Taking Zoloft dosing into my own hands....

[sammons]

I have a question about Zoloft dosing.  I have been prescribed a dose of 50mg. I have been taking half of that dose (25mg, of course) for about a month now.  I've noticed my depression lift exponentially; still experience some anxiety and anx attacks, though nothing I can't cognitively deal with.

I have always been scared of taking any medication that changes my mood, of course (anxiety), and therefore haven't taken any of the meds prescribed at their prescribed dose. I have Klonopin 0.5mg for panic attacks and just got the Zoloft a month ago (actually, I got it about 5 months ago and just started it a month ago).  When I feel a "full-blown panic attack" coming on, I break a Klonopin in half, and nip off approximately 1/6 of the half of the .5mg pill.  I know, probably a placebo, but it works for me.

My question is surrounding my particular dose of Zoloft.  I am still on 25mgs every day.  I tossed some of the pills that I had separated from the prescription bottle, and therefore about a month later, I had to go and get a new prescription because I was running out. I told my doctor (not the original prescriber) that I had been taking the whole 50mg, and he wants me to increase to 100 mg because I still have some anxiety, and a VERY small bit of depression, though nothing in comparison to before.  

I have read that the half life of Zoloft is significantly smaller than that of the other A.D. meds, making me wonder if I need to continue to increase my dose due to my body's acclimation to the drug.  I am wondering:

A: should I increase my dose if the current dose is working?
B: will Zoloft stop working if I don't continue to increase the dose?
C: does Zoloft work for people long term?  I know not everyone is the same, but does it continue to work for some people for long periods of time?

I understand that I am not being seen in an office and that for liability reasons, whomever replies to me probably cannot give me specific, direct advice about dosing, etc. but if you could give me some sort of generalized advice I would appreciate it, especially in regard to whether or not I should increase from 25 mg if it is already working for me.  

I would speak with my prescribing doctor about it, but I feel like (my fault) our relationship is starting off on a bad foot because of the inaccuracy in my reporting taking certain doses.

Any advice would be greatly appreciated!

***@****

Thanks!  I'm new, hoping to find information, answers, advice, and a few internet friends involved in the individualized cure for depression and anxiety!

[grazce914]

I am starting to take zoloft again after 11 yrs. I tried other med combinations and had some very sad affects. My advice is be very careful. Write down everything,on a pad of paper what you want to say to your dr. First.......g

[eronski]

Absolutely a positive attitude is the key - our minds are so unbeliveably powerful!  You sound like a pretty smart guy for such a young one - just kidding!

My husband is a drummer too and quite in demand where we live in Minneapolis & St. Paul.  His main band is called Auto Body Experience, check out their web site at www.AutoBodyExperience.com.  It's pretty cool music - kind of Frank Zappa like.
You play with your family, how cool.  My daughter plays guitar, my son plays piano and me - I'm a painter.  They won't let me sing when they play because  I always sing in opera - it just takes over, then they kick me out.  They always talk about all playing together some time just like you and your family.  My kids are still pretty young though, maybe some day.

Zoloft does the opposite for me, it wakes me up.  I have to take it very early in the morning or I can't sleep at night.  That is getting better, I have been taking Melatonin for a week or so.  My doctor told me to take Xanax everynight - again advice I Did Not Take, why would I want to take something I could get addicted to?  I smoke once in awhile but it tends to make me anxious so I have limited it to my visits to the casino every once in awhile.  Keep taking such good care of yourself!  Erin

[sammons]

No, I haven't gained any weight so far on Zoloft.  I have a few contributing factors, though.  I jog 2-3 miles every day after work (as one of my depression/anxiety coping mechanisms) and I am also a smoker.  I think that smoking suppresses my appetite, so I haven't noticed any appetite increase.  Put the two together, and I am not sure whether or not Zoloft has effected me in that way.  

The one major side effect that I have noticed so far is that I am very sleepy.  I am a 9-5er and about 12-1 o'clock I start feeling like I need a nap at work.  Usually when I do go home for my lunch hour and take a power nap for 20-30 minutes, it doesn't seem to help for very long like it used to; ex. I will nap and then I wake up feeling refreshed for about an hour and then it comes back after that.  I do have regular 8-hour sleep patterns.  Some days I feel this way and some days I do not.  That is what has been confusing to me so far.  I would think that Zoloft would increase my energy, but it really hasn't.  I do make sure that it doesn't effect my level of activity by making sure I'm keeping up with my commitments and exercise routine.

