Anti-depressants

[Itisallastruggle]

Has anyone experienced negative side effects with Sertraline and if so, was your medication changed? Did the new meds work and how long to see improvements enough to return to work (if off work before)?

I’ve been off work for a couple of months and I’m feeling under such pressure to say everything’s ok now and return but it’s not. I was prescribed Sertraline which didn’t agree with me at first but side effects lessened over time so I was left on it. I found no improvement in my mental health and it seemed to disturb my sleep. It was reviewed after 4 weeks and the GP said I should try a higher dose (50mg to 100mg) as swapping to something else may start worse side effects again. I’ve now had 3 weeks on the new dose and still feel the same with my mental health but my sleep is terrible and I had a lot of nausea again which has made me feel rubbish.

I’m due to go back to the GP again but don’t know what I should be pushing for. If they change my AD’s, will I have to start on a low dose again and risk more side effects? Is there a particular AD that might be better than Sertraline?

I’m asking as work are constantly wanting updates on how I am and when I’m coming back, but I don’t feel able. It makes me feel so uncomfortable to have to keep saying I’m no different as they just don’t care. They keep reiterating that my sickness becomes more serious the longer I’m off, like a threat and don’t seem to understand this is setting me back. I feel they’re looking at me like the AD’s can’t possibly be taking this long to work (about 8 weeks since I was first prescribed them) and keep asking if I’m going back to the GP every time I speak to them - yet GP said no need and I need to give meds chance to work.

How long do GP’s normally take to review meds and dosage as mine is saying 3/4 weeks for each change to take effect and won’t review before then. I’ve explained this to work but it’s making me so stressed. Should AD’s be working within 8 weeks of starting them and have me feeling well enough for work?

I’d appreciate any help or advice at all.

I would normally recommend 6-8 weeks for a dose to work and for side effects to settle. Probably nearer 6 to be honest if there's no change at all. The nausea and wakefulness are awful. I sympathise with you.

Work need to get off your case or refer you to occupational health to deal with things. Have you any counselling lined up? I know it takes a long time on the NHS.
I had sertraline for post natal depression 30 years ago and it worked very quickly but I was still off for a number of weeks. I would get you up to 100mg then 150mg then consider a change. The se from 100-150 should be fewer than the first increase. It's a horrible illness. Hope things improve soon.

Thank you @Musicaltheatremum I’m on the 100mg dose currently (for the last 3 weeks) but don’t feel any different yet. My GP was saying at my last appointment that they will review the meds again and may swap them if I’m not seeing benefit on this dose but I didn’t know if I’d then start on the lowest dose of a different antidepressant or a higher dose again?

Work seems to think that if it’s not worked within a week, I should go back to the GP and have almost accused me of not being proactive but GP suggested it may take time to see the benefit and no need to return. I’m just concerned that if Sertraline doesn’t work, whether I’ll have to begin on the lowest dose of another med or if they will start me at a similar dose I’ve been on with Sertraline?

I’m being referred to occupational health but concerned they will also just try to push me back to work. Every meeting with my manager is solely about getting me back in work, not how I am or if I’m well enough to be in work. I’m not a confrontational person to speak up but it makes me feel so under pressure and like it’s my fault I feel like this. I don’t feel like they believe I’m ill. You’d think the fit notes saying I’m not well enough for work would be enough to stop them asking when I think I’ll be back but I get this question every time. The contact from work has been twice in a week sometimes.

Thank you for taking time to reply to me.

I had mirtazapine years ago and it was excellent for sleep and appetite, worked straight away. GP can prescribe mirtazipine for sure. If being knackered is an issue it could be that you’d get an immediate lift of your mood purely from not being exhausted x

Also, I think that your work are being unreasonable harassing you - no need for twice weekly contact. I’m off work currently and I’ve only been contacted every two weeks and it’s just been a ‘Hope your doing ok’ and ‘don’t come back till your ready’. Sorry they are being like that with you x

Your work are walking on thin ice contacting you so much !

Take your time - a broken leg doesn’t fix in a week !

The ADs work in different ways - when I changed I noticed a difference straight away but perhaps lucky / slight placebo

good luck

It can take weeks to see the benefit of antidepressants and the antidepressants are just the start they give you a lift in mood and that allows you to do the things in your life that improve your mood and potentially therapy too and the combination brings you out of the depression.

I have switched antidepressants before and when they do that they have cross titrated them so they reduce the dose of the original antidepressant and the same time as increasing the dose of the new antidepressant. It eases the side effects and it means you don't have to go back to nothing as you change the medication.

Normal doses depends on your depression. My medication is controlled by psychiatrist rather than GP but in my last depressive episodes with the first antidepressants they systematically worked up the doses with reviews before dose changes. My depression was severe by the time we identified that this wasn't going to help. The next antidepressants I was put on the plan was set from the start that every so many weeks the dose would increase until I was on the top dose.

I'm on 150mg now and when I started it did take a good 6-8 weeks to stop feeling awful. I was on 100mg for a few weeks then decided I needed to up them and after another couple of weeks of side effects I'm now really good (on 150mg). I hope you find something that works for you, it's really hard 😕

Any AD takes more than a week to work. Your employer has to be guided by medical advice, so unless any of them are doctors/psychiatrists they have no business telling you when you should feel better.

If there’s no change switching to a slightly different class of drug like an SNRI such as Venlafaxine can be worth a go, works for many people. You would need to come off the Sertraline first but it’s usually a quicker one to start working. Sorry work are adding to your stress… that seems very backwards of them