# Going back to Zoloft



## OtterB (Aug 16, 2012)

I've been struggling a bit (well documented on some of my other threads) with a depression that came about after weaning myself off of Zoloft which I had taken (200 mg) for 20 years with overall good results.  This time around, partially through miscommunication with my doctor and curiosity on my part I agreed to try cipralex - It was as if the pharma salesman had just visited my GP that day and he couldn't say enough good things about it.  I thought why not?  Fewer side effects, a newer drug - it might work out better for me in the long run.  To make a long story short, the 20 mg cipralex did lift my depression but I was constantly anxious and couldn't sleep without taking something else.  By this time I had gone to a psychiatrist who agreed I should go back on Zoloft.  I've transistioned back now and am back up to 200 MG but I'm still anxious as hell and starting to slip into depression again.  My psychaitrist said it should be a relatively seamless transition as they are similar drugs and the antidepressant effect had already been established by the cipralex.  I wonder about others experiences.  My Psychaitrist said I should experience the same benefits with Zoloft that I experienced before.  I've only been on the 200 mg for a couple of days but didn't expect my mood to drop so much.


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## David Baxter PhD (Aug 16, 2012)

Your system is still adjusting to the medication change. It may well take a few weeks so bear with it and give it time.


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## forgetmenot (Aug 18, 2012)

Although it is from the same family its make up is still different so as stated my Dr Baxter  it will take time for your body to readjust   Ihope you get back to feeling better soon if not  make sure you doc knows ok  hugs


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## OtterB (Aug 18, 2012)

I'm feeling incredible nervousness since my dosage jumped to 200 from 100 while I stopped the cipralex. Clonazapam won't even touch it.  I'm hoping this will settle down as I get used to the dosage or I'll have to get in to a clinic.


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## OtterB (Aug 20, 2012)

I'm still struggling with the switch from Cipralex to Zoloft.  I'm crazy nervous and went to a psychiatrist today and he said its sounded unusual but he suggested beta blockers to stop the trembling. 

 I really want to stick with Zoloft because I did so well for so long on it.  I cut back the dose to 150 mm until the nervousness subsides but it's been 4 to 5 days of this.  I expected maybe a little adjustment period.  I was doing OK on the Cipralex except it wasn't handling anxiety that well and sleep was difficult.  I'm wondering if I should have stuck with that.  My wife is trying to assure me that all will work out and I'll get my old self back but this is really hell for both of us. 

 I'm going to stick with the Zoloft a few more days and if the nervousness doesn't improve (despite taking clonezapam) I think I'll check in to emerg. and see if they can help me ride this out.


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## David Baxter PhD (Aug 20, 2012)

Did you try the beta blockers as your doctor suggested? There is logic to that suggestion: What you're experiencing may be "pseudo anxiety", a physical jittery feeling like butterflies in the stomach, similar to what patients on Prozac or Wellbutrin sometimes experience.


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## OtterB (Aug 20, 2012)

I did take one.  I feel kind of weird but maybe a little more stable.  He said it would help with the tremors and tingling.   I just want to know if this pseudo anxiety will pass or am I going to have to abandon Zoloft (hard to believe considering I've taken it for 20 years)?


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## David Baxter PhD (Aug 20, 2012)

It may very well pass. If it doesn't, you still have a lot of other options.


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## Retired (Aug 21, 2012)

Beta blockers can be a valuable therapeutic option for certain types of anxiety reactions, often used to treat the symptoms of "stage fright" which is that overall jittery feeling some people experience before facing an audience.

There are beta receptors throughout our body, and although originally indicated for cardiac indications, beta blockers have been found to relieve symptoms associated with various other disorders, such as "jittery anxiety"

The effect is an overall calming of the body, as though your "engine" rpm's are reduced from 5000 rpm to 2000 rpm or like a calming purr.

There is sometimes a period of adjustment over the first couple of weeks, where your body may feel absent of energy, but this usually passes.

Once the body adjusts to the new rhythm you'll feel like a different person....calm, slower paced and comfortable.

