12 weeks on sertraline and feeling rubbish

[MouseandChops1]

Hi, I really would welcome some advice please. I have been on sertraline 50mg for anxiety for the past 12 weeks. Had been feeling like I'd turned a corner around week 7-11 and was dare I say happy, however, this past week feel like I've slipped back down again. I have backround anxiety nearly all the time. I'm functioning with it, at work today and have managed to put on a 'normal' face but I desperately want to go home and have a good cry! Not sure what about though.
I have struggled to sleep for the past three night and that's playing on my mind and getting me down
Anyone else experience this? Any advice on what it should do? TIA

Hi. 50 mg is the starting dose so it may be worth going to GP and upping it to 100? Afaik, 100mg is more of a therapeutic dose. Im on 200 mg and have been on it for years.
Hope you feel better soon.

50mgs of Sertraline in not a therapeutic dose and it sounds like it should be increased asap. Unfortunately the thing with anxiety (and depression) is that it tends to fluctuate from day to day and sometimes even through the day. I think you definitely need to see the GP again and tell him/her how you are feeling.

Do you know what triggered the anxiety - sometimes there is a trigger and sometimes not. Have you thought of therapy - might help.

Thanks both of you. No major triggers, just the small stuff getting on top of me. Challenging 6yr old, visit to in laws, husband who works all hours under the sun etc. feel like I should be coping better, some days I am though and get carried away thinking 'I've cracked it.....I'm better now'!! Then bang, the physical sensations of anxiety are overwhelmingly present and I seem to spiral with my thoughts quickly, if that makes sense? My husband last night said he can tell when I'm not feeling well as I've got a rabbit in the headlights look :(((
Having therapy nana, 6 sessions so far. Not sure how it's going. Sit there worried about what to talk about for the first five minutes and somehow end up chattering away for the remaining 40 minutes about random stuff that I'm not sure matter. It's very self directed and I leave feeling like I've not learnt anything or moved on.
Is 50mg considered too low a dose to be effective?

Hi Mouse - sounds like you're having CBT which is what you get on the NHS and usually 6 sessions. It seems to suit some people but it didn't do much for me I have to say. Suppose it depends on whose doing it - I think it can often be a mental health nurse from the surgery and they aren't therapists, they've just done a course on CBT. Can you afford private therapy - tends to be around £50 an hour dependent on where you live. If so the best thing to do is look on the BACP (British Association of Counsellors and Psychotherapists) and look for someone in your area - there will be quite a lot to choose from. IF you do go down this route the main thing is that you find a therapist with whom you feel comfortable and safe and a good therapist will suggest using the first session to see if you suit each other, so to speak.

YES 50mg is too low a dose. I checked this out with my CPN yesterday because I'm on Sertraline (started on 50mg for 2 weeks, but was also taking another AD and tapering it off) and then built up to 150mg Sertraline. I am more depressed (intermittently) than anxious. My CPN said 50mg is not a therapeutic dose - it's really a "test dose" to check that you're not having bad side effects.

The rabbit in the headlights look YES - because anxiety is actually another word for fear - fear of how we feel, how out of control we feel, how we are not like who we used to be, fear that we won't get better and god only knows what else. Is your DH sympathetic at all - I know a lot of men struggle to understand mental illness, well so do lots of other people too.

What physical symptoms are you having - the common ones are dizziness, shortness of breath, nausea, lack of appetite, sleep problems and much more.

I think you definitely should go back to the GP (preferably not the one you saw last time) and get the dose increased to something that might be more effective.

I'm on 200mg and have been taking for 18 months. I'm a different person since I started taking them, although I take other medication alongside this. It really has turned my life around.

Great news miss that life has improved for the better. It's lovely hearing how much better people are, it encourages met self and others to keep going, without sounding dramatic :)

Nana, thanks for your reply. Having private counselling, it's not CBT but talking therapy. She doesn't really say anything, just let's me get on with it. Makes me uncomfortable to be honest. Half the time I just come up with things.....
I've seen a GP today and she has increased dose to 100mg. Nervous about upping dose. Keep thinking maybe if I give it another few days things might improve and so on.
Will the side effects be bad this time?

I shouldn't worry about the increased dose Mouse - given that you haven't had any bad side effects from the 50mg dose it's unlikely you will get any with 100mg - as I think I said my CPN said the 50mg was a "test dose" to see if you were ok on it without bad side effects. Go for it - the extra dose might make a difference. I'm on 150mg and about to go to 200mg.

