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DrasticDreamer's avatar

Missing one Zoloft/Sertraline shouldn't cause this, should it?

Asked by DrasticDreamer (23983points) December 25th, 2015

I woke up perfectly fine today, looking forward to the day. I got really tired at one point so I decided to take a short nap. When I woke up, I was really down, and I then realized that I was about 6.5 hours late in taking my anxiety meds.

As far as I know, though, the meds are designed to stay in your system for quite a while, right? So I can’t imagine this happening when I didn’t even miss a full day. On the other hand, there’s nothing I can think of that should have made me feel this crappy.

Not really looking to hash out my feelings, I’d just like to know if missing one pill at my regular time is even capable of doing this. Thanks.

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40 Answers

ARE_you_kidding_me's avatar

@DrasticDreamer Missing one dose would fuck me up pretty bad when I was on that stuff (sertraline). Not out of the ordinary at all. Try to set some reminders like alarms on your phone or something to keep you on your regular dose. I had a pill fob on my key chain with one in it just in case I forgot. Getting off of ssri meds was the best thing I ever did for myself, I can’t express my sympathy enough if you are in the position of needing them so I’m sending you a great big hug

JLeslie's avatar

I just looked up the half life and it varies quite a bit in individuals, but the average is about 25 hours. This means that with a missed dose you could start to feel the effects by midday of the day you missed taking it in the morning. If you take a fairly low dose I think it would be even more likely.

I question the idea of the drug building in the system. I know that is what is told to patients, but the one time I was received an SSRI, I knew I took something the first pill. But, I also think it was the wrong drug for me, so I’m probably a bad and very invalid example.

I’m not a doctor as you know.

Edit: I thought I would take a minute to explain that drugs usually are prescribed to be taken at the half life point. If the half life is 8 hours the drug would be prescribed 3 times a day. If the drug has a half life if 6 hours, it is prescribed 4 times a day. There are exceptions like thyroid medicine like synthroid. The half life is close to a week, and it’s partly why testing isn’t very valid for how you will stabilize until about the 6 week point.

ARE_you_kidding_me's avatar

@JLeslie They do build up slowly but leave your system quickly. That is why you have to taper off of them very slowly. Missing a full dose like this causes strong withdrawal symptoms within 4–5 hours.

JLeslie's avatar

Tapering is done with drugs that have much shorter half lives too. I’m not sure that is the reason to need to taper down Zoloft. I know they say those drugs aren’t addictive, but I disagree. Not that I am against drugs like Zoloft.

ARE_you_kidding_me's avatar

@JLeslie Trust me, tapering off is 100% mandatory when you want to stop sertraline.

JLeslie's avatar

I absolutely agree you have to taper off. I was not disagreeing with that at all.

JLeslie's avatar

I guess if the half life is over 24 hours in many people then it is building if taken once a day.

ARE_you_kidding_me's avatar

@DrasticDreamer PM me if you want to know how to get off the stuff when you are ready, or if you want to know what my love-hate relationship with it was like.

JLeslie's avatar

^^She isn’t trying to get off of it I don’t think. She just recently started taking it.

If she wants to stop she needs to do it with a doctor. Not that I see anything wrong with advice from jellies, I’m just saying she should talk to her doctor too.

ARE_you_kidding_me's avatar

@JLeslie Of course, but eventually she’ll want to be rid of it. If the doc just tells her to stop taking it cold turkey like mine did she’ll need some advice from people who have actually stopped taking it. Getting off of it was harder than quitting tobacco.

si3tech's avatar

I do not think missing/taking dose few hours later is responsible for what you describe. Check with your doctor.

JLeslie's avatar

@ARE_you_kidding_me Well, yeah, there is always the possibility her doctor will be an idiot like yours was. I mean that in all seriousness. You know me, I see doctors screw up all of the time. It’s commonly known to wean these drugs let alone the drug manufacturer specifically advises it. It’s not just common practice, but part of the medication information for the drug.

I’m all for jellies helping other jellies with medical stuff. Don’t get me wrong.

DrasticDreamer's avatar

@ARE_you_kidding_me Yeah, honestly, I never wanted to get on it. I know they help people who need them (and I feel like I did/do), but there’s still so much we don’t know about what they do to our brains that it makes me really uncomfortable – especially with the latest studies that have come out saying they permanently alter your brain. Which, again, isn’t necessarily a bad thing if it’s altering it in ways that are only helpful, but it’s kind of a big unknown at this point.

