I'm Losing Hours to Zoloft
August 1, 2015 11:31 AM   Subscribe

25mg Zoloft makes me not feel depressed, but I'm sleeping a lot more. What are my options?

A few years ago I came down with depression when my career seemed to be in bad shape and I realized my autistic daughter was never going to be Temple Grandin. Zoloft sent the depression into remission.

And put me to sleep. Pre-depression, I regularly woke up after 8 hours of sleep. Now it's more like 9 1/2. That's not a crazy amount of sleep, but that's losing 10% of my waking life.

Also, I've gained weight.

My doctor claims that all SSRI's will have similar effects. Is he right? Are there other anti-depressants with less of a sleep and weight cost? Would drugs like Provigil counter the side-effects of the Zoloft?

I've tried taking marginally less Zoloft, but the depression comes back, often within a day.

YANMD, etc.
posted by Native in Exile to Health & Fitness (17 answers total) 6 users marked this as a favorite
Not all SSRIs are identical, and there's a range of effects they can have on your energy level. Some are known to be energizing, others are known to be sedating. Outside the SSRI family, there's an even wider range.

As far as I know, though, all the SSRIs have been linked to (at least a certain amount of) weight gain.

One common way to deal with SSRI side effects like these is to add Wellbutrin, a non-SSRI antidepressant that is pretty strongly energizing and tends to cause weight loss. But not everyone tolerates Wellbutrin well — for some people it causes serious anxiety. Switching to a different drug entirely would be another option. Ask Your Doctor etc etc etc.

Also: you don't mention whether the doctor here is a psychiatrist or your general practitioner. My experience is that GPs often don't know a whole lot of fine detail about the effects of psych meds, and it's really worth seeing a specialist if you're trying to fine-tune your regimen.
posted by nebulawindphone at 11:53 AM on August 1, 2015

Any interest in trying bupropion? I can't take it right now and actually just started Zoloft, but if I could I would. The few side effects I experienced leveled out after the first three months, and they were never that bad. The only thing that persisted was unintentional weight loss if I didn't specifically eat to counter it, and it doesn't sound like you'd mind that at this point. (On preview, I took it by itself, rather than to balance side effects. IANAD, TTYD, etc.)
posted by teremala at 11:55 AM on August 1, 2015

When depression set in really bad for me last year I started treating the depression first and had the same issue. Then in November I discovered that I also had hypothyroidism and my depression was being compounded by it. Thyroid medicine plus an anti-depressant help me sleep through the night without excess now.
posted by Hermione Granger at 12:49 PM on August 1, 2015

Bupropion is something you should ask your doc about, either to replace your current SSRI or supplement it. Bupropion can have a stimulant "caffeinated" side effect in some people, and generally does not cause weight gain or sexual side effects.
posted by Cool Papa Bell at 1:12 PM on August 1, 2015

Look into supplements like St. John's Wort and Fish Oil.

I was on Zoloft for a time in my adolescence, and I had a terrible experience (brain zaps, migraines, suicidal ideation, etc.). Some people just don't benefit from certain medications, and a good doctor will help you find the medication that's right for you. I don't mean to insult your doctor, but his/her job is to look out for your welfare, and if he/she isn't doing that, it may be time to get a second opinion from someone experienced in medication management. If you're paying Godknowshowmuch for a treatment, you might as well get your money's worth from someone who knows their psychopharmacology in and out.

Keep your head up.
posted by aristotlefangirl at 1:52 PM on August 1, 2015

You may have a class reaction to SSRIs, as I do. So like others have recommended see if you can take Bupropion instead. When I described the same primary side effect, sleeping way to much and never feeling rested so I slept some more, my doctor immediately thought class reaction and switched me to Bupropion. A friend of mine had the same reaction as well and made the switch.
posted by juiceCake at 5:30 PM on August 1, 2015

Look into supplements like St. John's Wort and Fish Oil.

Do not try adding St. John's Wort to your regimen without consulting your doctor. It acts on the serotonin system, just like Zoloft and other SSRIs. Combining them puts you at risk for serotonin syndrome. It also has a bunch of other potential drug interactions. Whether or not they work (and in this case, there's more evidence that it might than there is for most herbal remedies), herbs and supplements are not safe just because they are not controlled medicines. They can interact with things poorly just like medicines, and their dosages are not so carefully controlled.

Within the SSRI family, some SSRIs have a reputation for being a bit more activating. I've heard this said of escitalopram. Additionally, supplementation with bupropion (or buproprion alone) is often used when SSRI side effects are too problematic. There are other families of antidepressants as well that may be appropriate for you. Agreed that if you haven't been seeing a psychiatrist, it's probably worth it, since they generally know significantly more than GPs about the options currently available.
posted by ubersturm at 5:51 PM on August 1, 2015 [9 favorites]

There are lots of different antidepressants, and side effects vary widely.

is a wiki that talks about side effects.

