Psycho-Babble Medication Thread 241424

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Zoloft dosing (long question)

Posted by software guru on July 13, 2003, at 10:21:02

I have a question about Zoloft dosing:

The reason that I am taking Zoloft is that I was diagnosed with anxiety and panic. I also have an irregular heartbeat which I think is what brought on the panic because I obsess over my heart and it's rhythm. Of course, the panic may be what brought on the heart thing, but it's hard to tell which came first. Either way, I was convinced that I had some obscure cardiac defect that the cardiologists couldn't see and it was going to kill me. Intellectually, I knew that I didn't because I have had every heart test short of sending a catheter into my heart, but emotionally I wasn't convinced and continued to obsess over it. The main problem I have encountered in my life because of this is not being able to exercise without inducing at least a mild panic attack.

My psyc doctor started me at 25 mg/day and every 2-3 weeks increased me by 25 mg/day. I am now at 75 mg/day and my doctor would like me to get to 100. When I was at 50 I seemed to reach a point where I felt great, so great that it was almost too good. I felt a very refreshing energy and sharpness and started to get that vivid, colorful state of mind that I had years ago when I was 18 and everything was new and exciting. Everything smelled and felt new and cool. Then, as I passed 50 and went on to 75 the goodness seemed to subside and I started having more trouble sleeping (dose increases always messed with my sleep to some extent). I've been at 75 for 2 weeks and can't stand the thought of going to 100. My doctor insists I will feel great. Due to an issue with my ears, my doctor had me stop taking it for a few days (its been about 72 hours) and I feel like I have settled back to that good place I was at when I was on 50, almost like I've found a "sweet spot" in my dosage. Am I on to something here? Or is there some therapeutic significance to achieving the 100 mg dose that may help me more in the long run rather than just making me feel goood right now?

 

Re: Zoloft dosing software guru

Posted by Maximus on July 13, 2003, at 12:17:31

In reply to Zoloft dosing (long question), posted by software guru on July 13, 2003, at 10:21:02

Hi,

If you were feeling fine at 50 mg of Sertraline and you feel worse at 75 mg, then there is a lot of chance you feel the same way at 100 mg. Right now i don't have a name for it, but an inappropriate high dose of an SSRI and you may feel apathetic, non motivated, tired and flat.

So i would try it and see. If you were definitively feeling better at 50 mg then talk to your pdoc with respect but firmly.

Good luck!

 

Re: Zoloft dosing (long question)

Posted by KRM123 on July 13, 2003, at 12:20:19

In reply to Zoloft dosing (long question), posted by software guru on July 13, 2003, at 10:21:02

If you feel great at 50mg then stay there! If you start feeling crappy again in the future then up your dose. I had major depression when I saw my second pDoc. She wanted to start me on 100mg of Zoloft right away. Even though I had been on it in the past, I said no way and started out with 50mg. Within the first few days I felt great! I tried taking 75mg for a couple days just for the heck of it but I got "too happy"- anxious and acting retarded. My mom thought I was drunk lol. Anyway- I went back down to 50mg and I'm gonna stay there cause it works just fine. You may trust your Dr's but they don't know everything- listen to your own instincts! Good Luck.

