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I have been put into a strong leadership position at the age…

Hi Pearl, I have...

Hi Pearl, I have been put into a strong leadership position at the age of 60. I work in a hectic IT environment. I have been on 10 mg zytomil for about 10 years. The chemist ran out of 10 mg and gave me 20 mg without informing me. What I noticed after about 10 days was that I was laughing more frequently. I missed 1 day because I ran out - spoke to my Doctor and he advised that perhaps I should try the 20 mg. But now I am experiencing light headiness and fatigue and loss of energy. Will my body adjust or should I go back to 10 mg?

Doctor's Assistant: How is your mood? Are you experiencing regular sleep disturbances (e.g. trouble falling asleep, waking up early)?

No sleep disturbances

Doctor's Assistant: Anything else in your medical history you think the Psychologist should know?

No nothing

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Customer reply replied 1 month ago
I have not received an answer yet
Customer reply replied 1 month ago
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Answered in 1 day by:
3/5/2018
LeahMSWuofm
LeahMSWuofm, Clinical Social Worker
Category: Mental Health
Satisfied Customers: 963
Experience: 10 years post-MSW experience
Verified

Hi, thank you for writing. I am so sorry no one replied to you in a timely fashion. I wanted to give you a reply as I know you have been waiting... For one, that is so awful your pharmacist gave you an increased dose without warning. I hope you reported this as an error - those things shouldn't be overlooked in terms of importance. Second, I agree with your doctor that staying on the 20mg is worthwhile if you can ride out these newer side effects that are caused as your body adjusts to the upped dose. 20mg is still within normal range for zytomil but it would be normal to experience the side effects you described with the doubled dose. Side effects like this should not continue for much past 2 - 4 weeks, but you may see them fade sooner, reducing their impact a little each day. As long as the side effects are "uncomfortable' but not "intolerable", I think riding it out as 20mg is the way to go as you may get some help in terms of symptom reduction from the med that you were not getting at 20mg.

I hope this makes sense. I am not available for a phone call but am here to chat more if you'd like!

P.S. Congrats on your promotion! Stressful (even positive) life events sure can open the door for anxiety and depression to sneak back up so perhaps the inadvertent med increase was just a positive coincidence.

-Leah

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Customer reply replied 1 month ago
Hi Leah, I was getting relief at 10 mg but obviously the 20 mg may just assist me more as you have suggested. Is it a good health decision though to put stronger chemicals in my system?
Also would it be a gentler transition if I were to take 10 mg in the morning and then 10 mg at night as opposed to 20 mg in the morning?Kind regards
Essie

Hi :) Thank you for the reply. Generally speaking, yes, we want to keep you on the lowest effective dose possible. If you are taking it for depression, you may want to assess if you feel there is room for improvement in the following symptoms...

- Down, sad or hopeless feelings

- too much/too little sleep

- too much/too littler appetite

- physical and emotional fatigue

- changes in libido

- feeling restless/nervous

- agitation/irritibaility

- moodiness mood jumping around a lot)

- affected concentration

- affected memory

- feeling like you don't want to do anything - feeling like things aren't joyful

If you are taking it for anxiety, you'll want to assess whether you are feeling nervous, wired, having racing thoughts, have an impending sense of dread, feel uneasy, are worrying too much about inconsequential things, etc.

As far as you last question, you could try to take it at two points in the day to see if that decreases the current side effects. You could also considering taking 15mg instead. Again. this is all under the assumption you feel your symptoms aren't well-controlled or you want to test to see if you can sustain the improvement you think you gained when on the 20mg. Just know that taking 20mg consistently will eventually make it a bit more challenging and time-consuming to wean off.

Lastly, if you do have hesitation about being on a high dose on a med like this and know you are likely to feel ongoing stress as a result of your job, etc., you may find that adding some counseling greatly enhances your wellness, maybe even to the point at a medication isn't needed. Bang for your buck combo for treating anxiety and depression and even helping take the edge off stress is counselling combined with medications.