Over all, I am just really glad that I have this very small dose of Zoloft to take.  It has improved my depression so much!  I am very happy to be a bit drowsy instead of being depressed.  This is the first time in my life (that I am aware of) that I have been depressed.  It isn't very cool, that's for sure.  Anxiety has always been part of my life, but not depression.  It's funny that you say "I almost think depression is worse than anxiety, so glad I haven't had to deal with that."  because that's what I used to say and think about it also; then it hit me.

I hope you don't have to go through it like I have been lately.  Positive thinking is the key to all this, I think.  Attitude helps so much, immeasurably.  Even if you take the Zoloft and you are not depressed anymore, but you're still very negative, the changes will not be as effective.  Zoloft is only fully helpful to me when good thinking/coping skills are set in place also.

Yeah, sex, drugs, and rock n roll.  It's just that old saying because I couldn't think of anything else to put in my description box.  I'm not getting any sex right now, I don't do drugs, but I do play the drums in a 70's rock-type band with my brother and father.  So that is really quite innaccurate for me!

Best of luck to you, Erin, and to all others here searching for help.  It comes after a while; I think sometimes you have to feel hopeless for a spell before you can appreciate feeling good again.   :o)

[eronski]

Hey there, thanks for what you said about me - I took it as a compliment!

Good for you for listening to your gut and your own body - your doc sounds pretty aggravating to me too, time for a new one.  Is freaky how many different opinions you can get, kind of proves we have to look out for ourselves doesn't it.

So your interests are Sex, Drugs and Rock and Roll - ha!  24 is a great age hope your enjoying it a bit more now.  43 is a great age too, my 30's were OK but so far my 40's have been some of the best years in my life.  

It so smart to always take the lowest dose for anything then you always have the option to take more when necessary and it will be easier to stop if needed too.  Have you gained any weight on Zoloft?  I haven't but I sure have an increased appetite and am working against it.  I am very small 5'1" and 115 lbs so gaining a couple of pounds turns me into a "porker" so I have to be careful.  

Glad to hear your getting relief - I have suffered from depression too when I was a teen (started from having panic attacks).  I feel for ya - I almost think depression is worse than anxiety, so glad I haven't had to deal with that.  Take Care, Erin

[sammons]

I am glad that someone else didn't just blindly listen to their doctor about "upping" the zoloft dose.  I feel good at 25 mg.  Not completely healed, or peppy and super happy, but I feel good.  The 'edge' of the depression has been cut off the top.  

I know that doctors are necessary in treatment for depression, but seriously, can a doctor look at you and TELL YOU HOW YOU FEEL?  No.  Absolutely not.  I think that if you want to go up or down in your dose, you should consult your doctor on how to do that and if you have any adverse side effects or side effects that are simply uncomfortable for you, you should consult your doctor.  If you are bleeding and need stitches, consult your doctor.  If you feel fine on 25 mg of zoloft and things are going well for you (but you still feel a bit of anx/dep) why should you ask your doctor?  You are in charge of your own healthcare and making sure you get the treatment YOU are looking for.

In my particular individual situation, I don't think it is as important to speak with my doctor about every little thing like I am told.  They sure do carry on about 'consult your doctor' this and 'consult your doctor' that.  Good Lord, how much money do I have to spend to have simple questions answered?  I know my body better than anyone else, and if I am currently in tune with my own personal body, I know what is good and what is bad for me.  (I quit marijuana and alcohol 1 1/2 years ago because it wasn't good for me, mentally or physically).  You need to listen to your body, not necessarily your doctor, though they are a great resource and necessary for certain decisions and in certain cases.

