I wrote a whole ramble, but I’ve decided to edit to make it a little more succinct: I’m looking for anyone with experiences starting a low dose SSRI. In particular, my Dr has recommended Zoloft. I’m nervous to try Zoloft, predominantly due to the risk of weight gain/food cravings, which I’ve dealt with for YEARS and finally have experienced relief from through Ozempic.
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Let me share my story with SSRIs fwiw. I’ll try to be brief …
- you will get majorly different effects from each SSRI, so it is really worth getting a med from someone who is very familiar with the different ones. that is a shrink or a doctor who is familliar with you as well as the meds. So I personally would not take the (well-meaning) advice of your pcp - these things do not have a standard protocol. Low doses are good.
- For me, I am on 10 mg of Duloxetine (Cymbalta). This was recommended to me by my psychiatrist who I have been seeing for over 30 years. It is actually also prescribed on label for diabetic neuropathy, which my shrink liked especially - she felt she was getting two meds in one.
- I’ve been on this for about 10 years now, and it is great. However, shoirtly after I started it I gained about 10 pounds. The shrink and the mds don’t make any connection, and there’s very little about this in the literature, but I personally attribute some of the weight gain to the drug. I am about 15 pounds overweight.
- It didn’t have any effect on my insulin usage that I noticed. partly that could be because duloxetine had to be clinically tested on diabetics since that is one of its on-label uses, but that’s just speculation.
- I went on the drug reluctantly after a period of anhedonia in my early 50s. I was borderline depressed. My wife says my personality changed after I started taking the drug, and she would know. Probably just in small ways?
- the medication should start working within a couple of weeks - you should notice a difference (or perhaps an absence of certain strains of thought). If you don’t like what’s happening or how you’re feeling don’t keep going - try a different one. There are many and sometimes it takes a while to find the right one.
- Pay attention to, and be ready for, side-effects. For duloxetine, i was warned about more vivid and disturbing dreams - my shrink even offered to give me a sleeping pill as well to help with this side effect before I even started on the duloxetine. I do get those vivid dreams - a lot of anxiety dreams. It reminds me of my pre-SSRI life so I accept it.
- Once you’re on the drug, and it’s working, you can’t go off of it until something changes. Because, as I understand it, when you go off it, your anxiety comes back and it is also pretty difficult to quit it - ie the transition back to the unmedicated state is quite rough.
Whew … obviously this is an area where I have some thoughts. I have a lot more, that are more speculative on my part.
Let me just share my theory of how SSRIs work esp w/ respect to anxiety. If you think about your thoughts as music, then anxiety would be an unpleasant sound in the melody - think about too much treble - or a sound that may start very quietly but grows in volume and irritation until it blocks out all other more pleasant or important or relevant sounds.
Within that analogy, SSRIs serve as a filter or damper on that anxiety sound. Imagine if you have a knob to adjust the treble sounds in your music. SSRIs turn that treble way down.
Hope that’s helpful.
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Thank you for this information. I’m editing my post as I feel anxiety (shocker) at disclosing so much. But, I still would like feedback on anyone who has tried SSRI’s and very, very much appreciate your reply.
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No worries – and your post is much more succinct now.
Just to add a little bit to my story with SSRIs – I came to SSRIs after a couple of years of talk therapy with a psychologist who was employed by the Joslin Diabetes Clinic in Boston. We both decided that I should explore SSRIs with someone who could prescribe them - and that turned out to be my longtime shrink.
That’s where I’ve come from, so on the basis of that experience, I would suggest you start with some other kind of talk therapy if you can. I wouldn’t be relying on my pcp for anxiety meds if I could help it.
And, of course, be aware of drug interactions! One thing we’ve all learned here is that everyone is different – our diseases are all quite personalized – so your mileage may vary.
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Also ask about how to taper off an SSRI in case you need to change meds—sometimes one type will work better than others for different people.
