Is this normal for Zoloft/sertraline?
September 21, 2022 8:52 PM   Subscribe

My SO started Zoloft a few days ago - how much fatigue and discomfort is normal (vs doctor-worthy) at this point?

He is 10/10 EXHAUSTED. Sleeping tons and feeling very unwell, fluish. Other symptoms are: feeling hot and perspiring, headache, loss of appetite, loose stool (he already had some major GI problems to start with but this is new/worse), and palpitations (!!!). I don’t know if he has a fever or not…

Emotionally: says he’s depressed (not sure if this is actually worse than before), and flat (that is new). The extreme anxiety he was suffering from has lessened somewhat, and so far the most remarkable plus for him is waking up with a sense of euphoria. That’s brief and then the rest of it comes in.

Pharmacist said most of this is to be expected for the first few weeks, and online people are saying the ramp up with this drug can be horrible, however this seems extreme.

He’s a psych med veteran (many kinds, including APs) and says this is as bad as the worst withdrawal he’s ever experienced.

He’s alone at home tonight (I am taking care of my dad, SO was with us until today because it’s been hot and the bedroom A/C here wasn’t working). I’m pretty worried. He’s agreed to talk to a doctor tomorrow but is he ok tonight (is serotonin syndrome possible?)

If this IS normal, I hope to god it’s worth it, do share your experiences. This was prescribed for MDD and (C)PTSD (he has other diagnoses, I am not sure if they’ve been definitively excluded).
posted by cotton dress sock to Health & Fitness (13 answers total)
Response by poster: I don’t think he shared his other medical history with the prescriber (NAFLD, diverticulitis, recent drug-induced pancreatitis [antibiotics!], among other things). I guess this medication is primarily metabolized by the liver? Maybe his body is processing it weirdly?
posted by cotton dress sock at 9:02 PM on September 21

Yeah, the first week was murder for me, all this and nausea, though not depression (I was taking it for anxiety only) or palpitations. It levelled out pretty quickly in week two and further dose ramp ups were much easier. But I was a zombie for the first week.
posted by I claim sanctuary at 10:10 PM on September 21 [2 favorites]

I take Zoloft and have taken other SSRIs. I tend not to have huge terrible side effects from SSRIs, but this level of intensity of side effects does not seem normal to me.

You mention concern of serotonin syndrome--is he taking other psych meds that would be contributing to that? Did he tell the pharmacist, at least, about the medical history you mention?

Also, in case it's relevant: ingesting (not smoking) CBD products can affect metabolism of SSRIs because both are metabolized by the same liver enzymes (CYP450). It's been awhile since I read up on this but I believe the outcome is that the effective dose of the SSRI will be higher and there can be more side effects. (THC does not have this effect, just CBD.)
posted by needs more cowbell at 10:11 PM on September 21 [2 favorites]

I’m on Zoloft and this does seem extreme to me, although thinking back on it maybe my first three or four days ramping up were around this level of distressing. I slept an utterly bizarre pattern of like, little two and three hour naps with a few hours of near manic awake in between, then a huge chunk of sleep like fourteen hours, loosely repeat. Was hell. Also I had massive GI trouble, no appetite, and brain zaps. I didn’t ever feel feverish or sweaty or have palpitations I don’t think. In a bit less than a week I was feeling much better and way less anxious, though I agree it never helps with depression, just allows me to do things to help my depression that anxiety was keeping me from. I’ve gone off and on and off and back on it and each time was less arduous than the last. Recently I doubled my dose and the increase was almost seamless, I was like, “is this doing anything??” and then I realized I had paid bills and called my parents and took my cats to the vet without freaking out, so yeah, it was doing something.

My main side effect is that I can’t tolerate drinking any alcohol. I can have it cooked in dishes but a single shot of a spirit will make me feel like absolute shit for like a full day, and I’ll feel it in like twenty minutes. So I guess my liver is busy with the ssri. It’s absolutely worth it to me since I rarely drank before and never when I was anxious (because, lol, I was too anxious about drinking to drink) but if he is a beer enjoyer or the guy who sips a whiskey to relax, definitely don't do that for now.

