Starting sertraline (Zoloft), does trouble concentrating improve?

April 25, 2017 11:51 AM

I've been taking sertraline (zoloft) for about a week for generalized anxiety disorder. I am less anxious and sleeping better. However, I am really having trouble focusing at my desk job. I am feeling a little restless, not jittery. I am still on a half dose (25) of my target dose (50). Does increasing the dose or simply more time on the medication improve concentration at all? The irony is that I am concentrating better, in the sense that I'm not ruminating or dwelling. The downside is that I'm not as motivated to accomplish work tasks.
posted by ElisaOS to Health & Fitness (13 answers total)

You will feel all kinds of weird as your brain chemistry readjusts to your targeted dose. Just be patient with yourself and do your best. Talk to your psychiatrist if things don't get better in a few weeks.
posted by BuddhaInABucket at 12:07 PM on April 25, 2017 [5 favorites]

Oh man. My first two weeks were so strange. I was constantly fatigued like I hadn't been before. I couldn't focus very well. After those two weeks, everything sort of evened out and I've now been on it for 3 years. No issues. Like BuddhaInABucket said, give it a bit. Everything should settle down.
posted by holmesian at 12:11 PM on April 25, 2017 [1 favorite]

Best answer: A psychiatrist explained to me that it is possible to have more side effects at 25mg than at 50mg.

This is because of an effect called "kindling" where if you stimulate the brain with a close-to-therapeutic-dose, but sub-therapeutic dose, you get all of the side effects and none of the benefits.

When you increase the dose, you actually feel less impaired from the side effects.
posted by Sockpuppets 'R' Us at 12:15 PM on April 25, 2017 [5 favorites]

I was a zombie for about two months when I first started Zoloft. My doctor explicitly told me to take it at night because zombiness is a common side effect.

It did get much better after I adjusted to the medication, though.
posted by INFJ at 12:18 PM on April 25, 2017 [1 favorite]

Thirding BuddhaInABucket and holmesian. These meds are meant to alter how your brain is working, so yeah the settling in period can be rough. Give it some time.

I would suggest keeping a little journal of how you think it's making you feel, over time, so you have some concrete data points to take into your next appointment and discuss with your doctor. My doctor asks how things are working out after a medication change/adjust, and my mind always goes blank and "Uhh....fine..?" isn't the most helpful answer, specially when it comes to side effects.
posted by sharp pointy objects at 12:18 PM on April 25, 2017 [4 favorites]

I take a different SSRI (Prozac) for my GAD, and have been on it for about 15 months. I did experience the settling period that others have described. But even after that period (which lasted about 3 weeks for me) I have felt much more relaxed about getting things done. At first I thought that this was a side effect of the SSRI, but my therapist and I now think that it's simply the result of my anxiety being under control. My motivation for tasks was always driven by my anxiety. I can still get my work done but I'm just generally more low-key about it than I used to be.

So it's possible that this is a feature, not a bug, for you.
posted by schroedingersgirl at 12:27 PM on April 25, 2017 [2 favorites]

The first week of taking Sertraline for depression (straight in at 50mg) I was completely on another planet with lack of connection, co-ordination and attention (accompanied by the worst suicidal ideation of my life! Good times!) Second week was still a bit weird, but after two weeks I was completely settled, back to normal with attention and concentration, and feeling the positive mood effects.
posted by mymbleth at 12:31 PM on April 25, 2017

Yeah, your brain is going to need at least another month, probably longer, to adjust. If you're concerned by anything you're feeling you should definitely tell your doctor, but an extended period of strangeness is to be expected (I've been on it for ~8 years now at a much higher dosage).
posted by orrnyereg at 12:35 PM on April 25, 2017

I take it in the morning and no longer have a transitional fog. To be honest, I don't remember having one when I started it either, although I'm kind of ADD anyway.
posted by DrAstroZoom at 1:09 PM on April 25, 2017

Chiming in to second pretty much everything everyone else has already said. Think of it like wearing a new glasses/contacts prescription - It takes a little bit for your brain to understand the new format information is now flowing through.
posted by Constant Reader at 1:22 PM on April 25, 2017 [1 favorite]

Zoloft is the only SSRI I successfully took for several years(it's also easy to get off of which is rare for ssris). I remember the first 2 months being difficult, as on top of average side effects I found that zoloft also did weird things to my sleep and appetite before my body adjusted.

Also 2nding that taking in the morning with food can help, as it might be disrupting to your sleep cycle to take at bed time if that's what you're doing.

Give your body the time it needs, if it doesn't improve, then trying out another drug is in order.
posted by InkDrinker at 2:47 PM on April 25, 2017 [1 favorite]

~13 years on sertraline (Zoloft), here, max daily dose of 200mg for Premenstrual Dysphoric Disorder (PMDD).

Nthing nearly everything above, especially giving yourself time to acclimate, while strongly 2nding InkDrinker's excellent mention of taking with food - stuff tears my stomach up to the point of nausea, when I neglect to eat. On the topic of neglect, please heed the standard caution of taking your dosage daily (optimally, around the same time of day, if at all possible): withdrawal is no joke. Yes, you are at a much lower dose, but "brain zaps" are zero fun at any level. Three doses skipped seems to be the threshold, anything beyond has landed me in the ER, so trust me when I beseech you to be sure to obtain refills well before you run out. Also, Sockpuppets 'R' Us is dead on with respect to kindling, which also goes the other way: times I knew I was overdue for refill because reasons, trying to stretch what I had left by taking lower doses only fooled my brain into thinking I was "stepping down" off it. Constant levels, consistently, over time is the key.

Take it from me, you will get up to level in short order, and your experience should improve. If it doesn't, trying out other SSRIs to find what works is admittedly a hassle, but you might luck out - as I did - on the first try. To say taking it has been an absolute GODSEND for me, is understatement. Finally, and FWIW, I've never experienced suicidal ideations while on sertraline... though I've entertained innumerable homicidal ideations while low on/completely off it! ;D Hope things improve for you, soon.
posted by Amor Bellator at 9:51 PM on April 25, 2017

You will either feel a lot better in a month or two or have negative side effects, which can be about the same as depression or actively decrease your quality of life. I would advise talking to your doc as regularly as possible even if its just a text or phone call--they are the expert.

I find that most anitdeps take ~1mo to really "kick in" and the come off period in between is between 1-18mos. I tend to not have good results on antideps and my "come off" periods tend to be way longer than average. Lots of people have good results on zoloft but few people adapt to a new antidep rapidly. If you feel it is worsening or not helping please consult with your doctor. Everyone is different.
posted by love2potato at 8:19 PM on April 26, 2017