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I started taking lexapro about a year ago, relatively low dose. It’s a good thing. I think the world would be a better place if everyone was on it. No issues with weight or appetite or anything like that. Only “side effect” has been increased sexual performance…. In a way that might not be as rewarding for a woman, but that’s probably different for everyone
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Hi @jo_jo. I didn’t see your original post, so I don’t know what you took out, but I’ll give you a flavor of what I’ve dealt with in the hopes that you’ll find something to identify with. I’m also happy to discuss in pm’s if I can be of assistance in a way that saves you from disclosing too much. (I’m a 63 year old divorce lawyer - there’s nothing I haven’t heard or experienced, and I know how to keep my mouth shut. I’m also a professional ‘good listener’.) As a long time GAD sufferer, diagnosed at one point with MDD, I have way too much experience with SSRI’s, SSNRI’s, tricyclics and the add-ons. The unfortunate truth is that the medical community has many theories, but they don’t know precisely how or why SSRI’s work or don’t and, most importantly, everyone reacts to them differently. So, which one, if any, ultimately will be best for you will be a crap shoot. Because we were having so little success, my psychiatrist did a genetic test (for which I paid out of pocket because it wasn’t covered by insurance) to help determine which ones would work best for me and which my dna would resist - the results of that test were totally useless, I was resistant even to the ones to which I was identified as being receptive. I know people that swear by Lexapro and Prozac and Zoloft, and I know people like myself, who got no relief at all from those or a dozen others, both with and without add-ons. I also know people who felt better right away, and others, like myself, who felt MUCH worse and then either improved or, again like me, just stayed miserable and got no relief. My shrink has determined that the MDD diagnosis may not have been completely correct, and now I am only on 2.5 mg of Clonazepam (with an extra .5 as needed, which I rarely do), and that keeps my anxiety in check enough that I don’t spiral into the medically concerning levels of anhedonia and sadness I was previously experiencing (at one point I even had a ‘plan’ - but now I have a granddaughter). None of this has anything to do with D (for me), and I am NOT even suggesting that my experience is typical or even informative; I am saying only that you have to try for yourself, and be prepared for a potentially rocky road for up to two months before you’ll even know for certain one way or another whether any particular SSRI is for you. I’m also NOT saying that you shouldn’t do it; I know plenty of other people who’ve had great success - unfortunately I wasn’t one of them. The weight gain thing is a myth as far as I’m concerned. I experienced multiple uncomfortable side-effects, but I gain weight because I’m a stress eater and I’m always stressed, not because of any SSRI. Besides, while I know D complicates it, if a few extra pounds is the price of happiness (or at least less sadness), it’s one I’d be willing to pay.
Good luck, whatever you decide. We are all here for you.
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Hmm… you seem far more pleasant and well rounded than other divorce lawyers I’ve met
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Thank you for sharing your experience, and for the supportive message. I am still very hesitant to try an SSRI, and feel strongly that my stress is situational to my job and relationship. I have an appointment end of month to discuss again with my GP. I think if I decide to try Zoloft, I will request a referral to a Psychiatrist, so that I have someone closely monitoring me (which I’m sure will take time to be referred to and assessed) and a short leave from work so that I don’t jeopardize that situation. I just cannot imagine risking things becoming even worse for me at the moment. I am getting a LOT of help from Ozempic in terms of stress eating, and I’m utilizing the counselling services available to me through my union. I hope these things will help me keep my head above water for a little while longer.
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Thanks - I’ll take that as a compliment (and a sign of your good judgment 
)!
@jo_jo ‘Situational stress’ is the diagnosis where my psychiatrist and I ended up, which is why, after many years, we stopped trying different SSRI’s. That doesn’t mean it’s the right move for you, but what you’re describing was exactly what it turned out to be for me. Nevertheless, it took a LONG time to get there. Just be patient and perfectly open and honest with your doctors - tell them exactly what you are feeling, good and bad - it is the only way they can hope to get to the heart of it. I feel your pain and only wish I could just impart the benefit of my experience into your head so you wouldn’t have to suffer through some of the awful stuff I did while we were ‘experimenting’. Always keep in mind that, whatever it is, you can tough it out. You’ve got this.
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Thanks so much!!