> I have a question about Zoloft dosing:
>
> The reason that I am taking Zoloft is that I was diagnosed with anxiety and panic. I also have an irregular heartbeat which I think is what brought on the panic because I obsess over my heart and it's rhythm. Of course, the panic may be what brought on the heart thing, but it's hard to tell which came first. Either way, I was convinced that I had some obscure cardiac defect that the cardiologists couldn't see and it was going to kill me. Intellectually, I knew that I didn't because I have had every heart test short of sending a catheter into my heart, but emotionally I wasn't convinced and continued to obsess over it. The main problem I have encountered in my life because of this is not being able to exercise without inducing at least a mild panic attack.
>
> My psyc doctor started me at 25 mg/day and every 2-3 weeks increased me by 25 mg/day. I am now at 75 mg/day and my doctor would like me to get to 100. When I was at 50 I seemed to reach a point where I felt great, so great that it was almost too good. I felt a very refreshing energy and sharpness and started to get that vivid, colorful state of mind that I had years ago when I was 18 and everything was new and exciting. Everything smelled and felt new and cool. Then, as I passed 50 and went on to 75 the goodness seemed to subside and I started having more trouble sleeping (dose increases always messed with my sleep to some extent). I've been at 75 for 2 weeks and can't stand the thought of going to 100. My doctor insists I will feel great. Due to an issue with my ears, my doctor had me stop taking it for a few days (its been about 72 hours) and I feel like I have settled back to that good place I was at when I was on 50, almost like I've found a "sweet spot" in my dosage. Am I on to something here? Or is there some therapeutic significance to achieving the 100 mg dose that may help me more in the long run rather than just making me feel goood right now?

 

Re: Zoloft dopamine at 100mgs

Posted by jflange on July 13, 2003, at 20:23:57

In reply to Zoloft dosing (long question), posted by software guru on July 13, 2003, at 10:21:02

Hi!

Zoloft at 100mgs is supposed to have a dopaminergic effect, but I don't think that is necessarily what you need if you are experiencing panic and anxiety. It doesn't seem like a good idea to go through all the energizing effects of dopamine if you are essentially trying to calm down !?

If you are comfortable at 50mgs, tell your doc you want to stay there for now. It takes a while to find out if your body responds well to a certain dose. The worst that can happen is that you get only partial relief, in which case you can always titrate up or find an augmentor like Buspar or Klonopin.

jflange

 

Re: Zoloft dopamine at 100mgs

Posted by software guru on July 13, 2003, at 22:22:28

In reply to Re: Zoloft dopamine at 100mgs, posted by jflange on July 13, 2003, at 20:23:57

Thanks to everyone for sharing their thoughts. What does the dopamine do for our moods?
Does the Zoloft affect any other brain chemicals?
I've been taking the Klonopin (.5 mg) an average of once every three days for the past month to help me settle down at night and sleep better. I know this question has probably come up a thousand times here, but how long (asuming all other factors being normal) could I safely keep taking the Klonopin at that rate?

Thanks

> Hi!
>
> Zoloft at 100mgs is supposed to have a dopaminergic effect, but I don't think that is necessarily what you need if you are experiencing panic and anxiety. It doesn't seem like a good idea to go through all the energizing effects of dopamine if you are essentially trying to calm down !?
>
> If you are comfortable at 50mgs, tell your doc you want to stay there for now. It takes a while to find out if your body responds well to a certain dose. The worst that can happen is that you get only partial relief, in which case you can always titrate up or find an augmentor like Buspar or Klonopin.
>
> jflange

 

Re: Zoloft dopamine at 100mgs

Posted by jflange on July 14, 2003, at 0:04:09

In reply to Re: Zoloft dopamine at 100mgs, posted by software guru on July 13, 2003, at 22:22:28

Hi!

> Does the Zoloft affect any other brain chemicals?
Well, the simple answer is no, beyond serotonin and supposedly, at higher levels, dopamine, Zoloft is not known to have much effect on other neurotransmitters (like norepinephrine, for example). Dopamine is typically energizing for many who suffer from depression, whereas too much dopamine can sometimes effect motor function. Zoloft has a minimal effect on dopamine: its target is serotonin.

> could I safely keep taking the Klonopin at that rate?
In a word, yes.

