How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Elliott, LPCC, NCC Your Own Question

Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Type Your Mental Health Question Here...
Elliott, LPCC, NCC is online now
A new question is answered every 9 seconds

I have been getting increasing depressed over the past 7-9

Customer Question

I have been getting increasing depressed over the past 7-9 months. I was diagnosed with GAD in 1990 and have been on mostly 50mg. zoloft + 2-3 mg. of klonopin daily. A few months ago, my pdoc added 300mg of gabapentin 3x a day. I recently had to admit myself to the hospital for my depression and they upped my zoloft to 100mg. I've been on 100mg now for 4 weeks. I sought out a second opinion and that pdoc agreed that moving me up to 100mg was the right thing. She also told me she wants to get me off klonopin eventually and have me move to a higher dose of zoloft (125-150) However, I find it very activating and I'm getting agitated just on 100mg. I have always found klonopin to be very helpful and and worried about upping the zoloft even further and possibly removing the klonopin. What are your thoughts? I have been told that 50mg of zoloft do 80% of the serotonin "work", and that higher doses may be useless. I can't handle SNRIs because I am an extremely anxious person. She mentioned supplementing the zoloft with 7.5 remeron to replace the klonopin. I am skepitcal of this second opinion and wonder if 50mg of zoloft is really enough and I should stay on the klonopin.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Elliott, LPCC, NCC replied 1 year ago.

Elliott, LPCC, NCC : Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.
Elliott, LPCC, NCC : Dear friend,
Elliott, LPCC, NCC : I believe that I can help.
Elliott, LPCC, NCC : Is your anxiety constant or intermittent?
Elliott, LPCC, NCC : Do you have panic attacks or just feel general anxiety?
Customer: Fairly constant lately
Customer: Both
Customer: I am worried that the bump up to 100mg of zoloft may be too much
Elliott, LPCC, NCC : The bad thing about Klonopin (and other benzodiazepines is that: 1) they begin to lose their efficacy the longer you use them, and 2) they can become addictive.
Customer: I've been using it since 1990
Elliott, LPCC, NCC : The Klonopin?
Customer: Yes
Customer: If I have GAD, what's the difference if I am so called "addicted" if it helps and I'd need it lifetime?
Customer: SSRIs can be addictive
Elliott, LPCC, NCC : Not in the same way.
Customer: Okay, so you agree that I should try to control my anxiety w/o klonopin?
Elliott, LPCC, NCC : The benzos can lose their power to help ease your anxiety but you still will be addicted to thoem.
Elliott, LPCC, NCC : Not necessarily.
Customer: Okay, options?
Customer: Do you think 100mg of zoloft will take care of both anxiety & depression, with therapy, too, of coures
Elliott, LPCC, NCC : If you can slowly lower you dose (with pdoc guidance) and then take as needed (or switch to another benzo which is faster acting, namely alprazolam (Xanax) and take only as needed, then it might work better for you and you will not be taking as much. This must be discussed with pdoc.
Customer: Okay, the zoloft? Is 100mg really better than 50?
Customer: I've read studies that say after 50mg. there really is very little, if any, additional benefit
Elliott, LPCC, NCC : The recommended dose is up to 200 mg. max. so it would be within limits. Unfortunately is is impossible to have one standard that applies to all patients.
Customer: I've noticed 100 making me somewhat more agitated
Elliott, LPCC, NCC : I have heard this as well, but on the other hand, some patients respond better to it.
Elliott, LPCC, NCC : If it makes you more agitated, then you should not raise it.
Customer: Would you not agree that most studies say that 50mg. do the majority of the serotonin benefit
Customer: The rest may be overkill or placebo with more side-effects?
Customer: I know I need to discuss with pdoc but I thought I was getting a psychiatrist here, not a psychologist
Customer: No slight inteneded
Elliott, LPCC, NCC : I have not read most studies but do know there are differences of opinion and different clinical and anecdotal evidence to support both claims.
Customer: Okay, fair enough
Customer: What about the idea of supplementing with 7.5 remeron to replace benzo?
Elliott, LPCC, NCC : You will get differences in opinion from various practitioners. I cannot prescribe but I certainly know the effects of drugs and am well educated in their effects.
Elliott, LPCC, NCC : I have heard this done.
Customer: Okay, I appreciate your input
Elliott, LPCC, NCC : You have to understand that when you mix antidepressants such as as mirtazepine and sertraline you can have the risk of serotonin syndrome, although it is done (and should be closely monitored).
Customer: So, you would recommend possibly switching out to Xanax as needed over time?
Elliott, LPCC, NCC : Let me retrieve some info for you first:
Customer: Yes, I am a bit wary of mixing 2 SSRIs
Customer: I've read that too
Customer: Thanks, Elliot
Elliott, LPCC, NCC : Mirtazepine (Remeron) is not an SSRI, but a different class of antidepressant.
Customer: okay, but same basic result, I assume
Elliott, LPCC, NCC : Here is the quotes from www.drugs.com on the HIGH RISK nature of this mixture:
Customer: Mixing being the potential problem?
Elliott, LPCC, NCC : Interactions between your selected drugssertraline ↔ mirtazapine HIGH RISK OF INTERACTIONApplies to: XXXXX XXXXX to your doctor before using sertraline together with mirtazapine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Elliott, LPCC, NCC : This source for this is:
Elliott, LPCC, NCC : http://www.drugs.com/interactions-check.php?drug_list=1640-0,2057-0
Customer: Weird that she would even suggest this then?
Customer: I went to her for a second opinion. My main pdoc prefers lower doses and is okay with klonopin
Elliott, LPCC, NCC : Ask your physician about this. It is done and psychiatrists are permitted to step outside the regular guidelines. It could actually help, but you are at a greater risk.
Customer: Okay, I agree
Customer: I just am looking for the best way to climb out of this
Elliott, LPCC, NCC : Talk to him about taking Xanax, but ONLY AS NEEDED instead of taking the Klonopin, which is less effective, comes on more slowly, and stays in your system much longer.
Customer: Okay, will do
Elliott, LPCC, NCC : If you can lower your overall use of benzos then that would be good. They are brutal to wean off of.
Customer: Yes, I know
Elliott, LPCC, NCC : And they can lose their effectiveness as well. That is the downfall of this otherwise miraculous drug.
Customer: So you also think I may need to cut back on the 100 zoloft if I'm having the side efects I am
Elliott, LPCC, NCC : Unfortunately, you will have to be a guinea pig and try different approaches.
Customer: Yes, I have noticed a decrease in klonopin's effectiveness
Customer: over time
Elliott, LPCC, NCC : If you do cut back - please DO IT SLOWLY so that you do not get discontinuation symptoms from lowering the Zoloft.
Elliott, LPCC, NCC : That is the nature of benzos.
Customer: Like to 75 first?
Customer: on the zolo?
Elliott, LPCC, NCC : If you can taper down you will be doing yourself a favor.
Customer: On zoloft or kpin?
Elliott, LPCC, NCC : With your doctor's blessings and approval, yes.
Customer: Of course I will only do so with consultation from my doc
Customer: But I am grateful for your insights and assistance
Elliott, LPCC, NCC : I wish you great success and shall keep you in my prayers.
Customer: Thanks, Elliot
Customer: Be well, Tom
Elliott, LPCC, NCC : You too. Thank you so much
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7662
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Elliott, LPCC, NCC and 5 other Mental Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education