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I was diagnosed with GAD and given Mirtazapine. I took that for almost 2 months (no other med) ending at 30 mg for 18 days. Toward the end of the 18 days, I felt more anxious. I was told by my GP to give it more time, but I felt I needed something else.

She suggested a switch to lexapro. I took tjat for 8 days at 10 mg, but had a very bad experience with it. I was told to stop at day 8. My GP then recommended a psych as she felt this was not her field of expertise.

In the meantime, I was given klonopin to help during the day, with only 15 mg of mirtazapine at bedtime (to help with appetite and sleep, I had lost 15 lbs in the two months prior to these meds, so gaining weight was one of my goals. This regimen lasted for about 4-5 weeks.

Last week, I finally got into a psych. He told me to keep up with the mirtazapine and klonopin (i should say i take 0.25 mg klon BID). He told me if need be, i could add a third 0.25 mg of klon at bedtime. I have not yet done that. I tend to be more relaxed at bedtime with the mirtazapine, so I did not feel a need to take more klon at that time.

My psych feels the mirtazapine was not effective for my anxiety (based on 18 days at 30 mg) He says the energizing feeling I was getting would be great for depression, but not helpful for anxiety (this is my problem). he also says I could treat my anxiety with klon only. But this would be a bit more dangerous over a long period of time. Hence, the reason he added an SSRI.

My psych has added (Zoloft) sertraline starting at 12.5 mg, to move up to 25 mg in a week, then 50 mg a week after that.

I tend to be very sensitive to meds it seems. It is hard for me to believe that 12.5 mg of zoloft would have much of any effect. But it tends to make me a bit tired for about 2 hours after taking it, then about 5-6 hour after taking it I feel like I just drank a pot of coffee.

Very jittery, shaky, odd bowel feelings. Today is my 5th day of taking 12.5 mg. Last night about 5-6 hours after taking it, I felt very odd. I do not want to say I felt like passing out, but it felt like I was heading in that direction.

I never passed out on Lexapro, just terrible nausea where i could not move at all, and upset stomach with diarrhea all day, every day. I also had a strange warm sensation moving thru my body with the lexapro. These things started on Day 2 of lexapro.

With the Zoloft, I have not had anything like that so far. Which is a good sign. But I am also concerned why I would be getting some of these SE's on such a low dose.

I am med phobic. I tend to think these pills make you worse, not better. I have no reason to believe that. It is just one of my fears. So I tend to pay attention to EVERY feeling in my body and attribute it to the pill.

So my question is, does anyone have these SE's on only 12.5 mg of Zoloft? Or, is this my anxiety about taking these pills that is causing my problems? I get so nervous about taking them my stomach is in knots.

This effects my ability to eat or have an appetite, which fuels my fear about losing the weight I have managed to gain back this past month.

Also, my anxiety over taking the zoloft (or the zoloft itself) has seemed to negate any benefit I was getting from the klonopin.

Now, I am only taking 0.25 mg klonopin at a time. Is this dose enough to have an impact on anxiety?

My psych says he wants me calmed way down, even if that means taking an additional .25 mg of klon a day.

the goal is to get me to Zoloft only, with no need for mirtazapine or klonopin at all. sounds great, but seems so far away right now it is hard to imagine it happening.

4 Responses
480448 tn?1426952138
Hello and welcome!  Thanks for all of the info, that makes responding so much easier, to have a "back story", so to speak.  Really great info you've provided!

MANY people with anxiety are "med phobic" to varying degrees.  That's a very common occurrence.  You're probably right that you're hyper focused on every sensation, which you will surely attribute to any medication you've just started.  

What you describe with the Zoloft is VERY run of the mill as far as start-up side effects go.  I too just resumed Zoloft after years of not taking a long term (antidepressant) medication for my panic disorder, and I experienced almost exactly what you did.  

The feeling like I drank 3 pots of coffee, feeling VERY jittery, to the point I would tremble and shake at times.  The other side effects I had were some VERY mild GI symptoms (a few episodes of heartburn, and a TAD bit of very mild nausea one or two days).  The GI stuff was very isolated, and very mild.  I can't really even complain about that.  

I actually tapered up my dose much like you've been instructed to do, and I did very well.  I started at 25mg, bumped up after a week by 25mg increments, with the exception of the 75mg dose, I stayed on that for 2 weeks before bumping up to 100 mg, which was my target dose.  I started the Zoloft on 9/2 and made my last jump to 100mg on 9/30.  The most annoying side effect was the jittery feeling, which definitely started to improve after the first week or so.  

Every time I bumped my dose up I would notice a reemergence of the Zoloft "jitters", but the longer I was on the Zoloft, the more short lived that side effect was and the more mild it got with each dosage increase.  The jitters were the worst the first few days of my starting the Zoloft.  Those were the only side effects to speak of, I tolerated it pretty well (better than I had expected), and from what you've said here, I think you will probably have a similar experience.  