I agreed to start taking it because my doctor said there was a chance my anxiety was caused purely by my hypothyroidism, and me going to her about anxiety problems is actually what prompted her to look at my thyroid at all. But I already told her I didn’t want to be on a large dose (she filled it at 25mg) and that I wanted, once my thyroid levels were normalized for a while, to then stop taking it altogether to see if my thyroid was the culprit. My anxiety was getting bad, but I would always prefer to deal with it on my own, if possible, in positive ways. Meditation (before the meds) started helping a lot and is what made me get my panic attacks under control.

If what you’re saying about stopping taking it is true and that’s it’s harder than quitting smoking, that really makes me hope you’re wrong. Quitting smoking was one of the toughest things I ever went through. Ugh.

jerv's avatar

I am not so sure about Zoloft, but I know that some anti-anxiety meds have a very short half-life; short enough that 6 hours late is well over the amount of time it takes to start having withdrawal symptoms.

Metabolism also plays a role; I process things fast enough that they tend to spike hard then fade fast. If your metabolism is like mine, 6.5 hours may be the equivalent of 8–18 hours late.

DrasticDreamer's avatar

@jerv Before my hypo, it was extremely fast. I weighed 120 at 5’9’’ and people thought it was intentional. Now that I’ve been on my hypo meds for a few months, there’s a chance that it might be fast again. But I’m not sure, because I don’t know how long the hypo meds take to fully kick in, either.

All I know is, my mood took an extreme dive and I honestly have no idea why. That’s literally the only thing I could think of.

JLeslie's avatar

@jerv You’re most likely thinking of benzodiazepines not SSRI’s.

@DrasticDreamer I don’t see why you would try the antidepressant before trying the thyroid meds?

DrasticDreamer's avatar

@JLeslie I was really hesitant, but I was at a point that my general anxiety was getting really bad. I didn’t know how to deal with it and I wasn’t really doing it well my way, so I had to do something.

JLeslie's avatar

You MUST get your thyroid levels tested every 8 weeks or less when you are first starting thyroid drugs. It takes weeks to correct the wrong dosage.

DrasticDreamer's avatar

@JLeslie I’ve had them tested once after being on it for a while, and my levels were in the normal range. My next appointment isn’t until April, though.

JLeslie's avatar

@DrasticDreamer I understand. I wasn’t judging, I just am hoping your thyroid is part of the underlying cause of some of your depression and/or anxiety and it will correct once your thyroid corrects.

I just switched meds again for my thyroid and I tested at 4 weeks and was already showing overdosed. If I had waited the full 8 weeks I would have been climbing the walls, spacey, and my heart would have been going 90 beats a minute.

JLeslie's avatar

April is too long.

JLeslie's avatar

You don’t need a doctor’s appointment, you just need a blood test.

DrasticDreamer's avatar

@JLeslie I might bump it up, anyway. Not sure it’s too high – if anything, I’m thinking that it might be too low now, because I’m still experiencing very bad exhaustion. There have been two times now where I’ve almost fallen over on the treadmill because I’m falling asleep as I walk. :-/ One other reason I want to get off of the anxiety meds, because I know they can cause fatigue, too.

JLeslie's avatar

@DrasticDreamer Is a GP prescribing all of this? Or, a Psychiatrist? Endocrinologist? When they test your thyroid are they doing only a TSH? Or, T3 and T4free also? Some T3 might help your exhaustion.

JLeslie's avatar

Iron affects my exhaustion level a lot. I think I told you before. I would guess they check your iron though. That’s an obvious one in women. Although, with the other things they are treating they might have overlooked it.

JLeslie's avatar

I hope you feel better soon. It’s difficult to get to the root of the problem when there is possibly two or three things contributing to the problem. :(

It sounds like the meds were helping, but having some side effects you didn’t like. Maybe a different SSRI would be better for you? But, also get the thyroid panel done.

DrasticDreamer's avatar

@JLeslie It’s a general, yeah. She said she didn’t see much of a point in checking the T3 or T4 levels, but she might change her mind once I make it clear to her how exhausted I am all the time. It’s making normal activities extremely difficult for me. My iron levels are probably okay. I was checked for anemia a while ago and my levels were really good.