I feel the same way you do, Erin.  You said in your post that you don't want to be numb to your emotions/problems by over-medicating yourself and that you are willing to be uncomfortable to a certain extent because it keeps your self-regulation skills up to snuff.  Because of this comment, I think you are the most intelligent person that I have come across (so far) in this forum.  That is exactly right.  I am not against using AD meds as a TEMPORARY ADJUNCT to cognitive and behavioral therapy, but it is not the answer.  It just makes me a bit more comfortable with my life so that I can have the grounding to create and start using my own coping skills as an ultimate and more permanent method of self-therapy.  

My doctor is so headstrong about increasing my dose that he will not even prescribe me a 50mg pill so that I can split it in half anymore, let alone simply prescribe me a 25mg pill.  He will only give me a prescription for 100mg pill because he wants me to take at least 50mg and I can therefore only split it (accurately) in half.  Come on, is this drug pushing or what?  I am currently looking for another doctor covered by insurance in the area.

Meds are a WONDERFUL TEMPORARY tool, but I personally think people should beware of the "pushers" out there.  Doctors are compensated for drug prescriptions.  In my experience, if they are tetering on the fencepost at all, they will always go with increasing the dose.  That is just how it works.  

Of course, not all doctors are the same, and there are several thousands out there that really do listen and have your best interest in mind, but I have not met one of those doctors so far in my life.  I am currently asking around for suggestions on finding that doctor.  

I better quit now, because I feel like I am gettin off topic.  Sorry if I sound heated in my expressions here; I am still quite angry about my doctor only giving me 100's.  I went to a visit today with him and came clean with him about being only on 25mg when he was giving me 50's. Instead of talking with me about it, he refused to give me the same dose and wrote me a prescription for 100's, non-negotiable.  He wouldn't even listen to my argument about why I didn't want to increase.  Seriously, how can you call yourself a therapeutic doctor when you are doing this?  The only reason I didn't tell him I was only taking 25 in the first place was because he didn't want to listen to me when I said i wanted to take the med thing slowly and increase (as necessary) slowly.  

Anyway, sorry for spinning off topic, but this has been helpful for me to type this out and relieve some of the frustration I have with him right now.

Thanks, everyone.  I love this forum.  It helps me to read all of these posts and get a feeling of companionship throughout my current hardship.

:o)  Ammon

[thetaetazeta]

people are different......

Pharmacogenomics – antidepressants
Fifty years ago the first antidepressants came in to use. Subsequently their safety and tolerability has been improved, but efficacy remains little changed.2 Genetic prediction of antidepressant response has potential to inform the choice of agent and tailor dose to improve speed of response and reduce adverse effects.3–6
One of the most frustrating and problematic aspects of the pharmacological management of depression is the ‘hit and miss’ nature of response. It can take months of trial and error before an effective medication is found for a given individual. During this time patients are exposed to the morbidity and potential mortality from this common and disabling illness.7,8
Advances in our understanding of the pathophysiology of depression, including the molecular biology of limbic-cortical dysregulation, are beginning to inform individual variation in response to antidepressants.9 Genetic variation affects both the metabolism of drugs (pharmacokinetics) and drug response (pharmacodynamics).
Genetic variation in the pharmacokinetics of antidepressants
The alimentary tract, liver, and blood brain barrier are the main pharmacokinetic hurdles for antidepressants to reachtheir site of action in the limbic-cortical tracts.10,11 While most second generation antidepressants are well tolerated, some patients experience significant side effects at usual starting doses. Other patients need high doses to achieve efficacy with initial underdosing delaying response. These problems are routinely observed in clinical practice.12 For each individual an effective and tolerable dose of medication could potentially be predicted from the polymorphism profile of key enzymes and transporter systems involved in the pharmacokinetics of the antidepressant.13
Differing frequencies of side effects and efficacy have been noticed between individuals of different ethnic groups.3 Much of this variation is due to different polymorphism frequencies for the hepatic enzymes that metabolise drugs. The most well studied system is the cytochrome P450 system. Some P450 enzymes are found in the alimentary tract wall; the majority in hepatocytes. These enzymes (particularly cytochrome P450 2D6 and 2C19) are involved with the inactivation of many antidepressants and other medications. Slow, rapid, and ultra rapid metabolisers have been identified from different SNP profiles.14
Patients with genotypes associated with ultra rapid metabolism at P450 enzymes will have lower serum levels of antidepressants at standard starting dose than patients with slower metabolism. Such patients have lower rates of side effects but need higher doses for efficacy (see Case study 1). In contrast, slow metabolisers are more likely to experience side effects at ‘standard’ doses (Table 1).
The blood-brain barrier (BBB) has active transporter systems that keep medications and other substances from reaching the cerebrospinal fluid (CSF). The ABC family of transporters actively pumps many agents out of the CSF.15 MDR1 is one of the better characterised BBB pump systems. Polymorphisms in MDR1 have been associated with differential rates of antidepressant entry to CSF.16 Clinical relevance to dosing of antidepressants has yet to be demonstrated. Certain individuals may have more rapid pump systems and a less medication permeable BBB. Such patients would tend to have fewer central side effects but show reduced response to antidepressants even at high medication serum levels. Such patients require higher than average antidepressant dose to respond. This emerging area of BBB pharmacogenomics may explain why some patients have fewer central side effects and poorer response. Theoretically, MDR1 and P450 genotyping could enable determination of who requires a large dose and who does not from treatment outset. This could reduce side effects and speed rates of response by getting the dose tailored right from the start (Table 1). Large clinical studies are required to confirm the role of such BBB genotyping in clinical practice.

