My daily diary: Starting doses-first timer...

Treatment and medication
1

Hello Everyone,

As many of you in here, helped me through this starting process and your positive stories has been inspiration to me, so i decided to write my diary, so that it may help somebody who will be in the same situation like me, scared, anxious and starting with SSRI for the first time…

I just started taking sertraline for my anxieties, mainly health anxiety, but also few others too. Depression and sad mood is a part of this too. Never take any SSRI Ads like this before, this is my first time. Also i am not using any sleeping pills or benzos etc. during this starting treatment. GP prescribed 50mg without any instructions, but i started slowly from 12.5 gradually upping my dose to avoid side effects, because i am too sensitive to meds.

I will try to update this diary in future whenever i can…

Here is my starting daily diary of Sertraline (Lustral or Zoloft) :

Day 1: Starting dose 12.5mg, Sertraline brand: Lustral by Pfizer, taken at 8:30am. Also i am using B complex and iron supplement daily.

Being already anxious and nervous from fear of the side effects which i was reading before i took sertraline. I expected to feel sick and horrible, but hour later i just felt little bit calm and tired, two hours later i started to feel energetic, positive, but it seems to me that that was just false placebo effect. 8hours later i started yawning a lot, my mood changed to sad and i became lethargic. 10hours later started to feel little anxious, which is my usual 5-6pm anxiety time and my teeth are chattering a little. 12hours late i was calm and ok. Slept around 7 hours non stop which was a progress from previous night time wake ups.

Day 2: 12.5mg at 8:30am

Feeling calm, relaxed and tired. Mood is sad, in afternoon i have very short wave of anxiety which was suddenly switched to good mood, strange feeling… Later during the day i was tired and little anxious till’ evening, also started to feel little nauseous and i lost appetite, not hungry at all… Around 9pm i was ok, my mood was positive, but i was unable to go to sleep, barely slept 4hours in total.

Day 3: 12.5mg at 8:30am

I am feeling very cold, tired, nauseous and unable to eat, laying in bed. Feeling sad and anxious, but then again it disappeared again?! Later: Tiredness, dizziness, chills, cold feeling, i have to put on jacket while i am in bed, no fever or any other symptoms. not hungry. Frequent urination in late afternoon. At 11pm i felt a little better and was able to fall in sleep, wake up once around 4am, but i was able to get back to sleep.

Day 4: 12.5mg at 8:30am

Wake up around 8am, calm, feeling ok. Later around noon feeling tired but mood is ok, feeling more confident for a short time. Around 5pm back to feeling anxious, tired, still not much appetite, don’t feel cold like yesterday, but health anxiety causing me a hard time… Again feeling cold from 8pm till’ 11pm ,also frequent urination from 5pm. From 9pm anxiety disappeared and i am feeling ok but tired. Going sleep at 1am and sleeping till’ 7am.

Day 5: change dose to 25mg at 8:30am

Feeling very tired, visual disturbances not see things clearly, no energy at all, feeling dizzy. Still not hungry, nauseated, pushing myself to eat some crackers etc. In the bed reading sertraline forum from this website, trying to find positive stories and informations to calm my anxiety down. Lot of yawning, frequent urination in late afternoon. But not feeling cold anymore. Over all not great day at all… Not able to do much except bury myself in sofa under duvet… Jump from 12.5 to 25mg was definitely felt…Slept 6hours.

Day 6: 25mg at 8:30am

Wake up with morning anxiety, feeling dizzy, no appetite, don’t feel well, scared, questioning myself if i should continue and push through this, but reading through sertraline positive stories helps me to decide that i will continue with treatment. Feeling very tired, exhausted, energy is completely drained, drinking probiotics, eating crackers, trying to eat a soup… Then back under duvet… feeling dizzy. At 5pm starting to feel little better and around 8pm i am feeling fine for the rest of a day, another switch?! Wake up at 4am unable to go back to sleep…

Day 7: 25mg at 8:30am

Slept only 4hours, but strangely i am feeling ok, some change going through me, but i can’t explain it… Feeling energetic. From 10am starting to feel again tired but energetic as well, no nausea, calm and quiet. From 2pm more tired, little dizzy, calm and numb feeling with little headache. From 5pm mood changed to sad and anxious and very tired. 11:45pm Feeling ok, but tired, sleeping 8hours, wake up once at 2am, but get back to sleep shortly after.

After first week:
I would say at the beginning, first two days, not much happened, but then the side effects like nausea, dizziness, tiredness, lethargy, loss of appetite, blurry vision, clenched jaws, frequent urination, elevated anxiety and depression started and it was a not great feeling, not being able to do much, mostly stuck on sofa, eating crackers, soups, fruits, probiotics and drinking lots of water… Couple of short mood switches (from anxious to calm, from sad to ok) which lasted anything from 1hour to 4hours. Overall I would say 1st.week it’s doable even without calming/sleeping/benzos meds. I started slowly from 12.5mg for 4days then to 25mg after to avoid side affects as much as i could. Dosage change to 25mg was significantly felt and added more strength to the existing side effects for about next three days.