I was prescribed a beta blocker as a preventative medication for migraine for a while and it helped me feel a kind of bodily serenity I never felt before or since.

If your doctor thinks it might be right for you, I would say give it a try.  You may be pleasantly relieved of your symptoms.


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## OtterB (Aug 21, 2012)

It looks like beta blockers have a ton of side effects.  I'm not so much jittery  it have that uncontrollable feeling of dread in my chest that is totally paralyzing.  But I have noticed a glimmer of hope today where my anxiety isn't as extreme and I may be getting into the start of the therapeutic benefits of Zoloft. So much for the "seamless" transition from cipralex to Zoloft. But for the first time I'm starting to feel like I did when I was on it for 20 years.  I see all the scare mongering from certain sites warning that people often don't experience the same benefits the second time they go on an AD.  I know I've got a couple more weeks before this settles down but I'm confident I'll be my old self.


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## David Baxter PhD (Aug 21, 2012)

OtterB said:


> I see all the scare mongering from certain sites warning that people often don't experience the same benefits the second time they go on an AD.



My advice is to avoid those sites like the plague. At best, they are one-sided: You only hear from the people who are unhappy, not all the people who had good results. Additionally, a lot of things get attributed to medications via superstitious "cause-effect" links when in reality there are usually numerous uncontrolled factors that are at least equally likely to have produced whatever effect the individual is complaining about.


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## Retired (Aug 21, 2012)

> I see all the scare mongering from certain sites warning that people often don't experience the same benefits the second time they go on an AD.



According to my understanding of the mechanism of action of SSRI SNRI medications and their propensity for tolerance, I don't know the science supports the notion that returning to a discontinued compound might lessen effectiveness.

On the contrary, I think physicians look for successful history with this class of medications, sometimes even in siblings or parents previously successfully treated, to zero in on the compound that might work for the patient at hand.

Follow your doctor's advice and rely on your doctor's expertise and clinical judgement in selecting your medication options.


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## OtterB (Aug 22, 2012)

More on beta blockers. Steve, I appreciated your perspective - I was just a little spooked by the information sheet saying they can worsen depression and interfere with certain SSRIs amongst a host of other unpleasant interactions. My Psychaitrist explained that the dosage for my purposes is so low that there was little risk in taking them.  He said they calm the body which can lead to a calmer mind.  I'll try them as I continue to work through my readjustment to Zoloft. I went up to 200 mg last night and was a little apprehensive given what happened last week but I awoke at 5:30 AM feeling great. I should have got up then but went back to sleep and woke 3 hrs later feeling anxious and a little down.  Anyway I'm encouraged that the Zoloft seems to be finally having a positive effect.

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Is there any truth in the efficacy of generic Sertraline  vs Zoloft.  Our family doctor told us th generics do not have to measure up to the same standard.  I've taken the Sertraline since it became available and it worked fine for me.


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## David Baxter PhD (Aug 22, 2012)

OtterB said:


> Is there any truth in the efficacy of generic Sertraline  vs Zoloft.  Our family doctor told us th generics do not have to measure up to the same standard.  I've taken the Sertraline since it became available and it worked fine for me.



For the vast majority of people and the vast majority of medications, generics work just as well as the brand names. 

All  generics MUST contain the same active ingredients but some of the  stabilizers, etc., may be different. In a few cases, the non-active  ingredients may mean that a medication is absorbed less quickly or less  completely, or it may be metabolized more quickly, and for some  individuals this can occasionally make a difference. For most people, the difference will be nil or negligible.


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## OtterB (Aug 22, 2012)

Steve, The sheet provided by the pharmacy for propranolol was 5 pages long.  I won't quote it all to you but a few of the paragraphs that caught my attention.  It states it's mainly for treating high blood pressure, irregular heartbeats, shaking (tremors), migraine headaches, angina and after heart attacks to improve survival.  Under Other Uses: it states that it has also been used to control symptoms of anxiety or overactive thyroid.  There was the usual list of side effects including nausea, vision changes, unusual dreams, reduced blood flow to the hand and feet.  Unlikely side effects are  mental mood changes, swelling ankles and feet, very slow heartbeat, fainting, etc.  The part that worried me most was the Precautions section where they mentioned certain types of heart rhythm problems (which I've had), bronchitis (which I've had quite a lot), mental mood disorders.  Then there is a very long list of drug interactions including diazepam, certain SSRI antidepressants including fluoxetine, paroxetine, fluvozamine and trycyclic antidepressants.  Here's a link to another site on this drug.  Propranolol (Inderal)


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## Retired (Aug 22, 2012)

As a start, I wou drecommend reading this article http://forum.psychlinks.ca/prescrip...-making-sense-of-medication-side-effects.html posted by David a few days ago.

