Wired living through chemistry (and coffee)?

November 1, 2007 7:41 AM

Is this a reaction to my meds or am I just overcaffienated?

I have been on Zoloft for about 8 years for depression with a bit of anxiety. Currently on 50mg/day. I've also started taking Zyrtec and Rhinocort Aqua for bad allergies - been on them since July. I usually drink about 2 1/2 cups of coffee (Starbucks - Colombia) a day - mugs, actually, but not big ones. I have noticed that I am totally wired, in a hands-shaking kind of way, and irritable until about lunchtime (about 4-5 hours after taking my meds, all at the same time) and I'm wondering if this is possibly a normal reaction to taking this combo. I'm drinking about the same amount of coffee as I ever have, and I don't recall this sort of thing happening to this extent.

Other potentially relevant info: I breastfeed. I am slightly sleep deprived.

I have a dr. appt coming up in a couple weeks, so I'll ask then, but just wondering if anyone else has had this experience.

posted by missuswayne to health & fitness (20 comments total)

Why not switch your meds to the evening?
posted by OmieWise at 7:47 AM on November 1, 2007

What do you eat in the morning? That could make a difference, especially if it's nothing.
posted by sugarfish at 7:52 AM on November 1, 2007

zoloft can keep you from sleeping well if you take it at night.

You might want to ask a pharmacist about possible drug interactions. And you may also want to switch to decaf for awhile while nursing-baby is getting some of that caffeine and I imagine you'd want him or her to sleep so you can too.

(But my grandma made me toast and coffee as a preschooler so I turned out alright.)
posted by konolia at 7:56 AM on November 1, 2007

The Rhinocort is a corticosteroid, which can have a stimulant effect on the body. That, combined with the caffeine, could easily make you jumpy. You might want to cut back on the coffee, or mix some decaf in with the regular, and see if that makes it better.
posted by cerebus19 at 7:57 AM on November 1, 2007

Can't nasal spray make you hyper? Could it specifically be the Rhinocort and coffe combo that's getting you wired?
posted by amro at 7:59 AM on November 1, 2007

Or, what cerebus 19 said.
posted by amro at 7:59 AM on November 1, 2007

I assume you've checked this out, but I am rather curious. Is it ok to breast-feed while on those meds? They won't adversely affect the milk/kids?
posted by Grither at 8:25 AM on November 1, 2007

Overcaffeinated.

I'm in my final year of pharmacy school, so I'll tell you what the official literature says: no known interactions between rhinocort, zoloft, zyrtec and caffeine. The nasal sprays that are famous for making you hyper are decongestants like Afrin, not so much the corticosteroids like Rhinocort.

This is my personal experience as a caffeine addict who's currently breastfeeding, and has been on zoloft: I am stunned at how much more sensitive I have become to various drugs, including caffeine.

The 2 cups of coffee I'd drink at age 20 would get metabolized out of my system and be gone by noon. According to this wikipedia article, the half-life for caffeine is 3-4 hrs in average healthy adults, 9-11 hrs in pregnant women. This means those 2 cups of coffee hang around in my system for about twice as long these days. Yes, it might be the same amount of coffee I used to drink back in the day - but it's exerting a bigger effect.

I am working on this problem myself by drinking more water (dehydration leads to irritability for me), and by mixing decaf in with regular.
posted by selfmedicating at 8:36 AM on November 1, 2007

I don't want to make the annoying mistake of assuming your baby is still very young just because you said you're breastfeeding . . .

But is that the case? If your baby is between, oh, let's say 3 - 12 weeks old, could it be partly due to normal post-partum factors?

I don't generally experience depression or anxiety, but when my baby was little, I had severe anxiety. It manifested itself in a jitteriness that felt like I had smoked crack. I shook, clenched my jaw, ground my teeth, hardly ever blinked, and could not sleep unless the baby was asleep.

Right around 12 weeks when he started sleeping for 6-8 hour blocks, we both settled into a routine, and just like that the anxiety was gone.

If you were experience anything like this, plus drinking caffeine, plus taking allergy meds, the combo could be awful.
posted by peep at 8:51 AM on November 1, 2007

Zoloft can keep you from sleeping well if you take it at night.

Incidentally, it can also keep you from sleeping well if you take it in the morning (this is why I take it at night now).

I'd recommend cutting gradually back on the coffee and maybe spreading out your medications a bit.
posted by infinitywaltz at 9:13 AM on November 1, 2007

This sounds exactly like I felt when I was first prescribed Zoloft. This is apparently one of the possible side-effects of the drug. I wasn't taking any allergy medicine though and the symptoms manifested themselves after the first few days. My doctor just discontinued the Zoloft and switched me to something else. Try calling your doctor to discuss your symptoms. If you feel anything like I did, a few weeks if way too long to feel that way. IANAD
posted by dreaming in stereo at 9:16 AM on November 1, 2007

If you've been taking zoloft for 8 years, it's pretty unlikely the zoloft.
posted by selfmedicating at 9:52 AM on November 1, 2007

I assume you've checked this out, but I am rather curious. Is it ok to breast-feed while on those meds? They won't adversely affect the milk/kids?
posted by Grither

Both Zoloft and Rhinocort are considered safe for pregnant and breastfeeding women, and are routinely prescribed. Different medications pass through the placenta or metabolize into breastmilk in different ways, and these two are known to be among the safer choices for the conditions they treat.