I think he should talk to a psychiatrist if possible about this and see if they suggest slowing the taper or combining it differently with other meds he might take. Are you sure he’s not mistaking brain zaps for palpitations? They feel extremely weird but are apparently fairly innocuous as far as we can tell. When he talks to someone tomorrow be sure he shares all his current meds and medical history and all that. For tonight if he can get some easy to digest food and a comfortable temperature for sleeping it will probably help a lot. Unless he’s taking massive doses I doubt serotonin syndrome is something to worry about. I am not a doctor and am just making suggestions based on my own experience.
posted by Mizu at 10:29 PM on September 21 [1 favorite]

I consistently had horrific dystopian dreams. Tbey were all death dreams, along with blurry vision, sweating, I baggd it. I had enough consistent nasty side effects my doc decided I am someone that doesn't respond positively to antidepressants. I got over the divorce.
posted by Oyéah at 10:41 PM on September 21 [2 favorites]

Is there any chance he could have COVID or Influenza on top of adjusting to the Zoloft?
posted by carriage pulled by cassowaries at 10:43 PM on September 21 [2 favorites]

Response by poster: needs more cowbell - that’s right, I forgot that, I did once read about CBD potentiating all kinds of meds! Though he does smoke. (Hybrids, I think the THC content is pretty high.) But with NAFLD, maybe that’s not great? Other meds - lithium, lamotrigine, a statin, synthroid. The pharmacist knows about them and said they didn’t find interactions when they dispensed it. COVID - I’m pretty sure he had it when I did in the spring, I don’t think it’s COVID. (When he talks about feeling fluish, that’s a word he often uses for malaise, depression, and withdrawal. I don’t know exactly-exactly what it refers to.) He said he doesn’t have a fever. Also apparently Zoloft’s most notorious and unwelcome side effect is present :/. Mizu - definitely palpitations. Thanks, everyone.
posted by cotton dress sock at 11:11 PM on September 21

zoloft basically made me sleep all the time, it was worse than being depressed. i dropped it as soon as i could although the claim is that the side effects will improve with time. it had me falling asleep sitting at my desk, just exhausted all the time, 1/10 would not recommend
posted by dis_integration at 5:56 AM on September 22 [2 favorites]

I started and stopped Zoloft mutlitple times on different doses and this is way past what I experienced. On a very low dose I felt nothing but mild nausea. On a slightly higher starting dose I threw up a couple times after eating and as a result lost my appetite for somewhere in the range of 3-6 days. This all went away after 1.5 weeks max. That was it, that was all. My guess would be he's starting at too high a dose. My psychiatrist says to start very small and ramp up because you can always increase the dose later.
posted by stockpuppet at 6:33 AM on September 22 [1 favorite]

Also, seconding needs more cowbell - some of these symptoms DO sound like they could fit serotonin syndrome, which is worrying.
posted by stockpuppet at 6:36 AM on September 22 [1 favorite]

Best answer: Lithium + lamotrigine in addition to the zoloft changes the playing field IMO--like, I would be more concerned about making sure to seek medical advice in that scenario because it's possible/likely some of this is interactions/one drug intensifying side effects of the other. There's psych med combinations that some people may be OK taking when carefully titrated but that some people won't be OK combining. Has he spoken to a doctor or at least reported back to the pharmacist about these symptoms? (Did the prescriber know about the other psych meds?)

I am Not A Doctor but my understanding is that lithium + SSRIs can bump up the risk of serotonin syndrome, and on googling I'm also seeing some potential ways that lamotrigine + zoloft can make trouble/need some initial monitoring.
posted by needs more cowbell at 8:14 AM on September 22 [2 favorites]

When I started sertraline, I slept for almost 45 hours straight, waking only occasionally to go to the bathroom and get a drink of water. Now, I'm normally a bit of a bedbug, and I love to get cozy for a nice long nap at the weekend. The fatigue I felt on sertraline, though, was way beyond "I'm going to put on a documentary and doze on the sofa after a long week", it was like a physical presence. It was more than feeling like I couldn't keep my eyes open; I was unable to open them in the first place. I was JUST SO TIRED. Like, remember when you were in college and pulled an all-nighter before an exam, then got home after the test and just crashed, completely spent both physically and mentally? It was like that x10000.

Within a few weeks, I did start to feel slightly less sleepy, but overall, the sluggishness and fatigue never fully went away and I switched back to fluoxetine (Prozac) which I find much less sedating.
posted by easy, lucky, free at 6:39 PM on September 22 [1 favorite]

A few days is really not enough to gauge success. If he can stick with it for 2 weeks or more, he should see improvement in mood. It takes me a month or 2 to get my metabolism back to a healthier place. Pharmacists are really helpful with this kind of stuff.
posted by theora55 at 7:25 AM on September 23 [1 favorite]

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