Just started Sertraline and worried. Please help.

[Psion]

I spent 3 months taking Trazadone + a low dose of Quetiapine for severe anxiety and depression. The medication did absolutely nothing to help me, and in fact I believe it exacerbated my problems. But the psychiatrist insisted 'it was an excellent combination' and wouldn't take me off it.

A couple of weeks ago I was discharged from the Crisis Team, and sent back to my GP. He immediately agreed that my meds weren't working and changed me to 50mg of Sertraline + 100mg of Quetiapine, still.

I was nervous of starting as I have heard so many negatives about starting sertraline. But within 2 days I was feeling much calmer inside and sleeping very well, with none of the awful panicky early waking I'd been having before. My head felt quite buzzy and distant but it was actually quite pl;easant.

But I'm now getting really worried because 12 days into taking sertraline I am floored by the fatigue. I don't want to do anything just sit and sit. It is really hard to drag myself out of bed in the morning, and I spend most afternoons snoozing on the sofa.

Also, I feel totally emotionless, just hollow. I honestly can't muster any emotion about anything. There's no deadening depression, or intense feelings of despair like I was having whilst on previous meds. And the relentless suicidal ideation has completely stopped (which is a blessing). But those horrible feelings have been replaced by a sort of light 'nothingness' inside.

It's a definite improvement on how low and despairing I was feeling before, and I haven't cried in over 2 weeks. But it's starting to scare me how numb and hollow I'm feeling. I didn't get up until 10, had a quick shower and got dressed, and tidied up and put some washing on. But I'm just going to spend the rest of the day on the sofa either reading or napping. When on my previous meds I was far too anxious and agitated to ever sit down and relax during the day, it was impossible to do. But now the pendulum has swung too far the other way.

Has anyone experienced similar when starting Sertraline, and how long did it last for?

[Idontknowwhoiam]

If you're feeling a bit better emotionally maybe the fatigue is your body's way of healing and allowing you to rest after months of severe anxiety which would've taken a toll on your body.
I'd go with it for a couple of days and then maybe see your gp if you don't feel better after a good few days rest.

[foursillybeans]

I am not medically trained but have struggled with depression and anixety. I was given Sertraline but it did not agree with me and I could not take the side effects I suffered so stopped. Why not continue for now as your symptoms have improved but obviously you have other side effects and then see your GP after 4 weeks and ask about reducing one or the other medication and seeing if it helps. It can take a while to get meds for anixety right and if your symptons are better then before (just different) then stick with it and see how they can be adjusted. I read a lot about Sertraline and it seems most people take at least a month to 6 weeks to stablise on it but then seem glad they persevered.

Hope all goes ok OP and you start to feel better and more yourself again.

[shockandawe]

Sertraline has been amazing for me.

I recall being very critical and analysing my mood. Which I needed to overcome to really see how I felt. Does that make sense?

[foursillybeans]

Sorry, I didn't make it clear I stopped as my symptons were stomach related and I couldn't manage them in role at my work so had to stop. I wanted to continue as I read good things about Sertraline after initial problems have passed.

[lucy101101]

I am lucky as Sertraline just agreed with me from the first day of taking it... but I would be inclined to give it another week or so and if you aren't feeling better then ask to try something else. Maybe make an appointment in any case with your GP so you know you will be seeing them to discuss it? I have also been floored by fatigue when depressed but it wasn't linked with the Sertraline for me.

[mostimproved]

I'm on day 28 of Sertraline and have had similar side effects, I'm glad I'm not alone! I had extreme fatigue and was constantly yawning, and would sleep on and off all afternoon. This has improved slightly although still feeling tired, but have seen an improvement so hopefully you get one too.

As for the emotionless feeling, I have also hot this and it hasn't gone away yet - I am still getting the suicidal thoughts but feel very matter-of-fact towards them rather than emotional, which is worrying. I can't cry anymore and feel very hollow and empty, as if I have no emotional response to anything at all.

Sorry I don't really have much of an answer, but just to say I have felt the same way and fingers crossed it gets a bit better for you and you start to feel more 'normal!'

[Aveiam]

Sertraline did the same thing to me. Venlafaxine is also shit, fluoxetine worked quite well for me but interacted with another drug I'm on so been changed to escitalopram which has made me ten times worse. I'd keep going back to your GP until you can find something that works for you, but try to give things a chance to settle first if you can. Xx

[PitilessYank]

Hello. Do you think some of the symptoms might be from the quetiapine?

I have been on antidepressants for a couple of years, and in fact was newly on them when my father died. I remember remarking to my brother, at the time, that unlike our sister, I wasn't crying at all over our Dad's death, and that I thought it was the antidepressant doing that.