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Day 8: 25mg at 8:30am

Take a short walk 30min on beach, but felt tired and dizzy, don’t feel great… Back home feeling tired, sleepy, but ok. From 2pm mood changed to sad i am trying to go to sleep, but no, another switch! I became energetic from nowhere and started with some project i had. Mood is calm and i am feeling better. 8pm Heath anxiety, but shortly after disappeared then i stayed calm and feeling numb. Yawning and frequent urination. From 9pm i am feeling ok. Wake up twice during the night slept almost 7hours.

Day 9: 25mg 8:30am

Wake up at 8am don’t felt any anxiety. Mood is calm and numb and feeling tired. All day feeling sleepy, dizzy lot of yawning and again nauseated. Then anxiety and depression hits me big time till’ 8pm. From 9pm sad mood, but not nauseated. 10:30pm Feeling ok and calm. That was one of the worst days since i started sertraline…Slept 6.5hours.

Day 10: 25mg 8:30am

Little morning anxiety, but managed well, breakfast… Little anxiety in the car just for few minutes and it disappeared shortly after. Later on feeling little lightheaded, headache, but is better than yesterday. From 7pm feeling ok for rest of the day. Went to sleep at 1am slept 6hours. It was much better day than yesterday.

Day 11: 25mg 8:30am

Feeling ok, slept fine, no more yawning, hungry,cravings for junk food… being able to do things around me, i don’t feel tired anymore. Mood normal, not happy but not sad, all day. Thinking now, if is it a good time to upping the dose… Its strange to not being able cry, smile just being numb, but still better than anxiety…Sleeping fine no more wake ups…

Day 12: 25mg 8:30am

Same feeling like yesterday, no side effects or anything, just feeling numb… No yawning, feeling hungry, keep thinking about the dosage, if is it good time to go up to 50mg now, hopefully numbness disappear soon. Otherwise it’s a almost third day i don’t feel any side effects. I don’t know if is it a good idea to prolong a 25mg dose as it looks to me that my side effects are gone and maybe is time to start prescribed 50mg dose now. I know this may puts me back to day 1 for some time, but if i stay on 25mg it might leave me soon stuck without any treatment…

Day 13: 25mg at 8:30am

Last night i have a good mood and was chatty after a long time, i didn’t sleep well, wake up couple of times around 4am, 5am, 6am and felt little anxious, sweaty, but then all calmed down. During the day i was fine, no side effect, mood was normal, not tired and not numb anymore like days before. Eating normal. Early evening there was a little health anxiety, but nothing to compare with my anxiety before…In the late evening my mood changed and i became a little depressed and sad. Then from around 10pm i was ok. Scared to upping my dose to 50mg i was thinking to go with 37.5mg from day 15, but then again i would have to upping my dose to 50mg which means i will have to go through side effects twice…I don’t know, i can’t decide yet…

Day 14: 25mg at 8:30am

Didn’t sleep well, wake up couple of times again around 4am and once again i was sweating like hell. In the morning i was little anxious and felt little dizzy, but not as much as at my first days. After breakfast i felt better. Later on in the afternoon i was stressed and unable to relax for no reason, but it calmed down and my mood became sad and depressed and felt little dizzy for a short time. In the evening i am not tired it looks like its a best time of the day for me. There are no physical side effects anymore, it all looks like to me that either 25mg is not enough anymore or my body still going through some process. I know it is still early, today is the end of the second week, tomorrow starting a third week, but most of the people switch to 50mg by the end of the first or second week. I feel like yo-yo, different moods keep switching through this second week…

After Week 2:
First two days i felt horrible due to dose change to 25mg, but then i felt ok. I would call this week false week, as it makes me feel good, but that was not for long by the end of the second week i started feel anxious, sad and depressed. Good thing was, that there was no more side effects and i was able to eat and do few things around. Started thinking that dosage should be upped now, but still not sure about that. Overall, second week was better than first week.

