.. so far what's changed is my eyes hurt in the morning instead of the afternoon. This has to be from taking zoloft at a different time.

 

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Hmm. Well then if it is the Zoloft, then your doctor is going to have to come up with some other alternative because taking a sub therapeutic dose is really pointless.

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Jt07 

I'm not sure I have a lot of choices at this point .. I'm actually happy that I haven't become med resistant at least.

It's really bothering me that I'm so close to something but this damn eye issue. 

It's been 18 days I'll give it maybe 2 more weeks? I guess I can hope this is a side effect dissipates?

I've been reading more and more about Nac and Inositol.. I know it's reaching :(

.. 

Edited by 300.3

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mikrw33 has given you some other possible med ideas to run by your doctor if the Zoloft doesn't work out.

Is it a side effect of the Zoloft? I don't know. I've never heard of it so I'm thinking that it is some interaction with your eye problems and that it is aggravating the glaucoma or something. But I understand that it is intolerable.

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The last experiment I can do is after 4 weeks or more go down to 100mg and see if the eye issues subsides. If it does then it's the the zoloft. That will be the deciding test I guess.

How else can I determine if it's the zoloft or not?

 

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1 hour ago, 300.3 said:

How else can I determine if it's the zoloft or not?

There is a way, but you should run it by your doctor before doing anything. Sometimes people take drug holidays for a day or two. People who suffer from sexual side effects are sometimes advised to do this. Missing one day of Zoloft is usually no big deal, and it could help you to find out if it is the Zoloft or not causing the eye pain. But, as I said, make sure your doctor approves of it first.

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I never thought about that and never would do that without my doctor knowing.

 

But ... my question is how can this be done if Zoloft has such a short half life? And is 1 day enough to even make that call?

Wow jt I never even thought of using that to test the side effects zoloft. 

My past research has led me to believe that if I needed help with the holiday.I could use Xanax. Am I correct in saying that? How much time can xanax buy me if need be? 

Tonight was the first night I totally transitioned to taking zoloft at night. I had a lot of anxiety but made it without xanax. I have been getting by with  .25-12.5mg of xanax a day

 

Edited by 300.3

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Well, you said that you get the eye pain a few hours after taking your dose. So in that one day you either get eye pain or not. If not then it is likely the Zoloft. And the short half life of Zoloft works to your advantage, but your blood should be at steady state by now so even if you take a med holiday for 1 day, you will still have Zoloft in your system. The only question is whether you will get eye pain without the infusion of Zoloft or not like it is now.

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I noticed something interesting.  I used to have increased Anxiety starting at 5pm everyday.

Now that I take Zoloft at night I have the anxiety in the morning. It's crazy but it has to be related to the time I take Zoloft?

What's the half life of Zoloft?

Today is the 21 days taking 125mg Zoloft. This has been the longest amount of time on a given about of zoloft. Not sure what's going on but for awhile yesterday I almost felt "normal" just a great day in general.

 

 

Edited by 300.3

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The half-life of Zoloft is about 24 hours.

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Shoot not sure if I took my meds by accident in the morning ..

 

Not sure what to do now

Edited by 300.3

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I'm leaning towards that fact I missed taking zoloft yesterday. I feel like crap today.. 

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I saw the Dr yesterday..  It seems like he's frustrated with me.. 

He again said let's go down to 100 and after 75 maybe.. and see if the eye pain is definitely from Zoloft. I agree with this experiment to some degree. But I really don't feel like having bad thoughts again. Odds are this soon in the game I think I will. I was on 100mg for a week the Dr said. If I occasionally have breakthrough thoughts at 125mg why does he think I won't have that much at 100?? And worse I assume???

Once again he started bringing up other meds which I'm open to.  But my big question was if I keep playing with the dose what's the odds zoloft can poop out ?? The door is closed on luvox,prozac and now he wants me to potentially jump ship with Zoloft.

Not sure what to do but honestly I'm not experimenting until I get back from vacation.  

I have a follow appointment with the eye dr but really we know the answer.. they found nothing.. I'm going to talk to the doctor and have him refer me to a regular optometrist in the same facility.  I really think my vision is being over looked and maybe the basics need to be looked at again and I might need bifocals.

Can your eyes hurt even though your not looking at things closely all the time? To my understanding bifocals add reading glasses to my regular glasses am I correct?

 

Edited by 300.3

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There are different kinds of bifocals, but they often just weaken the prescription used for distance vision so that you don't get eye strain from looking at things closely. On the other hand, some people do require some magnification and they can do that also with bifocals.

You know, at this point, I think you should seriously consider trying a different med because the Zoloft just isn't working out. Perhaps trying a different med and going up on the dose faster than you have been doing with the Zoloft. But you can't keep  with the eye pain up even if it is working for the psych symptoms. And I think you have given the Zoloft a fair chance with regard to the eye pain.

If your doctor is getting frustrated with you, that is all the more reason to listen to him and follow his advice closely. You don't want to end up getting dismissed as a patient.

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I do know that I now have a difficult time reading my computer screen. Considering my job requires me to be on the computer makes this more 

Jt

I keep researching possible things I could augment Zoloft with if I do go down to 100 Zoloft.

 The thing is I had eye issues on Prozac also. If I stop zoloft what's to say cymbalta or effexor won't do the same? 

The frustration I sensed from the Dr wasnt a displeased kind .. it seemed more like he's at his Whits end. 

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14 minutes ago, 300.3 said:

If I stop zoloft what's to say cymbalta or effexor won't do the same?  

Nobody can see the future. But they are a different class of meds. 

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