With regard to your pre existing conditions, and concerns about how they might be affected, if at all, by the medications your doctor is prescribing, I would suggest arranging a follow up visit with your doctor to address these legitimate concerns.

Your doctor knows your medical history, your symptoms and you are entitled to understand the prescribing rationale being used in your situation.

The drug interactions being cited in the patient information brochure refer to interaction at the metabolic level, where the liver enzymes called Cytochrome P-450 2D6 are involved in metabolizing certain medications.  When two or more medications requiring this pathway compete, one of the medications may be affected in the amount that is either absorbed into the body, or in the amount that is eliminated.

Not all medications  (even those within the same class of medications)  use this pathway and your doctor should be aware which one do and which ones don't and how to manage any potential conflicts.

Sometimes all that's needed is a dosage modification of one of the medications, to compensate for the interaction, while at other times, the doctor may select another compound in the same class of meds to avoid the interaction.

So if you have concerns, take the information you have learned, have a look at the Forum section on Drug Interactions  where we have posted some resources among the "Sticky" posts on this very question, and ask your doctor for clarification for your own situation.


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## David Baxter PhD (Aug 22, 2012)

To add to what Steve has posted, OtterB, the use of beta blockers to treat anxiety is not uncommon. They don't work for everyone but for some they work quite well.

The caution about increasing depression is really an alert about (a) depressed individuals who are not already taking an anti-depressant and/or (b) people with depression but WITHOUT concomitant anxiety.

To put it into perspective, many individuals with concomitant anxiety and depression take both an antiudepressant and a low dose tranquilizer such as clonazepam or lorazepam. If you look at the literature on those medications you'll see the same cautions and the same comments I made above would apply to those medications.


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## OtterB (Aug 27, 2012)

Still struggling with Zoloft switch. We decided to go down to 150 mg today as the anxiety side effect was not abating and I was up to 2 mg of clonesapam to control it.  Although I was on 200 mg for most of the last 20 years I tapered to 100 mg for the last 3 years so maybe the 200 is just too much. Hopefully this reduction will work and I can cut down the clonezapam.  I was feeling pretty hopeless today - fortunately the pdoc said he hasn't given up by far.  I might consider going back to the cipralex after all this.


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## OtterB (Aug 29, 2012)

Looks like I'm sticking with Zoloft for another couple of weeks after meeting my pdoc today.  He is confident that the Zoloft will kick in on the anxiety. I forgot to mention to him some slight itching. Hopefully this clears up but can't figure out after using the drug all these years I would get a reaction now.  Any ideas?


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## David Baxter PhD (Aug 29, 2012)

That's a (slight) possibility but it's also quite possible that you are hyper-alert to possible side-effects and imagining that as a result.


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## OtterB (Aug 29, 2012)

I'll gladly put up with a little itching if the Zoloft can bring me back.


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## OtterB (Sep 20, 2012)

Well I'm on my third week of 200 mg of zoloft and the Pdoc says we should start seeing results between now and week 8.  I still find the need for clonezapam but feel like something is going on to suppress the anxiety.  Last night I had acid reflux when I took the Zoloft before bed (with milk).  This used to happen once in a while when I took Zoloft before.  It takes about 30 minutes (I took a zantac as soon as I felt it starting) to go away but in the mean time I end up spitting out a lot of phlegm (I know that's a bit gross).  I'll have to ask my Dr. if that dose of Zoloft comes up with the phlegm and do I need to do anything about it or just chalk it up to a missed dose.