But yeah, I’ll definitely talk to my doctor. First thing is getting off of the meds entirely, at least for a while, to see if my anxiety was mostly caused by my thyrod.

ZEPHYRA's avatar

No way! Definitely was not that. Look into hormones which I know can virtually change you as a person when they are messed up. Oh, and is your gastrointestinal system functioning well. I ask because if it is out of balance in any way it can cause major crap both physically and psychologically. Estrogen and progesterone levels also mess up!

Hope you feel better soon!

JLeslie's avatar

@DrasticDreamer Without you answering specifically I know she is not a specialist by your response. I encourage you to see an endocrinologist. Not testing your T3 and T4 when you are so symptomatic is unacceptable. The tests are cheap, and it takes weeks and months to correct thyroid problems. Not checking all parameters once one is proven to be off (your TSH) is incompetence. It’s possible your thyroid levels are all adjusting back into normal with the Synthroid, but she should not be guessing. Not with your case. It’s too important. You have suffered too long.

Not to mention that GP’s often allow TSH to go up above 3.8 and consider it normal, when most endocrinologists don’t.

jca's avatar

I don’t understand why they don’t just check the TSH when that seems like such an obvious thing yet such a simple fix.

JLeslie's avatar

I just realized, are you saying you purposely stopped your zoloft? I thought you simply “missed” taking it in the morning. That it was an accident.

DrasticDreamer's avatar

@jca I’m not sure. I really like her in general, but when it comes to stuff like this, I’d like her to be as in depth as possible. I’m sure if I push it, she’ll check for me – I just wish I didn’t have to push for it.

After having my blood drawn once I was on the Levothyroxine for a while, my levels showed that I was something like 2.1 (or 2.3… somewhere around there. I can’t remember exactly, but I could check), so she said she’d check my levels again in 6 months. She doesn’t yet know that my fatigue isn’t going away, so that might be something that pushes her in the direction of checking my TSH levels, but I think she just thought it wasn’t necessary before.

@JLeslie No, it was an accident. My alarm on my phone went off, but it was in the middle of Christmas festivities, so I silenced the alarm and then completely forgot about it. Definitely wouldn’t attempt to just stop taking it cold turkey without talking to my doctor.

JLeslie's avatar

I certainly hope you stabilized easily around 2.3 and your doctor was right to feel safe about it for several months. That would be great. :).

It’s still worth adding the extra thyroid panel next time you do get a blood test. T3 can be very high, while T4 free a solid normal number, and TSH normal too. One number can be whacked. It’s difficult to know without the test.

I understand not running back to the doctor. It’s draining having to complain and ask over and over again, even though it’s completely legitimate. My endocrinologist let’s me just get a blood test when I don’t feel right. I don’t have to ask her, I just need to see her at least once a year. Not having to ask saves me a lot of mental stress.

tinyfaery's avatar

If your new to the drug a late dose could have an effect as would taking a high dose, but that is the extreme. Unless you are one of the unlucky few I don’t think missing a dose by 6 hours should cause any side effects. Maybe you’re just tired. I know the past few days have worn me out.

I’ve taken all kinds of psych meds, the only thing that is absolutely horrible to miss is any kind of benzo.

DrasticDreamer's avatar

@tinyfaery Yeah, I was thinking that it would seem bizarre if it was because I missed a dose. I have been really, really tired lately.

tinyfaery's avatar

Zoloft can do that. Might need a med switch.

Tellitasitis's avatar

This is a question for a pharmacist, not strangers on a website.

DrasticDreamer's avatar

@Tellitasitis Actually, more like a doctor. That said, I’ve been coming to this site since 2008 and I value the personal experiences of a lot of my fellow Jellies. Their advice and personal accounts do not substitute professional advice, but I still like talking to them about certain things.

tinyfaery's avatar

^^Thanks for clearing that up. :)

JLeslie's avatar

Like the doctor who told the jelly near the top to quit the drug cold turkey? Give me some jellies chiming in any day with their experience to help me through.

Although, one comment about pharmacist v. doctor. Sometimes pharmacists are the best people to ask. They actually look up the drug, check warnings, check dosage, while doctors tend to write what they have always written, and don’t check warnings. Luckily, many doctors have electronic prescriptions now that help them not screw up so much, but not all doctors utilize them. Some pharmacists specialize in going over what patients are taking, what was prescribed by doctors, to make sure there aren’t redundancies, and see if there might be a better regimen for the patient.

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