Feeling better, except for the headaches, nausea, and ridiculous sweating
August 6, 2012 1:46 PM   Subscribe

Help me find a new antidepressant, or manage the problems with the one I'm already on.

After four decades of crazy highs feeling mostly normal and terrible lows I finally worked with my doctor and got onto the SSRI Setraline earlier this year. For the most part, it's worked pretty well; I no longer have the irrational urge to break down crying for no reason, and that's wonderful. I mean, really, really wonderful.

But the side effects are starting to be almost as bothersome as the depression. First and foremost, it's sort of like having a low-level flu most of the time; I'm much more prone to headaches (particularly light sensitive migraines which is a new experience for me) and a constant mild nausea. The doctor warned me that this could be a side effect, but one that might go away once I became acclimated to the drug. I incremented slowly up to the daily 100mg I'm currently taking, and I've been at this dosage for about a month now, and the stomach issues haven't gone away.

I've also started to sweat. A lot. Even in mild weather and when not exerting myself particularly hard, I just start perspiring like I'm running a marathon.

Lesser side effects, but ones I'd also like to rid myself of if possible, are slightly more difficult to quantify: I feel like I've almost completely lost my creativity. I can't put my finger on what it is specifically, but I have a much harder time moving into the creative head-space I've enjoyed my entire life. The absolute best way I can sum this one up is that I can't daydream anymore. Normally, I wouldn't consider this a deal-breaker, but I often used to find my best solutions to problems when my mind would race in the background.

I also am having a hard time remembering things, because that little nagging voice in the back of my head telling me not to forget to do something seems to have quieted down.

Another one is a sort of general listlessness. The entire summer has raced by, and I just haven't really given a shit. I don't pursue my hobbies (photography, writing, etc) with any kind of passion or excitement, I mostly sit around watching TV and waiting until I can go to sleep.

And that's the last component; I am sleeping a lot more. My whole life, I've suffered from insomnia (see the daydreaming/ mind racing comment from earlier), and now I have no problem at all, which would be awesome, except I don't really feel refreshed when I wake up. I can easily sleep 12 hours in a stretch, and wake up still tired. This is also a completely new experience to me.

So, the TL;DR short(er) version is that the SSRI I'm on is doing the part of the job I want it to do; controling my depression. And that's great. It's a huge quality of life win, but I'd like to try to sort out the other issues, and I'm looking for suggestions from others who might have gone through anything similar. The next time I talk with my doc, I'm hoping to know a bit more so that we can make some educated decisions about where I should go with this.

Other things that might be relevant: I asked my doc about my thyroid, because it could account for a lot of the listlessness, but my bloodwork looked good. My blood-pressure is just slightly the high side of normal, and I've talked about the possibility of a beta-blocker for both that and my head-aches. I really don't drink much anymore and I keep my other medications to an absolute minimum, so I'm guessing that it isn't two drugs combining.
posted by quin to Health & Fitness (6 answers total) 4 users marked this as a favorite
 
It took me about 8 weeks at 50mg to stop having lame side effects like tiredness/tremors/shakiness/headaches. I did 10 days at 25mg/day then 50mg/day after that, so it was really the 9th week or so before I started to feel back to normal (but on top of the positive effects of the medication).

Taking a magnesium supplement on top of the sertraline seemed to kill the headaches right away and I've seen a large number of people say similar things on sites like crazymeds.us, moreover my doctor was utterly unsurprised that it helped my post-sertraline migraines.

"The entire summer has raced by, and I just haven't really given a shit."
Sertraline, in my experience, will not make you give a shit -- it'll just make you feel not-like-shit.

"I don't pursue my hobbies (photography, writing, etc) with any kind of passion or excitement, I mostly sit around watching TV and waiting until I can go to sleep."
I'd guess this was probably your depressed routine too? To truly feel different you'll need to work (with a therapist preferably, or on your own) to start different behavioral patterns -- sertraline is just there to give enough leverage for you to feel non-shitty enough to start working towards a different lifestyle.

