alphainc: Severely fatigued - 18 months

[alphainc]

Hey Guys,

 

Its been 3 months almost now since I reinstated. I had moved from reinstating lexapro 2.5mg in Aug 2018, and changing it to Zoloft 12.5mg as advised by my shrink because the Lexapro was somehow not working optimally, he said. Also, had taken zoloft before discontinuing so he said maybe give it a try. 

Been taking it at 930am. Initially troubled me with getting sleep, made me very tired even after sleep. Slowly have been improving but still feel kinda sleepy even after the 8hrs of sleep. Been quite some time I have been on the reinstated ADs at low doses. Should I up it to a "therapeutic" dose or continue with 12.5mg and wait for it to slowlyyy normalise? 

 

My doctor says atleast start 25mg a day if not more :/

 

[alphainc]

Hey guys,

 

Can someone Kindly suggest something on this?

[ChessieCat]

Therapeutic dose is an arbitrary (based on random choice or personal whim, rather than any reason or system) term used by the pharmaceutical companies which teach doctors about the drugs.  A better term is lowest effective dose.

 

You state that you have been slowly improving.  Why are you thinking about increasing your dose?  Are your symptoms bearable?

[alphainc]

It has been 3 months now, I have had improvement in my early morning sleepiness and extreme cognitive impairment, since I reinstated. 

But for the last 45 odd days, I have been stuck at the same level (somewhere 20-30% better than my worst days).

 

I feel sleepy throughout the day until late evenings, when I feel close to normal. I take my 5mg Zoloft between 930-1030 am each day. I took ot once at night and it made me sleep less than 4 hrs, and taking it in the day makes me sleepy even after 8 hrs of sleep.

 

Also an interesting thing noted a couple of times was I don't feel sleepy in the day if I sleep for less than 6 odd hrs. Is this even possible? This also happened when I was in acute withdrawal right after stopping the AD last year. 

 

Kindly help explaining if this is expected behavior. Also, I reinstated after 18 months of suffering the withdrawal.

[ChessieCat]

From https://www.rxlist.com/zoloft-side-effects-drug-center.htm

 

Common side effects (not withdrawal symptoms) of Zoloft include:

• sleepiness
• drowsiness
• tired feeling
• nervousness
• sleep problems (insomnia)
• dizziness
• nausea
• skin rash
• headache
• diarrhea
• constipation
• upset stomach
• stomach pain
• dry mouth
• changes in appetite
• abnormal ejaculation
• impotence
• decreased sex drive
• difficulty having an orgasm
• dry mouth, and
• weight loss
•  

Edited November 11, 2018 by ChessieCat

[alphainc]

The sleepiness has been there for over 3 months now. Isn't that a bit too long?

 

It has been 3 months now, I have had improvement in my early morning sleepiness and extreme cognitive impairment, since I reinstated. 

But for the last 45 odd days, I have been stuck at the same level (somewhere 20% better than my worst days).

 

I feel sleepy throughout the day until late evenings, when I feel close to normal. I take my 5mg Zoloft between 930-1030 am each day. I took ot once at night and it made me sleep less than 4 hrs, and taking it in the day makes me sleepy even after 8 hrs of sleep.

 

Also an interesting thing noted a couple of times was I don't feel sleepy in the day if I sleep for less than 6 odd hrs. Is this even possible? This also happened when I was in acute withdrawal right after stopping the AD last year. 

 

Kindly help explaining if this is expected behavior. Also, I reinstated after 18 months of suffering the withdrawal. Should I increase or decrease the dosage gradually. Currently at 6.25 mg (1/4th) zoloft

[Altostrata]

On 11/8/2018 at 7:13 AM, alphainc said:

Hey Guys,

 

Its been 3 months almost now since I reinstated. I had moved from reinstating lexapro 2.5mg in Aug 2018, and changing it to Zoloft 12.5mg as advised by my shrink because the Lexapro was somehow not working optimally, he said. Also, had taken zoloft before discontinuing so he said maybe give it a try. 

Been taking it at 930am. Initially troubled me with getting sleep, made me very tired even after sleep. Slowly have been improving but still feel kinda sleepy even after the 8hrs of sleep. Been quite some time I have been on the reinstated ADs at low doses. Should I up it to a "therapeutic" dose or continue with 12.5mg and wait for it to slowlyyy normalise? 

 

My doctor says atleast start 25mg a day if not more 😕

 

 

 

On 11/11/2018 at 12:57 AM, alphainc said:

It has been 3 months now, I have had improvement in my early morning sleepiness and extreme cognitive impairment, since I reinstated. 

But for the last 45 odd days, I have been stuck at the same level (somewhere 20-30% better than my worst days).

 

I feel sleepy throughout the day until late evenings, when I feel close to normal. I take my 5mg Zoloft between 930-1030 am each day. I took ot once at night and it made me sleep less than 4 hrs, and taking it in the day makes me sleepy even after 8 hrs of sleep.

 

Also an interesting thing noted a couple of times was I don't feel sleepy in the day if I sleep for less than 6 odd hrs. Is this even possible? This also happened when I was in acute withdrawal right after stopping the AD last year. 

 

Kindly help explaining if this is expected behavior. Also, I reinstated after 18 months of suffering the withdrawal.

 

I'm very confused. It seemed you were doing okay on 2.5mg Lexapro, why did you switch to Zoloft? How did you accomplish the switch?

 

Are you feeling better or worse than when you were taking 2.5mg Lexapro?

