Is it a bad idea to start taking SSRIs right before finals?
December 9, 2011 3:15 PM   Subscribe

Will the immediate, short-term side effects from Zoloft and Klonopin have a serious impact on my ability to study and perform on tests?

I have suffered from anxiety and depression for many years without much treatment, and never medication. My symptoms have ebbed and flowed but in the last few months have gotten bad again. I got fed up and finally sought treatment and was prescribed some stuff in addition to therapy. Hooray for proactively addressing longstanding mental health issues!

However: I am a student and have extremely important final exams beginning Monday and extending for two weeks.

Is it crazy to start taking 12.5 mg of Zoloft and .25 mg of klonopin daily right now? What side effects have you experienced, and how debilitating were they?

My doctor acknowledged these concerns but suggested that because these dosages are low, the side effects will be mild, and would only consist of headaches/nausea/some fatigue. She seemed to think they are very unlikely to impact my academic performance, and that if the effects are too much, I can stop taking them and they will pretty much immediately recede.

Seeing as I am an anxious individual, I worried nonetheless, and took it upon myself to do some googling, which of course has turned up dozens of worst-case scenarios where starting even low dosages of these drugs leads to severe mental fog, dizziness, drowsiness to the point of falling asleep, and so on. I really don't think I can afford to deal with these symptoms right now. While my current mental state is exhausting and taking a real toll on me, at least it's predictable and I know I'm not going to fall asleep or feel terribly dissociated in the middle of an exam.

However, I want to start feeling better ASAP. I also fear that if I don't start on these drugs now, I will lose the motivation, and succumb to the fears about medicating myself that have kept me from pursuing medicine for years. I have some hangups and fears about taking medication, and have only finally arrived at the decision to try it after working up a lot of courage. But I can't afford to have it seriously impact my academic performance.

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posted by anonymous to Health & Fitness (13 answers total)
The Zoloft probably will do nothing to you for a couple weeks at least, but the Klonopin has a good chance of making you sleepy. It's very short-acting, though, so you should try it and see what happens. You can stop after just one with no problems.
posted by richrad at 3:19 PM on December 9, 2011

The half-life of Klonopin is 12 hours. Can you clear your schedule tomorrow? Take one in the morning and see how you feel. You'll probably feel a little sleepy. You can counteract this with caffeine, but don't overdo it. (In other words, if you have too much caffeine, then the klonopin was pointless.)
posted by desjardins at 3:29 PM on December 9, 2011

Anxiety and depression will do far worse things to academic performance. I was on much higher doses of benzodiazepines in college, and did quite well (far better than I was doing when I couldn't get out of bed or go to class), with only some passing sleepiness and brief euphoria at the very beginning. I was still able to work and do well in class. That 0.25 mg dose of Klonopin is what I take every couple of weeks now for occasional panic symptoms, and it doesn't cause any particular sleepiness or dullness. Klonopin is one of the slower, quieter drugs in its class, without the punch of Xanax or Ativan.
posted by mittens at 3:36 PM on December 9, 2011

I am a great fan of psych drugs. They saved my life and I will be on them forever, like a couple of my friends and one of my favorite teachers. But I might actually hold off on the Zoloft until the exams are over, since it's going to need more than two weeks to start working anyway. It doesn't do this for everybody, maybe it doesn't even do this for most people, but it made me pretty spacy. By the time it did kick in, the cognitive side effects were gone, but during those first few weeks I found myself staring at carpet patterns a lot.

If you don't think you're going to be able to convince yourself to open the bottle again in two weeks, start now. (I'll write to your address in two weeks; will you check it?) But winter break and the beginning of a new semester are not a bad time to get used to an antidepressant.

Klonopin you have time to try this weekend. It doesn't have to build up, and you're not going to lose anything by stopping and starting again.
posted by Adventurer at 3:44 PM on December 9, 2011

Zoloft is an SSRI. SSRIs can take up to a month before anything happens (good or bad), if anything happens at all.

Here's a study about Klonopin/Prozac interaction. (Prozac and Zoloft are the same class of drug.) In short, the Klonopin is there to minimize the side effects of the SSRI which, when they occur at all, are usually pretty mild anyway.

It's the weekend. Start taking both tomorrow. You can see if the Klonopin fucks you up (and in that unlikely event, just follow your doctor's advice and don't take it again), and the Zoloft, well, it won't do anything yet anyway.
posted by Sys Rq at 3:59 PM on December 9, 2011

In my experience, SSRIs take weeks to tackle depression, but the do *something* right away. The hassles and stresses of life become just a little easier to take. After a few weeks of this, your depressed/anxious brain starts to lighten up a little and it starts to lift.
posted by gjc at 4:06 PM on December 9, 2011 [3 favorites]

I started taking Celexa (another SSRI) and Klonopin a couple of months ago. I was taking them both at night, shortly before going to bed. For the first few weeks I was completely exhausted all of the time; I would sleep for 11 hours, then take a 3-hour nap in the afternoon. It completely fucked with my ability to get work done, because I was just totally wiped out at all times.

