Can I, and how do I, go off Sertraline safely?

April 6, 2012 2:31 PM

I recently started taking Sertraline (zoloft) to deal with anxiety issues, kind of on a trial basis. I think it's been working pretty well, but there are some side effect issues that are making me second guess things.

Namely, the sexual side effects. The lowered libido/difficulty reaching orgasm part was NOT explained to me by the doctor and I had to figure it out by myself. As a recently out and proud gay male (and getting outer and prouder), this is not something I want to deal with right now.

My doctor is currently on vacation and not taking calls, and the doctor's office never returned my call.

So:
1.) Should I stop taking it without talking to the doctor?
2.) If so, how can I safely dose down? I'm aware that you're supposed to slllooowwllyy go off it, the question is, how slowly?
3.) Are there anti-anxiety medications that don't have sexual side effects? Wikipedia mentions Serzone and Wellbutrin.

Additional info: 26 years old, fit/active, smoker, started taking sertraline 3 weeks ago.

posted by anonymous to Health & Fitness (22 answers total)

I stopped without phy knowledge. I tapered my dose down. Be prepared for side effects; or maybe not.
posted by Bun Surnt at 2:41 PM on April 6, 2012

As long as "kind of on a trial basis" doesn't mean that you've been going through nothing but free sample packs given to you directly by your doctor (3 weeks worth seems a bit much for that sort of thing), you should be able to consult the pharmacist who filled the perscription for advice. Even if it is the free sample packs, if you have a pharmacist whom you trust or already have a working relationship with, it would probably be worth your time to call.
posted by radwolf76 at 2:41 PM on April 6, 2012 [1 favorite]

*** I was on it for over 6 months at three per day dosing or more. Never felt better since stopping. Best of luck.

Obgliatory : talk to your doctor
posted by Bun Surnt at 2:42 PM on April 6, 2012

If you just started a few weeks ago, you're on a low dose still, so coming down shouldn't be hard, but there will be withdraw effects and the sexual issues will last for a while. Good news is that you might not get those side effects with a different SSRI. But definitely call you doctor and let him know you want to quit and why, he'll go over the plan with you, and have something to recommend switching you to. If he's not available, ask you pharmacist for advice.
posted by Garm at 2:47 PM on April 6, 2012

Wikipedia says discontinuation should be done gradually over three weeks to avoid withdrawal effects, chief of which is "brain zaps." You could start this process, but the thing I'd be wary of is how much to decrease the dosage and when. For this I'd definitely talk to a doctor (needn't be your doctor) or a pharmacist.
posted by kindall at 2:47 PM on April 6, 2012

Not exactly your question, but if you can get in a doctor's appointment, ask them about adding Wellbutrin to the sertraline. My partner had the same problem w/Zoloft, and Wellbutrin alone didn't work as well for the mood issues; but the two of them together work well and cancel out the worst of the side effects. YMMV.
posted by celtalitha at 2:58 PM on April 6, 2012 [1 favorite]

I would encourage you to not discontinue after three weeks --the sexual side effects may be mitigated by also prescribing a small dose of Wellbutrin or some of the other drugs in its class. If you were sufficiently concerned about anxiety to seek professional help take the time to let the side effects either sort themselves out (which frequently happens) or experiment with dosage or concurrent meds. You can always discontinue in the future. If the problem is delayed arousal and ejaculation that is not always a problem--just a change. If libido is completely suppressed and ejaculation is not possible--that certainly can be a problem. A bit of patience with your medication and sexuality might be useful.
posted by rmhsinc at 3:07 PM on April 6, 2012 [1 favorite]

If the Wellbutrin doesn't cut it as an addition to the Zoloft to fix this, you could try time-release ginkgo instead, which in my experience can be significantly less anxiety-symptom-producing than Wellbutrin.
posted by treblemaker at 3:13 PM on April 6, 2012 [1 favorite]

I would not discontinue without talking to your doctor. Do you have a pdoc or counselor? If so, call them. Or call the doctor's office every day until they call you back.