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## OtterB (Oct 12, 2012)

I haven't posted in a while.  I'll be 6 weeks on Zoloft after the weekend and I'm getting pretty discouraged.  

I've been able to get through a couple of days (like today) without taking a clonezapam but still feel a lot anxiety and some depression at times.  I'm also doing mindful based cognitive therapy with my Pdoc and have found it difficult to stay mindful but I think the amount of ruminating I do is less, likely due to the zoloft.  

I'm not sure, I just feel crappy most of the time unless I pop a clonezapam.  I'm trying to accept the anxiety and observe the sensations and feelings in a non-judgemental way and this has helped at times but it's very tough to sustain.  I have been pretty hopeful that the Zoloft would be the answer as I was fine when I was on it for over 20 years.  I know I may be jumping the gun and will need to wait the full 8 weeks or so at the max. dosage but I fear I may not get back to where I was just a few short months ago when I stopped the Zoloft.  

My Pdoc is being pretty forthright with me in saying there is no magic pill I can take and I have to accept the anxiety and work through it minute by minute and day to day.  I know that's likely the best route in the long run as mindfulness and cognitive skills will improve my quality of life if I can stick with them.  He has also been thinking of supplementing the zoloft with something but won't do that for another couple of weeks.  

Well, thanks for listening out there.  I'm not sure what the future holds for me as I am supposed to retire soon and sure don't want to spend it feeling like this.


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## Retired (Oct 12, 2012)

> I just feel crappy most of the time unless I pop a *clonazapam*.



By crappy, do you mean anxious, panic, unable to sleep?

Are you using the clonazepam in the way your doctor prescribed..for situational anxiety?


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## OtterB (Oct 13, 2012)

I mean mainly anxious but also depressed at the prospect of being this way for the foreseeable future.  I am using the clonazepam when my anxiety gets severe.  Today I rode it out since I wasn't at work.  I'm trying to accept the anxious feelings and experience them without attaching a lot of meaning like "will I be this way for the rest of my life?" and other "what if's".  I need to stop the ruminating as it becomes a spiral of getting anxious about being anxious.  When I step back, I suppose the main source of anxiety besides wondering when I'll feel better is reinventing myself in retirement.  I thought I had a plan (which I do) I just am for some reason fearful of the change even though I'd love to be rid of the stress of my job.  I don't think I realized how much I identify with contributing at work.  I need to replace that with other pursuits which is what the plan is all about.


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## Retired (Oct 13, 2012)

I was interested in knowing if your doctor prescribed the clonazepam with instructions to take it when you felt anxiety due to circumstances during the day, and to take it as needed.  Or was the instruction to take it at specific times during the day?

Do you feel you are lamenting or grieving over the cessation of your job and career?


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## OtterB (Oct 13, 2012)

Yes, my doctor said to take the clonazepam when I felt the anxiety was getting too severe, as needed.  On average I have been taking 1 mg a day.  On the retirement issue, it wasn't really an issue when I had the depression back in June.  I was looking forward to it.  The depression happened because I went off Zoloft (February) and then had an illness that had some symptoms of lung cancer so I thought this was where I was headed and I got really anxious about that and then major depression.  The anxiety about retirement is mostly about what if I retire and am still dealing with GAD symptoms?  I've delayed retirement to try to get over the worst but I'm at a point now where I don't know when that will be.  The zoloft doesn't seem to be helping me as much as it did before and the CBT with mindfulness techniques is going to take time.


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## Retired (Oct 13, 2012)

> my doctor said to take the clonazepam when I felt the anxiety was getting too severe



If your doctor is recommending a minor tranquilizer for situational anxiety to be used as needed, you may want to ask your doctor if using a form of another minor tranquilizer, (same medication family) that was developed in Canada, might be right for you.

The medication is Ativan Sublingual, and is identical to Ativan oral, but must be prescribed as Ativan Sublingual.  There is no generic version of the sublingual form, although there is generic oral lorazepam.   The sublingual is formulated specifically for situational anxiety and panic disorder because by placing it under the tongue, the medication is absorbed more quickly than by swallowing.

