so sleepy
June 3, 2014 8:17 AM   Subscribe

How long should I tolerate the grogginess of an anti depressant?

I started taking Clomipramine for anxiety and insomnia a week ago. I take 25mg and am supposed to go up each week until I reach 100mg. It really helps for the insomnia but I can't do anything during the day. I have zero motivation. Getting dressed is an effort. I can't walk my dog. I can't do much until it wears off around noon. At that point I feel like a lazy idiot for not doing anything all morning and it triggers my depression and feelings of hopelessness.

I can't get into see my shrink until August and the idea of feeling this way for another day or another hour isn't making me happy. I fear what will happen when I raise up to 50mg tomorrow. I am not sure if I should just tough this out. If this is a normal side effect and it will lessen once it is raised. Or if I should abandon ship.

Will this wear off? Is this something you would tolerate?
posted by kanata to Health & Fitness (17 answers total) 3 users marked this as a favorite
Call your psychiatrist today and see if you can get an appointment asap. Most antidepressants do have some side effects, and a lot of the time they wear off, but if the side effects feel worse than the condition you're trying to treat, that's a clear sign it's not working for you. Maybe the exhaustion will wear off eventually, but you don't need to gamble on that; you have other options available.

Don't quit cold turkey, however. Talk to your doc about the best way to transition off this medication and on to something else.
posted by Metroid Baby at 8:25 AM on June 3, 2014 [1 favorite]

What time of day are you taking it? Right before bed? Take it 3 hours earlier and see if that means you wake up okay.

If you're taking it in the morning, take it before bed.

Either way, I'd give it longer than a week and talk to your doctor if it's not better by 2 weeks. I had some severe grogginess that eventually evened out.
posted by OnTheLastCastle at 8:26 AM on June 3, 2014 [2 favorites]

Yes this is a normal, sucky, side effect.

It can take between 2 and 6 weeks for your body to adjust to a TCA (tricyclic antidepressant). And that's why it's crucial not to stop abruptly, because your body needs that 2 to 6 weeks to adjust to not taking a TCA.

When I was in your shoes, I countered the negative script re: "laziness" with "I am taking care of my body. I am seriously ill in the head, and treatment is important. If I had the flu, I wouldn't call myself a lazy idiot."

For me the first two weeks were the hardest. I was surprised that increasing the dose only meant one or two days of increased sleepiness.

I take my TCA (for less painful sleep) at dinner time, which helps with the dopiness. IAMYD or your psych nurse, but chances are excellent that the shrink would say "tough out four weeks before bailing."
posted by Jesse the K at 8:28 AM on June 3, 2014 [2 favorites]

I would try taking it at dinnertime with the assumption that the grogginess will wear off just in time to get up in the morning, and give it another week. After that I would stop taking it altogether, assuming that it is not medically dangerous to do so.
posted by elizardbits at 8:29 AM on June 3, 2014 [2 favorites]

"I just started a new medication a week ago" and "Next psychiatrist appointment isn't for at least two months" should not be statements that go together (assuming the psychiatrist is the one who prescribed the medication). You need an emergency appointment with the prescribing doctor within the next few days. ("Emergency" because most reasonable doctors would have had you back within 1-2 weeks as a matter of course, and now you need to push hard to get that level of care.)

I'm a big advocate of letting most side effects ride out for at least a couple of weeks, but anything that interferes with daily functioning to the extent you're describing falls into the "Doctor, immediately" category for me.
posted by jaguar at 8:34 AM on June 3, 2014 [9 favorites]

1) Take it around dinner time and see if that helps.
2) Push for an appointment ASAP to discuss dose and whether you want to continue on this one.
3) Totally normal for an antidepressant to have crappy side effects before it starts working.
posted by barnone at 9:02 AM on June 3, 2014

Jaguar it takes six weeks for an antidepressant to work. So an appointment 8 weeks is common and not that big of a deal.

I'd try and stick it out another week or two. Call your doctor and let him know about the side effects. It may be a good idea to stay on this dose a bit longer instead of upping it.
Good luck.
posted by AlexiaSky at 9:26 AM on June 3, 2014 [1 favorite]

The doctor did want me to see him sooner (marked for the receptionist to see me ASAP) but since it is at a provincial mental health clinic and he is only one of two in town the soonest was in August.

I will try taking it earlier. I took it at 7 the other day but still was incredibly groggy. Not being able to walk my dog first thing prevents me from exercising and spirals the depression down.
posted by kanata at 9:31 AM on June 3, 2014

You can call and bug them for a follow-up. Tell them you're having terrible side effects on a new antidepressant and need to be seen. They won't ignore you.