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2

Great job, smart and very helpful to all. So far....really close to what i experienced. My background>20 plus years of anxiety on and off. Last year mostly on(chest pain like heart problems, shortness of breath, really bad heartburn, higher heart rate and blood pressure, and negative thoughts of just falling over dead at any moment. Of course next comes the depression and the feeling of just being so tired of just trying to survive another day with no hope of ever being better. This last year has been just hell. Looking back I am not sure how some days i made it through each day. I have felt like i was being tortured. The pain, anguish feelings were overwhelming, but i kept on going...barely. 6 weeks ago i had to get bloodwork for my clonezpam script. I knew i needed help and asked about zoloft, due to thinking my heartburn which nothing helped was caused maybe by benzos...i then was taking .25 2xday. So, the dr thought it would be a good option to try. Start at .25 and up after 2-3 weeks to .50 if i wanted to. Okay to take clonezepam as needed with. So here i am. I work 7am-7pm 5 days/week, and do take .125 clonezepam morning and .25mg sertraline at 7:15 pm at home(changed quickly from morning to night due to feeling dizzy and sleep problems). Still only Sleep....4-5 hours wakeup, usually can go back for an hour or two. Urination....mine caused by dry mouth/drinking more water. Sexual desire....none, zip, 0 for 4-5 weeks then back to normal. Appetite...none for 3-4 weeks/lost 10lbs/picks up a little more each week after. Headaches...stopped after 7-10 days. Dizziness...lasted after dose only and 10-14 days. Negative thoughts...subsided after 2 weeks, still have on some days due to strenuous work and normal higher heart rate. Now my thoughts>>>The first 3-5 days (for some people maybe 3-4 weeks) was absolutely miserable after starting sertraline and i came very close to stopping(reading this forum gave me encouragement to keep going). So glad i kept going now. I wish i would have found this sooner. In the past i tried paxil/ effexor and had terrible lasting side effects with crazy bad thoughts. This so far is different for me. Truthfully, i may need to up to .50 and i may still, but .25 has helped me drastically. What has it helped for me so far?>>chest pains/heartburn gone. This is the biggie because these pains always made me think it was my heart even after many normal tests. Also, my resting and sleeping heart rate is lower so i have more energy and when i do sleep i have deeper sleep. The best thing is that when actively working my HR still goes up to like 120-130 but when i sit down it goes back down to around 70ish or lower. I used to feel panic and it would stay 90-100 for too long. This tells me it is helping my anxiety and thought process. I now have some hope where 6 weeks ago i felt doomed to the end. I am not great, but greatly better than I was. Finally, to anyone reading this... Give sertraline a chance to start working. If it don't work for you, keep hope something will. Sorry to hijack your forum. Any questions just ask. love to all CJ

3

Hi CJ,

I can see that you are going through a lot with your health anxiety, myself, i started to go through health anxiety, gad, social anxiety and agoraphobia from January this year, i do believe that some of those anxieties were triggered by my blood pressure medication amlodipine, after 3years of use due to my hypertension 190/110, At first 2.5 years meds worked and controlled my blood pressure, but then my system doesn't wanted to accept this medication anymore and caused horrible physical side effects and later also psychological side effects, i do believe this medication may changed my neuro system. I have written a long story in amlodipine forum on this website regarding this.

I will continue with 25mg for a few more days and see how things goes. Wish You all the best and Thanks.

4

Update:

Day 15: still on 25mg at 8:30am

Another sweaty night... up from 6am, little anxious and feeling cold. Nervous for no reason, sad. No physical issues, everything else ok. Kinda starting to feel like before Sertraline, its likei am stuck with my decision, to upping my dose and go through side effects or continue with 25mg and have no idea if this is gonna work. Trying to keep myself busy not thinking much about this. in a few days i have review with my GP regarding meds and how they work. Not feeling numb or tired anymore either. Will continue with daily updates until end of the: third week, then i will do a weekly updates.

Day 16: 25mg at 8am

Didn't sleep much, wake up around 2:30am, feeling that health anxiety trying to keep me up, but because i have something important to do in the morning i have to catch some sleep at least for a few hours, so i decided to take 2mg Diazepam)(Valium) and within 15min i fall in sleep till' 7am. Of course in the morning i felt tired and groggy with bad mood, but i was able to do what i was planned to do. Today i was talking with my GP and explained all to him and he thinks that its a time for upping my dose. I do feel same too, i have decided, that i will go up with my dose after three days which means that i was on 25mg for two weeks and 4days on 12.5mg,that would be total 18days on sertraline.

Day 17: 25mg at 8:30am

Today was a good day. Slept ok. Eat ok. Mood was ok. No anxiety, no sadness. Positive and energetic, from morning to evening. No side effects. Wish that this day is everyday. Its a middle of the third week and things looking better right now.

Day 18: 25mg at 8:30am

Wake up bit early, but it doesn't bother me anymore, i am feeling ok. No side effects, its all good so far. Later on in afternoon bit upset, but it was triggered by situation, but i would say i took the situation with much more calmer approach then i would usually do. Later on in the evening i have a little health anxiety sat back, but it was not long nor bad, i managed... So, yes i agree 25mg it does caused some positive changes in behaviour and yes they do work to some level. Still 18 days is too early to make any decision, but tomorrow i am starting upping my dose from 25mg to 50mg. This would possibly set me up back to side effects and feeling under weather, but there is no point going 37.5mg as this will be more harder going through the same twice.

