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What Causes Mood Swings And Lack Of Motivation Despite Being On Sertraline?
Question: Hello, I have been taking Sertraline since May after the death of my brother. For ten weeks I have been taking 150mg, and so far my sleep and appetite have normalised, anxious feelings gave settled and I am doing more tasks at home. However, I still have low mood, little motivation, and cannot get back to my hobbies. Should this normalise soon?
Thanks......XXXX
Thanks......XXXX
Brief Answer:
May need other treatments ... and time.
Detailed Answer:
I personally know how difficult it is to lose a sibling - I have lost both of mine.
The dosage range for Sertraline is 50 - 200 mg, so you are at the higher end and I would not expect that a dosage increase to 200 would make that much difference.
Ten weeks is long enough to see how an SSRI antidepressant is going to work for you (although you may still get some continued improvement).
Sometimes adding an antidepressant augmenter medication like Abilify (aripiprazole) or very low dose of olanzapine can make the antidepressant work better. These augmenters affect other receptors/neurotransmitters in addition to serotonin.
But you may also want to consider either a grief support group or a psychologist to talk with.
And time will help heal you. Your loss wasn't that long ago. It is not uncommon for grief to affect how you feel for a year (sometimes more) with the first 3 months or so being the hardest.
I am sorry for your loss. I hope this information is helpful to you. Please let me know if I can provide further information or clarification.
May need other treatments ... and time.
Detailed Answer:
I personally know how difficult it is to lose a sibling - I have lost both of mine.
The dosage range for Sertraline is 50 - 200 mg, so you are at the higher end and I would not expect that a dosage increase to 200 would make that much difference.
Ten weeks is long enough to see how an SSRI antidepressant is going to work for you (although you may still get some continued improvement).
Sometimes adding an antidepressant augmenter medication like Abilify (aripiprazole) or very low dose of olanzapine can make the antidepressant work better. These augmenters affect other receptors/neurotransmitters in addition to serotonin.
But you may also want to consider either a grief support group or a psychologist to talk with.
And time will help heal you. Your loss wasn't that long ago. It is not uncommon for grief to affect how you feel for a year (sometimes more) with the first 3 months or so being the hardest.
I am sorry for your loss. I hope this information is helpful to you. Please let me know if I can provide further information or clarification.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. One major condition which i think
may have held me back was that I suffered pulmonary embolisms in both lungs in July. Do you agree? Many thanks
may have held me back was that I suffered pulmonary embolisms in both lungs in July. Do you agree? Many thanks
Brief Answer:
Having a major illness will definitely compound depression.
Detailed Answer:
You have been through a lot in a short time. Yes, definitely having suffered PEs is a considerable stress on your body, and stresses on the body will compound emotional recovery as well. Prolonged or severe illness of any kind increases this risk. So I am not surprised at all that you are still feeling low. But you will get better.
And if you are interested in trying an antidepressant augmenter (Aripiprazole or tiny dose olanzapine), they are not contraindicated with warfarin, but may initially increase the blood pressure lowering effects of Lisinopril.
Having a major illness will definitely compound depression.
Detailed Answer:
You have been through a lot in a short time. Yes, definitely having suffered PEs is a considerable stress on your body, and stresses on the body will compound emotional recovery as well. Prolonged or severe illness of any kind increases this risk. So I am not surprised at all that you are still feeling low. But you will get better.
And if you are interested in trying an antidepressant augmenter (Aripiprazole or tiny dose olanzapine), they are not contraindicated with warfarin, but may initially increase the blood pressure lowering effects of Lisinopril.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
So am I correct to assume that Sertraline has had to work harder for me? I'm eating/sleeping well, starting to go out more/socialise at coffee mornings etc. I just need this low mood lifted, more motivation, and enjoyment to elevate. I suppose when mood lifts though, then motivation and enjoyment will return at the same time?
Many thanks
XXXX
Many thanks
XXXX
Brief Answer:
Yes, when mood lifts, these other things will follow.
Detailed Answer:
Hello XXXX,
Some of the symptoms of depression are difficulty enjoying things that used to be enjoyable, depressed mood, lack of motivation. So I expect that they will all improve together.