I also had a heck of a time getting decent sleep and not feeling all jangly when my babies were pretty young, and it didn't seem to matter if I was drinking regular or decaf or no coffee at all, and it happened when I was on Prozac after my second child and also after my first, when I'd never taken any kind of medication of the sort in my life.

One thing that does help, but is nearly impossible to get when you have a baby, is exercise. Getting out for a good walk in the fresh air, or doing some yoga, will really help your body get itself balanced out. Unfortunately I was never able to make this a regular part of my daily routine when I had infants in the house, but the days I could manage it were the Good Days.
posted by padraigin at 9:58 AM on November 1, 2007

great comments, thanks everybody.

padraigin - i was just saying to dh how much i'm desperate for exercise. i'm a sahm (a 3 yr old besides the baby) and it just ain't happening. i bet that would help though.

infinitywaltz - does the zoloft actually help you sleep?

peep - thanks, she's almost 7 mos old :) - yeah, i had that insane anxiety with my first baby - he was up all night every night, so i was a wreck.

selfmedicating - that's exactly what i was looking for - i was wondering if my body was metabolizing everything a little differently due to the postpartum/breastfeeding hormone upheaval.

i'm going to cut my caf with decaf and hopefully that'll help. i can't give up my morning coffee! (and the caffeine doen't seem to affect the baby at all, thankfully.)
posted by missuswayne at 10:41 AM on November 1, 2007

infinitywaltz - does the zoloft actually help you sleep?

Not necessarily, but when I first started taking it, I took it in the morning and experienced pretty bad insomnia. I also noticed that a few hours after taking it in the morning, I'd get really shakey. Taking the medication at bedtime seemed to eliminate both problems.
posted by infinitywaltz at 11:06 AM on November 1, 2007

I understand how you feel with regards to caffeine. I easily drank three large coffees day. (Not all were Starbucks.) I had to accept the following recently and it was tough.

1. Three is too many a day. I get WAY too jittery and can't focus.

2. If I drink excessive amounts of coffee, I notice a smaller tolerance for it as the week progresses. In other words, if I drank 3 on Monday, Tuesday, then on Wednesday, I'd be jittery by the second cup. (Someone published a paper in the last couple of years that reported, as I recall, not all people metabolize caffeine at the same rate as other foods. So, it can build up.)

3. But I really like the taste of coffee.

So, I drink typically 1.5 a day. I will go two on some days. If I really just want COFFEE in an afternoon, then I will go to Starbucks and get a decaf. The bold roast decafs taste fine to me.

Sometimes I will cut 1/2 caf as well.

I say you've got some great ways to test if it's the caffeine since coming off an AD would take considerably more time especially if you have to go back on. Start dropping the caffeine and see how you feel.

Hope this helps!!

m
posted by tcv at 11:29 AM on November 1, 2007

I know that if I drank 2.5 mugs of Starbucks coffee, I'd feel exactly how you're describing. There's about 3 times as much caffeine in Starbucks brew as there is in the stuff I brew at home, and I can't even drink 2.5 mugs of that.

That said, Zoloft and Zyrtec can both produce or exacerbate tremor and/or anxiety, and corticosteroids can produce anxiety and irritability, although I've never heard of them being implicated in tremor. So if whatever caffeine intervention you try doesn't work, you might want to take a second look at the meds.
posted by ikkyu2 at 12:37 PM on November 1, 2007

Oh, I should clarify! I'm just using Starbucks beans and brewing at home. I'm not even buying the "in-store" beans, I get them from my grocery store, and they're not nearly as strong as the ones in the store.
posted by missuswayne at 1:14 PM on November 1, 2007

Are you sure you aren't on Zyrtec - D? That has a whopping dose of decongestant, and would send you through the roof with some coffee.

Nothing in your description ought to amplify feelings of activation/over-stimulation.

Rhinocort has minimal systemic side effects and if it did the amount of corticosteroid wouldn't be anything close to what it takes to cause agitation, itself a fairly uncommon side effect of steroids.
posted by docpops at 2:44 PM on November 1, 2007

Since you mention the Zoloft is for 'slight-anxiety', your recent child and sleep-deprivation is likely just causing more potential activation and anxiety than a low dose of Zoloft can control, esp. with the sleep deprivation added in and a large bolus of am caffeine.
posted by docpops at 2:47 PM on November 1, 2007