Day 19: Dose change: from 25mg to 50mg at 9am

Day 1 on 50mg

After 4days on 12.5mg and then 2weeks on 25mg (18days total) i decided to finally take my prescribed dose of 50mg. Feeling pretty nervous about it, but i already decided to do it. I am expecting side effects, but who knows... maybe i'll be lucky one and don't get any with dose change...

An hour later i am starting to feel little bit tired, but not as much as before, when i started on 25mg. 4hours later feeling more tired and little bit dizzy. I have to take a nap in the afternoon, then wake up and feel little anxious, little teeth shattering started. In the evening i started to feel better, no more anxious or tired. I was able to go to sleep around 11pm,wake up around 3am,but then i was able go back to sleep and wake up around 8am.

5

so far good for you on 50. I am not sure why but i can sleep only about 4 hours straight. I can usually get back to sleep, but it is frustrating. I am still doing pretty good on 25mg, so i am staying here for now. Really appreciate your sharing and time put in for this. Keep the faith cJ

6

Hi CJ,

I am glad you doing fine on 25mg, so far upping to 50mg does not caused any side effects.

Yeah, that sleeping issues... I hope that my sleeping pattern gets better soon too, on 25mg i was up in the middle of the night for a few minutes frequently, i am trying to avoid benzos and any sleeping meds, took 2mg of diazepam only once since i started sertraline, because i was unable to get back to sleep and next day i had something important to do, otherwise i would not taking it.

I was trying to use sleeping supplements, but i have a problem with 5-htp and melatonin supplements, they cause me more anxiety and depression (they do actually deplete serotonin) , propranolol cause me the same. Only what works a little bit for me without side effects is magnesium glycinate, i take one 100mg pill about one hour before i am going to sleep.

What's new is that i am starting to have cravings for junk food, which i am avoiding for almost 7months. I will do my best to keep updating this diary till' i will start feeling better/levelled. Wish You all the best and stay strong.

7

I have been on 100 mg for about 2 weeks and have felt pretty good. I had a stressful situation this past week and sure enough my anxiety went up, but I seem to do ok now. However, my sleep is getting worse, waking up 2-3 times at night, sometimes not being able to fall asleep right away, but overall I still sleep about 7 hrs/night. In regards to cravings, the first 4-6 weeks on sertraline I lost 4 lbs due to poor appetite and nausea. Well, in the last 2-3 weeks I gained 5 lbs due to cravings. I try to stay away from junk food and sweets, but I still gained 5 lbs, which I am ok with if I feel better otherwise. Not sure yet, but having cravings may mean you're on the right track?!

8

Hi Anne,

That's great, that after 2 weeks on 100mg you feel good, i hope that i will have same good experience with my upped dose.

This week I had a few stresful situations as well, but what i find out is the difference how am i dealing with them now. Before sertraline, it would take me longer to calm down or spent longer time on the situation and overthinking everything.

I know, these sleeping patterns are a bit difficult, but if i compare them to my sleeping patterns before a few months ago, it was much more worst, i had to wake up somebody in the middle of the night and asked them to sit with me, because my health anxiety was acting up, it was horrible. I have diazepam (benzos) , but i am trying to avoid them and using magnesium instead.

I am trying to keep my weight under control, because my weight is now almost as it should be, i am trying to eat healthy, but like you said, at first i lost some weight due to a nausea and loss of appetite, but now i am starting to eat lot of unhealthy food, especially sweet and fried food, which was always no-no for me.

I hope you are right, that these are signs, that things are starting to get better, hopefully in a few weeks time, it will be even more better. Thanks Anne, wish you all the best.

9

Rob, I cannot believe how similar our experiences are. Especially feeling calmer in stressful situations and the craving for fried food. I usually eat pretty healthy, mostly vegetarian diet with seafood and some turkey now and then and perhaps steak once in a while. I have never had a sweet tooth, but guess why, now I indulge a key lime or silk chocolate slice of pie, or do not necessarily say no to breaded chicken or waffle fries. I exercise on a daily basis (3-4 mile walks), run few times a week, and that helps me mentally in the first place and perhaps to stay in shape, but seriously I have to not give in to my unhealthy cravings.
It is just my assumption that once we start having appetite we may be on the right track as I know from my own experience that when I am anxious, I can hardly eat anything. One technique that my therapist taught me and works well for me when you become anxious to calm down and push the unwanted intrusive thoughts away, is to move your attention/awareness to your feet (see how they feel, move them, wiggle your toes). In regards to the dose, do not feel you must stay on the current dose forever, talk to your doctor and see what they say, but if needed and recommended by the doctor, up it. I can undoubtedly say that I feel much better on 100 mg than on a 50 mg, and as I probably told you, I was very reluctant to increase it. I am still not 💯 back to my old normal but I am definitely better than 2 months ago and I am grateful for that. All the best!