But don't be alarmed - it's the norm to feel the side effects very strongly, and does not signal that it won't work, or that the side effects won't go away.

Get in touch with your doctor to talk it over, and hang in there.
posted by barnone at 9:41 AM on June 3, 2014

I understand antidepressants take longer than 1-2 weeks to work. I also understand that most intolerable side effects show up very quickly, and often cause patients to stop taking the medication entirely, which is why every doctor I've seen or worked with has had patients come back within a couple of weeks when starting a new medication -- not to see if it's improved the initial symptoms, just to make sure the side effects are not intolerable.
posted by jaguar at 9:45 AM on June 3, 2014

Kanata, if switching the time you're taking it doesn't help (are you taking it at 7am or 7pm? I've been assuming evening), you should absolutely call the doctor's office and see if you can even talk to a licensed professional (doctor or nurse) just on the phone to get advice. As the doctor wanted you back in quickly AND you are having side effects that are interfering in a major way with your functioning and increasing your depression, this is not a situation where you should just wait it out. Even your doctor thinks you should see him sooner. I know scheduling is hard when resources are thin, but this is a situation where you can very ethically push to the front of the line. (And if that feels overwhelming right now, is there someone who can call and advocate on your behalf? Friend, family member, therapist?)
posted by jaguar at 9:54 AM on June 3, 2014

I am taking it at around 9 p.m. I tried 7 p.m. one night. I guess I will try to take it earlier regularly for another week and if it doesn't go away I will see if I can get up the nerve to call my doctor.

I have life long insomnia and PTSD and panic attacks and it is helping the anxiety that was getting out of control and I have gone from sleeping two hours to eight.

I don't do well with medication (tried almost everything in 20 years) and feel that a lot of doctors don't believe me about it not helping so hesitant to bug my current doctor. I panic when it comes to making medical decisions that doctors may not agree with due to feeling like I will get in trouble (child abuse issues that I am working on).

Thanks for your answers.
posted by kanata at 10:36 AM on June 3, 2014 [1 favorite]

I panic when it comes to making medical decisions that doctors may not agree with due to feeling like I will get in trouble (child abuse issues that I am working on).

I totally get that. Would it help to remember that you are actually trying to follow your doctor's orders by going back in to see him sooner?
posted by jaguar at 11:30 AM on June 3, 2014

Two more ideas:
1. Call your doctor's office and ask if there have been any cancellations. Ask to be put on a list to be called if there are any cancellations. You can do this as many times as you can stand it. The squeaky wheel does get the grease, oftentimes.
2. Call your doctor's office and talk to the nurse - at least in the US, usually there is a nurse who will talk to patients for fairly straightforward questions. Tell whoever you talk to about the side effects you're experiencing. Ask about delaying the step up to 50mg for another week to see how you feel or whether they have any other advice.

Taking it in the early evening sounds like a good idea for now. Could a little caffeine in the morning help you get yourself moving more? I'm talking small dose of caffeine, as from what I understand, TCAs change the metabolism of caffeine somewhat so use caution. You definitely, definitely should talk to your doctor before abandoning ship. I am sure they would prefer you discuss this with them so try not to stress about 'bothering them'. Any physician who prescribes psychiatric medications should be pretty understanding about the fact that many people have side effects with them and have to try a lot of different things before finding what works.
posted by treehorn+bunny at 12:31 PM on June 3, 2014

For me the soporific effects of clomipramine abated somewhat after a few weeks. It was the best AD I've ever taken. I've taken nearly all of them.

You might try a bit of modafinil in the morning. It also boosts the clomipramine.
posted by persona au gratin at 2:23 AM on June 4, 2014

I talked to my therapist and he was concerned as he hasn't seen me this lethargic in the four years I've been seeing him and was worried about my worsening depression. He contacted my doctor and I was advised to cut it back to 12.5 mg for a few weeks before trying to up it again. After trying it for five days and the lack of energy getting more pronounced as well as increasing suicidal thoughts he contacted my doctor again and I've been told to stop it.

Thanks for your responses as it encouraged me to let my therapist talk to my doctor for me and hopefully the increasing depression/intense suicidal ideation/utter laziness will stop in a few days.
posted by kanata at 5:15 PM on June 9, 2014 [2 favorites]

Good for you!!! I've been worried about you. I'm glad you talked to your therapist and let him talk to your doctor -- it's so helpful to find the people you can talk to when you need that kind of support.

I do hope you find a medication that works better for you, too.
posted by jaguar at 7:20 PM on June 9, 2014 [1 favorite]

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