what works when zoloft does not?
February 10, 2013 6:25 AM   Subscribe

I am getting very discouraged dealing with anxiety disorder (not social, general) and depression. I am taking Sertaline (zoloft) which does not seem to be touching it although it had worked in the past. I am seeing a psychiatrist as well as my GP. This has been several months altogether, two weeks on the higher dose plus an anti-anxiety drug that does not do much either, low dose.

I get night sweats and also some in the daytime, as well as fear and loss of interest in things I was interested in. Has anyone dealt with this sort of thing and found something that helped? My blood tests for my general physical were all ok. Might a different anti-depressant make a difference? I know everyone is different, just looking for some hope.
posted by mermayd to Health & Fitness (23 answers total) 5 users marked this as a favorite
Talk with your professionals. Individual reactions to specific drugs vary. And the effectiveness of drugs in individual cases changes over time. It may be time for you to consider a different drug. You can make that decision only in consultation with your psychiatrist. *But* your psychiatrist can't do anything if you aren't informing her/him of the issues. You may need to push a little to get action. Be an advocate for yourself.
posted by driley at 6:34 AM on February 10, 2013

I have found that antidepressants did not work for my anxiety. Benzos do. I had ativan that worked well but wore off quickly.

My doctor decided to try me on a longer acting one a few weeks ago (tranxene) and i take as needed, about twice a day, sometimes 3. It has helped better than anything. My anxiety isnt "gone" but i feel much better able to reign it in using various quick meditation ot ACT techniques.

Ymmv of course but it is a thing to ask about.
posted by sio42 at 6:47 AM on February 10, 2013

Are you also doing therapy and taking care of yourself (aerobic exercise, yoga, spending time outside, eating right, etc.)? These things can help some people as much as medication.
posted by three_red_balloons at 6:48 AM on February 10, 2013

This sort of stuff works very differently in different people, but I've had luck with Pristiq and Effexor for depression with mild anxiety. Don't get too discouraged- there's tons of different kinds of drugs for a reason.
posted by NoraReed at 6:48 AM on February 10, 2013

Yes, a different anti-depressant could definitely make a difference. People respond very differently to different drugs. Keep trying - there's a good chance you'll find something that works. I hope you feel better soon.
posted by walla at 6:50 AM on February 10, 2013

It could also be a matter of trying a different manufacturer's version of generic Zoloft. Despite what they would have you believe, generics are not all the same.
posted by Thorzdad at 6:56 AM on February 10, 2013 [1 favorite]

A different antidepressant may make a difference. In particular, the SNRIs such as Effexor and Pristiq have sufficiently different effect that they work for some people that don't respond to SSRI's. Adjunctive therapy with a low-dose atypical antipsychotic (such as seroquel, abilify or risperdal) is also sometimes effective for people without adequate response to an antidepressant alone.
posted by drlith at 6:58 AM on February 10, 2013

Thanks everyone so far. To clarify, I have only seen the psychiatrist once so far, was dealing with my GP before that. Not doing therapy, the whole thing feels very physical and there is nothing wrong in my life now to be causing this. I am older also, 60s. Yes I am exercising, work out with a trainer a couple of times a week, walk on the treadmill, eat healthy. I recently lost a lot of weight and felt great, then this anxiety hit.
posted by mermayd at 7:05 AM on February 10, 2013

I'm in my 60's, too and have had lifelong anxiety.
I've never taken any antidepressants as I'm too afraid of the side effects plus my Chinese Medicine MD is dead set against them.
I just try to control my breathing (diaphramatic) slow and easy. Outdoor exercise and meditation are the best for me. For the latter, I just sit in on the couch, close my eyes and count my breaths. Sometimes I visualize a pleasant scene.
I find my anxiety is always there but comes in bunches like speedbumps, too, and those are the things I try to manage with proper breathing and meditation - I want to smooth them out.
He (TCM doctor) also advised I adopt a project so I took up painting and 'found that its fun and creative and I get positive feedback which helps me be happy.
posted by Tullyogallaghan at 7:31 AM on February 10, 2013

