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Dawnie

Correct dose for SSRI?

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Hi guys. 

I take Sertraline in mornings. 50mg. Along with doing my CBT (notes) to try and get my OCD back in its box. However my symptoms are tolerable. But OCD still daily part of my life and ruins my recovery. Should I increase Sertraline? At least until I have OCD under control. My GP said I could tritate it up or down pending how I felt. Is 50mg not really cutting it? One of my friends takes 200mg? I first took citalapram but this was too much for me. I know it’s not going to be the same dose for everyone just wonder if I’m actually under doseing. OCD/anxiety/depression better on sertraline then off. Any help welcome?

 

Edited by Dawnie

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Hi Dawnie,

I am afraid none of us are doctors so we can't really answer questions about medication.  The problem is you touch upon there is no exact science to dosages, what medication works for person A will cause problems for person B.  What dosage works for person A, may not help person B.   Medication is very much trial and error.

The problem is, if your symptoms are tolerable, increasing medication won't necessarily suddenly make them even more tolerable. The recovery will only come through prolonged therapeutic work. 

We have some information here (via NHS Choices) - https://www.ocduk.org/overcoming-ocd/medication/sertraline/

Quote

Adult dose: The usual dose for adults is 50mg daily, as a single dose,  however, it may be started at a lower dose and gradually increased at 50mg intervals to a maximum dose of 200mg

 

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Yes thank you for this. Was just wondering if I increased the dose it would put me in a better place to deal with it? Thank u Ashley. X

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10 minutes ago, Dawnie said:

Was just wondering if I increased the dose it would put me in a better place to deal with it

It could do Dawnie, that's the problem we can't know for sure.  We all have very different bodies and tolerances to medications so until you were to take it we can't know for sure. 

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For some it is a pain to come off them. I personally don't even think it is fair to say that you can try and see because there are risk of having a hard time comming off them. And I would watch up for this notion about it getting easier. Ultimately there is no better place and time to deal with it than now.

50mg sertraline for couple of years in my early adulthood than 25mg lexapro 5-6 years. 25 mg lexapro is the same as 250 mg sertraline. Did nothing to me-. Well it made me a lot sleepier and zombielike. I understand that you could argue that every little step which makes it easier to overcome it is a good thing but then again would I point out that maybe it is not just benefits in taking SSRI. But it is a personal choice.

I did have times when I "upped the dosage" when I did feel a comfortzone, like I was able to move on, but it never lasted and my doctors adviced me to up the dosages, when I asked what would happen when that dosage wasn't enough he said that it is a life long battle where you use more and more medications. That didn't convince me at all. 

 

What I have read is that high-dosages seems to make it easier to overcome it when you are in therapy. I don't know if this effect will last if someone comes off SSRI. 

Edited by OCDhavenobrain

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34 minutes ago, OCDhavenobrain said:

I personally don't even think it is fair to say that you can try and see because there are risk of having a hard time comming off them. And I would watch up for this notion about it getting easier. Ultimately there is no better place and time to deal with it than now

Of course anyone can have a problem coming off a medication.  But SSRI's are generally not addictive and most people can come off them without problem if done under guidance. 

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I used to take 400mg of Sertraline but like Ashley says one size doesn’t fit all, by all means try it an see if it benefits you anymore, if not reduce again. It’s all about experimenting and finding out what works for you.

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2 minutes ago, Ashley said:

Of course anyone can have a problem coming off a medication.  But SSRI's are generally not addictive and most people can come off them without problem if done under guidance. 

I have to disagree with this about SSRI’s not being addictive.

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13 minutes ago, Ashley said:

Of course anyone can have a problem coming off a medication.  But SSRI's are generally not addictive and most people can come off them without problem if done under guidance. 

I know. It wasn't the case for me. I got severe symptoms, where dizziness (of a hellish nature) came over me, that one was the worst one. It is good that doctors are starting to acknowledge this fact, because they are. 