I guess you could say the sertraline has had to work harder - it either hasn't been enough in and of itself or there hasn't been enough time for your body to heal given all of the trauma you have had.
I hope you are soon feeling better.
Yes, when mood lifts, these other things will follow.
Detailed Answer:
Hello XXXX,
Some of the symptoms of depression are difficulty enjoying things that used to be enjoyable, depressed mood, lack of motivation. So I expect that they will all improve together.
I guess you could say the sertraline has had to work harder - it either hasn't been enough in and of itself or there hasn't been enough time for your body to heal given all of the trauma you have had.
I hope you are soon feeling better.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I guess Ive had a triple whammy this year, but I'm working so hard to help myself, and get so frustrated some days because the motivation/feel good factor doesn't work. However, I'm being a little more adventurous in the kitchen when cooking, and I'm starting to plan these extras into my day for my evening dinner.. I'd been hoping to go on 20 min walks, but can you believe I have sçiatica now? Maybe a gentłe swim then. I know I won't sit still and just wait for meds to work. I know I'm a strong person. I was widowed in 2007, had bilateral mastectomies in 2008 with follow up reconstructioñs, my son emigrated to NZ in 2010, and in 2011 I was diagnosed with CLL. I think it's time that God allowed me to have some time off bad luck.
Brief Answer:
It seems it's your turn to have some relief from life's hardships.
Detailed Answer:
Oh, that is a lot to deal with. I agree, it is time for things to get better for you.
Yes, some exercise as tolerated can be very helpful. Some studies show that regular exercise can be as helpful as certain antidepressants.
For your sciatica, here is a link that has pictures of exercises that may help you:
http://www.nhs.uk/Livewell/Backpain/Pages/sciatica-exercises.aspx
Do try to get together with people you like as often as possible. This will help too.
One thing that I didn't mention previously is to supplement your sertraline with B vitamins, in particular Folic Acid (Folate) and Vitamin B6. These can help the sertraline/SSRIs to work better. A good B Complex vitamin preparation will have both of these in it and a balance of the rest of the Bs.
And if you are a spiritual person, as I am thinking you might be from your last sentence, that will help you too. Studies have shown that people who are spiritual or have religion recover from grief and depression better than their non-spiritual counterparts.
You do sound like a strong person, having gotten thru all that you have, and I have little doubt you will continue to improve with your grief and depression. I will say a prayer for blessings for you.
Best regards,
Bonnie Berger-Durnbaugh, MD
It seems it's your turn to have some relief from life's hardships.
Detailed Answer:
Oh, that is a lot to deal with. I agree, it is time for things to get better for you.
Yes, some exercise as tolerated can be very helpful. Some studies show that regular exercise can be as helpful as certain antidepressants.
For your sciatica, here is a link that has pictures of exercises that may help you:
http://www.nhs.uk/Livewell/Backpain/Pages/sciatica-exercises.aspx
Do try to get together with people you like as often as possible. This will help too.
One thing that I didn't mention previously is to supplement your sertraline with B vitamins, in particular Folic Acid (Folate) and Vitamin B6. These can help the sertraline/SSRIs to work better. A good B Complex vitamin preparation will have both of these in it and a balance of the rest of the Bs.
And if you are a spiritual person, as I am thinking you might be from your last sentence, that will help you too. Studies have shown that people who are spiritual or have religion recover from grief and depression better than their non-spiritual counterparts.
You do sound like a strong person, having gotten thru all that you have, and I have little doubt you will continue to improve with your grief and depression. I will say a prayer for blessings for you.
Best regards,
Bonnie Berger-Durnbaugh, MD
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You've been very kind and helpful, thanks. It's a lousy dull day here in UK, so I've done my shopping, and now sitting with a light lamp in front of me for 20 mins. I know it's definitely more helpful to get outdoors, even on a dull day' but it certainly didn't do anything to lift my mood!!!!!!! I've arranged to meet a friend for coffee this afternoon.....she's a widow too, and I have a friend visiting early evening. I do try to occupy myself. Just a further question, when the low flat empty feeling in the stomach eases in the afternoon, is that a sign that the depression is lifting?
