Maybe sertraline is the issue?

[JoeyLin]

My mum is 60. She is 2.5 years since depression started. First by not getting up and about and it's progressively got worse. a UTI about 1.5 years ago caused manic and paranoid behaviour, which antibiotics calmed down - however has left something in her with paranoia and phobias to leave the house still apparent.

She started sertraline from the start - 50 then 100. Then we stopped as concerned about stomach health. But once all clear she has been on 100 then 150 for nearly a year now. Every dose increase gives a boost and positive effects , but then after a couple of months it just goes backwards again.

She has pychotic depression and since October she has been on olanzapine.

The olanzapine has made a difference. She is pacing around a lot less and anxiety has chilled slugmtly.

We went for an appointment last week and the focus has turned again to the depression. She is down , she doesn't dress, she doesn't bathe or cook unless prompted (even pushed).

For once doctor has said maybe sertraline was never the answer for her at all?

One last roll of the dice is to go to 200 of sertraline for 2 months. She only started 200 this weekend.

Doctor was almost shocked that mum could be so down and depressed on 150mg of sertraline.

Is there a new hope for her with changing her medication entirely?

When we were worried for her tummy, we tried a month or two on mirtazapine and didn't really think it did anything for her.

Sertraline sent me completely manic! It's definitely not for everybody but it's a widely issued anti depressant and is usually the first one offered by a GP (or citaloptram)
Sometimes you need to try a few to see which gives the most benefit with the least side effects.

@angelalansburysteapot - is the negative effect that sertraline gave you reversible once you came off it?

I know it's a secondary concern ( jumping the gun a bit) but if sertraline is found to be the wrong one for her. The more hurtful thing would be if we have made it worse.

@JoeyLin yes, as soon as I stopped taking it, with exception to some mild withdrawal, the mania stopped almost straight away...until they put me on another SSRI.
As it transpired, all SSRI's trigger mania for me so I now take a mood stabiliser.

Sertraline stopped working for me after a while - It was always okay for a bit and then stopped working. I was up to 250mg by the end and wasn't really getting any benefits. I came off it and changed to escitalopram and it's like night and day.

What skills and tools does your mum use to stay well?
Medication with depression is one part of the puzzle but there is so much more to sustainably feeling and keeping well.
Is she using Activity scheduling, self compassion, structuring the day, any CBT/DBT tools etc?
Also has impact of menopause been considered?

At the risk of getting flamed, consider a functional medicine approach to identifying and addressing any underlying gut microbiome imbalances. Antibiotics wipes out gut bacteria and disturb the balance between good and bad bacteria, which can have sigificant effects on physical and mental health.

@Mermaidsh1t I am interested in what you have to say. Just don't understand too well.
We have always worried about why that UTI had so much impact to her behaviour ( it was so hard that time).
Are you saying something could still be there?
Are you saying antibiotics are good or bad for this? Sorry I just didn't understand and would like to know more ...

Is your mum seeing a GP or the CMHT? I would be asking about whether a different class of antidepressant may be worth trying. I would try not to think about the sertralije making it worse - these meds are not one size fits all, and it can take some time to find the right medication.

@JoeyLin Antibiotics are really good at getting rid of infections (eg UTIs) but theure really bad for the gut as they wipe out bacteria that protects us amd keeps us healthy. There's lots of research going on into gut health that not all GPs or soecialists would be aware of yet. A GP that practices functional.medicine lools at the underlying reasons why illness amd disease occurs rather than treating symptoms with medication. This may be a route to look down although it's likely you would need to pay privately for a practitoner.

@Mermaidsh1t there is a lot of research in this field, but not enough that is conclusive and if I had a relative experiencing psychosis, I think I would be focusing on what is known to work at the moment.

Thanks for responses so far. In terms of my mum's journey. A lot of the sertraline doses and actions has been done by ourselves and GP discussions. I've asked friends who are GPs and my sister in law is a mental health nurse. Sertraline also worked for her 11 years ago on 50mg for several months.

Since October my mum is being seen by mental health consultant at a specialist hospital. We have had 3 appointments with them so far. First they started her on Olanzapine, second was to increase Olanzapine to 10mg. Now it has been to question sertraline but give it one last try.

In octoBer there was also an option to keep her at the hospital. We are glad we didn't consider it. Olanzapine has made some of extreme anxiety go. She is not pacing anymore. So now depression is the important part.

We'd love to get her on talking therepies. But she just doesn't talk . Not to anyone. Not even to us. Any question about her and she'll change subject.

Sertraline didn't agree with me at all. The doctors response was to increase the dose and stick at it but I felt absolutely vile, anxious, barely eating or sleeping. I switched to citalopram and was 50% better in 2 weeks and 100% better in 4

I am seeing responses here about citalopram .. I see that is also an SSRI so could the difference be that significant away from sertraline if sertraline is even causing the negative effects.

Doctor was suggesting the move would be to SNRI. But I don't recognise any of them

Your poor mum. Depression is horrible. However antidepressants often make it worse, especially as someone gets older.

There may be some sort of therapy which will help her though obviously she will need to be coerced into getting up and going.

I hope things improve for her (& for you all).

I became manic on Sertraline after a few years and got off because I felt like I wasn't in control of my behaviour.

@WhoWants2Know- what was your process to come off and did you switch to something new ?

My grandmother too acted very odd after a uti, could your mum be dehydrated which continues the behaviours?

@tintodeverano2 she doesn't drink water. Have to force her.