However, my thinking at the time, and now, is that numbness is definitely superior to depression, and certainly suicidality, and one generally develops a tolerance to it over time and resumes a more typical range of emotions.

As for fatigue, I generally always take my antidepressant at night, and if this does not help, you may find venlafaxine or bupropion cause less fatigue. (Bupropion can cause anxiety, however.)

Quetiapine is a dopamine blocker, and may thus also suppress certain emotions. I don't love it but you are on a modest dose so if it works don't be afraid to take it.

[PitilessYank]

Trazodone is a fairly weak antidepressant-here in the US we generally only use it at night as a sleep aid.

[EasterRobin]

I've been on sertraline since having my baby, and it's been a huge help for me. I felt calm, but yes also numb and distant on it for a while but I think that's partly in comparison to the excessive emotions I was used to feeling. It's created a new "normal" base line for me which took a while to get used to. It's a hell of a lot better than the base line that was there before!

[Psion]

Thank you for all your replies. Funnily enough I started to feel a bit more engaged this afternoon, hope it continues.

I am very relieved to have not suffered the increase in anxiety that often comes with starting Sertraline. But this may be because I also take Quetiapine, or so my GP tells me?

PitilessYank I am a bit bothered by taking Quetiapine. They put me on it, because after nearly 4 weeks the Trazadone wasn't helping my awful anxiety at all. But even though I went as high as 150mg of Quetiapine at one point it did nothing for my anxiety either. Neither did 250mg of Trazadone. It didn't even help my sleep that much, and could only manage about 5hrs per night. And I always, always woke with dreadful panic and feelings of dread.

Since stopping Trazadone those horrible early wakings have completely stopped, thank God. And since being on Sertraline + Quetiapine I sleep for a good 7hrs and just wake feeling sleepy.

I think once the Sertraline had properly built in my system I hope to taper off the Quetiapine as I don't think it has done anything to help me at all. I'm hoping it will be easy to taper off as it is quite a low dose.

If I had more energy I would be tempted to tackle the psychiatrist for keeping me on meds that were clearly ineffective for over 3 months. Even the CPN was puzzled. I don't know if it is possible but I actually believe the Trazadone + Quetiapine combo made my anxiety much worse. I certainly didn't have suicidal ideation before taking that combination.

[Elledouble]

What times do you take your drugs? I take my Sertraline in the morning and quetiapine at night because it knocks me out, could you try swapping it about to see if that helps the fatigue?

[Psion]

I take them the same as you Elle. What dosage do you take?

[PitilessYank]

Psion-

I had a few thoughts when reading your last post:

I am also dismayed sometimes at how slow psychiatrists are to ramp up dosages on medications or switch medications. I am an Internist, and I am very aggressive when it comes to treating depression. I have spoken to my psychiatrist-colleagues about this and it seems as if the reasons are multiple; many of them have not experienced true depression and anxiety themselves and do not appreciate that it is an urgent problem; some of them are genuinely convinced that the meds take months to work (I disagree with this-if a med is going to work it will start to work within 7-14 days, although the dose may need tweaking); some of them are just naturally medically cautious; and some of them are actually relying on time to heal the depression, and using meds to give hope in the meantime.

I am not a fan of quetiapine for anxiety, as I think the doses needed to lessen anxiety may be sedating. But some of my patients swear by it.

We say that trazodone "opens a window" to sleep, but does not cause a sustained period of sleep. I tell my patients that they must go lay down after they take trazodone and not depend on it to make them "drowsy" enough to fall into bed, you know what I mean?

I wonder if UK doctors use labetolol or buspirone for anxiety? Those are both non-addicting and tend to work well.

I know it can be difficult to access therapy in a timely fashion via the NHS, (much as I respect the NHS), but talk therapy works as well as antidepressants and the two have a synergistic effect. Could you sign up for therapy?

[Elledouble]

Psion I have 200mg of each. Different drugs have different effects on people, might it be worth trying to take your Sertraline later? If it's making you dozy it might help you sleep better too if you get the timing right.

[Psion]

pitilessyank yes, I have to agree with you. If more doctors and psychiatrists had actually suffered with depression or anxiety themselves they'd be a damn.sugjt more empathetic and hard-line about it.

One doctor just advised me to try deep breathing and take up knitting FFS.

I don't even understand why they added Quetiapine to my meds, rather than just acknowledge the Trazadone wasn't working for me?

As it is, I am only on 100mg of Quetiapine which I understand is a very low dose, and at such a low dose it's unlikely to have any mood improving qualities, and is probably just helping my sleep.

Would you agree with that?

[PitilessYank]

Psion-yes, I do agree with you about the quetiapine. Was it explained to you as having antidepressant effects? My understanding is that is was designed as an antipsychotic, but was not very effective, so is used more as a sleep aid/anti anxiety agent/mild mood stabilizer.