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Should I increase zoloft dosage or wait a few more weeks?

I have been on 50 mg Zoloft for anxiety/stress the past 5 years.  Zoloft has been awesome!  About 21/2 months ago, my stress at work (love my job) took its toll and I started feeling those old panic feelings again.  I kicked in my CBT practices, but too late!  I asked Doc to increase my Zoloft to 75 mg about 71/2 weeks ago.  The anxiety has calmed down quite a bit, but some still there.  I want to get back to how I was feeling just 3 months ago!  Should I wait another few weeks and hope the Zoloft continues to improve or should I bite the bullet and ask the doc to raise my dose to 100 mg.  I am not real tolerant to medicine and like to keep a sharp mind for work, so try to keep my medicine dose low.  I can't recall how long it took be feel my best on the 50 mg.  Any recommendations?
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Avatar universal
First, stress is not a mental illness and can't be treated by medication.  Anxiety is a mental disorder.  It's important to be able to tell the difference, because stress requires you to learn not get stressed out by something specific while anxiety is free-floating and spreads if not controlled.  You can't avoid stress in life, and everyone feels it at some point.  Not everyone suffers from anxiety, which is chronic and usually makes no real sense.  As for CBT, theoretically, if that works, you're cured and don't need medication anymore.  Therapy and medication both have pretty dismal rates of success, but that ignores that if one doesn't work you can try another.  Studies don't and probably can't account for that.  As for your Zoloft, if your stress at work is a temporary situation because things got harder, that will pass when you get past this part.  Medications aren't magic pills.  While they can mitigate symptoms of a mental disorder, they aren't happy pills that get rid of all the difficult things that are going to happen in life.  Which brings us back to the question -- are you suffering from stress or has the drug stopped working for your anxiety requiring a higher dose?  You can't look at the drug as a happy pill because if you do, every time you're confronted with a difficult stretch you'll ask for higher doses until you max out and the drug isn't your friend anymore.  As for the proper dose for you, Zoloft users usually take more than what you were taking, so yeah, you can go higher.  The proper person to ask about that is your psychiatrist, who can evaluate whether your mental illness is getting worse, the drug isn't working anymore, or you're just facing a temporary harder time like anyone else does.  A general doc won't necessarily be able to do this evaluation, as they might know a little bit from the drug manufacturer about the drug but haven't studied any psychology and very little psychopharmacology and so have less experience and education to allow them to make an accurate evaluation.  This isn't to say psychiatrists are all that great, most aren't, but they are the specialists and this is all they do.  But again, everything I'm saying or anyone can tell you is based on our own experiences and generalizations, not on you as an individual, and we do vary a lot in how our illnesses manifest and how they respond to treatment.  But if you still need Zoloft, the CBT you did didn't take, if it had you wouldn't have needed the med anymore.  I know this is very hard to grasp for us, but when therapy truly works we don't need meds anymore.  If we still do, it might be helping, but it hasn't cured us and we still need to keep looking for that even if we never find it.  This is a long way of saying, the recommendation is, do what's not only going to make you feel better for now but for always.  If it's just some added stress, you might want to see if you can overcome it and wait it out.  If it's the anxiety, the drug isn't working anymore at the current dosage and you do need to increase it but sometimes drugs stop working.  All the best.
1 Comments
Should have added, it can take 4-6 weeks for a drug to start working, and also for an increase in dosage to be felt.  
973741 tn?1342346373
How are you feeling now?  I'm really happy to hear that you found a medication that works well for you.  It can make all the difference.  50mg is a very low dose of Zoloft.  The average dose of those who take it is much higher.  But it worked great for you until recently.  I would stick with the increase you are at for now and give it a couple more weeks and then increase if you are still feeling the panicky bad feelings.  You know yourself and you  know what feels 'right'.  While stress is normal, you aren't describing that because you are a patient that is treated for anxiety.  You know the difference.  But do give this a bit of time to work too.

Is this a situational thing at work?  Or is this just the day in and day out job?
5 Comments
Thanks so much for your reply!  I hope I did not increase my dose too early, but on the eight week mark on the 75 mg I was still having anxious feelings everyday.  Not like before Zoloft, but not nearly as good as I had felt for five years on the 50 mg dose.  I was having to really work hard to ignore it and correct negative thoughts, it seemed to be getting a little worse.  I thought it was time to get it under control.

I am on day 4 of the 100 mg dosage and feeling some side effects - -mainly extra anxiety -- which I know is normal.  

I love my job, I am passionate it about it, but it does involve having a lot of plates in the air at the same time -- every day!  I also keep busy outside work with a lot of hobbies!  I have been to CBT therapy for many years and have learned a lot about managing my "Type A personality type" --- but I am not afraid to acknowledge the I have anxiety -- not just stress that started in my 40's.  When on the Zoloft 50 mg -- my stress reactions felt "normal" and gave me warnings to relax and not react.  But for some reason about three months ago the anxiety starting back up.

So right now I am dealing with extra anxiety from the Zoloft increase -- and hope I made the best choice by increasing to 100 mg after 8 weeks on 75 mg.  What are your thoughts/recommendations?
I think that was a reasonable increase and I'd stick it out to see if helps.  You can always back it down if you feel it doesn't.  Really, most people that get true therapeutic effect from Zoloft have to take a little higher dose and you aren't at the average dose YET, believe it or not.  I'm all for taking the lowest dose you can but it also has to work.  I will cross my fingers that it does what it needs to do for you.  I would practice your breathing, work hard to get proper rest/sleep, and exercise daily to help during this transitional time. That's what I'd do any way.  

I'm glad to hear you love your job!  That is wonderful and so many people don't!  Life is hard and stressful and then add anxiety on top of it, it sounds like you are doing a great job.  Truly.  
At week four on the 100 mg dose I have a bad medicine head (for three days) and some shakiness.  Will this go away or should I be concerned the 100 mg dosage is not going to work.
Nobody can answer that.  These meds affect people differently.  Only time will answer this question, unfortunately.  4 weeks is a fairly good test, but alas, sometimes for a particular person it's not enough time.  If it gets more than you can tolerate, it's probably not the right med for you.  Is it working otherwise?  Because when a drug works side effects are usually easier to tolerate than when it's not doing much.
Hang in there, Treehugger.  A lot of people feel bad and then feel good.  Give it a few more days unless it is unbearable.  Let us know how it goes!
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