10

Hi Anne,

I think i spoke to soon, later on this afternoon i was driving and anxiety hits me from nowhere, i was able to get back home and calm down, but some new side effects came with it... It was not that bad, but not great either...

I Just like to ask you, did you experienced during your upping to 50mg side effects, like clenched teeth/jaws, muscle twitching in legs and if so, for how long did they persisted after upping to 50mg? Also when you upped to 50mg and anxiety re-started due to dose change, how long it took to subside for these side effects for you?

Thank You i Appreciate your help.

11

Sorry to hear you have had an anxiety flare up. It happens to me too every now and then, not that often since upping the dose to 100 mg. When i upped the dose to 50 mg I still got the low appetite and nausea, I do not remember of teeth/jaw clenching. I get muscle twitching every now and then, I believe it is related to being tensed because of anxiety , but not sure though. i have left eye twitching now but my left side of neck is very tensed and achy and I assume the two may be related. I nay go see a chiropractor to get an adjustment. I did not get noticeable side effects when I upped the dose but whatever side effects I was experiencing before that kind of kept happening. They would usually fade away within several days. However, I believe that due to anxiety we are hyper-aware of everything happening with and in our body, and that may escalate some symptoms. I mean I guess that's the case for me. Anytime I am focused on an ache, twitching, sensation etc, I feel it even more. If i switch my attention to another part of my body, I may feel a sensation there and not the body part I was worrying about just 30 seconds ago .

12

Hi Anne,

Thank You Anne, you are right, whenever we pay attention to a side effects or to that part of the body physical symptom of anxiety it gets worst, i am using "Mundane method technique" to turn my attention away from them and slow deep breathing techniques with mindfulness. Sometimes it works and sometimes anxiety wins...

After 3 hours my clenched jaws and tense muscle eased and i am feeling better now, anxiety already subsided. I know that this is caused by upped dose and will have to go through this...I hope that in few days, upped dose side effects will subside completely. Thank You Anne, i feel relieved now by talking to you, re-assurance is the biggest help in the situations like this, especially in the beginning of the sertraline treatment.

13

Update:

Day 20: 50mg at 9am

Day 2 on 50mg

In the morning i felt ok, but i don't want to get up from the bed, don't feel sleepy, just lazy... Don't feel any side effects or anything as i did before when i started on 25mg.

Feeling hungry bit more than usual. In the evening, everything is fine too, clenching teeth and feeling little muscle tension, but no other side effects, so far, it looks like i was worry from upping my dose to 50mg and nothing major happenned yet... Mood is ok, no anxiety or depression. Not tired, but not energetic either. Not sad and not happy, just normal. It feels like any anxious thoughts are somehow blocked...at least for now. Went to sleep early and once again i was wake for a few minutes around 3am, but i was able go back to sleep.

Day 21: 50mg at 9am

Day 3 on 50mg

Wake up bit early, but don't have any morning anxiety or any side effects. I don't feel sleepy, or lazy like yesterday morning. Teeth clenching and little teeth trembling around 11am. Checked my blood pressure and heart rate, all normal. Don't feel that much hungry like yesterday, but it's still too early to say...In the noon, triggered by a stressful information, but dealing with it calmly as much as i can, feeling little shakiness, its more like a little twitching in my right foot and my jaws are bit tight, but is nothing major.

I think i spoke to soon...in the late afternoon around 5pm, my anxiety came back, together with clenched jaws and little shakiness, its not great, but its manageable. Around 6pm i am feeling a little bit dizzy, but not as much as on 25mg when i started. 7pm feeling bit tired, jaws and muscles are still little bit tense. 8pm Starting to feel better, clenched jaws eased a bit, so does muscles, so i would say that from 5pm to 8pm when i was feeling anxious with those side effects is the time when sertraline is at max. peak in my body/system and because my system is not adjusted yet to that dose, it is causing these side effects, especially at "sertraline peak time". I can simply take 2mg of diazepam, because it is also works as a muscle relaxant, but like i said, i am avoiding them as much as i can and "rolling with a punches..."

Sertraline Plasma peak concentration:

6-8 hours after i take sertraline, it should be working at its max. peak (plasma peak concentration) , which means from around 3-5pm sertraline will have max. concentration in my system, since i took sertraline at 9am.

============ Week 3 Summary:

Week 3 was mostly about a scary jump from 25mg to 50mg, didn't know what to expect, so many people describing 50mg with bad feelings/experiences and with so many side effects, but so far i would say is not that bad, didn't feel much elevated anxiety or not that many side effects so far. I don't know, maybe it was because i gave my body/system longer time to get used to sertraline? (4days on 12.5mg then 14days on 25mg), therefore 50mg didn't caused any "major" shock to my system? , also my jump is only by 25mg. I am using branded Sertraline (Lustral by Pfizer), some people have explained, that generic sertraline may cause more side effects and make you feel sick. Also before i take sertraline in the morning i eat a little and drink some probiotics. Then i take B-complex and iron supplements. All of this could be the reasons why i didn't feel that many side effects after upping to 50mg, but i can't proof or guarantee, that this will work for everyone, if anyone, maybe i was just lucky...

