Can you advise me please - moving from st john's wort to sertraline

[nothingcomestonothing]

Hi all, I need some advice please if anyone can help. I was on citalopram for anxiety for many years, and had to come off it to be approved to adopt. My GP was extremely helpful and helped me reduce, stop and then move safely onto SJW (double the dose on the pack), which worked really well for me (and I had the added bonus of losing the 5 stone I put on on Citalopram!).

Fast forward to now - living with two traumatised children, having broken sleep, and not having had the structure of work while on adoption leave means my resilience has all gone and my anxiety is back with a vengeance. I have struggled on hoping outside things were going to help me get back on top of it - once the summer holiday started, once the kids were back at school, once I'm back to work etc etc - but have now accepted I need some help.

I know the GP is going to prescribe sertraline when I go back next week -she's tried 3 times already and I wouldn't do it - and I need some advice re getting from SHW to sertraline safely. I have since moved house and changed GP, and I'm not sure my current GP will be aware if there are any risks - I'm worried about serotonin syndrome, and also about making side effects worse, as the common side effects of sertraline, nausea and diarrhoea, I have bad anxiety about. I haven't got long to stabilise on the sertraline as I go back to work in 3 weeks (I know, I know, I was in denial that I could get it in hand without meds) so I don't know whether I should be cutting or stopping the SJW now, so I'm ready to take the sertraline, can anyone help please?

Why Sertraline specifically? I don't wish to be unhelpful so all I will say is please start on the lowest dose possible. Be very wary of any increase in dosage. In my experience - low dose of 25mg made me relaxed and carefree. 50mg destroyed my short term memory and made me gain a stone which I now cannot shift. Your experience may be different.

I know it will be sertraline because that's what she's tried to give me 3 times already. I've said I won't go back on the citalopram because they were no better than SJW, I was exhausted all the time and grew several clothes sizes. I'm interested you've gained weight Gilbert, as she said this was not a side effect of sertraline - not that it'd be the worst price to pay for feeling better, it's just I've only just bought a load of new work clothes cos my old ones are all now too big! [shallow]

Sertraline has been the best AD for me with the least side effects & no weight gain. I was always told to take it in the morning & to break the 50mg starting dose in 1/2 for the first few weeks. I have tried so many & have had to stop due to side effects. I've always gone back to this one. I have been on it for 20 years. The only side effects on 1/2 a dose the first few weeks were a mild headache, mild diahrea, tiredness & I could feel my heart racing a bit. I started to feel better within a few weeks.

I would suggest getting the SJW out of your system before you start taking the setraline. It can clash with antidepressants.

I didn't have any weight gain on sertraline, in fact I lost weight. I think something like 1 in 4 people on anti depressants will gain weight, so just be careful with your diet. I increased from 50mg to 100mg with no problems at all and am now decreasing with no problems. So a very different experience to Gilbert. I think fretting about potential side effects is pointless as ADs affect people so differently, it's all trial and error. I did have some diarrhoea and nausea but it only lasted a few days.

I'm about to start on mirtazapine where weight increase is the biggest side effect. I'm terrified but I'm going to give it a go as I'll never know if it could have helped if I don't try. I would gradually decrease your SJW if I were you so you're ready for the sertraline.

Pandora37 I don't want to alarm you but just to warn you Mirtazapine is notorious for weight gain. Some people have put on 3 stone. It's very sedating but very good for treating anxiety. it makes you crave sweet things. I was only on it 10 days but was craving biscuits & jelly babies. It made my depression worst so I had to come off it. The starting side is 30 mg but I started only on 15mg & couldn't handle the tiredness the next day. Apparently on higher doses the drowsiness gets better.
My psychiatrist said to try & eat fried fruit or muesli bars if craving sweet things.

*Starting dose

I personally find fluoxetine much more effective for anxiety OP.

The fluoxetine gives me no side effects while when I was on sertraline if I missed a dose I went all lightheaded, dizzy, and then once I took it felt utterly sick for hours. It wasn't nice. Had to use fluoxetine to wean myself off in the end and will never go back to it.

I think you need to reduce the St John's Wort and actually have a gap after that before starting the Sertraline, however check with your GP and pharmacist whether a gap is needed and how long for.

I am on Sertraline, started on 50mg and was on 100mg within quite a short time, couple of weeks maybe. No nausea or the d word I can't spell, but I think if you do get those they will pass quickly. No weight gain as yet.

I am interested that you gained weight on Citalopram, I was on that for a while and my weight went up at times but I didn't connect it to the drug, especially as I was on other meds too. I have also taken Prozac in the past and I lost weight on that, but due to the fact it made me feel sick.

Congratulations on your adoption, it sounds like you are doing a wonderful thing. You've your hands full for sure .

Kittykat thanks I have been reading about mirtazapine and weight gain on the internet. I'm still going to give it a go, if I put on lots of weight then I will come off it. Am glad to hear it's good for anxiety, although I was told venlafaxine is more useful for anxiety. I already have a HUGE sweet tooth and eat tons of chocolate so I don't really see how it could get any worse. I'd be very worried if it did. I don't know what other ADs I can take though as my GP won't let me go on any SSRIs as sertraline has effected my clotting and platelets and he doesn't want me to take venlafaxine as that can cause blood disorders as well. So mirtazapine is my next option. I don't know what I'll do if it doesn't work out, I may have to come off ADs completely and take SJW? I don't really know what other ADs there are as SSRIs are by far the most common. [Sorry for hijaking your thread OP!]

I took a SJW this morning without thinking, then missed my second dose when I realised I need to get off it asap. Will try taking none tomorrow - I feel so crappy anyway I'm not sure that going cold turkey will be much worse (famous last words). Am also telling myself that I feel so sick and have diarrhoea from anxiety anyway, so if the sertraline does that I'll be no worse off and it should help me feel better soon - fingers crossed.