Do you know what kind of therapist she is - what her psychological orientation is - some therapists use a bit of a "mix and match" approach as far as their orientation is concerned. You could ask her. She could tend towards a psycho dynamic approach and therapists will always see troubles in the present as an "echo" or "re-enactment" of what happened in the past, usually our childhood and the way we were parented. I don't disagree with this as a concept, in fact I very much believe that behaviour is a product of experience, but these therapists tend to listen to the words and phrases we use as a "clue" to the way we are thinking and they are big on transference and projection - sorry I don't want to insult your intelligence, but google them if you don't know what they are in psychological terms.

I'm concerned that you feel uncomfortable with the therapist. Therapy isn't meant to be comfortable as such, but feeling uncomfortable (maybe even embarrassed) sorry someone's just come I'll come back later

Sorry about that - ironically it was my neighbour (who is suffering from anxiety and been on 50mg Sertraline for a month - prescribed by a young inexperienced GP....and just been back and got it upped to 100mg) and I wanted to show her the surgery web site so she could get an appointment with one of the partners.

Feeling uncomfortable and maybe embarrassed isn't a good sign, unless it is just going to take time for you to get to know each other better - but it almost sounds like you are just thinking up things to say to break the silence and that's no good. You should be doing more of the talking but she should be commenting/asking for clarity/asking how something makes you feel etc etc. How many sessions have you had? Therapy isn't cheap is it and you need to get the best out of it - maybe don't talk as much next time and tell her you feel uncomfortable - that might bring about a better understanding between you, but if you continue to feel uncomfortable I'd definitely end it and find someone else. I went to one a couple of times and I really didn't like her so didn't go again - she was writing down everything I was saying which put me off.........I saw a lovely one on the NHS though and I felt very comfortable with her, even though she challenged me sometimes, I always felt I could tell her exactly how I felt and I sometimes criticised her a bit and she was fine with this. I used to find that I'd think back over something that she'd said after the session and it would bother me, so the next week I would bring it up and she was always glad I felt able to do that - in fact a good therapist should always welcome feedback, positive or negative. Maybe tell her you feel uncomfortable and see what her reaction is...........could be quite revealing!

Oh and my neighbour has also been given beta blockers for anxiety.

I know I shouldn't feel uncomfortable nana. I just do, I feel like she's bored maybe. I seem to spend the whole session talking about things I already know are 'triggers' without identifying coping mechanisms. Maybe I'm expecting too much from counselling.

Initially, I was assessed by someone lovely. I went like a good school girl with a list of concerns ( just to prompt myself and avoid backing out). She just put me at ease. I was hoping to have her, wonder if I could ask to see her? Would hate to offend the current councillor though so that's stopping me querying it.

Not having a good evening, feel really on edge. Coping but feel like I could stop at any minute if that makes sense? I did have side effects with starting on 50 mg. I seemed to feel really low, nauseous more anxious etc. Do you think that will happen again?

Sorry to ask so many question, you seem very logical and knowledgeable :)

Oh Mouse there isn't a should and shouldn't about the way we feel - there are no rights and wrongs of feelings, they are just that feelings and I think it's really important that we "listen" to our feelings and take them on board. Many people don't really understand the difference between feeling and thinking and if you ask someone how they feel, they often tell you what they think! You feel uncomfortable with this counsellor and your feelings are real - so there!

I know it's difficult, especially when we feel low and mental illness has knocked us for six, but I honestly think you don't need to worry about offending the counsellor. You are paying FGS - you're the customer, and she doesn't sound like she's doing a very good job. You met someone else who put you at ease - and so YES of course she is the obvious person for you to see. Sometimes it's a simple matter of chemistry, that you get on with A but not B. SO take courage - this is your mental health that is important and talk to the counsellor next time about your discomfort and ask if you can see whoever it was (is it a practice where there are several counsellors) Just thought they might have a policy of not "passing on" people to others in the practice, but if this IS the case, I still think you need to tell the counsellor that you aren't comfortable with her and that you feel you need to end the sessions. Then you can look for another counsellor and this time, ask if the usual practice is to use the first one or two sessions as "tasters" to see if you and the counsellor can work together in a therapeutic alliance. As I said before a good therapist will always work in that way.

Sorry you're not so good this evening - I've had a crap day (depression with me) but it usually lifts in the evening. Interestingly my neighbour said that she often gets worse in the evening.

