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What Causes Insomnia And Nausea After Taking Zoloft?
Question: As discussed, my daughter has been on 25 mg of Zoloft now for 4 weeks. Has trouble sleeping and was experiencing nausea when she took it in the morning, so switched to night on your advice a few weeks ago.
You have now suggested she try 50 mg per day or switching medications. She is an athlete (competitive) and is worried about muscle weakness and fatigue. What do you recommend?
You have now suggested she try 50 mg per day or switching medications. She is an athlete (competitive) and is worried about muscle weakness and fatigue. What do you recommend?
Brief Answer:
Consultation
Detailed Answer:
Thank you so much for using my private service. I now consider your daughter a private patient of mine, and will do everything in my power to answer all your questions in full detail, and give you my most comprehensive recommendations.
I've thought about this case in some detail, and here's what I've come up with. First, if your daughter experienced significant improvement on Zoloft 25mg, even if it is causing insomnia, we need to weight that benefit against the problem of insomnia and figure out if it's worth staying on Zoloft. Sometimes if we switch a medicine, we don't see the same effectiveness as the one we were already using. So this is why I think the best solution is an augmentation strategy to address insomnia, rather than a total switch of medications altogether. In other words, we keep the Zoloft because it has been so successful, but we add another medicine to address the insomnia, and then taper it off slowly once the insomnia resolves.
Benadryl is not a great augmentation medicine because it loses its effectiveness over time as the body gets used to it. There are other safe, effective, non-addictive options to treat insomnia. My go-to is melatonin, as it is natural and effective. I start with 3mg 30min before bed and increase as high as 10mg if needed. If this doesn't work, I would consider trazodone or Remeron, as these augment antidepressant effects and also treat insomnia very well. These can always be stopped once the insomnia improves, and they have no risk of withdrawal.
Finally, I remember your daughter is a figure skater. None of these medications I have mentioned have any effect on musculature, I can assure you. Sometimes depression and and anxiety can cause muscle weakness and fatigue themselves. This is an additional reason we can consider bumping up the Zoloft a bit.
Let me know what you think.
Dr. Sheppe
Consultation
Detailed Answer:
Thank you so much for using my private service. I now consider your daughter a private patient of mine, and will do everything in my power to answer all your questions in full detail, and give you my most comprehensive recommendations.
I've thought about this case in some detail, and here's what I've come up with. First, if your daughter experienced significant improvement on Zoloft 25mg, even if it is causing insomnia, we need to weight that benefit against the problem of insomnia and figure out if it's worth staying on Zoloft. Sometimes if we switch a medicine, we don't see the same effectiveness as the one we were already using. So this is why I think the best solution is an augmentation strategy to address insomnia, rather than a total switch of medications altogether. In other words, we keep the Zoloft because it has been so successful, but we add another medicine to address the insomnia, and then taper it off slowly once the insomnia resolves.
Benadryl is not a great augmentation medicine because it loses its effectiveness over time as the body gets used to it. There are other safe, effective, non-addictive options to treat insomnia. My go-to is melatonin, as it is natural and effective. I start with 3mg 30min before bed and increase as high as 10mg if needed. If this doesn't work, I would consider trazodone or Remeron, as these augment antidepressant effects and also treat insomnia very well. These can always be stopped once the insomnia improves, and they have no risk of withdrawal.
Finally, I remember your daughter is a figure skater. None of these medications I have mentioned have any effect on musculature, I can assure you. Sometimes depression and and anxiety can cause muscle weakness and fatigue themselves. This is an additional reason we can consider bumping up the Zoloft a bit.
Let me know what you think.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Brief Answer:
Followup
Detailed Answer:
Yes, based on the information I have, I think her Zoloft dose should be increased to 50mg. It can always be lowered if she experiences worsening side effects, but I believe the benefit outweighs the risk.
She does not need a prescription for melatonin. Remeron and Trazodone do require prescriptions.
She should use supplementation for insomnia until the insomnia is treated effectively, at which point I would consider slowly tapering her off the augmentation medication.
The hot flashes are a bit unusual. It may be that this is more of an anxiety response than anything hormonal, as Zoloft is not associated with hormonal changes. Zoloft treats anxiety effectively, so I would monitor her for several days at the higher dose to see if these hot flashes subside.
Dr. Sheppe
Followup
Detailed Answer:
Yes, based on the information I have, I think her Zoloft dose should be increased to 50mg. It can always be lowered if she experiences worsening side effects, but I believe the benefit outweighs the risk.
She does not need a prescription for melatonin. Remeron and Trazodone do require prescriptions.
She should use supplementation for insomnia until the insomnia is treated effectively, at which point I would consider slowly tapering her off the augmentation medication.
The hot flashes are a bit unusual. It may be that this is more of an anxiety response than anything hormonal, as Zoloft is not associated with hormonal changes. Zoloft treats anxiety effectively, so I would monitor her for several days at the higher dose to see if these hot flashes subside.
Dr. Sheppe
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Apparently she upped her dosage to 50 mg after the first week. Should she up it again? to what?
Brief Answer:
Followup
Detailed Answer:
Yes, I would increase it to 75mg but only under strict supervision of your treating physician .
Please do not hesitate to ask me another premium question in a separate thread!
XXXX
Regards
Dr Sheppe
Followup
Detailed Answer:
Yes, I would increase it to 75mg but only under strict supervision of your treating physician .
Please do not hesitate to ask me another premium question in a separate thread!
XXXX
Regards
Dr Sheppe
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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