The very best thing you can do is to TRY to stay distracted as much as possible.  The less you sit around and think about how you're feeling, how many days you've been taking the Zoloft, the better you will feel.  When I first started the Zoloft, I kind of dove into some projects I had been putting off (ie cleaning my bedroom, lol).  

The jittery feeling can sometimes work in your favor.  I know it kept me moving and busy.  The more active I was, the better I felt.  I actually looked at it as kind of an energy boost.  If I was sitting around, the symptoms were MUCH more noticeable.  Also, keep in mind that with 5 days under your belt, you can just about eliminate the possibility of a very severe reaction, which should be reassuring.  I'm a big believer in the way you (and I) were instructed to taper up the dose.  It really minimizes the severity of the side effects, and allows the body to adjust to the med more gradually, less of a "shock" to the system.  Another thing, do not fall into the trap of turning to Dr. Google, searching for info about Zoloft.  As you probably already know, the educational monographs that come with a prescription meds are full of a lot of info, some of it which is terrifying.  An anxious person will ONLY focus on the scary stuff.  You sound very knowledgeable...you probably don't need to be doing much homework at all.  Internet searches are an anxiety sufferer's mortal enemy.  

You're wise to have concerns about the Klonopin, but I think your doc has got a good plan for you.  While you're adjusting to the Zoloft and waiting for it to start helping to control the anxiety symptoms, the Klonopin will be helpful in controlling the anxiety.  Take it as prescribed, and while you're adjusting to the Zoloft, if the side effects are becoming a bit much, take that 4th dose as your p-doc advised.  Your doc will help you taper off the Klonopin once the Zoloft starts (hopefully) doing its thing for you.  I think his goal is a good one, to have your anxiety managed with only the Zoloft.  Try not to "what if" too much about the future with the Klonopin.  You and your doc will cross that bridge when you come to it.  

Just remember that these adjustments with meds take some time.  Be patient with yourself and with the process.  The way I ramped up on the Zoloft, I didn't really start noticing OBVIOUS improvements until after that 2nd week on the 75mg, and that was minimal.  A few weeks after I got to the 100mg mark (which was my goal dose), I finally started seeing more noticeable progress in the way I felt.  I've only recently really started enjoying a much improved mood and a MUCH lower level of anxiety.  What is your goal dose?  Remember also that you may end up needing a higher dose to see the kinds of improvements you're after.  So, unfortunately, that adds a bit of time onto the process, but I would personally rather endure a longer adjustment period as a trade off for an easier "ramp up" transition.

Are you in therapy?  That's definitely a vital part of anxiety treatment as well.  If you can find one, ask for a referral to a therapist who is well versed in CBT.  Anxiety sufferers really do well with that kind of therapy.

Please keep us posted on your journey, let us know how you're doing.  I know pretty much EXACTLY what you're going through.  I had a slight fear of how I would tolerate the Zoloft also (that's why I waited so many years to resume taking a med), but I'll tell you that the longer I was on it, the more confident I got.  By about week 2, I realized I was going to tolerate it just fine and was actually optimistic and hopeful that it would help me a lot.  I became almost excited about it.   I would be willing to bet you'll have a similar experience, and like I said above, you're already 5 days in, which is awesome.  A positive outlook goes a LONG way.  Some days you kind of have to "fake it til you make it", which seems silly, but the brain benefits from that, even if YOU aren't totally convinced.  :0)

Bottom line and MOST important is to stay distracted, as much as humanly possible.  I ran myself almost ragged those first 2-3 weeks, to keep my mind off the ruminating about the med, and also to help cover up that "jittery" feeling.  My house was never so clean, lol.

Very best to you...I really hope this will work for you, I suspect it's going to.  You're among friends here, and people who understand.  You're definitely FAR from alone.

Keep us updated!
Avatar universal
Thank you for the long and detailed reply.  

After posting I ended up in the bathroo with the big D.  I did talk to my psych last night just to touch base.  He says all that I am experiencing is typical (although last week he emphatically said "loose Stools", and there would be no D).

Regardless, he said that and the jitters are normal.   Seems to be overpowering any benefit I get from the klon or the remeron.   October was a good month for me, in hindsight.  I gained weight back (still a way to go), slept well too. I think remeron was helping with that.  at least i think so.

Yes, I am in therapy. She was a bit surprised I had a new med added.  She was thinking more along the lines of altering the existing dosages for the klon and rem that I was taking.    She did see the reasoning behind going from a 3 med regime to 1. I can to.  I am just afraid it will not work.

My therapist told me during my very first visit (August) with her I would be a 13 out of a 10 for anxiety.   Up until a week ago, we both agreed I was probably at a 6, with some higher moments.