Re the Sertraline. The thing is that on such a low dose it could well have been the anxiety that was making you feel low, rather than the AD. I know quite a few people suffer from nausea in the first few weeks but mostly this seems to pass off - don't be scared of trying the 100mg - it's still only half of the maximum dose of 200mg and if it does really cause side effects you don't have to continue taking it. On the other hand it might just improve your anxiety.

You sound so similar to my neighbour I began to wonder if you were her (!) but she has 3 boys all under 8 (one with SNs) and I think you said you had a "challenging 6 year old" - is your DH supportive/empathetic - it's difficult for people to understand mental illness I think, and what really gets me is that there is still a stigma attached to it, after all these years. You probably know that 1 in 4 people will suffer from a mental illness at some point in their lives (depression and anxiety being the most common) and approx. one third of all GP consultations are MH related.

Don't worry about asking questions - I was a social worker/manager with a career spanning some 30 years but retired in 2009 and I'm very old (!) 70 - and a grandmother of 5, and so it's sort of second nature to want to "reach out" to others. I'm very logical when it comes to giving advice but not when I go to bed feeling fine and wake up in the morning feeling shite and I'm wailing to my long suffering DP (we've been together over 40 years) just didn't get around to getting married!

So take the Sertraline - talk to the counsellor - or if you really feel you can't do that, write to her and she should invite you in to discuss your concerns.

My neighbour is continuing to go to work but fortunately has a boss who is very sympathetic. She had to leave early today - she just couldn't cope. I'm trying to get her to have some time off and she's thinking about it. I'll let you know how she gets on with her 100mg Sertraline and her beta blocker for anxiety.

There is a thread called the Autumn Village thread that you might want to look at - it's been going for at least 2 years and I dip in and out of it and there is loads of good support on there. MN MH threads have passed away many a dark hour (or two) for me I can tell you.

Hi nana, not your neighbour, although, she is very lucky to have you for support at this hard time. You sound so lovely and caring. I noticed your reply to me last night was very late. I hope you're not struggling too much with sleep? Hopefully you too have people to encourage you along in your days of need.

My husband is very supportive too, feel terribly guilty to burden him with my ways :) he try's very hard to say the right things etc but he works long hours and I find it tough going with the responsibility of bringing up our two children pretty much as a single parent during the week.

I increased my dose last night to the 100mg, had the second one at 5pm today as I'm trying to work out why I'm struggling to get to sleep.
Having a hard few hours this evening, very teary and over tired. Completely devastated that I feel so anxious/overwhelmed again. Do you know how long roughly it takes to see an improvement from increased dose?

I had a good chat to the assessment person at the counselling centre this evening and was honest with how the approach wasn't working for me. She was very understanding and we are going to meet in two weeks to find a new route. Thanks for highlighting what I was already feeling but unable to see.

Hello Mouse - yep my post was late - I'm a bit of a night owl and so stay up late (too late really) and I've always hated mornings, so get up late too. Also if I'm going to have a bad day, mornings are the absolute worst, so waking up late shortens the mornings - so there is method in my madness. I sleep reasonably well. And yes I have a very supportive DP thanks and a few close women friends.

Well done for taking the increased dose - you can take the whole dose together - my CPN told me to take mine in the morning because they could cause bad dreams, but I started taking them at night and I don't have bad dreams.

It's really tough when you think you've "turned a corner" and then the symptoms come back - I'm afraid to some extent it's the nature of the beast, but I think the 50mg dose wasn't enough to "hold you" as it were. I'm not surprised you are over tired and teary (so is my neighbour - she looks totally done in......and has lost so much weight and she was slim to begin with - she just can't face food) you are struggling with a mental illness and at the same time working outside the home and caring for 2 children.............why wouldn't you be overtired and teary. Sorry I know that's not much help but I think sometimes you young moms have such a heavy load and don't realise the toll it takes on you, let alone mental health problems as well.

I'm trying to encourage my neighbour (C) to have some time off work as she has 2 at school and 1 in nursery full time 3 days a week but she's reluctant, and she could rest and re-charge her batteries, but knowing her she will probably be doing housework! Are yours school age? If so, how about you take some time off - be kind to yourself - you need to rest and have a break from work?

I don't think anyone can say if/how long an increased dose will take effect. I asked the psychiatrist if he thought 150mg would have a good effect and he said, rather shortly (as they do) "we don't know until we try" and there you have it I'm afraid. Having said that medics will always say that ADs can take 2/3 weeks or more to "kick in" and so an increased dose is going to take a while to take effect. ADs are very "hit and miss" unfortunately and what works for one doesn't work for another. Just to confuse us a bit more!