I have had anxiety problems my whole life and they only seem to be increasing as I get older. I have never been able to tolerate SSRIs. I've taken Ativan a few times and it worked well for me, but doctors don't like to prescribe benzos long term, since addiction to them is hard to break. The things that seem to help me are

- walking outdoors, no matter what kind of weather
- getting enough sleep (difficult for me, but afternoon naps help)
- being around people that are laid-back types
- having some type of hobby that you enjoy (I agree with Tullyogallaghan on this). Cross-stitch helps me focus my mind and I like the process of creating something.
posted by jenh526 at 7:49 AM on February 10, 2013

I have been on just about every antidepressant at one time or another. In the end, antidepressants just aren't very helpful for me. Klonopin (a benzo) has been very effective for me for anxiety, which is also very physical for me, and it also has the least risk for abuse of the benzos. Klonopin and the other benzos can be taken as needed, and don't need to build up a serum blood level to be effective, which is nice - you don't need to take them every day if you don't need them.

Your best course of action is to do some reasearch on your own, read about different drugs, and people's experiences with them. You can find tons of info online Crazy Meds! is the place to start. then you can bring the info you've found to your doctor and make some suggestions of what you might be interested. most doctors respond very well to patients who have done their research and have ideas about their own treatment.

Here is some advice I can give you from my own experience: when I was on antidepressants, I found that the best one was Lexapro, and a good friend of mine has also had good results with it for anxiety. My doctor has also said she has observed that Paxil is a good antidepressant for anxiety. I'd be very careful about considering taking Effexor, it has a lot of side effects, and the worst withdrawal of just about any psych med when it comes time to stop taking it. Buspar is an atypical anti-anxiety drug. Unlike benzos, it does need to be taken consistently. A doctor once told me it only seems to be effective for about 30% of people, but for those 30% it works extremely well, so it may be worth trying.

Of course, that is just one side of treatment, although for anxiety with mostly physical symptoms, I think medication IS the most effective thing, therapy is important, and something you should at least try. You say there's nothing wrong in your life that should be causing these issues, but a therapist might be able to help you figure things out. Especially if these problems have come on suddenly at your age, and you don't have a history of depression or mental illness. I assume since you were working with your GP medical problems have been ruled out? Have you had a test of thyroid function?
posted by catatethebird at 10:19 AM on February 10, 2013

Have you considered trying biofeedback training? It has been clinically proven to work on anxiety. It helps you train your brain into better patterns and subvert the anxiety pattern. I am close to someone who is trying it because she can't use anti-depressants, and she found it started to help within a couple of sessions. (She also found cutting down on caffeine, simple carbs, and sugar to help too, to eliminate blood sugar spikes that seemed to be one of the triggers.)
posted by min at 10:37 AM on February 10, 2013

Lexapro has been the best for my anxiety.
posted by pantarei70 at 10:40 AM on February 10, 2013

Even though Zoloft isn't effective for you, it would be worthwhile to try another SSRI. You can have very different effects depending on which you take. Unfortunately, there's no way to predict how you'll do on a given SSRI, because it's different for everyone, even among family members. Choosing an antidepressant is kind of a crap shoot...trial and error, says my very experienced psychiatrist.

Methods like biofeedback, breathing, and meditation (mentioned above) can be super-helpful even after you do find a medication that keeps anxiety under degree of control. For a long time, I lived with debilitating physical effects of anxiety. It was very hard -- I really wish you well in finding relief.
posted by wryly at 11:08 AM on February 10, 2013

To echo some of what's above, yes, a different antidepressant might make a difference. If you've never taken an SSRI besides Zoloft, another one might be worth a try. If you have, it might be worth looking at another class of antidepressant. When you research, it's important to remember that people are far more likely to report negative experiences than positive ones.

If it's an option, you might want to ask family members what they take and find effective.

