Brief Answer:
Sertraline is safe to use in pregnancy

Detailed Answer:
Hello thanks for choosing HCM for your health related queries

I have read your question and will try to resolve your doubts. You have been suffering from GAD since last 10 years. You were taking Citalopram but discontinued the drug because of lethargy and weight gain. Then switched on Venlafaxine which caused sleepiness. Now you are on ZOLOFT or Sertraline. You have gained weight and are feeling tired and drowsy after starting Sertraline.

Venlafaxine is a SNRI group drug and help to improve concentration of Norepinephrine and Serotonin in brain (low neurotransmission of both neurotransmitters has been implicated in causation of anxiety and depressive symptoms). Norepinephrine neurotransmission results in alertness, wakefulness and concentration.

Sertraline is a SSRI drug and it mainly increases serotonin neurotransmission and has little effect in symptoms of alertness, wakefulness etc. The drug is equally efficacious to Venlafaxine in depression, or in some studies have more efficacy in depression and anxiety. So probably shifting to Sertraline from Venlafaxine has resulted in symptoms of drowsiness, tiredness (which are better controlled by norepinephrine). But there is no need to worry, after few weeks Sertraline will also result in similar action because of indirect increase in norepinephrine by receptor medicated actions. (I have gone in a little details of pharmacology and pharmacokinetics of drugs, but I hope you will be reassured with this :).

So no need to worry your symptoms will improve in some days.

Now coming to safety in pregnancy. Outcome of any normal pregnancy can't be predicted. Any drug use in first trimester may increase risk to foetus, but still as depression and anxiety are distressing to mother so risk-benefit of drug is judged and usually most of psychiatrist recommend the drug use in lower possible doses.

Sertraline is safest antidepressant to use in depression as per available guidelines and it usually doesn't cause significant risk to baby if taken properly under supervision of psychiatrist and obstetrician. Discuss with your psychiatrist for lowest possible doses as per your clinical condition.

Just to sum up-

Your symptoms of tiredness and drowsiness will go in some days.

Sertraline is safe to use and I personally prescribe sertraline to pregnant patients of depression in my clinic.

Attend your obstetrician regularly for regular checkups.

Start taking Folic acids and vitamin B12 supplements as folic acid reduces risk of congenital malformations.

Thanks, hope this helps. Do ask again for more follow up doubts.

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Brief Answer:
Gradual tapering of doses is needed to come off Zoloft

Detailed Answer:
Hello thanks for asking a follow up question.

Safest way to come off from Zoloft is gradual tapering of doses over 6-10 weeks. Doses are reduced by about 20% every two weeks and then stopped completely at about 8 weeks. You have anxiety disorder so you may suffer mild increase in anxiety even on progressive tapering, but that would be tolerable. For 150 mg doses you are taking you can start with 125 mg doses for next two weeks then 100 mg for next two weeks and then decrease the doses progressively every two weeks. This is the method I usually advise to my patients in my clinic. Discuss with your psychiatrist for prescription of the drug.

The drug will be out of your system in about 5-10 days of stopping the drug. After that time you can plan for pregnancy. You can try relaxation methods like Breathing Exercises, Progressive Muscle Relaxation Exercises to keep yourself relaxed during pregnancy.

Thanks, don't hesitate to ask again if you have more doubts.

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Brief Answer:
Wait for some days to see effect of Sertraline

Detailed Answer:
Hello thanks for asking a follow up question

The symptoms of tiredness, fatigue are occurring most probably due to withdrawal of Venlafaxine and mild symptoms may even persist for long periods of time.

Raised appetite, weight gain may occur with Zoloft. The drug takes time to show its antidepressant effect. Normally individuals start showing response in about 4-6 weeks but in some the period may get prolonged. Wait for some days the drug will show response.

Sertraline has efficacy comparable to Venlafexine in depressive and anxiety symptoms, so no need to worry you will feel better in some days.

Thanks, please ask again for more doubts.

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Brief Answer:
Yes it's safe to come off all medicines

Detailed Answer:
Hello

Yes it's safe to come off all medicines. Tapering of doses should be done as I have mentioned earlier. You will not suffer any significant side effects. Discuss about tapering of dosage with your doctor.

Thanks, try relaxation methods to keep yourself relaxed and you will be free of all medicines.

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