However, when I experimented with stopping the Klonopin, I discovered that the Celexa was making me sleep extremely poorly. The Klonopin had been disguising this by keeping me unconscious even if I wasn't getting refreshing sleep, but without the Klonopin sedating me I was waking up every 20 minutes or so. At my psychiatrist's suggestion I switched the Celexa to the morning (and stopped taking the Klonopin) and it made a huge difference. The first night after I switched to morning dosing, I got 8 hours of restful sleep for the first time in a month. I felt like I could lift a car.

Anyway, this is just to say that yes, I did have side effects that interfered with my ability to do work, but if I had been more aggressive in terms of figuring out what was making me feel awful, I could have resolved the problem much earlier.

Honestly, I would start by just trying a small dosage of Klonopin without the Zoloft (I AM NOT A DOCTOR), which is what I did for a few months before trying SSRIs. As desjardins said, Klonopin leaves your system pretty quickly, so even if it does have some negative side effects you can just wait them out. The Klonopin might attenuate your anxiety enough to help you get through the next couple of weeks, or it might even help you work up the courage to start the Zoloft. Feel free to MeMail me if you want to talk.
posted by pluckemin at 4:34 PM on December 9, 2011

FYI, if you do start Klonopin, and are on it for a while, know that it might cause some dependency. When I was on it, if I missed one dose, I couldn't sleep for the whole night.
posted by dhens at 4:43 PM on December 9, 2011

I don't know anything about Klonopin, but if your experience with Zoloft is anything like mine was, you will gain far more from getting your anxiety under control than you will lose from dealing with Zoloft's generally minor side-effects. Like gjc said, I started feeling something right away - I could feel something shifting in my brain within a few hours. It got easier to deal, easier to stay emotionally balanced, easier to make decisions, easier to act on my knowledge. Zoloft sort of oiled my mental gears. Therapy got a lot more productive. So, yeah, easing my depression took a while, but the cognitive benefit kicked in right away.

Besides, your doctor is definitely easing you in slowly. 12.5 mg is a quarter of the lowest standard dose. If you do experience any side effects they are going to be mild, because there's just not going to be much of the drug in your system.

The side effects I experienced when starting zoloft consisted of a mildly rumbly digestive system, for about a week, and a mildly depressed libido, for about a month. The same thing happened again when I ramped up my dose, and again when I later dropped back to 50 mg. It was never debilitating.

I've never had any of the sleep problems people talk about, but I've always taken my pill in the morning rather than the evening.
posted by Mars Saxman at 5:12 PM on December 9, 2011

Bad idea. At least for me it was: I found myself waking up hours later after I sat down to study. I happened constantly and i was always exhausted. It ended badly and I'll be retaking the class.

It wasn't till after did I realize it was the meds.

If you can hold off, I would consider it.
posted by Bun Surnt at 5:16 PM on December 9, 2011

** I was on zoloft.
posted by Bun Surnt at 5:16 PM on December 9, 2011

IANAD. I've taken both Zoloft and klonopin. My experience was that the Zoloft (esp. at that dose) is not going to mess you up -- esp. if you start taking it now. My experience with klonopin, even at .25 mg, is that it basically knocked me out. It took a couple days before I felt like I could operate at a normal level of alertness. As desjardins pointed out, though, the half-life of klonopin is short, and sertraline HCl (Zoloft) is, too -- about 24 hours. Since your exams go on for a couple weeks, a lower anxiety level would help, and you've got the weekend to get used to it, my advice is to go for it and take both. If you drop anything, let it be the klonopin. It will clear your system faster, and Zoloft is supposed to help with anxiety anyway. Getting help means you are a strong and brave person. Way to go! And good luck with your exams.
posted by Shoggoth at 10:23 PM on December 9, 2011

For what it's worth, I agree with others that you've been prescribed a low dosage of Klonopin and Zoloft. The usual starting dosage of Zoloft is 50 mg. Klonopin's starting dosage is usually .5 mg multiple times a day.

As others have said, you could just try the Klonopin over the weekend and see how it affects you. As for the Zoloft, doctors seem to see it as taking four to six weeks to "work." The side effects can appear before the beneficial effects do, but the Klonopin may take the edge off some of those. YMMV.
posted by zxcvz at 11:02 PM on December 9, 2011

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