I discontinued Zoloft abruptly and completely, when I started throwing them up while I was pregnant. If I had any side effects from it, they weren't bad enough to break through horrible first-trimester awfulness. I did have some pretty major lability until I realized that I'd been off my meds for weeks (because, see, I was still TAKING them, I was just throwing them up), but apart from that, everything was hunky dory. However, I was on a small dose (50 mg) and in the hormonal stew that comes along with being pregnant, so I would not use my experience as any kind of yardstick.
posted by KathrynT at 3:30 PM on April 6, 2012

I would say deal with the side effects until your doctor returns, as they are relatively harmless. When your doctor comes back, talk to him/her about your issues and see if they can put you on another drug.
posted by Lt. Bunny Wigglesworth at 3:38 PM on April 6, 2012 [1 favorite]

If you decide to taper yourself off, do so over the course of 10-14 days. Obviously you should talk to your doctor, but if you decide not to, that's the timescale that seems to be recommended for such things.

It's possible that a lower dose of sertraline could have the beneficial effects without the libido-deadening side effect.
posted by hattifattener at 3:43 PM on April 6, 2012

I'm sorry your doctor is being unhelpful. For whatever it's worth, the side effects are not necessarily permanent, and it may be worth sticking things out a little longer. I experienced sexual dysfunction as you describe when I started taking sertraline, but it was worst in week 2-3 and faded away over the next couple of months. The side-effects returned when I stepped up to a higher dose, but they again faded as my body got used to the new chemistry.
posted by Mars Saxman at 3:44 PM on April 6, 2012 [1 favorite]

You just started 3 weeks ago? Setraline can take take twice that just to build up in your system to full effect. If you're already unhappy with the side effects, just quitting now probably won't yield too much discontinuation syndrome.

But yes, you should talk to your doctor.

I got of Zoloft without many problems. Getting off Cymbalta, now, that was a different story completely. But everyone is different.

Wellbutrin I have been on as well. It's sort of different kind of drug than Zoloft, much more 'up,' at least in my experience (no pun intended), and you need to talk to your doc about what meds might be right for your condition, not just based on side effects (although that should defo be part of your convo).
posted by Lutoslawski at 3:45 PM on April 6, 2012

I took Lexapro and was on and off with little side effects, and no sexual side effects, though I am not a guy.

Talk to your doctor of course before making any changes. His/Her vacation can't be that long?
posted by sweetkid at 6:07 PM on April 6, 2012

Stick it out a bit longer - about three more weeks, if you have enough. Everything's getting re-adjusted in your brain, and once you get settled, you might find that your sex drive is back, and possibly things get better since it's taking care of that pesky anxiety problem.

If it still isn't working out, talk it over with your doctor, find one that does work.
posted by Katemonkey at 6:30 PM on April 6, 2012 [1 favorite]

Usually doctors will have another physician cover their patients while away. Can you contact another doctor who works with yours?
posted by annsunny at 9:37 PM on April 6, 2012

I've been on quite a few different drugs for anxiety as well. YMMV, but I had almost no sexual side effects when I was on Wellbutrin.
posted by erstwhile at 11:07 AM on April 7, 2012

I was on that in college for anxiety and after a few months being anxious was much better than medicated.

It ruined my sex drive; hell, it took an HOUR to orgasm masturbating, and that's if I didn't give up.

Emotions were like a sine wave from +/-10 before but On it it became x=2.5 always. I wasn't sad but everything was meh.

And that relates into the suicide feelings! I wasn't suicidal persay but taking my own life was "meh" as well.

I'm sure there's people that it helps but for me as an anxious 20 year old it was easier dealing with it than dealing with the side effects.
posted by wcfields at 1:34 PM on April 7, 2012

>Usually doctors will have another physician cover their patients while away. Can you contact another doctor who works with yours?

Seconding this. Another idea: If you have both a psychiatrist and a primary care provider, and the psychiatrist is the one who prescribed the Zoloft, have you tried talking to your PCP about your side effects and the possibility of taking other meds?

Do *not* stop without talking to a doctor.

You ask, "Are there anti-anxiety medications that don't have sexual side effects? Wikipedia mentions Serzone and Wellbutrin."

Crazymeds is your friend here. For "mentally interesting" people*, by "mentally interesting" people, it offers an overview of sertraline (including pros and cons, rare and not-so-rare side effects, a timeline for how long you need to take it until it kicks in, etc.). There is also a discussion board where you can bet that somebody is talking about how Zoloft is decimating their sex life. Because, sad to say, sexual dysfunction is not rare among those of us who take neurological/psychiatric drugs aka "crazymeds."

Good luck. I know the trial-and-error process is a pain in the ass. But it's worth it to find something that makes you feel better and that has side effects you can live with.