Anxiety can definitely feel very physical. But a lot of effective coping skills are cognitive. Therapy can be useful for acquiring those skills, regardless of anxiety's root.
posted by gnomeloaf at 11:16 AM on February 10, 2013

One more thing: If you haven't already, cut out caffeine and all other stimulants. They can trigger anxiety, especially physical symptoms. I've also found excess b vitamins, such as in 5 Hour Energy drinks, triggers anxiety for me.
posted by catatethebird at 11:30 AM on February 10, 2013

The big drag here is that you have big time windows to work with when getting off one thing and on another to test efficacy for your personal chemistry.

but, if you stick it out, you will find the right mix if you have a doctor that is willing to listen.

diet and exercise are super important, don't punish yourself, but find a plan and stick to it. you will go from hating the grind, to embracing it for the endorphins.

for the depression, if you haven't already tried it, check out a SAD lamp. It sounds ridiculous, but it works for me.

There are several excellent amino acid combos that are effective as well, but you have to be careful if you are taking an SSRI, so do the research.
posted by bobdow at 12:13 PM on February 10, 2013

Zoloft helped me, but it took more than 2 weeks.
posted by fifilaru at 2:50 PM on February 10, 2013

Just an FWI, both Effexor and Paxil have a wicked discontinuation syndrome. If you don't plan on staying on them, you might want to consider something other than those.
posted by kamikazegopher at 5:13 PM on February 10, 2013

It's absolutely normal and expected that one antidepressant won't work for you but another will. Zoloft, Effexor and Paxil were worthless for me, but Lexapro works perfectly. Just have a chat with your doctor - he won't be surprised and will be happy to try something else.
posted by aryma at 10:24 PM on February 10, 2013

My mother has to take twice the highest dose of Zoloft with daily low dose Klonopin to get anxiety relief, so it can be pretty variable. But it does work. While I am better off taking a low dose of Wellbutrin and a tiny tiny dose of Xanax, as Zoloft has no effect on me at all and Prozac makes me more depressed the longer I take it. Risperdal as an adjunct has also been helpful at times for both of us.

Basically, nothing beats benzos for anxiety relief but sometimes it can be hard to find the right one. I had to try several and wound up on the one that I was most scared to take, but the only one I can tolerate. My personal theory is that the antidepressant seems to stabilize and keep me from wanting or needing more benzo. There is no proof for that, it is just my personal idea.

Also, even though it might not feel like the Zoloft is working, it might be relieving any underlying depression which could make the anxiety seem more intense.

If you don't like the idea of benzos, atarax (an antihistamine) and clonidine and beta-blockers are other options for fairly quick relief from symptoms.

It is a very good idea to explore options with a psychiatrist. GPs are lovely, but not so good for dealing with brain issues. So just be honest about everything so the pdoc can do his/her job.
posted by monopas at 10:37 PM on February 10, 2013

I had the same problem with Zoloft (and subsequently, Lexapro) that you are having. While on Zoloft I was perfectly content with just vegging out (which is not so great long-term!), and also had a lot of the generalized anxiety you speak of.

Different strokes for different folks, unfortunately - it's hard to tell what will work until you try it, as everyone's body chemistry is different. I am now on Wellbutrin, which is reported to have the side effect of increasing anxiety. It has in fact decreased mine. I think this is partly because I dwell less on negative thoughts and am more motivated to get **** done while on the Wellbutrin, which contributes to my self-esteem and as a byproduct reduces my anxiety.

Keep trying new meds, give them time. This is important! Don't try them for a week then say "nah, it's not doing anything for me." Also make good lifestyle choices (exercise, social activities, limiting your caffeine/alcohol intake).

Good luck!
posted by Kamelot123 at 1:31 AM on February 11, 2013

Thanks again everyone. I did have a thyroid bloodtest , it was normal with the thyroid meds I have been taking for years. The two weeks on sertaline were an increased dose, but I have been taking a lower dose for almost two months. I have been honest with the doctor. I am afraid of the things like Abilify due to the ads for it with the awful side effects. It was one of the possibilities suggested. I can't stand feeling like this forever.
posted by mermayd at 8:53 AM on February 11, 2013

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