Today I have been reading about how to use my light box, during which times I started reading about diurnal variations. At the start of my depression, I wasn't sleeping well, so I blacked out all light coming through my curtains each morning, with the result that I don't get any natural light until I get up each day. Maybe I should consider having early morning light again to reset my circadian rhythms. Interestingly, when I returned from NZ at the end of January (leaving very light mornings, and plunging into very dark winter mornings, I always felt that my jet-lag had never restored my sleep pattern, and NZ has a 12 hour time difference. Soooo, we will try again with these circadian rhythms. I've got the VitB complex 50 mg today, I cannot take magnesium because they affect my bowels, so with some extra light therapy I hope I will improve soon! Nobody can say that I don't help myself?!?!?!?!
Today I have been reading about how to use my light box, during which times I started reading about diurnal variations. At the start of my depression, I wasn't sleeping well, so I blacked out all light coming through my curtains each morning, with the result that I don't get any natural light until I get up each day. Maybe I should consider having early morning light again to reset my circadian rhythms. Interestingly, when I returned from NZ at the end of January (leaving very light mornings, and plunging into very dark winter mornings, I always felt that my jet-lag had never restored my sleep pattern, and NZ has a 12 hour time difference. Soooo, we will try again with these circadian rhythms. I've got the VitB complex 50 mg today, I cannot take magnesium because they affect my bowels, so with some extra light therapy I hope I will improve soon! Nobody can say that I don't help myself?!?!?!?!
Brief Answer:
About using light to your advantage -
Detailed Answer:
As you mentioned, natural light is best, even if it is a cloudy day. It may not help that day, but overtime.
Some people do find they get benefit from light boxes.
About whether to let morning light into your room, I would base that on whether you can get good sound quality sleep if you let some light in. The sleep is more important. It is especially good to get some natural light midday to help your body with normal circadian rhythm. But the early morning light is not as important as your sleep. You can experiment and see if you can still sleep well, feel rested when you get up, if you let some light in.
I am glad you are getting together with friends - so important!
About that feeling in your gut that is lifting in the afternoon - that is good that you are getting some hours of relief. People who are depressed often have certain times of the day that are heavier. With time and all the efforts you are making, and the sertraline, hopefully you will have more time feeling good and less of the low, flat, empty feeling. Hopefully you will be able to add exercise to your regimen when the sciatica improves. But if all of these things are not helping enough and you don't see continued progress in about another 6 weeks, then do go back to your doctor and discuss a change of meds or an augmenter.
About using light to your advantage -
Detailed Answer:
As you mentioned, natural light is best, even if it is a cloudy day. It may not help that day, but overtime.
Some people do find they get benefit from light boxes.
About whether to let morning light into your room, I would base that on whether you can get good sound quality sleep if you let some light in. The sleep is more important. It is especially good to get some natural light midday to help your body with normal circadian rhythm. But the early morning light is not as important as your sleep. You can experiment and see if you can still sleep well, feel rested when you get up, if you let some light in.
I am glad you are getting together with friends - so important!
About that feeling in your gut that is lifting in the afternoon - that is good that you are getting some hours of relief. People who are depressed often have certain times of the day that are heavier. With time and all the efforts you are making, and the sertraline, hopefully you will have more time feeling good and less of the low, flat, empty feeling. Hopefully you will be able to add exercise to your regimen when the sciatica improves. But if all of these things are not helping enough and you don't see continued progress in about another 6 weeks, then do go back to your doctor and discuss a change of meds or an augmenter.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou very much......I know I'm making subtłe.......very subtle .........improvements on a day by day basis. For three months I could not stand the thought of eating broccoli, but yesterday I bought some......a change of mood (?) and I enjoyed it! I will use my light box at breakfast time to see if it helps.
XXXX
XXXX
Brief Answer:
Wishing you well!
Detailed Answer:
I am glad you are noticing improvement. You will get better!
All my best wishes to you,
Bonnie Berger-Durnbaugh, MD
Wishing you well!
Detailed Answer:
I am glad you are noticing improvement. You will get better!
All my best wishes to you,
Bonnie Berger-Durnbaugh, MD
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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