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Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7664
Experience:  35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
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I have been getting increasing depressed over the past 7-9

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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.

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 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 :,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
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