For Halloween, I planned, put together, and hosted a part for about 50 people for a Haunted Trail.   Was not sure I could handle it all, but did (i also had help from family).   Therapist said maybe I should not do all of it just to be safe.  She was just being cautious.

I told her I do not know how I will feel hosting it, but I do know how I would feel if i did not do it.  I have an 8 yo daughter who asked me if she was going to be able to have her friends come over to a party this year.

Not doing it was not an option for me.  

I was originally told by my GP that I could take up to 1.5 mg klon as needed.  There has only been one day when I took 3 half pills (or .25 mg 3x in 1 day).  that was when I was waylaid by the Lexapro I was given in mid September.  Other than that, i take the 0.25 mg x a day (1 pill basically).

the lex just did not agree with me, although I know other people who like it.

Zoloft has been nowhere near that experience, but after yesterday I was a bit nervous I might be heading down the same path, albeit only in a slower fashion than the lex.

My therapist did say when I feel more anxious, what has changed in my life at those times?    It is just stress level.   The majority is from work. The rest, ironically, is from taking meds and or switching/adding meds.

I need to do something to alter my handling of the stress levels.  I look back now and can see how I had some symptoms beginning to break through over the past year.  I thought I was simply getting high blood pressure, or just being dizzy now and then, headaches too.  Stomach upset every now and then (I have always had this).

Something broke, and whatever coping mechanisms I had no longer worked.   I do know the meds will help, but only to stabilize, and I have to change my life or outlook or add other helpful activities to my daily schedule to truly help for the long term.

In the end, my psych said to give the Zoloft until Fri night/Sat.  If I still feel the same odd way and have the same SE's, then he would stop it.

I dont know where we would go from there.  I think he feels that I should not be feeling anything at all on 12.5mg zoloft.  I did not think so either.  He thinks if I do feel this way on such a low dose, maybe I will no tolerate it well.

I did still have anxiety thru October, but I was heading in the right direction.  I just do not want to go backwards at this point.

once again, thank you for your reply  
480448 tn?1426952138
Thanks for the update.  It sounds like you do a nice job pushing yourself.  That's sometimes half the battle.  The more we pull back from the things that scare us (which for someone with anxiety, that pretty much covers everything, lol)...the more we are sending a message to our brains that there is something to fear.  Pushing ourselves sends the opposite message, that there is nothing to fear.  That's great that you recognize the importance of trying to follow through with goals you've set.  That will go a LONG way in retraining the way you think.  

My opinion is to stick the Zoloft out.  You have to give it time, including allowing the side effects to start improving.  That will take some time, and like I said, you will likely notice a reemergence of the side effects slightly each time you bump up your dose.  

The bottom line with these meds is, often times we have to feel a little bit worse initially before we feel better.  I would just hate to see you throw the towel in unnecessarily when the Zoloft may end up really helping you.  It's definitely far too soon to tell.  If you had been on it for 3-4 weeks, and had made it to a 50-75mg dose and still had NO relief from the side effects, THEN I could see reevaluating it.  In all sincerity, everything you describe is 100% typical for initial side effects.

Try to hang in there, and like I said, the very BEST thing you can do for yourself to get through this is distraction.  I cannot tell you how much that helped me.  When I was busy and distracted, I didn't hardly notice the side effects at all.  Only when you're frequently thinking, "what iffing" and over-analyzing do you really notice the side effects.  

GI symptoms are also very common start-up side effects.  While diarrhea is certainly unpleasant, it can be managed.  If you are having frequent episodes of diarrhea, you can always take as needed immodium.  Check with your doc first, but it shouldn't be a problem.  Also remember that anxiety itself will cause GI upset and diarrhea, so to be fair, factually, not everything is probably related to the Zoloft.  We just tell ourselves it is.  ;0)

You can do this.  I would love to see you endure the Zoloft and give it the necessary amount of time to fairly assess whether or not it will be effective for you.

Please keep in touch!
10361664 tn?1409613007
I too have just start on Zoloft..im tapering off Paxil to go on Zoloft...20 mg of Paxil at night and 25 mg of Zoloft in the morning...I too Have the big D..along with increased anxiety and depression...some tremors. I have been in bed for 5 days now just praying it goes away. It has been 7 days and I know I have to give it time...we are moving from florida to kentucky and my husband has been in kentucky for the past month while I have been here falling apart..o havent worked much but very glad that they understand what I am going through..im going to try and stay busy as nursegirl6572 says..but I feel weak from loss of appitite. .been drinking boost in the afternoon for nutrition because of the diarrhea I get all morning. Im praying that in 2 weeks this will get better...im also reading the bible and praying alot. Some days I feel lost of all hope and others I feel a ray of sunshine coming through..hopefully we will all get through it! By the way the move is stressing me out too I hate leaving my comfort zone!
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