Edited by OCDhavenobrain

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Well sorry you went through that, but let's avoid scaremongering.  For many people (including the original poster) they find SSRI medication helpful and your experience does not indicate it will be shared by other people taking the same.   

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I know I know. But I do want to warn against trying to find a perfect spot in time where you can start recovery. We never know what will happen tomorrow, for some it is more true than for others. Let's say life gets totally different tomorrow something real happens, OCD will still be there and it can get tough. Start today.

Edited by OCDhavenobrain

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I’m not planning on coming off them. I do not care if they are for life. I did reduce them down and stopped via very slow wean. But after 3 months OCD back again. But I do not feel Sertraline addictive as I had no withdrawal from them but I did wean off them super slowly. When I was off the SSRI I exercised regularly which kept me feeling good but then got back into negative habits and the OCD came back. So restarted them. I will cont to take 50mg and I will increase them if I need to.

Im in the medical profession and know they are not addictive. The longer you have been on them the slower you need to wean off. NICE guidelines point towards combination of SSRI and CBT so that’s what I will do. I also read somewhere that you need to be “OCD free” for approx 1 yr before thinking of stopping SSRI. I’m not thinking of stopping just wanted advice re. increase. Sometimes people need them for life while others can come off them. 

I am only talking about my personal experience here and I do not speak for everyone as everyone is different, which is quite clear from the above posts. It’s a good thing were all different.

I value your opinions. I really do. 

Thank you all for your help 

Thank you Ashley for your advice. X

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Have you gone off them before it didn't make you feel that bad it could be a clue. If you was able to jump off them without a problem maybe you won't get the same symptoms. 
Taking medications and being free of OCD is much better than having OCD. The reason I went off was a combination of things, my doctor told me to take more + I was not certain that it helped + it made me sleepy + some obsessive thinking about it being bad. 

50mg sertraline is a low dose I never upped sertraline but I switched to citalopram and then to escitalopram. I took high doses of escitalopram (lexapro). It did make it easier when I went on the high doses but then did I do nothing about the compulsions and it creept back into my life. 

The only thing I would advice against is not having CBT.Which you realise, I think you have a nice plan. Everything which you feel safe with which increases the chances off overcomming OCD is great. 

Good luck.

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I agree with Ashley and his use of the adverb ‘generally’.  I have no problems going on and going off SSRIs. I believe that I am in the majority. Individual stories can be enlightening, but I remember a women who smoked tobacco and said that she did not believe in the research that smoking caused lung cancer or other lung diseases because her grandmother was a smoker and lived to be 96. Sometimes we need to look at the evidence in a scientific way.

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Thanks for this OCDhasnobrain.

I had 2 lots of CBT a few years back. Therapist told me his  job was to train me to be my own therapist. I’m better when I do ERP and write stuff down. I’m slack at keeping to it though. I read lots about it. Knowledge is power - in the right places.

I agree with what you say about better to take meds and be free of OCD. Then not to take meds and be suffering. 

It took me 3 years to get help and take meds. I was so worried about the stigma attached to them and beliefs that I needed meds to be happy. Hard choice. 

But glad I took them and haven’t looked back. One day I reckon I will be able to stop when I can dedicate more time to physical exercise. This defo helps. But life’s too busy atm with young family and responsible occupation. 

I will be free of OCD one day. I was before I had children. Well, it was probably there but not a disorder. 

Angst

What you say is spot on. I have researched this disorder so I can attempt to recover. I’m just not consistent in my approach. My downfall. Maybe a New Years resolution to make CBT part of my weekly plan. 

I like the saying of

“keep your friends close and your enemy’s even closer”

The more I know about OCD and MY disorder the more I get it and bits fall into place

Xx

 

Edited by Dawnie

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I am also pretty bad at making things to a habit. Really bad. I have also been "guilty" of not taking it serious, which wasn't a good idea at all. This could be because I am pretty good at procrastinating. That's the thing, we have to do all of this to a habit, it could be that it takes life-long commitment to keep it at bay. It won't be that hard after a while and it won't come with the same extreme anxiety (if any anxiety) but it could be that we need to have awareness and commitment through our lives.

