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Doctor Kevin
Doctor Kevin, Ph.D.
Category: Mental Health
Satisfied Customers: 1482
Experience:  25 years in private practice
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Hi, I have been taking Zoloft for over 10 years now, on and

Resolved Question:

Hi, I have been taking Zoloft for over 10 years now, on and off but on most of the time. I started Zoloft in 2001 when I have postportam depression and doctor prescribe me 100 mg. I was taking it for a few years and eventually stopped for about 1 year becuase I feel better. And then in 2007, I was dignosed with general anxiety disorder and doctor prescribe me with Zolof again 100 ml. Since then I have been on Zoloft but for the past year I reduced my dosage into 50 mg. Sometimes in 2009 I started experiencing choronic nausea in the morning (like morning sickness but I am not pragnent), I usually have to take a Gravol (Dimenhydrinate) in the morning and then the rest of the day will be better. On top of feeling nausea, I also started to feel metalic taste in my mouth or tongue, at one point it taste bitter but after a week the bitterness gone away but the metalic taste stays. So the symptom is a combination of nausea and matelic taste in mouth.

I have checked with doctor and they cannot determine what the problem is becuase it does not looks like a gastric problem because I only have gastric pain occasionally. Last week I have a serious case of nausea that I have never experienced before for whole day even I have taken 3 times of Gravol and it does not help. So I booked an appointment with my family doctor and he suggested me to take an ultra sound and X ray test of my stomach. But he also proposed that it may be due to the medication that I have been taking which is Zoloft. I told him that I never have any side effect when I first started Zoloft years ago. When I started Zoloft in 2001 I was 31. So now I am 42. He said it is possible that as I aged, my body changes and it started to have side effect on long term taking of Zoloft.

These few days I have started checking internet on side effect of Zoloft. Seems like all my symptoms are related to overdoes of long term use of SSRI. These past week I also started to feel anxiety symptoms (heart bid faster than usual, hand swierring etc), not too sure if nausea caused anxiety or anxiety caused nausea. The internet also mentioned about diarrea. I did realised that for the past few months I have more eppisode of dierrea compared with before.

I have also tried getting help from accupuncture and it seems to help a bit. One thing I noticed very strange is that everytime I have a cold or flu in these last few years, in those days that I have not recovered from the cold or flu, I will not experience any nausea. The moment I start recovering, the nausea came back. I am not sure if that is because my body needs more serotonin during my sickness therefore the body did not feel the side effect during my sickness, or the cold medication I took during cold and flu help reduce the nausea feeling.

Anyway, I am here to try to get 2nd opinion. I will be talkihg to my family doctor as well next week but it is very difficult to book a time with Phychiatrists in Toronto, the waiting list is extremely long.

Based on your professional experience, do you have any patients experiencing similar symptoms like me?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Doctor Kevin replied 2 years ago.

Dr.Kappler :

thank you for choosing just answer. I must commend you on your awareness of your symptoms and your ability to take control of your health which is very important. Your realizing that taking an antidepressant such as Zoloft for a long period of time may incur side effects in your research into it is certainly interesting and may be true. As you know nausea is a fairly common side effect which was found in approximately 13% of the participants in trials that the drug company conducted. Your question about the relationship between anxiety and nausea is a good one and I think there is certainly a psychosomatic correlation. People with generalized anxiety disorder often feel it is a nausea. Rollo May wrote an excellent book entitled"the meaning of anxiety" in which you made a correlation between nausea and anxiety. having experienced generalized anxiety disorder myself I can attest to a higher correlation between nausea and anxiety. With help from me was drinking a lot of ginger tea, learning relaxation techniques such as yoga and soft martial arts like tai chi and taking relaxing baths and hot tub. All of this helps reduce and listen my muscles as well as quelled my nausea. I also tried acupuncture and found it to be tremendously helpful in the overall reduction of anxiety at its resulting somatic symptoms. You mentioned having diarrhea and as you know over one quarter of the participants in the drug company study reported diarrhea as a side effect. you also mentioned that when you had a cold or the flu your nausea went away. You might want to consult with a pharmacist about the interaction of over-the-counter cold and flu medication and Zoloft. Pharmacists are by far the experts in such drug interactions. Physicians rely on drug companies to warn them of side effects and these tend to be focused only on the drug of their prescribing.I would recommend talking with a pharmacist first with the information he gives you you will be able to speak your physician from much more knowledgeable place.