You could ask your Dr about Brintellix (vortioxetine) - it's a new antidepressant that's much less fogging / sedating / mentally clouding than other antidepressants.

My boyfriend is on it, and mornings are SO much easier for him now than on his previous med regime.
posted by Year of meteors at 6:33 PM on August 1, 2015 [1 favorite]

I function best with nine hours of nightly sleep, so that part seems normal to me. YMMV, of course. I did not have much luck with SSRIs, but I am thrilled with my SNRI. With what I'm on now, I had a Dorothy moment. My life before was black and white Kansas, and then I woke up one day and my life was in color.
posted by Ruki at 6:50 PM on August 1, 2015

Try changing the time of day that you are taking it and ask for a sleep study, in case the Zoloft isn't what is keeping you from the deep sleep that you need to feel well rested after 8 hours.

Lack of quality sleep can cause weight gain, which can make us move around less, which can make us not sleep as well, which can cause more weight gain, which can make us move around less- you see where I'm going with this? Commit to more exercise which can help with depression, sleep, and weight gain.

If all else fails, ask to try a different medication. But, since this one is working for you, I would explore other options first. Even just adding an herbal tea before bedtime could help. You know how awful unmedicated depression feels and only you can weigh that out with how it feels to need more sleep and larger clothes. If I were you, I would focus on ways to make the medication work for me, so that I could keep taking it. I have to do that with my Singulair. It makes me eat like a starving woman, bloats me up, and keeps me awake at night. So when I have to take it, I get more exercise during the day, I keep fruit and veggies on hand for binge eating (instead of pie), and I have a plan A, a plan B, and a plan C for getting to sleep at night. Plan B calls for Lunesta, which is a very lovely sleep aid. A is herbal tea and C is a glass of wine, all plans include exercise during the day to wear myself out. Just keep tweaking your lifestyle until you find options that work for you.
posted by myselfasme at 8:30 PM on August 1, 2015

I just switched from Zoloft to escitalopram for a similar reason (sleeping too much, being exhausted all the time when awake) and was shocked at how big of a difference it made!
posted by raspberrE at 8:54 PM on August 1, 2015

Best answer: This depends if you also suffer from a co-morbid anxiety disorder, or if depression is your biggest issue.

There are so many options and I've tried literally dozens upon dozens for both depression and anxiety. Please feel free to PM me if you'd like.

I was on up to 100 mg of Zoloft and the reason I stopped it is because it made my emotions too flat. It worked but the zombie effect didn't make life worth living for me.

One SSRI for you to consider is Luvox. It does not typically cause weight gain (I've actually lost weight on it). Many people find that it has a lower SSRI typical side effects than the more common ones. It is indicated primarily for anxiety and OCD but most psychiatrists would prescribe it off label if you wanted to try it.

As others mentioned, many find Wellbutrin (Buproprion) is really great for depression. It is not an SSRI but is indicated for depression. It is basically a mild but non-addictive stimulant. Most people lose weight. There are almost never any sexual side effects or flattening of mood. It works relatively quickly. The main downside is that if you have significant anxiety it can make it worse (this is why I had to stop it).

Another good choice for you may be an SNRI such as Effexor or Pristiq. Unlike SSRIs which focus on serotonin, these inhibit the reuptake of norepinephrine (a stimulating neurotransmitter). They are usually not quite as stimulating as Wellbutrin, but are less likely to make you tired than SSRIs or TCAs.

Worse case, low dose ketamine treatment might be worth looking into if it is practiced in your state (MA, AZ, NY, and CA to my knowledge). You will be almost always be accepted and it is the most effective antidepressant drug in existence (~85% of patients find enormous and INSTANT relief without significant side-effects. The main downside is that it is pricey and your insurance may not cover it.

Again, although I am not a doctor I've tried so very many treatment options and I have formal education in biochemistry and job experience in pharmacy and healthcare. PLEASE PM me if you have any questions or just need someone to talk to.
posted by WhitenoisE at 9:40 PM on August 1, 2015 [1 favorite]

I'm now having the same problem on escitalopram, although I didn't for several years. Switching from one thing to another will probably involve tapering, during which you may experience a lot of really unpleasant side effects. Be prepared for that. My attempt to switch to Pristiq (SNRI) was so unpleasant that I have stuck with the Lexapro because the sleeping is less problematic.