So far i am starting to feel some benefits, my anxiety is now more manageable and less frequent, i am starting to have a few good moments from a few hours in some days to even a whole day. Social anxiety and agoraphobia is getting better too, i am starting to be able to do things, that i would normally avoid. Depression and sadness is little bit better, but this will take a much more longer time to fix this. Sleeping before sertraline was bad, i think it changed a little bit too, i do wake up sometimes in the night, but i am able to get back to sleep shortly after, which was not possible before sertraline. From now on i will try to update my diary once every week, so next time it will be at the end of week 4, which should be my halfway to start to feeling some more benefit and good moments from sertraline.

14

Update

Week 4: 50mg at am.

Day 22 (day 4 since dose change to 50mg) First day of week 4 was already better than yesterday, no morning anxiety or lethargy, no morning side effects. Took a walk on the beach, it was not a long walk like i am used to, only around 30min. In the afternoon i started yawning a lot and feeling a bit tired. In the late afternoon once again, around 5pm, my jaws became bit tense, but it is less tense than yesterday and my muscles are not tense at all. Health anxiety thoughts keep bothering me during this time, but i am trying to keep them under control, also they are less intense than yesterday. At 8pm once again they are all gone and i feel ok. Slept ok.

Day 23 (day 5 since dose change to 50mg) Next day i wake up fine, seems to me that mornings are mostly without any issues now, mood is normal (not sad and not happy) i don't feel numb. Afternoon i felt crashed around 2pm, but i am not going to take a nap... otherwise i wouldn't be able to sleep at night. Late afternoon again, same thing like days before during the sertraline peak time, felt anxious and depressed, but i can control it without needs for benzos. Health anxiety is playing with my head in the evening, but doing my best to turn my attention to something else, feeling bit dizzy, tension headache, teeth are trembling, sweating a little bit, feeling hot and then feeling cold shortly after and lot of yawning, around 10:30pm it all calmed down, waiting for night so that i can sleep on it and move to another day. Not feeling well tonight, my mood is not great either. Day 23 was definitely not a good day for me, but i did expected that, these good/bad moments/days, will be playing with my mind for a while until i'll get levelled.

Day 24 (day6 on 50...) Well that was a horrible night... didn't sleep much, wake up at 1am, 3am, 4am, 5am... morning was ok, but i was tired, i can feel that this will shape up the rest of my day... By the noon i was like a zombie, tired, kinda waiting when these upped dose side effects subside... Few more days, week... who knows... It's afternoon now, feeling tired, have a headache, feeling a bit anxious again,dizzy and over all, don't feel great, not even hungry, all i want to do is wait for dark and go to sleep, still too long it's 3pm now...everything is going so slow, every hour feels like forever... Bad mood, depressed, upped dose adjustment is showing it's nasty side...Finally, it's evening, it's around 10pm and i feel fine, i am not even tired, that's crazy...after that long and bad day, i feel positive, energetic this is how i should be feeling during the day...these mood switches just proof that sertraline is adjusting and rebuilding slowly serotonin levels.

Day 25 (day 7 on 50...) Finally my sleeping was better, did sleep all night, wake up bit early, but i am ok. It's raining a lot, everything looks grey outside today, but it doesn't bother me... I was reading again some good stories about sertraline in here and it seems that most of the people graded first two weeks as the most bad ones and i agree, they graded third week as a good week and week 4 and 5 again as a bad weeks, but not as bad as the first two weeks, so far it almost matches with my experience. Afternoon was great i was able to get to my hobbies and activities which i have not touched for a long time, good energetic positive mood. Evening is ok, much better than a few days before, actually this is one of the first days on 50mg when i am feeling fine without any side effects a whole day. That is seventh day since i upped dose...

Day 26 (day 8 on 50) Wake up early, but didn't get up, feeling ok, no side effects or anything, looks like side effects from upped dose are gone now for at least two days. So it took me something around 7days to adjust to a new upped dose and to get rid off side effects, at least for me. At noon my mood switched to sad and depressed, didn't want to get out of the house, even going out with my dog causing me a lot of trouble today...anxiety and agoraphobia acting up... don't feel like to do anything, i would like to sleep through this mood swings and wake up when everything gets permanent, stable and levelled, but that would take at least another month...At 5pm i feel little bit better. Around 7pm i have a little headache and anxiety. At 10pm all is again better. All moods keeps switching a whole day and night...