IANAD, but you might consider talking to your doctor about the dosage. From what I've read, the difference in efficacy between 50mg and 100mg is not terribly large but the side effects increase accordingly. Some people are super sensitive to sertraline and 12.5mg/day makes a huge difference for them.
posted by Matt Oneiros at 2:03 PM on August 6, 2012 [1 favorite]


Sertraline is Zoloft. I was moved to Zoloft from Prozac when I wanted to have a second child, and I found that the effectiveness was very similar but that the side effect profile was very different. I would ask your doctor about maybe moving to Prozac (fluoxetine) to see if the side effects are better for you. Zoloft's were better for me, but this is so individual that it might be worth a try.
posted by KathrynT at 2:04 PM on August 6, 2012


Response by poster: I'd guess this was probably your depressed routine too?

Actually, no. (I mean, I've always been lazy, just not to this degree). Before I went onto the setraline, I had a sort of constant energy which I used to keep myself busy. In retrospect, I was probably trying to stay occupied to keep my mind from straying into areas that would send me into a emotional nose-dive.

I don't actually mind being lazy, and there's a fair chance that one might not have anything to do with the other, I just started to notice it after I began this course of medication and thought it might be a relevant data point.

Truth be told; if I have to trade not feeling like a worthless piece of shit, for being, you know, kind of an actual lazy shit, it's a deal I'm willing to make.
posted by quin at 2:21 PM on August 6, 2012


The listlessness/apathy you describe sounds a lot like how I reacted to fluoxetine. From your question, it sounds like you're working with your regular medical doctor on this. Is there any way you can see a psychiatrist or psychiatric nurse practitioner to find out if there is a better SSRI/combo of meds that would work for you without the unpleasant side effects? A psych will have more specialized knowledge about these types of medications and can almost certainly cut down on the amount of experimenting time it takes to find a solution for you.

My doc tells me there's something of a serotonin continuum with SSRIs, with fluoxetine on the high-acting end, sertraline after that, and Celexa/Wellbutrin/etc lower on the scale.
posted by trunk muffins at 4:57 PM on August 6, 2012


I had a big case of "who gives a fuck"/apathy when I was on Paxil. I also always had a feeling of being slightly unwell and not quite up to snuff (like your low grade flu I guess). I also was tired all the time and gained weight. I really didn't want to try a different antidepressant because I was feeling emotionally okay and didn't want to lose that. Like you, feeling emotionally okay but physically shitty was way better than feeling emotionally shitty all the time. Eventually, though, the side effects became more than I was willing to live with (having my libido disappear and casue an inability to reach orgasm was my breaking point...) I finally switched off Paxil and started with Welbutrin and whoa the difference! I feel good emotionally, so that is taken care of, but I also have my energy back and I'm not in a fog or feeling "drugged".

Everybody reacts to drugs differently. There maybe a med that gives your the emotional effects you need but that doesn't come with the side effects. I'd talk to your doctor about maybe trying a different kind of antidepressant.
posted by PuppetMcSockerson at 3:48 AM on August 7, 2012 [1 favorite]


When I was on a (higher) dosage of sertraline and having (different) negative side-effects, the doc added a pinch of Wellbutrin to the mix, which fixed things.

Why Wellbutrin might help you as well: it has a stimulant side-effect. Sertraline can be either a stimulant or a sedative depending on the person, and it sounds like for you it's a sedative. So Wellbutrin might cancel that part out.

Truth be told; if I have to trade not feeling like a worthless piece of shit, for being, you know, kind of an actual lazy shit, it's a deal I'm willing to make.

You show great wisdom and maturity. Seriously, I mean it. Stick with this decision. If it helps, tell yourself you're being all Zen and shit.
posted by feral_goldfish at 5:06 AM on August 7, 2012


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