 

Drug switches are destabilizing. It could be that your nervous system responds to this kind of stress by wanting to get lots of sleep. (This is by far preferable to the usual reaction, which is not sleeping at all.)

 

As you made this drug change in September, we have to identify your current baseline again. Please keepdaily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Are you taking any other drugs? Please update your signature.

[Songbird]

On 11/9/2018 at 4:13 AM, alphainc said:

changing it to Zoloft 12.5mg as advised by my shrink ...

Been taking it at 930am... 

Should I up it to a "therapeutic" dose or continue with 12.5mg and wait for it to slowlyyy normalise? 

 

On 11/11/2018 at 9:57 PM, alphainc said:

I take my 5mg Zoloft between 930-1030 am each day.

 

 

I'm confused - are you taking 12.5mg Zoloft each morning, or 5mg Zoloft each morning?

[alphainc]

6 hours ago, Altostrata said:

 

 

I'm very confused. It seemed you were doing okay on 2.5mg Lexapro, why did you switch to Zoloft? How did you accomplish the switch?

 

Hey Alto,

 

I was doing ok initially and then started feeling fatigued and groggy after I woke up each morning. So he changed it to zoloft as I had last taken Zoloft before CTing. I switched them pretty much right away and didn't have any adverse reaction at the time. I've been on Zoloft for almost 3 months now.

 

6 hours ago, Altostrata said:

 

Are you feeling better or worse than when you were taking 2.5mg Lexapro?

 

Initially after the switch, I felt the same. I was feeling good on lexapro because I wasn't somehow sleeping for more than 6-6.5 hrs a night when I started it. Then when I could sleep more, I started waking up groggy and disoriented. I felt the same way on Zoloft, no difference. Then some days were pretty normal but most days weren't. Same grogginess if I slept after I once woke up maybe 5-6 hrs into the night. (I wake up on my own every night after arnd 5-6 hrs of sleep and feel like sleeping back. If I dont, I'm not groggy the whole day, just a little sleep deprived. If I do, I'm groggy till the evening or night.)

 

Is this even normally heard of with others?

 

6 hours ago, Altostrata said:

 

Drug switches are destabilizing. It could be that your nervous system responds to this kind of stress by wanting to get lots of sleep. (This is by far preferable to the usual reaction, which is not sleeping at all.)

 

Strangely, I felt almost similar on both the drugs.

 

 

6 hours ago, Altostrata said:

 

As you made this drug change in September, we have to identify your current baseline again. Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

What does baseline mean exactly in this case? And how can I identify it? I'm currently back to the 5mg zoloft in the morning. I accidentally took 12.5mg for arnd 3-4 days and felt even more sleepy and groggy.

 

6 hours ago, Altostrata said:

 

Are you taking any other drugs? Please update your signature.

 Am not taking anything other than Zoloft. Updated.

[alphainc]

3 hours ago, Songbird said:

 

 

I'm confused - are you taking 12.5mg Zoloft each morning, or 5mg Zoloft each morning?

 

@Songbird @Altostrata  I'm currently back to the 5mg zoloft in the morning. I accidentally (cut the 50mg instead of my regular 25mg) took 12.5mg for arnd 3-4 days and felt even more sleepy and groggy. 

 

I'm not understanding how to identify a dosage that will work and make me get up better/ungroggier. Been at 5mg for almost 3 months. I never had this problem when I started the drug for the first time back in 2015-16. And I always had this grogginess/brain fog as the one and only WD issue since CTing.

[Altostrata]

It could be that the grogginess is not a side effect of the drug but the way your nervous system is fixing itself after you suddenly went off Zoloft in December 2016. It's been trying to recover from all the drug switches ever since.

 

Just this year, you've been up and down on mirtazapine, Lexapro, and Zoloft.

 

Or, grogginess might be the way your nervous system responds to SSRIs. They do make some people sleepy. Did you do better on a bit of mirtazapine?

 

To determine if the drug is causing your symptoms, please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. 

[alphainc]

14 hours ago, Altostrata said:

It could be that the grogginess is not a side effect of the drug but the way your nervous system is fixing itself after you suddenly went off Zoloft in December 2016. It's been trying to recover from all the drug switches ever since.

 

I feel this is somewhat closer to what maybe happening. 

 

14 hours ago, Altostrata said:

 

Just this year, you've been up and down on mirtazapine, Lexapro, and Zoloft.

 

Or, grogginess might be the way your nervous system responds to SSRIs. They do make some people sleepy. Did you do better on a bit of mirtazapine?

 

I did feel quite better on mirtazapine initially but then when I reinstated the SSRI (lexapro), it made me too sleepy. Hence slowly tapered it over a couple of months. I've noticed generally that I do good with benzodiazepines (Clonazepam, lorazepam) when I'm on an SSRI. But I've been to afraid to add anything else to the current zoloft 5mg. Will it help, or maybe create unnecessary complications?

 

14 hours ago, Altostrata said:

 

To determine if the drug is causing your symptoms, please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right. 

 

Sure. Just wanted to understand how I know if my current dosage is the best amongst others, if not, how do I increase or decrease?

[Songbird]

14 minutes ago, alphainc said:

I've noticed generally that I do good with benzodiazepines (Clonazepam, lorazepam) when I'm on an SSRI. But I've been to afraid to add anything else to the current zoloft 5mg. Will it help, or maybe create unnecessary complications?

 

More likely to create unnecessary complications.

 

14 minutes ago, alphainc said:

Just wanted to understand how I know if my current dosage is the best amongst others, if not, how do I increase or decrease?

 

That's why we want the daily notes, to figure out how to move forward from here.