Can I ask if this is your first episode of anxiety - if so, there is every chance that you will make a complete recovery once you are on the right meds at the right dose. Sometimes, you do have to try a different AD. I went through a change of meds this summer which was a bit traumatic but I'd been on one AD for many years, so it took a lot for me to change. I honestly think Sertraline suits me better than the other one, though I still have fluctuations, but that's because it's not my first episode, and because of my age, so don't compare yourself with me!

There's a thread called Sertraline buddies or something like that. I think a lot of posters on there have anxiety rather than depression.

Glad you talked to your counsellor - well done, and glad you have a supportive DH.

OK - all for now - have a think about "cutting yourself some slack" and taking a few days off to re-charge your batteries. I don't know what your job is but no one is indispensable you know.

Morning nana, having a rubbish morning. Feeling all jittery, really teary and nauseous. Can't seem to stop crying and built up a picture in my mind of not coping and spiralling down hill to the extent of being sectioned!!! Very dramatic and as I write this I'm slightly laughing at how ridiculous I sound. Feel like I need so much reassurance all the time, that I'm either not as bad a 12 weeks ago, I am going to get better and so forth.

Don't know if the increased dose is affecting me and heightening how I feel or if it's just me?

Really appreciate you taking the time to answer

Hello Mouse - are you at work or at home? I do wonder if your anxiety is "tipping over" into depression as the two usually go hand in hand. Prolonged bouts of crying are usually a symptom of depression (this has always been one of my main symptoms) as are "negative automatic thoughts" which you are having. I know all about those too.........the thing is dep/anx are deceitful illnesses because they make us believe that we should be able to "do something to get better" - we can feel guilty or even ashamed and worthless whereas we don't feel those things when we are physically ill.

ALSO - anxiety is fear - fear of the present and fear of the future and this is one of the reasons that your negative thoughts are spiralling down and down, and even worse, depression makes us actually believe that we will never get better. It took me a long time to work this out, even though my CPN kept telling me that. Also "catastrophising" is very common in mental illness and make us feel worse of course. The other thing is the stigma of mental illness makes it all so much harder to bear.

You are not going to be sectioned Mouse honest unless you go on the rampage with a meat cleaver!

I don't know if this is of any help to you, but it helps me. I keep a diary (a big A4 spiral bound pad from Sainsburys) and write down every day how I am - if I'm ok I write hardly anything but if I'm not I write a lot and lots of LARGE swear words sometimes fill the page! I've always been someone who finds a bit of release in getting things out of my head onto paper and this gives me a bit of control as mental illness makes us feel out of control and that in itself is so scary. I score every day : VGD (very good day) RGD (reasonably good day) NG - lifted at 2.00/4.00 (Not good in the morning but better in the afternoon) Bad day (speaks for itself) "wonky 2 hours in the morning then VGD. Then at the back of the book I write all the days of the month and just put the score by each date. This helps me keep track of how I've been and at the end of the month I add up the VGDs and can see how I'm doing through the year. As I said my MI is very different from yours and I haven't made a complete recovery since I relapsed in 2010 so I've got lots of Sainsbury's pads!! If I'm lucky I average around 80% VGDs but sometimes much less. It's so much easier for me as I'm retired and don't have small children to care for - I honestly feel SO much for you young mums as on my bad days I can't even be bothered with the cats!

CBT is all about trying to replace the automatic negative thoughts with more balanced ones - easier said than done when we feel crap. The first CPN I had was very into CBT and used to get me writing how I felt on one half of the page and then writing something more balanced on the other half e.g. "I feel so scared and empty and flat and I can't stop crying and I know I'll never get better and might even get worse......." then something like "I've felt like this before, and it's passed over and I've had some better days and the more I catastrophise the worse I will feel, so I need to try to distract myself........" That concept is all very well when we feel ok but I found it difficult to do when I felt crap, and don't do it any more.

Do you know about breathing stuff for anxiety - breathing in through the nose (to a count of about 7) holding the breath for a second or two and then a long breath out through the mouth (to a count of about 10) don't worry about the numbers, so long as the outbreath is longer than the in breath. Notice the tension in your shoulders too and release then down when you think about it, they'll tense again, but release again. If you do the breathing stuff lying down you can place your hands on your tummy and feel it rise with the in breath and fall with the outbreath.

I wouldn't have thought the increased dose was making you worse - it's more likely that you've been left on too low a dose for too long. You really need to give the increased dose a chance as it can take a while to be effective (differs with individuals) can be up to 4 weeks.

