Advice on anxiety meds

November 8, 2019 11:09 PM

I've been unhappy with zoloft/sertraline and don't know if I should try something new or continue to make the best of things without it. What should I tell my psychiatrist?

I've had anxiety(maybe a bit of depression?) all my life, bad enough to make work, leaving the house, even stuff like sending emails a real problem. This spring I finally tried medication, after not making any progress in therapy, and it was great! I felt so much better, and I have been more confident and doing really well in my career. Unfortunately the side effects (I was taking 50mg sertraline) eventually caught up with me-lots of fatigue, some weight gain, but mostly the problem is the sexual side effects. Sex is a really important part of my life and being constantly disappointed by how I felt (numb, disconnected from my body) was too much. I stopped taking medication about two months ago, and I feel like myself again. But as time passes the anxiety is getting harder to keep a handle on. I have a therapist, and I'm working on this with her, but I'm afraid that I'll just slowly slide back down to the place I was in at the beginning of the year.
Should I try a different drug? A lower dose of sertraline? Should I keep on trying to tough it out unmedicated? I like my psychiatrist, but I get the sense that she is not going to take the sexual side effects seriously.

posted by anonymous to Health & Fitness (16 answers total)

There are way too many options for these drugs to give up after just one that has side effects that are unacceptable. Definitely try a few.

I like my psychiatrist, but I get the sense that she is not going to take the sexual side effects seriously.

You should check to see if that’s true, and if it is you really need a different psychiatrist. Sex is a fundamental part of life and anything that affects it is by default very important.
posted by Tell Me No Lies at 11:51 PM on November 8, 2019 [6 favorites]

I've found that a lower dose of Zoloft helped ease the sexual side effects. Also, I found that they went away with time even without lowering my dosage. However, everyone is different; I didn't experience the other side effects you described so perhaps a different medication would be best. Regardless of what you chose, your concerns are absolutely valid and you deserve to be taken seriously!
posted by smorgasbord at 11:53 PM on November 8, 2019

Have you tried using medication for ADD? When I started out with my psychiatrist, I tried a few different meds at different doses, and I found that they all helped me stay calm and confident in situations that normally provoke anxiety, like driving and social interaction. Adderall was the only one that didn't trigger even worse anxiety as it wore off, so I stuck with that. Unlike my experience with sertraline, the ADD meds all took effect quickly and were pretty obvious once the dose was high enough. In short, I was able to quickly and confidently settle on a medication that greatly benefited my mental health with unnoticeable negative side effects, at little risk or cost to myself. If all that appeals to you, consider asking your psychiatrist if you can try something similar yourself.
posted by J.K. Seazer at 11:56 PM on November 8, 2019

I'm sorry that this wasn't explained to you, but you should basically expect to have to go through several different drugs to find one that works optimally for you. Definitely try a different one.
posted by DarlingBri at 12:12 AM on November 9, 2019 [6 favorites]

My therapist said, "I don't think these are working, better see a psychiatric prescriber." I saw a psychiatric nurse practitioner who said, "I don't think these are working. Let's try this new thing." I titered from Zoloft to viibryd. Stayed consistent w Wellbutrin. After 6 weeks, no bad side effects (and maybe a little less gloom. Hard to say, I've had some unexpected good life stuff land on me). Ymmv, but a fresh opinion seems useful.
posted by j_curiouser at 12:20 AM on November 9, 2019

The thing about psych drugs in general and antidepressants in particular is that nobody really understands how what they do chemically translates to what they do mentally. Every single one of them is a "this works for some people, maybe it will work for you" lucky dip.

I don't know anybody who lucked onto their most effective antidepressant first time through the gate. But I know a lot of people, myself included, who got good results after working through two to five of them.
posted by flabdablet at 3:39 AM on November 9, 2019 [2 favorites]

I get the sense that she is not going to take the sexual side effects seriously

Any competent psychiatrist will take any side effect that distresses you seriously enough to work with you to mitigate it. And they can't help do that if they don't know. So disclose, disclose, disclose! Tell your doc in person exactly what you've just told the Internet anonymously, and if they blow you off, get a better doctor.
posted by flabdablet at 3:42 AM on November 9, 2019 [2 favorites]

There’s no reason not to try something else. With that said, in my experience, going to a little higher dose of Zoloft actually worked to control my anxiety which had the effect of making it more likely I’d want to have sex. Also, if you’re drinking ANY alcohol it will have the side effect of decreasing the effectiveness of any SSRI’s and may also decrease sex drive.
posted by photoslob at 4:40 AM on November 9, 2019

Try something else! Fatigue and weight gain are also side effects you can report to your psych.
posted by esker at 5:15 AM on November 9, 2019

Response by poster: I believe in general that stimulants like ADHD meds and Wellbutrin are strongly contraindicated when anxiety is the main issue, rather than anxiety ancillary to depression or ADHD, because the stimulant effect can make the anxiety worse. So if your psychiatrist is leery about those, that's why.
posted by Anonymous at 5:24 AM on November 9, 2019

"What should I tell my psychiatrist?" The truth of what you feel and are experiencing and what you need. If the doc doesn't respond well to that, get another doctor.

I know that's not easy. But it's the only way to feel better if your doc doesn't listen to you or give your needs high regard.
posted by tmdonahue at 5:56 AM on November 9, 2019 [1 favorite]

Also, even though SSRIs are the first-line medications for a lot of people, sometimes your body is just like “nah.” I failed 3 different SSRIs and started taking the tricyclic Amitriptyline and it’s awesome for me. Don’t be afraid to look at tricyclics and MAOIs if SSRIs/SNRIs don’t work for you, but understand that there are a few dietary restrictions with some of these medications. Good luck!
posted by sara is disenchanted at 6:09 AM on November 9, 2019

I take an SSRI for anxiety, and have experienced sexual side effects. For me, I was so miserable before I started treatment that it's definitely a worthwhile tradeoff. Some people benefit from adding Wellbutrin to their SSRI, but it didn't work for me. The problem is worse for anxiety treatment than depression because the dosage is higher for anxiety. A lower dosage might not be effective, but trying that seems better than discontinuing the drug altogether.
posted by serathen at 6:47 AM on November 9, 2019

You may want to try Genomind or other genetic testing to help see which meds may be more likely to produce side effects.
posted by kbbbo at 7:40 AM on November 9, 2019

Definitely try a different kind! Third time was the charm for me.
posted by kerf at 10:28 AM on November 9, 2019

I'm on a low dose of Abilify for anxiety and it's clean for me - no side effects to speak of - but it also has the effect of *distancing me* from my anxiety rather than making it go away, if that makes any sense. It might matter to you but for me it works out all right.
posted by Medieval Maven at 7:55 AM on November 10, 2019