Many people find this to be a more effective alternative to other forms of minor tranquilizers when used for this purpose, and because of the way this particular medication is metabolized, there are metabolic advantages to using this together with the Zoloft you currently use.

Your doctor should be familiar with all this, so you may want to ask if this might be a suitable option in your situation.



> The anxiety about retirement is mostly about what if I retire and am still dealing with GAD symptoms?........ I've delayed retirement to try to get over the worst



I'm having difficulty following your rationale here.

To me, from my own experience, both as already being retired and having retired during a time of anxiety and depression myself, the most therapeutic time in my recovery came when I stopped working, and left every bit of work related memory behind me.

In your case, how is remaining on the job helping you heal from stress, anxiety and depression?


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## OtterB (Oct 13, 2012)

Good question.  I just know that when I've been at home during this ordeal it hasn't been that helpful to sit around (in fact I got more and more anxious) so I tried to keep busy but found it hard to stay one step ahead of the anxiety. There's only so much you can do.  Sometimes it's nice to just relax and that I can't do very well, yet.  Eventually when I was able to go back to work it was therapeutic to engage with people and solve problems but I think that now the stress is building and I'm not seeing much reason to put off retirement.  I think I need to cut the cord and make the leap and deal with the anxiety without the stress of work.  It's encouraging to hear that you have done this facing similar problems as I'm facing.  I'm just concerned about all the extra time I'll have on my hands when I'm not in a good mental place to enjoy it - sort of a chicken and egg problem.


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## Retired (Oct 13, 2012)

Retirement is hardly sitting around, and it should not be.  I don't have enough hours in the day to do all the things I would like to do.

The key is "doing the things I would like to do"

The day you pull the plug on the job, is the day YOU decide what you're going to do.  

If you have ever had thoughts of projects, fantasies about travel, volunteer involvement, hobbies that you've started, desire to learn to play bridge, play a musical instrument, swim the English Channel, learn Yoga, study Archaeology....whatever,  now is the time to implement those plans.

I started a model ship back in '72 that I'm still working on, but keeps getting interrupted by my carving projects, travel, golf, Forum work, condo committees and my wife's To-Do lists.

What interests have you had during your lifetime, that you've put off or dropped due to a lack of time?   Do you like to travel?  Escape from "Cold Canadian Air" during winter?


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## OtterB (Oct 13, 2012)

Yes, I have a long list of pursuits in my plan including rediscovering the piano and guitar, taking a course in creative writing, getting some training in counseling, mountain biking, golfing and kayaking, yoga, etc.  I just know that in my current state I won't feel much like doing a lot these activities.  I'm hoping I'll be better soon but I don't have a time table and just have to go with the process.  How were you able to transition from anxiety/depression to getting active in rewarding activities?  I would have to force myself if I retired today.  I think I'd need to devote a few months to getting better, especially if there's another medication change.


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## Retired (Oct 13, 2012)

In my case, much of the basis for my crash was job related, not the work, but circumstances with the employer.

Getting away from it in itself provided some relief, then with the help on continued therapy and medication and strong family support, I succeeded in regaining control over my life.

I understand that it might be difficult to engage in the pleasurable activities that you enjoy, but you might find that by trying one of these, say the activity you love best, just a little at a time, might help to break the ice.

For me, I began doing some carving in the early stages, and found I was able to escape the demons in the solitude of the project.

It might not be the right time just yet, for you to make grand projects, but consider one of your interests, that would allow you to work at it alone, at your own pace, where you might experience small successes of accomplishment.  This might rebuild your confidence and thereby start the new phase of your life.

Not necessary to answer, but would you share the kind of work or profession you would be retiring from?  I came from a sales background.


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## OtterB (Oct 13, 2012)

I'm a manager of an engineering operation for a large company.  Definitely stressful but rewarding at times - stressful is winning right now.  I may get back into the field some day but that's not even in the picture right now.  I appreciate all your great suggestions and advice Steve.  I have been dabbling with the piano and guitar and have done some biking.  I also have a few projects half done here that I haven't been motivated to finish.  When I tried working on the projects before my heart just wasn't in it and I ended up making mistakes and decided to leave well enough alone.  Thanks again.


