Question: Hello, I am the mother of a 28 year old married daughter. She is a ER RN. From the time she was born she would not sleep and was always agitated. Growing up we took her to many counselors and psychiatrists. She was very good at pretending to be cured (she'd look happy for a short time). She would not cooperate and tell them how she felt. We witnessed depression and social anxiety and an obsession with sneaking snacks (lots of snacks). She was never overweight, but was fixated on secretly getting food. At the same time she was the lead in a school musical, played on the soccer team and earned good grades.
In high school the food issue turned into bulimia as she became obsessed on her weight. The bulimia has continued for 13 years. Then came alcohol. Just as with the food, she would try to sneak alcohol...resorting for a time to buying vanilla extract. Buy the time she was old enough to purchase alcohol she was drinking it (secretly) almost daily...All the while she appears to be a beautiful academically successful student.
She earned her RN license, got married and has worked the last 4 years as a nurse. The 12 hour shifts plus a one hour commute have taken their toll. 4 to 1 ratio in the ER, no breaks, extremely stressful work environment. She tried to make an appointment with her family doc to get back on Prozac...which she'd stop taking because of anxiety about going back for a check up with the doctor. She's become very depressed, exhausted and would be afraid to leave the house except for work. Her doctor had left the practice so she was seen by a young Nurse Practitioner. She was prescribed Abilify and 20 mg of Prozac.
Her speech was badly effected. The NP took her off Abilify and DOUBLED her Prozac to 40MG. That's when things REALLY got interesting. My daughter became convinced that there were people outside her house (or in). Is convinced there were cars, trucks in her driveway. She actually called the police and had them come and check her house and driveway. She was unable to sleep and continued with the hallucinations the entire night. She called the NP on Friday after Thanksgiving. She switched my daughter to 50mg Zoloft. My daughter continues to look terrified and is continuing to see "people" mostly at night but also during the day. She believes someone is after her. Clonazapam helps calm the symptoms, but the NP will not prescribe more.....I guess thinking my daughter is unstable. My daughter has spent the last two weeks trying to get into see a psychiatrist. Most are not taking any new patients...others won't even return a call. She is on waiting lists with 3. One has agreed to see her....ON JANUARY 13TH 2016.
So (finally) here is my question. Should she continue taking the Zoloft? She took one dose yesterday after stopping the Prozac. She is very nervous, her stomach hurts, she has diarrhea and most importantly...continues to see "people" Please tell me if she'd be better off NOT taking any more Zoloft. She was taken to the ER Wednesday night...but as an ER nurse...was able to downplay things so she would not be admitted to the psych ward. She is TERRIFIED of going there as she has done clinicals during nursing school.
We will start again tomorrow morning to find a psychiatrist that will see her. It has been impossible as it is Thanksgiving Weekend. Thank you for your advic

Yes....there are other contributing factors. It is our belief that there was alcohol and drug abuse included that DID stop abruptly. Because of the slurred speech at work (abilify) she was drug tested at work. The test was positive for some drugs that would typically be in the hospital. Nothing in her bloodstream...just evidence that it had been used in the last 30 days. She was not working impaired...just the speech made it appear so. The test showed drugs in general. I am guessing she was taking the meds that should have been "wasted". Diladid, (sp)....and something else that I cannot think of the name. We think there was a variety of things she would take. The drug use has been going on for at least one year, maybe two and that is in addition to the alcohol. My husband and I only learned of this recently. She and her husband had been dealing with it on their own.

At work, however, she was promoted from Ortho to ER and has been well respected. She was the hardest working nurse there. At home, she was obviously having many issues. Not leaving the house etc.
The hallucinations started suddenly. From zero to ten in one day. That day did coincide with the the doubling of Prozac and the elimination of Abilify.
She was suspended from her job pending the outcome of the drug screen that was sent away for further analysis. She is under incredible stress, as she could possibly be losing her job, house and husband who has demanded AA meetings and working on recovery. Because she is not at the hospital anymore she has had no access to meds and so the drugs have stopped completely...and has stopped alcohol as well. She has passed drug screens.
The amount of stress she is under IS overwhelming and is magnifying her anxiety and depression. Prior to Tuesday evening at 6pm, she had never experienced the paranoia and hallucinating. She had not been getting any sleep over the last 4 weeks and on the day the hallucinating started she had not slept in 3 days. The hallucinating has improved somewhat, but she continues to think she sees the shadow of someone that's walked by, or that cars driving by are after her. She has a terrified look on her face....distant, wide eyed, like she's watching a scary movie in her head. She looks like she is isolated and almost in physical pain. She is quiet and doesn't interact much.

Can this be the culmination of stopping all drugs, stopping the alcohol suddenly and the severe stress involved facing the possibility of losing everything that is important in life, including her reputation at work?

The Nurse Practitioner changed her from 40mg of Prozac to 50 mg of Zoloft. No Ablify. Last year she'd been on 20mg Prozac with Wellbutron and did well....although she was also self medicating with meds and alcohol.

She has made the statement recently that she "can't remember a single time in her life when she was happy". I can tell you that statement is the truth.

I hope this additional information well help you decide if she SHOULD stay with the Zoloft. She took one dose yesterday of 50mg. She is convinced that the drugs (Prozac or Zoloft) are causing the increased nervousness, paranoia and hallucinations. I don't know whether to advice her to stop or continue with the Zoloft and see if symptoms improve in 4-5 days.

If the clonazpan takes helps with the off the charts anxiety....should she stay on that? 1mg every 8 hours if necessary?