 I think that I oftentimes am forgetting that not everybody am so comfortable with having OCD. Forgetting that many people just have come to the conclusion that they have OCD. I think I need to be more aware of this in general when I write about OCD. 

Try not to care if someone is dismissive of you having OCD. It really isn't your problem. 

Edited by OCDhavenobrain

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9 hours ago, Ashley said:

We have some information here (via NHS Choices) - https://www.ocduk.org/overcoming-ocd/medication/sertraline/

Hi Ashley, I hope you don't mind me saying this, but I've just read your summary of Sertraline on the main website and to me it's a little bit strong in relation to pregnancy and breatfeeding. When I clicked on the link on the OCD UK website to the NHS choices information on Sertraline I felt that it gave a much more rounded description. For example, on the OCD UK website it states that Sertraline does pass in to breast milk, but it is in tiny amounts, which I feel is an important thing to add. The BNF also states that its not known to be harmful whilst breastfeeding. With regards to pregnancy as stated on the NHS website, Sertraline is associated with a very small increased risk of problems to the unborn baby. 

I do feel that it's only a little bit strong, but enough to cause a bit of undue worry. If I'd read your website when I was pregnant, I would of been worried. But, if I'd read the NHS choices website it wouldn't have worried me. I think because the information on the OCD UK website is concise, a bit of important detail has been lost. Obviously, this is close to my heart because I took sertraline throughout my pregnancy and during breastfeeding. It never worried me because my Consultant explained it to me. My OCD never attached itself to it and I never googled it. But, if I was pregnant or breastfeeding now, I think I would be concerned if I read the OCD UK website information. The reason I say that is because it did give me a bit of a pang of anxiety when I read it. Maybe that's my OCD, as one of my themes is causing accidental harm to my daughter, so please feel free to ignore. It's very hard for me to be objective. I don't know if you'll see this Ashley, but if you do, I hope you don't mind me saying this. I just thought that maybe you could take a look and see what you think. 

Dawnie, sorry for writing this on your thread, I just thought it was the best place for it. 

Edited by Emsie

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No probs. 

I took sertraline while pregnant and breast feeding from the advice of the Pre- natel  health team at the hospital. 

My GP told me to stop taking it. 

So the pre natal team wrote to the GMC and complained about the above. 

No probs Emsie. Good point to make. I do think info re. this is limited atm. 

Thank you xxxxx

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16 hours ago, Dawnie said:

Is 50mg not really cutting it? One of my friends takes 200mg? I first took citalapram but this was too much for me. I know it’s not going to be the same dose for everyone just wonder if I’m actually under doseing. OCD/anxiety/depression better on sertraline then off. Any help welcome?

Some good advice and discussion above.  I will just add on that in my experience the "right" amount can not only vary by person but over time as well.  In the 25ish years i've had OCD i've used 3 different medications at varying dosage levels.  Sometimes, when things are going well we lower for awhile, if I start having trouble again we move it back up a notch (always in consultation with my psychiatrist).  As long as you and your doctor are on the same page the only way you will know whats right for you is by trying different levels.  Keep in mind (though it sounds like you are pretty well informed and probably already know this) it might take some time for you to notice a difference, so don't assume just because you don't notice something right away that you need to keep going up.  Otherwise as long as the symptoms are improving for you and/or you don't have/don't mind any side effects do what you need to do!  Best of luck :) 
Maybe someday in the future we'll just be able to take a blood test or home brain scan and get an exact dosage for our brain chemistry.  🧠
Or better yet a tiny robot that goes in and "fixes" our brain to work right darn it! 🤖

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12 hours ago, Emsie said:

Hi Ashley, I hope you don't mind me saying this, but I've just read your summary of Sertraline on the main website and to me it's a little bit strong in relation to pregnancy and breatfeeding. When I clicked on the link on the OCD UK website to the NHS choices information on Sertraline I felt that it gave a much more rounded description. For example, on the OCD UK website it states that Sertraline does pass in to breast milk, but it is in tiny amounts, which I feel is an important thing to add.