Dr.Kappler :

To answer your last question in my 30 years of private practice working closely with the psychiatrist I shared an office with I've had many patients who taken Zoloft for their anxiety and nausea and diarrhea are very common side effects. I would always make sure the psychiatrist was aware of that and I would encourage my patients to utilize psychological techniques to reduce their anxiety and suggest other ways to reduce their nausea. The psychiatrist I work with was fond of using what was called drug holidays in which he would recommend a tapering off of an antidepressant with the two-week period of not using it to see if there any change in side effects or symptoms. I'm not sure if this may help you. I see that your online so I will wait for your reply

Customer:

That is interesting that you mentioned about drug holiday. I remember I started feelilng nausea feeling in 2009, and there was a time I went for a long vacation for almost 1 months and I was feeling relax, I remember at that time, I kind of forgot to take Zolof most of the time becuase I was feeling relax. And I remember during that period of time my nausea feeling actually went away. And then I want back home and started working again, and life beginning to get back to normal and my dausea came back.

Customer:

One thing strange, why is the nausea feeling only mainly happen in the morning? Is it possible that that is the time I am feeling 1) hungry 2) a litle more neuvous because I was worry that I might feel nausea again? I do realised that during time of relaxation I do feel less nauseious.

Dr.Kappler :

I have several ideas as to why nausea occurs more strongly in the morning. When my anxiety attacks were at their worst I would wake up in a cold sweat and felt tension throughout my body. Once I got up this would switch to a feeling of nausea in my empty stomach. When I learned to spend 10 or 15 min. lying in bed stretching and relaxing and then spend 15 min. sitting quietly trying not to think of anything and allowing my mind to rest in its transition from sleep to wakefulness followed by 15 to 20 min. of mild exercising and a large cup of freshly brewed ginger tea I was able to take control of my body and reduce the nausea. If I felt particularly tense in the afternoon during the day some stretching and either ginger tea or Kava-Kava tea would help with the symptoms.

Dr.Kappler :

Generally I did not eat much in the morning but relied on oatmeal which helped my stomach immensely

Customer:

My nauseas feeling do not start right away, it usually started about 1 - 2 hours after I wake up. Generally I do not even feel anxious (at least emotionally). It is just frustrating that the side effect of taking Zoloft will make you feel more anxious, which is the first reason doctor asked me to take Zoloft to take away anxiety. It sure did help. Is it possible that my anxiety disorder has been healed but I still keep taking zoloft and it cause serotonin overdoes?

Dr.Kappler :

.as you know Zoloft has the side effect of nervousness in 2% of the population tested. Your hypothesis is certainly reasonable since I have found levels of anxiety correlate to the degree of which the patient feels in control of their environment and their bodily reactions. That is why stress reduction and relaxation techniques as well as acupuncture works so well because they can be applied as needed. Medications like Zoloft tend to have a more blanket response is difficult to judge the fluctuations of a person's mood and its physiological correlates.

Dr.Kappler :

as to the question of serotonin overdose here's an excellent article describing the symptoms (http://www.serotoninlevelsyndrome.com/About/Serotonin-Overdose.htm). It does mention nausea is one of the symptoms but there are several others. You might want to discuss this with your doctor is prescribing the medication. They

Customer:

I agree with you. I have started slowly reducing my Zoloft intake and observe any positive chances in my nausea and other symptoms. Hopefully this is the right thing to do. Thanks a lot.

Doctor Kevin, Ph.D.
Category: Mental Health
Satisfied Customers: 1482
Experience: 25 years in private practice
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