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Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience:  Psychiatrist
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Hi. I'm a 35 year old female who was diagnosed with a panic disorder at 21 years old..I was put on Zoloft. Over the years I have done great on Zoloft. However recently (past two years) my husband and I have suffered two still birth pregnancies after spending a small fortune on IVF. Also my mother is chronically ill. In Sept I will be having an elective major surgery out of state to correct a cervical issue that has caused the two still births. Along with the two still births I have also suffered from six early miscarriages. Anyway for the past three months my anxiety has certainly crept up ten fold on me. I am currently in cognitive therapy every week which doesn't seem to be helping. That is weird as therapy always helps me I've been active in it for years. I also see a psychatrist too. She recommended I increase my Zoloft to 125 mg. I'm currently on 100mg that was raised from 50mg during my last pregnancy. I tried the 125mg of Zoloft for a very short time and did notice a decrease in anxiety however I was extremely tired very hungry and had terrible mind rages. Everyone was driving me crazy etc so she suggested I back down to the 100mg. The problem is I'm worried my Zoloft is no longer working. I hate that because it has worked for so long and I have a terrible pill phobia so I'm scared to try anything else although I'm sure that's what needs to happen. My question is my side effects from the increase of Zoloft...can those go away and were those normal? Also my doc is very hesitant for me to try any anti depressant besides Zoloft due to wanting to get pregnant again. Are there not other safe anti depressants to take while pregnant? I just think everything I've been dealing with has gotten the best of me and I am beyond tired of feeling bad an anxious. My obgyn even suggested a low dose birth control thinking maybe my hormones were playing a.role as my.cycles and PMS have been very different.

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Customer: replied 5 years ago.
I'm still waiting. Thank u

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Dr. Anderson
Customer: replied 5 years ago.
Yes still waiting..thank you
Ok, happy to help out. First off, I'm sorry this anxiety has taken off again! It was very reasonable for your doctor to increase the Zoloft to 125 mg since 100 mg worked so well for you for so long. The symptoms you experienced, such as the increased irritability and mind racing, while can be worrisome in that it suggests a bit of hypomania, is also quite typical in Zoloft for some people. Zoloft tends to be an "activating" medication, so dosage increases tend to activate people. This activation presents pretty much how you described in your own experience.The activation side effect MAY go away with continued use of the Zoloft, but it needs about a week to tell. So, it is quite reasonable to re-try the Zoloft at 125 mg. Work your way up to it,, though, by taking the 25 mg and cutting it in half, so you are at 112.5 mg for a few days, then go up to 125 mg. If you get those same activation side effects, hang tight for a few days and see if they get better. If they get worse or do not go away, then it will be necessary to consider a different, less-activating option to control the anxiety.This leads to the next part of your question...(with me so far, by the way?)
Customer: replied 5 years ago.
Yep! Totally understand and I did fail to mention we did do the 1/2 of 25mg increase. I actually got the hypomania side effects at that dose but continued to the 125mg in hopes it would pass. Which it didn't sadly as I have had no problems with Zoloft in the past. It was VERY hard to get up to 100 and sometimes I think I felt better at 75. does sound like the Zoloft is just too activating at the doses that would bring you better relief of the anxiety. SSSoooooo...that does probably mean a switch is in order. I know, from your prior post, that such a notion is very nerve-wracking (no pun intended), but it does not have to be. Regarding safety in pregnancy, I wrote a chapter on that (literally), but the botXXXXX XXXXXne is most of the ones we use for anxiety are relatively safe in pregnancy, although there are ones we prefer over others. Paxil is a great anxiety medication, but it has been linked to certain kinds of birth defects (although the studies concluding that were in themselves flawed). In general, the risk (or birth defects) of being on these kinds of meds in pregnancy is 3-5%, the same as for a woman NOT on the meds. But, we see specific kinds of defects more often than others in women taking them. There has been a lot in the news lately about autism and antidepressants, but untreated anxiety and depression themselves are risk factors for autism.

If Zoloft is not going to do the job, the next one I'd lean towards for you is Prozac. I have had tremendous success in my pregnant patients with anxiety. Plus, not a lot of adjustments need to be made, and it is not activating like Zoloft. A cross taper from Zoloft to Prozac would ensure relief of symptoms and medication tolerance, so you do not have to be left "uncovered."
Customer: replied 5 years ago.
Ok great just a handful of questions. Years ago I tried Prozac and could not even get out of bed I was so tired. Ao i went back to Zoloft. Can I expect to be tired when switching? Also is there a chance if I'm off Zoloft for awhile it might work again in the future? Is there a.chance my body chemistry has changed and it has just stopped working? Also what are your thoughts on Celexa? Is it possible my anxiety has come full circle due to life events? I'm just so disappointed as I was and have been doing very well the past 14 years.
Greetings! Happy to be of service...

What time of the day did you take the Prozac? It is best taken in the morning, because if it is taken at night it tends to "mess" with sleep - giving a person poor sleep and leading to troubles with getting out of bed and fatigue the following day. There are some people for whom Prozac is sedating, though so taking it in the morning makes them tired. If you are in this group, then a p.m. dose is very reasonable. Regardless, the sleepiness ought to pass with continued use of the Prozac.

My guess is that the underlying anxiety itself has just amped up, so the 100 mg of Zoloft is no longer effective. A higher dose would probably work to overcome these new symptoms, but the higher dose can't be tolerated. Has it come full circle? Unclear on that point, but certainly the life story (you life events) play a role. You mentioned that you are doing CBT, which is great, definitely keep up with that. The therapy can help manage the life circumstance aspects, while the medication handles the biological imbalance due to the anxiety disorder.

Celexa is also a very good option. It is related to Lexapro, so that medicine would be reasonable to try, too.
Dr_Anderson, Doctor
Category: Mental Health
Satisfied Customers: 335
Experience: Psychiatrist
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Customer: replied 5 years ago.
Thank u so so much for your time .i am very grateful and it was worth the wait!!! Have a great day