To Zoloft or not to Zoloft

[MeganAja]

Hey everyone! I've had issues with panic disorder and gad since I was 18-now 33. Been on ssri's most of that time. 4 years ago I was switched back to my initial drug that worked- Zoloft along with .5 clonazepam 2x daily. About 6 months ago I weaned off them both and was feeling great! A few weeks ago I took a narcotic for a toothache and realized I had heavy anxiety when it wore off. I gave it a few days but it got worse and started feeling derealization. I had zoloft from my previous script and a small stash of clonazepam - I called a friend husband who is a psych doc and 17 days ago I started 25mg zoloft and clonazepam same dose and he also said take as needed. Two days ago even with the clonaze it seemed like my anxiety was through the roof. I am considering stopping the zoloft but realized I felt pretty ok yesterday. My insurance found a new Pdoc but I don't see him until 1/10. Any thoughts would be highly appreciated. I know the dangers of benzos so I'm trying not to pop them like candy. I never want to get back to the agoraphobic, crawling out of my skin, shell of a person I used to be.

[panic_downunder]

I called a friend husband who is a psych doc and 17 days ago I started 25mg zoloft and clonazepam same dose and he also said take as needed. Two days ago even with the clonaze it seemed like my anxiety was through the roof.

I think there are several issues here. Firstly 25mg is a sub therapeutic dose for most so it probably is not doing that much. Ideally, you should have increased it to 50mg, the usual minimum effective dose - though most need to take 100-150 mg for good results. Also antidepressants typically take 3-12 weeks to kick-in.

Another issue is that this isn't the first time you've taken SSRIs. There is growing evidence that antidepressants become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. They may also produce more severe, and/or different, initial side-effects. According to one study the likelihood of antidepressants working after each stop-restart cycle drops by nearly 20% (unfortunately I can't yet post links, but Google: pubmed and go to the link, then add the following numbers one at a time to the end of the URL in the browser address field which should initially end with /pubmed/ - 19571597 (Amsterdam JD, 2009), 18694599 (Amsterdam JD, 2009), 17469884 (Leykin Y, 2007)). This applies whether returning to a previously taken antidepressant or a different one. Given your panic disorder is an ongoing issue I think you need to seriously consider remaining on an antidepressant permanently to reduced the risk of them failing.

The final thing you need to be aware of is benzodiazepines (BZD) can interfere with hippocampal neurogenesis, the mechanism by which antidepressants are thought to work so it is probably best to use them only for a few weeks while weaning onto an antidepressant, and occasionally for breakthrough anxiety. If an antidepressant isn't fully effective even at the maximum dose then it would be better to switch to another that may rather than supplementing it with BZDs. BTW-therapy also seems to work by stimulating hippocampal neurogenesis so BZDs may reduce its effectiveness too, though I'm unaware of a study showing this.

[RossySoonDone]

I personally think 'to not' and that goes for any medication. You can beat anxiety for good on your own, thats the only true way for permanent recovery.

[salvator here]

^I couldn't agree more with this statement, medication covers up and masks symptoms (IMHO) that are perfectly normal and natural depending on certain situations and circumstances. I see nothing wrong with using meditation and other means to deal with the pressure of life in this stressful society. I (personally) feel there is nothing wrong with saying its ok to feel unwell some days. That being said; I DO feel there are better options for medication that deal with anxiety on a short term basis. I've never bought into the idea of the whole "chemical imbalance" theory. I've been on just about everything and all it did was turn me into a walking zombie cadaver!

[RossySoonDone]

^ I agree, if there was one benefit to me taking Zoloft its that I may have been able to win a casting role as a Walker in the Walking Dead - thats about it.