Also be aware that bupropion (Wellbutrin) is (as far as I know) only used to treat depression in the US. In the UK and Australia, it is available as a treatment for stopping smoking and if you can find a doctor who knows enough about it, they may be able to prescribe it for your depression as an off-label use, but it would require more hunting.
posted by Athanassiel at 10:13 PM on August 1, 2015

Many SSRIs may have similar effects for you -- most did for me -- but there may be some that don't. Brintellix (vortioxetine) is a newer antidepressant that works for me without the hypersomnia.

I think it's well worth trying Wellbutrin and the SSNRIs like Celexa, Lexapro, and Effexor -- they boost norepinephrine as well as serotonin. If those don't help the sleepiness, try Pristiq and Brintellix.

My doctor did consider adding Provigil, but we ran across Brintellix before that happened.

Brain chemistry is highly individual and sometimes one med will tweak your neurotransmitters in a better way than another, for no clear reason. So it's worth trying ones with slightly different mechanisms of action.

(Also, applause for bringing this up with your doctor and pushing for a solution! I waited far too long to do that, assuming that being unable to get up in the morning was a personal moral failing and feeling ashamed of how "lazy" I was. Keep remembering that it's not you, it's a side effect, and you don't have to just live with it.)
posted by snowmentality at 3:29 AM on August 2, 2015

IANAD, just someone who has taken a lot of psych meds.

I definitely think it's worth trying a different SSRI, or giving Wellbutrin/bupropion a try. I know that the Wellbutrin+SSRI combo is pretty popular since Wellbutrin can counter some of the fatigue/low sex drive/weight gain side effects. Of course, YMMV.

Frankly, prodigal seems like kind of an extreme next step to counteract a medication side effect. I would encourage you to try different SSRI combos before trying this. I actually did take Provigil for a bit, although it didn't do much for me, but my issue with sleep (delayed sleep phase disorder) were not medication related.

Also, I will 100% second not taking St. John's Worts, especially without talking to your doctor. Please don't do that.

SSNRIs like Celexa, Lexapro, and Effexor

Celexa and Lexapro are SSRIs. Effexor and Pristiq are SNRIs as is Cymbalta, I believe. I've never tried any of these, but I have known several people who have taken Effexor, and they have all reported that it has very extreme withdrawal/discontinuation effects, and these effects can happen even if you just miss a dose. Of course, anecdota does not equal data, so talk with your doctor. Still, my inclination would be to give Wellbutrin (a norepinephrine-dopamine reuptake inhibitor) a shot first.

However, you mention the sleeping 9.5 hours thing, but what happens when you force yourself to wake up after 8 hours of sleep? Do you feel groggy for the whole day? Or is it just that you aren't naturally getting up after 8 hours? If it's the latter, maybe first try working on regulating your sleep/wake times and see if that helps. Although this won't help with the weight gain effects, and I'm guessing you've probably already tried this already.

So basically, I vote for talking to your doctor about trying a different SSRI or giving Wellbutrin a shot, and if your doctor isn't open to giving this a try, then go get a second opinion.
posted by litera scripta manet at 5:38 AM on August 2, 2015

Are you are incapable of waking up with an alarm clock after eight hours? If so, that's concerning, but simply being able to sleep nine or ten hours unless woken earlier is not a health issue; indeed, it's often a sign of, and even a cause of, good health generally and healthy body weight in particular.

Remember that weight gain can simply be an issue of metabolic change and decreasing physical activity with age, and isn't necessarily caused by your psychiatric medication. And even if caused by your medication, unless it's gotten to the extent that it's a clinical issue on its own (e.g. causing you hip or knee joint pain, or a diabetes or hypertension diagnosis) you should at least give non-pharmaceutical steps -- i.e., a diet and exercise regime -- a chance before you change a drug regimen that appears to have done a good job at keeping your depression at bay.
posted by MattD at 1:00 PM on August 2, 2015

I've tried taking marginally less Zoloft, but the depression comes back, often within a day.

Just checking:
Are you sure it is depression and not withdrawal? You may have depression lurking beneath that, but it can be hard to tell til you are over the withdrawal stage. A med decrease can have similar symptoms to missing a dose. Blood plasma levels should have evened out after only a week of a new dosage, but I know when people taper off, it's often a couple of months before the last effects really shake off.

Yes, provigil would probably still work, but not sure you'd be able to get a prescription for it if you are still in the normal range for sleeping.

You could experiment with taking it at different times of day, or do things to have more restful sleep, like a hot shower beforehand, dark, quiet, and bright light in the morning. I have allergies that I wasn't controlling well enough, and avoiding them has made the biggest difference to me, in terms of the amount of sleep I need (nearly 2 hours less - and yes, it really does have a big impact on the amount of free time I have).
posted by Elysum at 4:22 PM on August 3, 2015

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