Should I stay or should i go... up?

Treatment and medication
1

Hi,

I am looking for advice regarding my dosage. I have been prescribed to 50mg, but due to my anxieties i started at 12.5mg for 4days and now i am on 25mg for 6days. A 50mg dose was prescribed by my GP without any instructions or advice about it. This forum helps me with initial start up on sertraline, but now i am not sure if i should start raise my dose to 50mg as prescibed or wait it out.

First 4 days 12.5mg i didn’t felt any raised anxiety or depression, just loss of appetite, felt dizzy and tired with couple good moments actually, which i am guessing have been placebo effect. Still they felt good being able after long time to deal in social situation for a short time. Then it all drop…

Then 6days on 25mg i started to feel raised nausea, sad mood, feeling anxious, dizzy, tired, yawning, couple early wake ups and they started on 2nd. day on 25mg and continued through 3rd and 4th. day on 25mg. 5th.day was yesterday and was the worst day since afternoon till late evening i was contantly anxious and i was panicking. But in the late evening around 10pm i started to feel ok. Then 6th. day today on 25mg and (10days in total on sertraline), i felt little morning anxiety, then otherwise all gets better.

My question is, should i increase to 50mg now or should i stay on 25mg for little longer?

As i understand by using sertraline medication, natural production of serotonin in the brain will stop now as the brain sense extra serotonin from the meds, but body can’t accept it right away and it has to build its new own system for it, which takes some time, therefore i now feel elevated anxiety and depression and other bad side effects, because my natural serotonin is turned off and new one is not build yet.

So if i stay on low 25mg dose with natural serotonin in the brain turned off now, (because brain sense extra serotonin and shutdown its own production) is the 25mg dose enough to support and build new serotonin system in the brain or will i cause more anxiety and depression by staying on such a low dose and not being able rebuild much on 25mg? By prolonging low 25mg dosage seems to me i may cause more damage then good, but i don’t know…

If i use now, 10days later, higher dose 50mg, (i understand my body may have already get used to sertraline as some side effects subsided now) , but because anxiety hightened a little, is this the sign/point that my body may need to raise to 50mg so it can have more “building material” for new serotonin system?

Some of you going from 25 to 50mg felt for couple days bad(body is trying to adjust etc. ), but then you start feeling better effect on them than on 25mg is that correct?

Also i find out that extra melatonin (prescribed or supplements, htp, etc…) can deplete seratonin as well and therefore some people with anxiety and depression become more anxious and depressed after melatonin use, can somebody confirm that please?

Thank You for any input.

2

I started with a 12.5 mg dosage too, increased to 25 and stayed on it for 2 weeks mostly because I went on a vacation and was afraid of side effects that would have come with upping the dose. While on vacation, I had to up the dose as I started feeling really anxious and could not enjoy my time there. This was on week 4 and those first few weeks I had all the side effects someone could have. When my doctor advised to increase to 100 I was very skeptical but she assured me that going from 50 to 100 is not as bad as going from 12.5 to 25 or 50. Nevertheless, I delayed the increase for couple of weeks and, since my anxiety and intrusive thoughts were still bothering me a great deal still, I upped the dose to 75 for 4 days and have been on 100 mg for 5 days. I have not had side effects so far, so kudos to my doctor, she was so right. I have also started therapy, had a session, and that could have played a role too
In regards to melatonin, I took a small dose (2 mg) several times and did not feel an increase in anxiety. The melatonin supplement I took had L-Theanine as well in it, and the L-Theanine is supposed to help with anxiety, so this could have been the reason I did not feel any anxiety increase. Not being able to sleep more than few hours at night really increased my anxiety during the day so I kind of saw the Melatonin as “if the benefits outweigh the risks, I’ll go with it”. But again, took it only few nights as needed

3

Hi Anne,

Thank You very much Anne, for your response and explanation and story. That is exactly what i was thinking with upping the dose, your story helps me to confirm this and actually helps me understand little bit better how the sertraline really works on our system.

I think any imbalance with melatonin, seratonin, dopamine, adrenaline and so on, cause us to be depressed, anxious, sad. It is interesting how all this works. More melatonin then we need in time may cause less seratonin and with less seratonin in time began all the troubles, add adrenaline to it and we get anxiety or panic attacks, subside dopamine by constant stressful situations without any positive or good moods and dark and sad mood become our new way to live… It is so complex how everything have to click together, add dopamine and become happy, lower adrenaline and become calm, add seratonin and see things more positively…lower adrenaline too much and become fatigue,tired… if only there would be simple and fast process without side effects from pills and struggles, that would be fantastic…

Once again Thank You Anne, i think i will start upping my dose to 50mg in a few days and bite the bullet with side effects and see how things will goes… Wish You all the best.

4

I took my first 50mg today morning, that is 18days after my starting doses of 12.5mg (for 4days) and then 25mg (for 14days).
4hours after i took 50mg, i have to go take a nap, so far i am tired and little dizzy, feeling lethargic. Hopefully all gets better soon.