Genetic variation in the pharmacodynamics of antidepressants
Serotonin, noradrenaline, dopamine, melatonin, corticotropin releasing hormone, glutamate, gama amino butyric acid, brain derived neurotrophic factors, substance P and other centrally acting substances are essential to limbic-cortical functioning.9 Various patterns of dysregulation in these systems can be precipitated by chronic stress. Current antidepressants act primarily on the monoamines serotonin, noradrenaline, and dopamine.10 Physiological factors are important determiners of why one patient responds to one antidepressant and not another. Recent findings suggest that in the future genomic tests may be used to determine which type of antidepressant patients are most likely to respond to.17,18
In recent years, associations have been demonstrated between serotonin transport gene polymorphisms and susceptibility to depression.19,20 It has also emerged that there is genetic variation in noradrenaline dysregulation in the limbic-cortical system.17,18 Early evidence suggest that genotyping for polymorphisms in the serotonin transporter promoter region gene 5-HTTLPR and the norepinephrine transporter gene NET polymorphisms may help inform clinical choice of noradrenergic or serotonergic antidepressants18 (see Case study 2). It is likely that further pharmacodynamically relevant genes will be identified to match patients to the most likely effective antidepressant from the outset of pharmacotherapy.

[umya]

the less medicated you are the better i think, though if you feel a need to up your dose to 50 do it.  but i would say having been on zoloft also,  

A) stay where you are if it's working
B) no it wont, not in my experience anyway
C) it worked superbly for me for a year or more until i weaned off.

D)  regular psychotherapy will help ensure you wont need drugs to deal with anxiety and depression.  

[eronski]

You are right I am very sensitive and very small (not sure if that makes a difference or not).  A neurologist told me that many people benefit from 25mg or even 12.5 and in my case I believe it.  Who knows though maybe it won't last long and the benefits will ware off.  I'm would be willing to go to 50 if needed but I doubt much higher.  I do have some sexual side effects and some sleep issues because of the Zoloft, right now it's tolerable but a higher dose could make it worse.

Like I said earlier, I'm OK with some discomfort cause it keeps me working on my issues.  I know the Zoloft is not curing my anxiety and when I stop taking it, it may be knocking at my door so I really want to have tons of tools to deal with it.  It's trial and error isn't it...but for right now I do feel great and I am really enjoying it!

Thanks for your input - I enjoy the conversation, Erin

[Hensley258]

I'm trying to figure out how you were able to get any theraputic effect from only 25Mgs a day of Zoloft.

The minimum effective dosage is at least 50 Mgs a day, with the most common dosages from 100 to 150, all the way up to 200Mgs a day.

But hey, if only 25Mgs a day is working for you then why bother raising it. Maybe your system is just really sensitive to medication which is why such low a dose works for you.

[eronski]

Hello, I realize you posted a while ago, I just read it and find your situation exactly like mine.  Hope it's not to late to comment...