-Leah

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Customer reply replied 1 month ago
Hi Leah, I do not intend ever going off this medication. I went into menopause at an extreme rate over a short space of time and experienced a chemical imbalance. I am the bread winner of my family and need to perform at a very high level at work. I like your idea of 15 mg except it is difficult to break the tablet into that portion. But I hear what you are advising - if I can JUST get away with the 10 mg I should stay with that rather than indulging in the 20 mg - right?Kind regards
Essie

Hi Essie, you can ask your doc if they can prescribe you 15mg so you may not need to worry about splitting. In the US, this medication comes in 5mg options, as well as 10mg and 20mg. I think that if you felt the 10mg was treating symptoms effectively enough, then staying on it is advisable. But, if not, there is no significantly large issue for not taking the higher dose that provides the most benefit to you. So, if the 20mg is giving you hope of additional benefit beyond what the 10mg did, then I think staying on 20mg (or trying 15mg) is fine. Especially so because the side effects you are having now which are making you question the dose at 20mg are not expected to be long-lasting.

-Leah

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Customer reply replied 1 month ago
Thank you so much Leah for all your advice. Just one more question - if I were to try the 20 mg and find it is too strong for me, and that the side effects do not wear off, do I need to wean myself off from the 20 mg to the 10 mg or can i simply drop back to the 10 mg?
Kind regards
Essie

You are welcome. If you take the 20mg for more than 3-4 weeks, then you may be in a position where you will benefit from tapering down so as to minimize chances of withdrawal. If you go back to 10mg now, after only a couple of weeks, you should not feel any significant withdrawal. Withdrawal symptoms are pesky and uncomfortable but typically not monumental - achy/flu-like, heightened anxiety, headache, nausea, dry mouth, etc. These usually decrease within a matter of days up to a week or two, but based on the shortness with which we are talking in terms of taking 20mg, I don't suspect it is going to be a huge factor for you. Regardless, if you are thinking about going back to the 10mg, better sooner rather than later.

-Leah

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Customer reply replied 1 month ago
Leah, I obviously want to perform at my peak - so what is the disadvantage of taking the 20 mg. This is actually a huge decision for me as on the one hand I am coping with 10mg but I enticed by what the 20 mg can do for me. Also if I were to stay on this medication for life as advised by my Doctor what do you suggest?

The disadvantage right now is the current side effects. That should be temporary but some side effects can inger at longer doses. Sexal side effects are commmon with this drug, even after your body has adjusted. The other disadvantage is you have maxed out on the recommended dose for this medication. While SSRIs like this are safe for long-term use, they often "poop out" aka tolerance occurs. So the likelihood of receiving symptom control from a med like this for a period beyond several years is reduced. You may already have been at this point and not realized it, hence the boost to 2-mg gave you some spark. When that tolerance occurs, peoples original symptoms tend to return. At that point, they can up the dose (not a good possibility if you are already maxed) or change to an alternative SSRI (a very feasible option).

Some people, but not most, take an approach of thinking they will need SSRI therapy forever. Some people do need this, but many don't. Usually, medication like this is best used for no less than a stretch of 8 months, but there is a good chance in the future you may not have the same stress and may not come to rely on this med or need it. If you do, that is okay, too. I just want you to take what your doctor said about needing this for life with a grain of salt. It does depend on your diagnosis and symptoms, but because you ha been on 10mg for 10 years already, it is quite possible the med wasn't actually helping much at all - your internal coping mechanisms were carrying you through. Regardless, if coming off this in the future, higher doses can make tapering more difficult and longer, but not impossible.

A lot to think about but if you are liking the way the 20mg is making you feel in regards ***** ***** you were but on this med in the first place, then I would just roll with it and consider adjustments/changes if/when you need to down the road.

LeahMSWuofm
LeahMSWuofm, Clinical Social Worker
Category: Mental Health
Satisfied Customers: 963
Experience: 10 years post-MSW experience
Verified
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LeahMSWuofm
LeahMSWuofm, Clinical Social Worker
Category: Mental Health
Satisfied Customers: 963
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Experience: 10 years post-MSW experience

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