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## Retired (Oct 14, 2012)

Thread Split to Retirement Projects..


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## OtterB (Oct 15, 2012)

Back on the topic of my struggle with GAD and depression I have an appointment with my psychiatrist tomorrow and I think it is going to be pivotal in my road to recovery.  As I've said, I've been on Zoloft for 6 weeks now and have had minimal improvement.  He is trying to move me away from relying on the Zoloft and clonazepam and be more reliant on what is within me to control.  I'm finding this difficult as the more anxious I get the more I ruminate and get sucked down.  I think his approach (mindfulness cognitive therapy) is probably the correct one for me as I do want to grow from this and not just rely on medication although I seem to have some hereditary predisposition.  I've had a tough few days of considering the possibility that zoloft may not be the answer this time (it worked well for me for years) and that I'm staring at a long period of recovery going into retirement.  I may ask if I can get some more intensive help throughout the process as, although I practice mindfulness every day I don't find it making any foothold yet.  The only relief I get seems to be when I take a clonazepam and then I can think more clearly for a while.  I know it's probably a matter of baby steps and celebrating some milestones which I've had a few of but I still am very anxious and seem to start each day with a feeling of dread and a pit in my chest and tingling all over.  I know I'm rambling a bit so i'll stop.  I'm not sure what anyone can offer - perhaps some ideas on what to ask my pdoc going forward.


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## Retired (Oct 15, 2012)

One of the realities of treating the illness of depression, given today's understanding of the illness and the accepted medications and treatment strategies is that it can be a trial and error process.  There is no "one size fits all" medication, and often times the doctor has to modify the prescription of anti depressant several times, both by dosage and even compound, until the right combination is found that relieves your symptoms.

This process takes time and patience and perseverance on your part.

One of the best documentary programs I have ever seen on this subject aired several years ago on PBS hosted by Jane Pauley, who became an advocate for taking mental illness out of the shadows, following her own experience with bi-polar disorder.

Have a look at the online video of this program TAKE ONE STEP: Caring for Depression, with Jane Pauley

I think you might find it very informative.


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## OtterB (Oct 20, 2012)

My psychiatrist is considering upping the Zoloft to 250 mg or adding Wellbutrin to the 200 mg of Zoloft I've been taking for 7 weeks.  I've noticed slight improvement this week but am still dealing with a lot of anxiety.  He can see that I'm suffering a lot and the mindfulness CT is going to take time.  I'm finding it difficult to stay positive but will see him on Monday to decide which way to go.


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## Andy (Oct 20, 2012)

Glad to hear you are seeing a slight improvement OtterB.  These things take time (medications) but as long as your continuing to put the work in I am sure you will be feeling better soon. Stay positive, that will be key to your recovery!


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## Retired (Oct 20, 2012)

> My psychiatrist is considering upping the Zoloft to 250 mg or adding Wellbutrin to the 200 mg of Zoloft I've been taking for 7 weeks.



Will be looking forward to hearing what the doctor's recommendation will be.



> I've noticed slight improvement this week



Progress takes time as your medication resets brain chemistry, however as long as there might be more good days than bad days in the way you feel, celebrate the improvements in your health.

Glad to hear there has been some improvement.


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## OtterB (Oct 22, 2012)

I'm pretty nervous about meeting my psychiatrist later today.  It seems every move I've made, first with my GP going onto Cipralex, and then switching to Zoloft with the Pdoc has been the wrong move.  Although there has been slight improvement (at least my wife seems to have noticed) and I'm not quite as anxious, I leery of making changes, even though I understand Wellbutrin can be an effective augmentation drug for Zoloft.  The other part of the therapy, mindfulness based cognitive therapy, is hard for me to evaluate as I seem to slip back into old thought patterns, especially when I'm already anxious.  It's difficult to accept the anxiety with open arms, and "turn the mind toward it" rather than falling into the trap of ruminating and avoidance.