I too was to start at 25mg of Zoloft and increase to 50 after a week and eventually work my way up to 100.  I have anxiety and found that right away I felt better, placebo or not I felt better and still do.  My brother is a Neurologist and I was constantly asking him questions because I was very nervous about taking Zoloft.  I told him I was reluctant to double my dose because I felt much better and I was having some icky side effects like not being able to sleep, headaches and dry mouth etc.  He said it is very common for Doctors to prescribe it at that dose 50-100 and that if I get benefits from the 25mg I absolutely shouldn't need to double my dose and my doctor agreed.  I do still have a little anxiety but it is much, much better.  I'm ok with a little discomfort, I don't want to keep drugging myself until I feel nothing, I'm sure you know what I mean.  

Just like you if I get feeling bad I will take a 1/2 Klonopin or Xanax though it's pretty rare.  I have been on the Zoloft for nearly 3 months and so far the 25mg is working just fine.  I have even considered taking only 12.5mg just to have as little as possible in my system but I feel good now with no side effects so I'm happy.  Hope things are good for ya, you seem very conscientious & that's great.  Take Care, Erin

[sammons]

Thanks for the advice.  I have been diagnosed with clinical depression, and it has been quite scary at times.  I don't think that I am experiencing a placebo.  I know for sure that zoloft is working for me.  There is no way that it could not be at this point.  I think it might be a good idea for me to increase because I could probably get more benefit out of a little more of the chemical.  There are times when I feel like I am going to "lose control" of my emotions, motor function, etc. that I believe to be connected with my anxiety state.  The problem for me is that sometimes I feel like the zoloft is a contributing factor to my depersonalization (or spaced-outness).  I guess I've felt that before the zoloft and I'm probably just feeling it still, but have something to blame it on now...?

I don't know.  I would like to have an actual doctor's opinion about my previous question regarding the half-life of zoloft, etc.  

I appreciate you responding to my post, amda77rnbow.  Thanks a bunch for your words!

[amanda77rainbow]

disclaimer: I'm not a doctor and I'm only offering my non-medical opinion here. That's the disclaimer you could put before just about every post in this forum :-)

First, I suggest you tell your doctor exactly how much you're taking. I've messed with doses before and life was just easier when I was honest about it. I called my doctor and left a message that went something like, "I wanted to touch bases with you and ask your opinion. I've been taking a little less [Zoloft and Klonopin] than you prescribed because [fill in the blank]. I know I should've consulted with you first and I'd like to talk to you about it to see what you think." You might add something like "I haven't been entirely honest with you and I'd like to start again." Your doctor will figure out that you haven't been honest, and you probably want him or her to know you regret it and you plan to be entirely up front from now on. Psychiatry is a risky profession, and doctors really don't like it when a patient isn't fully honest with them. Anyway, you're paying your doctor for his or her expertise, and it's a waste of time to not use that expertise. If I were a doctor I'd tell you not to bother coming to my office if you're not going to listen to me.

Remember that you can always tell your doctor that you're uncomfortable with something. If he/she tells you to increase a dose of something, you are *allowed* to say: "I'd rather not increase just yet. I'm not concerned about that particular symptom and I think I'd like to stay with the current dose for a while and see how it works." Your doctor is probably responding to your concerns. If you make it clear that the anxiety attacks aren't bothersome, your doctor shouldn't feel the need to medicate you for them. If you talk about them like they're unmanageable, your doctor will recommend options to treat them.

I don't know anything about Zoloft's long-term effects or the need to keep increasing dosages over time. But if you feel the current dose is working, and your doctor agrees, you probably wouldn't need to increase. That being said, 25 mg seems like a pretty small dose. In my mind you're actually pretty closer to being off of Zoloft than on it. I'm no doctor, but I've taken Zoloft and the small amount of research I've done indicates that 50 mg is pretty much the lowest effective dose. You may be experiencing a placebo effect or it may just be that you feel better when you have someone to talk to (your doctor?).

There's been a lot of research lately about the treatment of mild or moderate depression with SSRIs (Zoloft). The research mostly seems to be pointing to the theory that SSRIs are best for treatment of severe or major depression and that other medications and therapies are best for other forms of depression. I don't know your diagnosis, but you might talk to your doctor about it.

Good luck and keep us posted!