Brief Answer: Unlikely to be due to sertraline. Detailed Answer: Hi, Welcome to Healthcare Magic! I do not feel that your present problems are due to sertraline. Firstly, the dose of sertraline which you are currently on is not too high. We can use doses of up to 200 mg per day if required. Secondly, the symptoms that you have described are not usually seen with sertraline but are very common in menopause. Night sweats, weight gain, breast tenderness, fatigue, irritability, anxiety, abdominal cramps, electric shock like sensations etc are all very commonly seen in menopause. The persistence of your depression may also be due to menopause. The other thing is that you are on Cerazette which also can worsen some of your symptoms like breast tenderness, weight gain etc. Many women have menses even on progesterone-only contraception methods like Cerazette, while some do not. The question is how does one know that one has attained menopause when one is on progesterone-only contracepive pills and therefore, can stop the pill? For women who have menses, it is recommended that they continue the progestogen-only pill (POP) until they are 55 years of age, when loss of fertility can be assumed for most women. But for those who do not menstruate, two options are recommended. They can either continue the POP until the age of 55 years. The second option is for women over the age of 50 years, one should check follicle stimulating hormone (FSH) levels on two occasions, with an interval of 6 weeks between tests. If both FSH levels are more than 30 IU/L, stop the POP after 1 year. This is as per the NICE guidelines of UK ( WWW.WWWW.WW uk/contraception-progestogen-only-methods#!scenariorecommendation:10). The point I am trying to make is that though you are only 45, it is possible that you are going through menopause and you probably do not need Cerazette, which is just worsening your symptoms. If your mother or sister or other female blood relatives also attained menopause at around this age, it is possible that you too are going through menopause. I would advise you to look at your symptoms from this angle as I do not feel that sertraline is likely to cause all this. Hope this helps you. Please feel free to ask if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Do not stop sertraline at present. Detailed Answer: Good morning, In my opinion, you should continue on sertraline for two reasons. First, if your present problems are not due to sertraline, then stopping it will not have any benefit but will just worsen your condition. Second, sertraline has brought you at least some improvement while the new agent which you will replace sertraline with, may or may not work. If you feel that the sleep disturbance, vivid dreams and nocturnal sweating are due to sertraline, there are a couple of things you can do. If you are taking sertraline in the night, shift it to the morning, preferably after breakfast. Secondly, ask your GP if he would be willing to prescribe you something for sleep, like trazodone (Desyrel) which will reduce your sleep problems and also augment the anti-depressant action of sertraline. Trazodone is not a benzodiazepine and has no dependence potential, so I expect that your GP will not object. Think of stopping sertraline only if these measures do not help you at all. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Get well soon! Detailed Answer: Hi, You have rightly said that thinking positive is what you should be doing. Hope you get better soon. Best wishes. Dr Preeti Parakh MD Psychiatry

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