Of course you're wanting re-assurance that you'll get better as you're scared because mental illness is very scary and reduces us to an almost "child like" state - I often find myself biting my thumb or fingers on bad days and this is what children do isn't it. My CPN told me (in relation to my neighbour) that if this was her first episode and with a therapeutic dose of an AD she would almost certainly make a complete recovery, but it would be delayed because a) she didn't see the GP for about 4 months of feeling anxious and b) she was kept on a non therapeutic dose of AD for too long. SO the same should be true for you.

PLEASE don't compare yourself with me and worry that you'll be up and down all the time - everyone's MI is different and mine is very different from yours. Oh and the nausea could be a side effect of the Sertraline as it's one of the common side effects OR it could be related to the anxiety. Try and nibble ginger biscuits, dry crackers, toast etc but keep up your fluid intake.

I'll look back in this evening.

Hello Mouse just wondering how you are? Hope my post hasn't upset you. I'm going to Ireland tomorrow for a week to see my son dil and grand-children, so won't be on MN. Hope you're ok.

Hello nana, sorry I was having a rubbish day yesterday. Went to bed after I got the children down at 8! Good news is that I slept most of the night. Coincidently, I too am off to Ireland in the morning for a week. Let's hope the weather holds out for us and we get to enjoy Ireland at its best!

I certainly wasn't upset regarding your post yesterday, with my crying and low low mood yesterday I too was wondering the same. I do think my overriding problem is anxiety but get really low and desperate when I'm in the full throws of anxiety. I just feel desperately lost and frightened. I honestly am normally the happiest person. That's why I struggle. I feel so much pressure to hide it from people who don't know me very well, school mums, work colleagues etc. I have a wonderful circle of good friends to support me though. I really am lucky in the respect, without them I would struggle more.

You asked of this was my first episode of anxiety but unfortunately it's now my third. First two times were post natal. It's really been since the birth of my daughter 6 years ago that it's all started. I had a horrendous 3 day labour with absolutely no sleep, followed by an emergency after an adverse reaction to a drug. It was panic stations, full on crash alert where all the medics were panicking as they didn't know what to do. My poor husband was pushed to one side and didn't know what was happening to us. It all ended well after intervention but I was a wreck. I had a huge panic attack within 24 hours and it's started from there really. Never experienced anxiety of panic attacks up to this point so I was come rely sidelined. I sought help after about 3 months and was on citalopram for 8 months.

With my second child 2.5 years ago, I was so worried about the labour and tiredness that I truly believe I made myself anxious. I was doing really well for the first 8 weeks but I was constantly checking myself. I think the endless feeding and tiredness tipped me over the edge. This time I was prescribed sertraline 50 mg as I really wanted to continue feeding. I was on that for 14 months and weaned off over 3 months.

It's really only been a short time I'm off them. It's weird really as I don't remember the finer details of each time. Only that it was awful and hard. It's like a bad dream that happened. Does that make sense? I think I'm so upset this time as in my mind it's been a post natal problem with me. I truly thought I was fine so stopped taking them. It hit me so hard 13 weeks ago.
Now I have to contend with the fact that it's happening again.

Hope you don't mind me indulging myself and writing a huge essay about myself.

Have a wonderful trip and enjoy seeing your family nana , thanks again for your much appreciated support

Nice to hear from you Mouse and the trauma of the birth of your daughter sounds very scary, and small wonder you got anxious. How did you find the citalopram I wonder. I wonder if you came off the Sertraline too soon?

How strange that we are both going to Ireland. My family live about a 20 min drive North of Dublin - on the East coast (Bettystown) and the wind that whips off the sea can be very cruel in winter!

I long to see my grandchildren but always get anxious in case I have bad days when I'm over there as I too hate anyone to see me (especially my family) when I'm feeling crap. We go every 6 weeks courtesy of Ryanair. One time I was crying in the airport and on the plane - so embarrassing.

Anyway let's hope we both have a reasonably peaceful time!

Hi,

I know it has been a while since both of you have been on but I wondered how you both we doing??

I have read your thread and have found it incredible helpful.

I would love to chat as I am in a very similar situation as Mouse and nana you sound really lovely with a wealth of experience.

I hope you both are well :)

Hi kitty wake i too loved this thread is there any way to get in touch with u or nana and mouse I'm in totally same boat and would love to hear from someone x

I am sorry to hear of your problems. Just a quick point, have you tried a drug called pregabilin for your anxiety, it works for me.

Setraline makes you feel suicidal when you first start taking it... Need I say more.. This is stupid enough.