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## OtterB (Oct 24, 2012)

Well, I had my appointment on Monday and came away guardedly optimistic. My Pdoc had checked with his colleagues, some who are very experienced with all forms and combinations of anti-depressants. He thought making a change at 6 weeks or even 8 weeks might be premature as he was advised it's not uncommon for the full positive effects to take 12 weeks for some patients. With me being a return user of Zoloft I'm not sure if that makes my acceptance of the drug that much more difficult. We also talked a lot about specific strategies for retirement and finding purpose and meaning. I'm still not doing so hot this week on Zoloft but find my late afternoons and evenings are pretty normal. I'm tempted to ask him to bump up the dosage to 250 mg but he may want to wait a week or 2 longer. As for Wellbutrin, it sounds like it's a good augmentation for Zoloft as it affects the other neurotransmitters. I'm just concerned that it might further disrupt my sleep and cause more anxiety (I know it can be expected during the first few days of taking it). I continue with the mindfulness and cognitive therapy but that's really an up and down experience for me so far.  I am more aware of the anxiety (it's pretty constant) and I constantly turn toward it and fully accept that it's uncomfortable and painful but it is what it is and I can fully accept it in the moment.  The problem for me with this approach is you have to do this constantly, hundreds of times over and over, similar to practising mindfulness where you bring your mind back to the present moment over and over and experience everyithing that is going on at that moment.


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## Retired (Oct 24, 2012)

> Wellbutrin, it sounds like it's a good augmentation for Zoloft as it affects the other neurotransmitters. I'm just concerned that it might further disrupt my sleep and cause more anxiety



I don't believe it should, based on my understanding, as the large part of it mode of action is on dopamine, with less effect on serotonin and norepinephrine.  

If there happens to be some form of sleep disruption, you would probably notice it in the first or second dose, and it should wear off by morning, in which case you would contact your doctor, who would likely make a change.

Most people tolerate the augmentation of an SSRI with Wellbutrin, but some don't, and that happened to be the case with me when my doctor tried the same thing when I was being treated for depression.  

With me, it was sleep disruption, so I just let myself get through the night the best I could, and called the doctor in the morning.


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## OtterB (Oct 24, 2012)

I expect he'll either want me to stick it out at 200 mg of zoloft for another week or 2 or bump me up to 250 mg.  I just feel like I've been spinning my wheels with fairly good evenings but lots of anxiety during the day.  By the way, I put my notice in to retire on November 15.  That's coming up pretty quick.  I'm half looking forward to it and half dreading it but I regard it as a life change that I've been avoiding and I need to jump in and figure out what this next stage of life will be.


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## Retired (Oct 25, 2012)

> I need to jump in and figure out what this next stage of life will be.



It might help reduce your anxiety about it if you allow yourself time to acquaint yourself with your new way of life, without any expectations.

Your time is your own, and although you probably don't want to be sitting in front of a TV all day, you may want to simply decompress for a couple of months, use the time to regain your health, and just do a few things that you didn't have the time to do while working.

Some people find pleasure in taking on a part time contract using their professional skills, while others prefer to leave their work and profession behind, spending more time with the important people in their life. perhaps travel, or set up a lifestyle where they might live in a different place for part of the year.

There are lots of options for time management, as long as there is sound financial management after retirement, taking into consideration reduction in certain job related expenses, downsizing of home etc.

Hopefully your anxiety levels might moderate when you have more quiet time at home.


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## OtterB (Oct 25, 2012)

Thanks for the comments Steve.  Throughout this struggle I haven't handled leisure time that well due to high level of anxiety I'm feeling.  Work was at least a distraction but lately the stress at work has convinced it's time to go.  I've accepted that I might experience a sense of loss and might see my anxiety increase for a time.  But I'll work through it with my psychiatrist and hopefully get some adjustments to my meds to help with the anxiety.


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## Retired (Oct 25, 2012)

I believe the key to adapting to your new retired lifestyle is to view your new lifestyle as the beginning of something new with all its new discoveries, surprises and fascination, rather than the loss of the old work lifestyle.

Your psychiatrist / therapist can probably help you here, especially if your identity is tied up with your profession, your work and your job.

