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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by MattSanz on August 5, 2008, at 1:20:27
As some of you might know, I've been on Zoloft for 5 and a half weeks now with no response (I've been taking 150mg for the past week and a half). I've experience no response and if anything, my depression and anxiety might have actually increased. My doc wants me to stay on the 150 another 2 and a half weeks, but I'm growing impatient and if I haven't had any response yet after nearly 6 weeks, why continue to wait? I was thinking about calling him and telling him that I want a change immediately but I'm not sure if I should do that or just wait it out in agony. Any advice? Thanks so much.
Posted by manic666 on August 5, 2008, at 7:30:25
In reply to How long till switch??, posted by MattSanz on August 5, 2008, at 1:20:27
im not tryin to put you on a downer . but 5 weeks come to the uk. as you no im just comming of cymbalta that was 10 weeks at 60mg an 10 weeks at 120 mg so 20 weeks make 5 look a breeze.most things i have tried take 8 to 10 anyway even prozac. manic666
Posted by raisinb on August 5, 2008, at 9:17:39
In reply to How long till switch??, posted by MattSanz on August 5, 2008, at 1:20:27
I have tried Zoloft twice, and each time I had an almost immediate response--but it did not last. It took at least a month to get the real results.
Many doctors advise giving SSRIs 8 weeks before giving up. Not only because sometimes they just don't work for 8 weeks, but also because often, you are improving in microscopic increments and just don't notice it until you reach a critical point. This makes sense to me, because I know when I'm depressed, I can't even notice significant positive trends.
Everyone is different. I guess if I were you and had already invested 5 and a half weeks, I might go ahead and give it 8 just to make sure. If you start another SSRI, it may very well take 6-8 weeks to work and you'll have to start all over. But if your situation is critical, talk to your dr again.
Posted by Justherself54 on August 5, 2008, at 9:18:10
In reply to How long till switch??, posted by MattSanz on August 5, 2008, at 1:20:27
> As some of you might know, I've been on Zoloft for 5 and a half weeks now with no response (I've been taking 150mg for the past week and a half). I've experience no response and if anything, my depression and anxiety might have actually increased. My doc wants me to stay on the 150 another 2 and a half weeks, but I'm growing impatient and if I haven't had any response yet after nearly 6 weeks, why continue to wait? I was thinking about calling him and telling him that I want a change immediately but I'm not sure if I should do that or just wait it out in agony. Any advice? Thanks so much.
If it were me, I'd call him and tell him you are feeling worse. I know within 2 weeks of starting a SSRI if it's going to work for me, as I watch for subtle signs, as simple as I may have felt like putting make-up on one day. I know lots will disagree with me and tell you to stay the course, but how many weeks of our lives are we prepared to give to medications that either don't work, or make us feel like crap from the side effects...
So I quess you have to ask yourself if you have seen any small signs of improvement. If not, and you're feeling worse..I'd at least voice that to your pdoc.
Posted by Phillipa on August 5, 2008, at 10:47:59
In reply to Re: How long till switch??, posted by Justherself54 on August 5, 2008, at 9:18:10
In a way what is depression? Seriously as I make myself put on eye make-up daily and get out even if don't want to. I admit never been up high on any SSRI or SNRI other than luvox which first time did do all those positive things. That said I'd call my doc too as you don't want to be like me and waste 13 years of your life. Phillipa
Posted by Racer on August 5, 2008, at 11:46:15
In reply to How long till switch??, posted by MattSanz on August 5, 2008, at 1:20:27
Most protocols recommend a full six weeks at a therapeutic dose before assessing whether to increase the dose, augment with another medication, or switch. The STAR*D study showed that many responders actually required EIGHT weeks at a therapeutic dose before their response was clear.
If you discontinue prematurely, you are likely to miss out on a medication which would have worked for you if you'd given it a chance. Your doctor, hard as it may be to believe right now, is giving you the best possible advice based on current medical knowledge. There's no short cut on anti-depressants, which I think is another of those lousy parts of reality, you know?
I know from my own experience how frustrating it can be to take these drugs and feel as though they're doing nothing. If you stick it out, though, and the medication helps you, then it's worth it. Hard as it is to be patient, especially when you're feeling so very bad right now, it's a necessary part of the process.
Best luck to you.
Posted by bleauberry on August 5, 2008, at 18:32:25
In reply to How long till switch??, posted by MattSanz on August 5, 2008, at 1:20:27
If you want to be able to say you followed the STARD protocol for maximum odds, then somehow you gotta make it another 18 days.
Other things to ponder though: A couple studies looked into the topic of delayed response. The general findings were: Early hints of improvement = higher likelihood of robust improvment given more time; lack of hints of improvement = low likelihood of robust response, or a longer than usual delayed response. It doesn't mean someone's fate is definately determined by the first week or two, but that the odds one way or other are.
I do not see someone getting remarkably well after getting worse in 5 1/2 weeks. Why? Because I've never seen it happen, that's all there is to that story. If on the other hand you were feeling the same as you started or neutral, that's a world different than feeling worse. Feeling worse at 5 1/2 weeks is what they call deterioration in clinical studies and is what gets participants removed from continuing the trial.
You are your own best boss. Only you can decide. I am just throwing some different points of views out there to ponder. If there is credence to recent topics about balanced norepinephrine and serotonin, then another route would be to keep zoloft, maybe at a lower dose, and add nortriptyline or desipramine.
Actually, a Ritalin test would be cool. If you could just get a prescription for one day supply of Ritalin to see what it does for your mood (2.5mg-5mg once to thrice per the day), that would be a good hint. Forget the anxiety, jitteriness, etc, if it happens. Just look at the mood part. If Ritalin improves mood on top of Zoloft, then you automatically know you need something in the noradrenergic arena in your treatment. It's called the methylphenidate challenge test. It's so easy, cheap and fast to do, I'm surprised it isn't better known and used all the time. It doesn't guarantee anything, but it is a tool that can increase your odds of success in going a particular direction versus another.
Worst case scenario: Hang on for 18 more days and then make a decision.
This is the end of the thread.
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