Day 27 (day 9 on 50) Vivid dreams, wow, that was a night... This is the first time since i started sertraline that i do remember my dreams, they were so realistic, nothing scary or anything like that, just very realistic, no wonder i wake up in the early hours, my heart rate was elevated, my blood pressure was slightly up too, i was screaming on my chemistry professor in that dream, its like physical symptoms of very short panic attack, that's why my brain wake me up with eyes wide open, at least now i know... Then i was able to go back to sleep, but the vivid dreams continued till' morning. In the morning i feel ok, but tired, its Sunday, took a sertraline, crackers and probiotics and went to back to bed, just reading and waiting for time to pass by.There are no side effects in the mornings anymore from upped dose. Feeling lazy again, just wish i can skip this Sunday. Noon, sad depressed mood, i just want to get back to a sofa and sleep over this. Afternoon, anxiety kicks in and in the evening everything is ok, this pattern keep repeating itself for a couple of days now...

Day 28 (day 10 on 50) Ok, last day of week 4, finally. That was a long week, full of up and downs, yo-yo effect non stop. Today i am up early, slept better, but not without vivid dreams or a waking up. Seems to me that i am able to go to sleep much earlier, than i was used to, tired bit more and overthinking less. Great, another bank holiday, this week really doesn't want to end... Almost noon, feeling tired and lethargic. Afternoon sad and depressed, trying to push myself to take a walk and do something to make my mind to switch. Evening once again is fine, this is really not great week at all, week 4 really sucks, i know some things are getting better i can feel that, i don't cry anymore, but also i don't smile, just existing, i know these are depression caused thoughts, few intrusive too, i just want to feel ok, like others in here experience with sertraline, i know 4 weeks...is nothing, i have to wait it out..i am just mentally tired today...but i don't give up. It's a long journey, but tomorrow is a another day.👍💪🙏

Week 4 Summary

Upping dose to 50mg definitely set me back, spend 7 days waiting for some of the side effects to ease and subside from the upped dose, side effects like tension headaches, tense muscles, jaw clenching, teeth trembling, tiredness, sleeping troubles, vivid dreams, legs twitching. Some anxieties, depression, sad mood and overall, mentally i don't feel great either. Night sweating and nausea, loss of appetite does not came up this time during this upped dose adjustment. Not great week at all, but is not that bad like first week was. On the other hand i have a few good moments and even one good day in this week, mostly mornings and evenings are ok. For me, it was doable without benzos or sleeping pills, but there was a moment or two when i was trying to reach for diazepam, but in the end i didn't. I will keep going with this sertraline treatment and "roll with a punches" even if i will have to increase to 100 or more, i just want to get better... Week 5 should be same as bad as week 4, at least that is what people describing, will see how it will goes in week five, let's hope it gets better...

15

Hi Anne,

Sorry to bother you i just had a horrible night, i didn't sleep at all, i had a panic attack very bad one too, during the evening my blood pressure skyrocketed to 168/104! My hand and body felt pins/needles everywhere, hot/cold sweats, nausea, blood pressure meds didn't helped to lower my blood pressure, it was sround 4am when my blood pressure calmed down, i am just scared, normaly, i would continue with treatment, but at this point i don't know what to do as it is dangerously messing with my blood pressure, Did you experience or anyone in here similar problems? I am just scared to continue, today i took 37.5mg instead of 50, my gp will not take me today, so i have nobody to talk to and ask. Thank You for your help.

16

Day 28 to day 29: WORST DAY SO FAR!!!

Most horrible night and day since i started sertraline. Whole 4 weeks which i am on sertraline can't match with last night. All started at 9pm, first i felt hot and cold flushes, so i checked my blood pressure it was slightly elevated 138/90, took propranolol 20mg to lower my blood pressure, 10min after my anxiety started and my blood pressure skyrocketed to 160s/104, i am also taking blood pressure meds, but when anxiety kicks in, it won't help to lower my blood pressure. Around 11pm my blood pressure calmed down, took diazepam and went to sleep, two hours later i wake up with high blood pressure 150/100 anxiety kicks in again, felt pins and needles all over my body, felt nauseated and with gastric problems, have to wake up somebody from family to stay with me till' 4am, i was scared. At that time i took another propranolol 20mg and fall in sleep while i was sitting, i slept till' 8am. Scared, i took only 37.5mg sertraline this morning, then i drive and felt like a zombie, around noon my blood pressure was again elevated to 150/100, so i took 30mg propranolol, hour later blood pressure calmed down, health anxiety and panics kicks in, after a long time, i started crying, scared of dying and what is gonna happen to my family if i die. Then later afternoon i felt ok, my blood pressure is under control. Everything i have written in here till' this day, now everything has completely changed by this single day event. I don't understand, why this is happening a month later, this is a start of fifth week, day 11 on 50mg and i am scared, like i never was before. Feeling lonely, i can't eat or sleep, now i really don't know what to do... Now i understand why so many give up on Sertraline.