Software guru, I read your above post about the panic and irregular heartbeat and I can relate to many of your experiences. I also went through the whole cardiology thing and couldn't work out without having skipped heart beats, panic, etc.. Zoloft has been a big help for me (at 75mgs, after a long time on 50mgs), it is a great motivator. I also augment with Buspar for the general anxiety, and to tolerate the Zoloft. I hit my limit of Zoloft when I found 100 mgs far too speedy for me (read: near-panicky).
Anyway, your combo, Zoloft with Klonopin, is a really good bet for your symptoms. There's really no reason why you need to start at such a high dose!
Best of luck,
jflange

 

Re: Working out, arrhythmias, and panic jflange

Posted by software guru on July 14, 2003, at 8:02:15

In reply to Re: Zoloft dopamine at 100mgs, posted by jflange on July 14, 2003, at 0:04:09

Please tell me some more about you heart symptoms. Can you exercise now? I used to exercise a lot, going for 20 mile bike rides, 10 mile walks, sweating and pushing and working my body in general. I miss it so much. But I'm still afraid that if I go out and really work hard my heart is going to go into some horrible arrhythmia that it can't get out of. I get PVCs and PACs, and can tell the difference in the way they feel. My cardiologist was shocked that I could discern the difference between the two during one of my stress tests. I've had a 24 hour halter, 30 day looping event monitor, echo, nuclear vapor perfusion, stress test, stress test with nuclear dye, several EKG, and some more tests that I can't remember. Wow. I guess my heart is probably OK. I've never been afraid of anything, used to be a pilot, an avid diver that casually pushed the outer depth limits of sport diving and a little cave diving, and just a balls to the wall adventurer in general. I can't believe I'm to the point where I'm afraid of my healthy heart.
Last night after being off the Zoloft for just over 72 hours (to try and pinpoint my tinnitus) I was starting to feel like something was wrong with my heart again. I guess the Zoloft was really working. Of course I'm back on it as of now.


symptoms> Hi!
>
> > Does the Zoloft affect any other brain chemicals?
> Well, the simple answer is no, beyond serotonin and supposedly, at higher levels, dopamine, Zoloft is not known to have much effect on other neurotransmitters (like norepinephrine, for example). Dopamine is typically energizing for many who suffer from depression, whereas too much dopamine can sometimes effect motor function. Zoloft has a minimal effect on dopamine: its target is serotonin.
>
> > could I safely keep taking the Klonopin at that rate?
> In a word, yes.
>
> Software guru, I read your above post about the panic and irregular heartbeat and I can relate to many of your experiences. I also went through the whole cardiology thing and couldn't work out without having skipped heart beats, panic, etc.. Zoloft has been a big help for me (at 75mgs, after a long time on 50mgs), it is a great motivator. I also augment with Buspar for the general anxiety, and to tolerate the Zoloft. I hit my limit of Zoloft when I found 100 mgs far too speedy for me (read: near-panicky).
> Anyway, your combo, Zoloft with Klonopin, is a really good bet for your symptoms. There's really no reason why you need to start at such a high dose!
> Best of luck,
> jflange

 

Re: Working out, arrhythmias, and panic

Posted by jflange on July 14, 2003, at 22:50:21

In reply to Re: Working out, arrhythmias, and panic jflange, posted by software guru on July 14, 2003, at 8:02:15

Hi software guru:

Yes, indeed, I have been through all those tests. I figured I owed it to myself to try everything with my heart before I settled on anxiety disorder. I also had some PVCs and PACs that came up with some of that monitoring that are considered benign (most are). It sounds like you checked everything with the cardiologist, so it makes sense to get the anxiety in check to see if it makes your symptoms go away.

In the first month or so of Zoloft, once I was getting used to my dose, I felt a bit weird when doing more intensive exercise like running, as if my heart (the the rest of my body) were working too hard. This went away, however and now I do not even notice my heart anymore. I also strongly recommend taking Calcium/ Potassium/ and Magnesium (especially the latter), since this too will definitely regulate your heart rate and calm anxiety (a lot of heart fluttering is caused by magnesium deficiency, I have read).

It sounds like a Sesame Street-type resolution to the problem, but once I stopped feeling my heart (once it stopped making anxious little extra beats and flip flops thanks to the anti-anxiety meds), the less I focused on my heart rate and the more even the heart rate became. Thus: the weird heart rate was probably a symptom of my anxiety/panic.

The tinnitus you are experiencing from the Zoloft (?) might also go away with time, though it's not really an acceptable side-effect if it's really bad, even for a short time.

jflange


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