Those whom I know who embraced their retirement, saw their new lifestyle as the goal that was enabled by the job / profession, thereby forming a forward looking view to the next phase of their life.

Is there a significant other in your life, OtterB with whom you will share your new lifestyle?


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## OtterB (Oct 25, 2012)

Yes, my wife has been very supportive through all of this and is very eager to start this next chapter of our lives. Our retirement place is on the west coast and she is itching to get out there.  I don't blame her.  It's beautiful there but I'd like to get a lot better before I make the trip. We do plan to split our time between here and there for the first couple of years and eventually relocate.


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## Retired (Oct 26, 2012)

> Our retirement place is on the west coast and she is itching to get out there.



Sounds great.  We have several friends who are set up that way, living in Eastern Canada and Victoria in winter.  

Taking it on step at a time, while refraining from making major decisions until you feel you can handle the process should alleviate some of the pressure.


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## OtterB (Nov 8, 2012)

Well it's been 2 weeks since my pdoc upped the Zoloft to 250 mg.  I've noticed that I can handle the anxiety better but it's still there.  I am also more like my old self and am up to doing more and interacting with people at work.  He is still holding the option open to add Wellbutrin but I'm a bit leery of the effect it could have on my sleep as I have a hard enough time as it is.  My retirement is now a week away and I experienced a jump in my anxiety when this hit me as I drove to work this morning.  On the one hand, it's a crappy day here with lots of snow and the thought of not having to venture out in these conditions once I'm retired is some comfort.  I'm also lining up some projects to keep me busy but I'll take my time and leave space for reading, prayer, exercise and meditation.  I need to keep working with my pdoc on therapy and mindfulness (I'm getting a little better at watching my thoughts and being in the moment).  We want to head to the coast after Christmas so I've asked him about therapy by Skype or phone.  He seems reluctant to do so, mainly because he isn't a tech savvy guy although he said one of his colleagues does this and he would check into it.  I appreciate Steve's comments about taking things slow, step by step.  Good advice.


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## Retired (Nov 8, 2012)

> I've noticed that I can handle the anxiety better but it's still there.



OtterB,

The expectation to become 100% anxiety free may not be realistic.  I think each of us experiences some anxiety in life, it's probably what keeps us sharp and alert.  

Anxiety that paralyzes us or that impairs our ability to function is what needs treatment, but I don't think you would be the person you are if you were completely anxiety free.

One week away from owning your own time can be a little daunting, until you reset your daily expectation of yourself, and similarly reset your "identity".

Though it's good to have activities to occupy you time in retirement, I would caution against putting pressure on yourself to stock up on activities just for the sake of having stuff to do.

Your wife will likely have a TO-Do list for you, but the important thing, in my view, is that you will be the ruler of your time, and you will choose what you want to do and when you want to do it.  

You will also have the luxury of turning down projects or demands on your time...another adjustment many retired people have to make. 

You will be able to say "yes" to projects you want to do, as well as say "no" to projects you prefer not to do...what a treat!..


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## OtterB (Nov 8, 2012)

No doubt, everyone lives with some anxiety.  My Pdoc told me this my first or second appointment with him.  He said having no anxiety was likely only possible for someone in a coma.  I suppose my compiling a list of projects is a way to deal with the excessive anxiety I'm feeling so I at least will have some distractions as I adjust to retirement.  Most of these are home renovation type jobs - some big, some much smaller but having in common the fact that they have been put off for quite a while.  I like the idea of being the "ruler of my own time" but at the same time know that this will be an adjustment for me.  Getting some enjoyment from how I spend my time will be important but I may have to push a bit through the anxiety until this starts to happen.  It's great to bounce this stuff off of you Steve, especially since you have gone through a similar experience.  Thanks again.


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## Retired (Nov 9, 2012)

Glad to hear you're making progress toward "time independence", OtterB!  Retierment life is wonderful, and I would recommend it to anyone who is fortunate to have the financial independence to make it work.

Financial planning is an important component to the lifestyle, and for anyone planning on retirement living, the plan should begin taking shape as early in life as possible.

Will be eager to know how you are making out!


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