17

Hi CJ,

Sorry to bother you, just want to ask, how high is your blood pressure during your anxiety? Did you felt pin and needles sensation during this? I had it last night and this morning worst experience ever, my health anxiety kicks in big time... I am scared, feeling lonely it's not good, i just want to know if this is sertraline acting up, i even took propranolol and diazepam to calm down it was horrible... Thank You for any input. Rob

18

MY HR and blood pressure used to go really high before i finally accepted it was panic attacks. Many times i would just lay in bed waiting to die , but i didnt. People dont understand if you have never felt it...so hopeless. My BP at my worst would go to like 170/100, HR maybe 150ish. I got so tired of the panic of maybe having a heart attack i just adapted the mindset of if im going to die so be it...i dont care(a terrible feeling to live with). The only thing that worked...no helped me survive was being prescribed clonezepam. At least on it it kept my bp down to 140/90ish and HR lower so i could go through the motions. Honestly, the last 20'yrs i have trully suffered( only me and God knows just how much). I fought through and still fighting every day. I have been married 27 yrs, raised 2 daughters(the best i could with my demons...surely not as good as most) through college just now and worked my ass off...somehow. Now, 8 weeks on sertraline my bp is 115/75 and heart rate is lower too. The thing this medicine is doing is taking my mind off my health/panic. I can not do it all the time, but we have to realize our health is not the problem it is our brain chemistry and the way we think. We constantly scan our bodies for new or weird sensations. It feeds our uncontrollable panic thus higher HR and BP which in turn causes numerous other symptoms. It makes us feel weak and just want stay at home in our safe place. My suggestion to you is stay the course with the sertraline. You will get better physically and mentally. Also, right now i still have to take a small dose of my clonezepam before work. Dont be afraid or stressed if you need something extra too. Every morning i take at least 15 minutes before i leave for work and deep breathe. You will find you can make your BP and HR temporarily go down by breathing exercises so it makes sense they go way up being anxious. I wish i could take your pain away brother. You will get better! Think positive and practice relaxing chris

19

Thank You CJ for your response and for your re-assurance, i feel much better. I will continue with sertraline treatment, but from now on, i will take that yesterday experience from different prospective or at least i will try, it was a blip, nothing else. Like you, I think i died 100 times already, but i was unable to accept it, so i panicked all the times and pray that i will see another day. Checking myself 24/7 for every single symptom, sleeping with my blood pressure monitor connected to my arm, every headache, migraine was brain tumour, any pain was a heart attack and any muscle tension was a stroke... Having three teenage children and trying to hide this from them was next to impossible for me, felt ashamed everytime i was unable to mask it or hide this from them. Spent so many hours crying in the car, thinking about my life and why this is happening to me, slow re-breathing of my own carbon dioxide under heavy duvet was the only thing that calmed my panic attacks and blood pressure. So, yes i know, how bad it can get with this stupid health anxiety, fight/flight choices, panics, scared to leave the house, feeling difficulties in social situations and thinking how much time i have left and so on, most difficult part for me is to feeling lonely in these situations. Feeling like a nutcase to others who doesn't understand it what we are going through. That's why i am here and now, taking sertraline and hoping that i'll get better. Today i feel ok, it's like yesterday even never happened, strange how this sertraline works, first it make you feel worst than ever, than you feel fine, while benzos works the opposite way, at least for me. I will use them when i need extra help, i still have some left, but doctors don't want to prescribe them. Lets hope week 5 ends soon without further blips and week 6 brings at least few good moments or even a days. Thank You for your help and Wish You all the best.

20

Rob, I am so sorry to hear that you are not feeling well. I'd be concerned as well about this side effect I were you. My blood pressure is usually very low so I never had this issue, but i wear a fitbit and when my anxiety was skyrocketing, my resting heart rate was about 63-64 while it usually is around 55-57, which may seem low but it is pretty normal for active people ( runners). Now, it does mean it is very accurate as Fitbit says their devices are not to be used for medical purposes, but the leap in my RHR associated with hogh anxiety was real, and my doctor confirmed that. I assume you live in the UK so I do not know how the medical system is there, but can't your doctor talk to you over the phone or have a web meeting? Can you email them to explain what is going on and see what they say? Can you call a nurse advice line? I'd continue to take the lower dose till you get a hold of your doctor but if you keep having increased BP, I'd definitely go to an after hour/walk-in/urgent care clinic to be checked and see what they recommend. I know that some people take xanax or ativan when they have an anxiety or panic attack to calm down, not sure anything like this was prescribed to you. I took a very small dose of xanac couple of times when my anxiety was very high and it helped but made me really drowsy the following day so I usually avoid it as much as I can. My mom has BP issues and is on medication for that, and anytime she's anxious or nervous about something, her BP goes high, so she gets a pill to get the BP down and sometimes a small dose of xanax to calm down. Did you try mindful meditation? It can help as it teaches you on what to focus to be calm. Hope you will feel better soon and let me know how i can help you.