* I count myself in this category, FYI.
posted by virago at 4:07 PM on April 7, 2012

I'd wait till your doctor is back from vacation and talk to him/her.

Serzone is no longer prescribed, as far as I know. I used to take it. At one point in the early/mid 2000s I ran out, and was told it had been pulled off the market because it had been linked with a few rare cases of liver failure (!!).

Zoloft killed my sex drive too.

One thing I think about with anxiety is this: there are short-acting pills like Xanax and Klonopin that are specific for anxiety (unlike Zoloft et al., which are technically antidepressants), and they work great. You take one when you're having an anxiety attack. It's best if you don't use them every day ongoingly, though, because they can be habituating (which I guess is a nice way of saying addictive; if you take them too frequently, you start needing more to have the same effect).

In my experience, doctors are much more likely to prescribe antidepressants than these antianxiety pills—which are controlled substances, yadda yadda. But I've always thought that's a shame. So many people who have anxiety problems have them in waves—there will be a day or a few days that are really bad, then life will be okay for a while. And a temporary pill that can get you over the hump of that anxiety would likely be better, IMO, than a pill that causes lots of side effects, which you have to take every day. I wish more doctors would consider that.

So if you do suffer from anxiety intermittently, asking about Xanax or similar could be a good idea. Just a thought.

FWIW, I tried Wellbutrin after Zoloft, for the same reason. It didn't have much effect on my mood but it did give me terrible tinnitus. But everyone's different. I know people who have liked it.
posted by toomuchkatherine at 8:48 AM on April 8, 2012

I'm a girl, but a proud gay girl who had similar issues. So the biology might be a bit different, but the similarities might be important.

I went on a pretty hefty dose of generic paxil (peroxatine) for my generalized anxiety disorder. It has been amazing for me, and my life is much better for it. But I did have some serious side effects. Namely drained energy and drowsiness, and inability to orgasm. Both pretty big deals, but the med was working so well for me.

Never, never ever stop taking an SSRI without a go ahead and the supervision of your doctor. It can be really horrible, just as far as how it affects your body and brain. And the sudden change in seratonin levels has a high risk of causing suicidal thoughts, even in people who have never experienced them before. Big deal. Please don't do it.

First off, these side effects could chill out once your body has adjusted to the med. This eventually happened to me, but it was a long while.

Second, different SSRI's effect different people in such varied ways. You might do better on a different drug in the same family. Or look at a different type of anxiety med, like Busprin. Busprin is non-habit forming, and very effective for a lot of people. You can talk about the options with your doctor when he's back.

Wellbutrin isn't normally used for anxiety on its own. Part of the reason it has a different side effect profile not including the same sexual side effects is the same reason it can increase anxiety. The antidepressents wellbutrin and strattera have a stimulating effect (they're often used with ADHD). They often worsen anxiety.

That being said, my psychiatrists first move when he found out the sexual side effects I was experiencing on Paxil was to add wellbutrin to the mix. It often counteracts these effects. We talked about the possibility of it increasing my anxiety, so we paid close attention. I was fine, and this combination worked wonderfully for me for a good while. I went off of the wellbutrin for unrelated reasons.

A lot of this depends on how immediately you need the sexual side effects to get better. 3 weeks is pretty early, and if it's already working on your anxiety it might be very effective for you in the long run. After a couple of months your body might adjust to the drug and the side effects will go away on their own. But they might not. You might be able to add wellbutrin without it affecting your anxiety levels, but you won't know until you try. You might try other meds that affect you differently.

This is a pain in the ass and I know how much it sucks. My anxiety was better, but one of the bodies most effective forms of stress relief was gone! It was crazy frustrating.

Are you doing any therapy along with the medication treatment? I went about a year with just meds, and only started therapy a month ago. It's been helpful. For me, I think that the paxil got me to a steady and managed state so that my own work to deal with the underlying causes of the anxiety could actually progress. My therapist and I are pretty sure that I won't always need medication. With some people, the anxiety is so purely biological that medication might always be needed.

But if you're not in therapy, I recommend it. Even if just for two or three months, because a therapist who specializes in anxiety can teach you really effective techniques to manage the stress and anxiety.
posted by f_panda at 7:19 AM on April 9, 2012

Oh, and feel free to memail me if it would help to talk with someone who's been through the exact same thing.
posted by f_panda at 7:20 AM on April 9, 2012