A story of hope and some additional things to consider

About 4 years ago I started taking Sertraline for anxiety (social and general). When I started, I recall getting some mild side effects, like feeling a bit down. But, it wasn't unbearable and working with my doctor, I ramped up to 200mgs over the first weeks. I found that 200mgs was effective and I was very happy after being on it for a while. But, within the first couple of years, I gained weight (about 20lbs) and my cholesterol went up quite a bit. I did some research and found that some believe Sertraline can increase cholesterol. So, I asked my doctor if I could try a different med and she suggested Effexor. Long story short, that medication didn't really make a difference with weight or cholesterol, so I asked to switch back to Sertraline. I started at 50mgs about 8 or 9 weeks ago, with a plan to ramp up 50 mgs a week to stop at 150. When I made the switch back to Sertraline, I was going through a very stressful time at work (probably not the best time to make the switch). Work had me very depressed and anxious. As I started the Sertraline, I found the side effects to be much worse this time. I was feeling very down (lowest I've every felt) and very anxious. I found myself coming to this forum all the time looking for hope and whether what I was feeling was normal. I found some storied of hope, and some stories of people stating the medication made them feel like a zombie and numb. I needed hope and I stuck with it.

After reaching 150mgs, I stayed there for about 3 weeks. During that time, I didn't sense much of a change. I wasn't as low as when I started, but I found that I couldn't really feel happy. That was a horrible feeling. Near the end of the 3 weeks, I was debating whether to stay on the medication or go off of it. I didn't want my long term experience to be just feeling neutral and never happy. I read a post on this forum of someone that had a similar experience who, working with his doctor, decided to go up in dose again. Like him, I was afraid to do this to go through the same side effects again. But, he did it and within a week, his depression lifted and he was on his way to recovery. So, I decided to try it, going to 200mgs. But, this time, I used a pill cutter to slowly ramp up to 200 instead of just making the 50mg jump in one day. The pill cutter allowed me to more precisely cut the 100 mg pill, cutting a bit less off every day for a week until I was at 2 full 100mg pills. As I got to 200 mgs, I didn't really have any bad side effects, and I started to feel much better. After being on 200mgs for about 2 weeks, I feel much better. I can feel happy, I don't feel numb and I think I'll continue to improve.

Some things that I learned from the experience and research:

• I wanted to better understand what causes depression and researched it a bit and found two things that might be helpful for others:
• Inflammation - Research has found a link between inflammation (which is connected with lots of health issues) and depression. And research has found that things that reduce inflammation can help the effectiveness of SSRIs. So, diets the reduce inflammation can help. Fish oil can help. And the supplement Tumeric (curcumin is the active chemical, look for tumeric supplements with that in particular) has been shown to help. I tried all this and I think it has helped me too. It's hard to know for sure, but all of these things are good for general health anyway.
• Folate - Research has shown that people with depression often have a genetic issue that prevents them from properly metabolizing folate into the form that your brain uses (l-methylfolate). The depression doesn't cause the genetic issue, but people with depression are often found to have this genetic issue. Research has shown that taking the l-methylfolte form of this supplement can improve the effectiveness of SSRIs and other anti-depressant medications. There is a prescription form of this called Deplin and there are over the counter version (Methylpro is a reputable brand). This has been found to have a pretty quick impact too, and little or no side effects. So, again, something that there isn't much harm in trying.
• Research has shown that there appears to be a progression of relief with SSRIs, starting with relief from anxiety in the first couple of weeks, followed by relief from depression over the next couple of weeks, followed by relief from anhedonia (not sure if I spelled that correctly, but this is the issue where you cannot expeirence joy or happyness) around 20 to 50 days into treatment. So, it is possibly normal to have the experience that I had. And that reserach suggests that people may be ramping up the dose to address the anhedonia may simply need to wait. And in my case, where I happened to go up to 200 mgs, perhaps I would have found relief if I just waited longer at the 150mg dose. But, I don't think so. At any rate, I can always try going back down to 150.
• Aside from medications, I found that reading books on the topic provided hope. One book that has been around for a while, highly rated, is Feeling Good: The New Mood Therapy. It is a very practical book that covers the techniques of CBT in a self-help format. Simply reading the first few chapters of the book, which talk about the effectiveness of the techniques provides tremendous hope and opens up a different way of looking at why you feel the way you do.
• Exercise - I had exercised before this episode, but getting regular exercise definitely helps. Try not to skip a day.
• Talk - Find someone you can talk to. Simply voicing what you're going through is helpful and discussing it helps you put things in perspective.
• Focus on Other Stuff - Try to not focus on your depression and the medication. Find other things to do and stay as active as you can. When you withdraw from anything you would normally do, or you simply become inactive, it simply becomes worse. If you have to, develop a daily routine and stick to it.
• Most importantly, know that things will improve. The side effects of the medication will go away, particularly that down/anxious feeling at the start if you suffer from that. Consider going up in dose if you find the current dose isn't effective (of course, consulting with your doctor). As you go up, go slow and consider the pill cutting technique if your dose increase involves splitting pills.

Best of luck of anyone reading this and keep moving. 😃

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