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I suffered from GAD for a number of years, and my PCP put me on Xanax which is not approved for (and should not be used for) long-term use. After several years of Xanax (when Xanax was no longer enough), my PCP had me try Paxil (which gave me much worse anxiety), Lexapro (made me super depressed), and Wellbutrin (also made me much worse). With each of the drugs, my PCP said hold on, it takes a while to work. So I ended up spending about a year miserable, depressed, and practically comatose.
The ticket for me was seeing a psychiatrist who referred me to a psychiatric pharmacist. The psychiatric pharmacist started me on a Xanax taper (slowly tapering off) and suggested I try Remeron (mirtazapine), which has been a game changer!
Remeron is not a SSRI (works on different pathways), but the point is different drugs work for different people, and finding a prescriber (in my case the psychiatric pharmacist) who has a lot of experience with drugs for depression and/or anxiety is beneficial.
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My PCP just started me on 5 mg of Lexapro for insomnia. For the last year or so I’ve been sleeping 4 or 5 hours a night, with sporadic naps thrown in, often at odd times (on a bus, when visiting family, etc) when my body just says “sleeptime!”. Last night I slept 6.5 hours and am groggy as hell, but I’m grateful for the extra sleep. Of course I read about all the potential side effects, and will be watchful. The worst for me would be loss of motivation (especially in winter!) and even lower metabolism, but I’ll figure out the pros and cons if those happen.
I hope its all working out for you!
Edit: TMI, but it seems diarrhea is a side effect. That better go away soon!
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I have had generalized anxiety as long as I can remember. My anxiety talked me out of talking to my doctor for years (“Doesn’t everybody have anxiety, why am I special?” “What if I’m not myself if I’m less anxious?”). My PCP started me on a low dose of Escitalopram (Lexapro) about two years ago. My family has had good luck with Citalopram (Celexa) for depression, and my PCP said he’s seen fewer negative side effects with Escitalopram. My doc has me take it before bed to sleep through negative effects some people experience in the first few hours after taking it.
My PCP also required that I see a counselor for the first three months, to add some CBT tools to my belt. (As with meds, if you don’t vibe with a counselor, ask for a new one – it’s normal!)
My SSRI has been such a game changer. Like @bostrav59 says, it’s like turning down the volume on my anxiety. Who knew I could live life at a level 1/10 daily anxiety instead of a constant level 3+/10? Easier to fall asleep, and way fewer intrusive thoughts. A little weight gain, but nothing concerning for me, maybe 10 pounds. I keep an eye on my anxiety levels and symptoms, since reduced dose efficacy over time is common.
My pre-SSRI anxious intrusive thoughts were more of a hindrance to my T1 management. Worried about overnight lows, I was overcorrecting lows before bed and running higher than I should overnight. Sharing those anxieties with my endo was helpful, she helped me slowly fix my anxious habits too. I still deal with anxiety over possible complications. But with my SSRI and CBT, I’m more able to accept that I can only do my best – and that doing my best is worthwhile.
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Funny, I was on 5mg of escitalopram for various things (mild depression, anxiety) for a couple of years, but since starting insulin and achieving solid control I’ve come to suspect that a lot of my former… emotional lability, let’s say, was linked with spikes in my blood glucose. They’re reciprocally connected, of course (stress always notches it upwards), but it’s fascinating to contemplate that my weird moods might have been pushed around by my developing diabetes.
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The mental health connections really are fascinating! The only time I specifically visited a psychologist was for episodes of depersonalization/disassociation (very rare now, but still freaky). He told me to just “play detective”… and come to find out, those episodes were pretty closely linked to low blood sugars.
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Thank you for sharing. I’m so glad you found something that works for you. Unfortunately, even a little weight gain is not so little in my mind—it’s one of my main considerations for not trying SSRIs. I’m presently trying to be more consistent with cardio, and I’m on a sleeping pill. I have not been able to connect with any of the Counsellors I’ve seen despite tons of money and effort to do so. I’ll keep trying on that front though.
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Absolutely fair. I hope you will be able to find a solution that will work really well for you!
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Can I ask a kind of personal question for the ladies in this thread—-
With SSRIs were there negative side effects re libido?
I’m on a very low dose, so it doesn’t affect much of anything at all. But I was told that that is one of the side effects.
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