Hi Emsie,

I have had a look, and I think the medication pages on NHS Choices for all the SSRI's seem to have changed slightly. I have re-read our advice and I think I agree with you. Whilst I do think the text we have is right, it could be written better.  Is that something you fancy having a go at rewriting for us?  I think you have my email :)  Ashley

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1 hour ago, Ashley said:

Hi Emsie,

I have had a look, and I think the medication pages on NHS Choices for all the SSRI's seem to have changed slightly. I have re-read our advice and I think I agree with you. Whilst I do think the text we have is right, it could be written better.  Is that something you fancy having a go at rewriting for us?  I think you have my email :)  Ashley

Hi Ashley, thank you for your reply. So glad you didn’t mind my comments. I’ll email you in a min about it. 

Thank you,

Em 

Edited by Emsie

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10 hours ago, Dawnie said:

No probs. 

I took sertraline while pregnant and breast feeding from the advice of the Pre- natel  health team at the hospital. 

My GP told me to stop taking it. 

So the pre natal team wrote to the GMC and complained about the above. 

No probs Emsie. Good point to make. I do think info re. this is limited atm. 

Thank you xxxxx

Thank you. X

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On 05/12/2018 at 00:28, Emsie said:

Hi Ashley, I hope you don't mind me saying this, but I've just read your summary of Sertraline on the main website and to me it's a little bit strong in relation to pregnancy and breatfeeding. When I clicked on the link on the OCD UK website to the NHS choices information on Sertraline I felt that it gave a much more rounded description. For example, on the OCD UK website it states that Sertraline does pass in to breast milk, but it is in tiny amounts, which I feel is an important thing to add. The BNF also states that its not known to be harmful whilst breastfeeding. With regards to pregnancy as stated on the NHS website, Sertraline is associated with a very small increased risk of problems to the unborn baby. 

I do feel that it's only a little bit strong, but enough to cause a bit of undue worry. If I'd read your website when I was pregnant, I would of been worried. But, if I'd read the NHS choices website it wouldn't have worried me. I think because the information on the OCD UK website is concise, a bit of important detail has been lost. Obviously, this is close to my heart because I took sertraline throughout my pregnancy and during breastfeeding. It never worried me because my Consultant explained it to me. My OCD never attached itself to it and I never googled it. But, if I was pregnant or breastfeeding now, I think I would be concerned if I read the OCD UK website information. The reason I say that is because it did give me a bit of a pang of anxiety when I read it. Maybe that's my OCD, as one of my themes is causing accidental harm to my daughter, so please feel free to ignore. It's very hard for me to be objective. I don't know if you'll see this Ashley, but if you do, I hope you don't mind me saying this. I just thought that maybe you could take a look and see what you think. 

Dawnie, sorry for writing this on your thread, I just thought it was the best place for it. 


I just wanted to point out that in my post above about Sertraline I did say that: 

‘The BNF also states that its not known to be harmful whilst breastfeeding’

But, on the BNF/NICE website (that there is a link for on the OCD UK website page about Sertraline), it actually says the following about Sertraline and breastfeeding: 

Not known to be harmful but consider discontinuing breast-feeding.

I just wanted to make that clear to everyone and not be misleading in any way because the BNF/NICE website page about Sertraline does say that extra bit, that is consider discontinuing breastfeeding

Just wanted to be completely clear and not mislead anyone as I feel my comment was biased and not the full picture regarding the BNF/NICE information about Sertraline and breastfeeding. 

Edited by Emsie

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Generally speaking, SSRI doses are higher for OCD than for general anxiety. That is after slowly working up to a higher dose. Of course if a smaller dose is helping a lot, great. Always talk to your prescribing physician first.

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