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Suggest Treatment For Depression

Posted on Thu, 3 Apr 2014

Question: I started taking Zoloft three days ago (25 mg at night) and have been feeling tired during the day. I'm also have been taking 3mg of klonopin for the last three months, before that I was on 0.75 of Xanax for three months. I know it takes a whole for the Zoloft to kick-in, but it seems like I have an increased leave of despair and hopelessness. Is there anything else that can be done in the mean while before the Zoloft kicks in the help with the depression? Additionally, over the last three months, I've lost 40 pounds and while I've been exercising, I'm concerned I'm not getting enough calories.

Answered by Dr. Ashish Mittal (3 hours later)

Brief Answer: zoloft take time to show response Detailed Answer: Hi. Welcome to hcm Your current symptoms appesr due to depression. zoloft take 3 to 4 weeks to response in effrctive dose (50 to 200mg) which differ patient to patient. Considering your history it is better to increase zoloft dose to 25mg 2 times day. Same time you can start medicines like amisulpride 50mg in night for faster response and to augment effect of zoloft. Same time taper klonopin 10% doses every 5th day after improvement in depression, as its long term use can lead to addiction. All medicine related changes need to monitored by psychiatrist. Wish you fast recovery.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ashish Mittal (8 hours later)

I've had problems with other SSRI causing increased anxiety. This morning I woke up with dyspnea and wondering if the medication is causing the problems. Is there a way to reduce the dyspnea such as increasing the dose of klonopin?You mentioned tapering from Klonopin after Zoloft becomes effective. I recall reading Zoloft addresses panic disorder, but wasn't sure if it also addresses the anxiety I've been having. Aside from being tired today - so much I had to take a nap, (I'm assuming this will go away once I get use to the Zoloft), I had tightness in my throat all day. I assume this is anxiety as this has been a common experience for me. I'm scheduled to see my doctor on Wednesday and if all things go well over the next few days, I'm assuming he'll double to dose to 50 mg and see how I will tolerate it, and then maybe up to 100 mg. (We talked this morning). amisulpride isn't available in the US. I have anxiety about taking any medication particularly klonopin, I feel much more comfortable about taking an SSRI, but it's been difficult to get on one because of the increase anxiety the medication brings. Is there any way to cope with the tightness of my throat? I really want one of these SSRI to work so I can start tapering off klonopin.

Answered by Dr. Ashish Mittal (19 hours later)

Brief Answer: hi Detailed Answer: Hello again, Thanks for follow up. In initial days (upto 1 week) SSRI used to increase anxiety for that you can use klonopin under psychiatrist supervision. Panic is severe form of anxiety and occur in episodes. Zoloft is effective for both: anxiety and panic. Tightness and something inside throat most probably due to anxiety in your case. Do not worry about zoloft doses, as your psychiatrist is planning to increase gradually. This medicine do wonder in anxiety, but take 3-4 weeks to show response. If amisulpride is no available then go ahead with your current treatment (zoloft and klonopin). Your major symptoms: tightness in chest will improve after reduction in anxiety. Currently only klonopin is reducing your anxiety (although not fully). So do not taper klonopin self without your psychiatrist advice. It should be taper after zoloft effects are visible, which takes time. Although you are suffering for months, but you need to wait for few more weeks (3-4 weeks) to have good anti anxiety effect of zoloft. After that you can request your psychiatrist to taper klonopin. Please accept my answer and give feedback in case there is no further query and you found reply helpful. In case of doubt, I am here to help you. Wish you good health. Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar