I still feel low on Sertraline. Should I change my meds?

Question

Hello doctor,

I am 31 and started on Sertraline 50 mg daily six weeks ago for depression.

My recent thyroid and vitamin D reports are normal, but I still feel low energy and lack motivation. My concerns are -

Does it usually take longer than this for antidepressants to work fully, or could this be a partial response?
Would adding therapy sessions make a big difference, along with medication?
Also, I have been having mild weight gain and tremors. Are these temporary, or should I discuss switching medicine?
How often should medication be reviewed before considering a dose change or alternative treatment like Bupropion or SNRIs?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Usually, antidepressants take six to eight weeks to show maximum effect, but 50 mg is not the standard dose for depression.

It should be escalated to 100 mg in the next two to three weeks. Increase dose to 75 mg, 50 mg in the morning, and 25 mg in the evening, and then take a 100 mg tablet in the morning.

The positive point is that Sertraline showed an effect. It is difficult to find an effective drug for a specific person, and before considering a switch, we usually check the following points.

One, it did not improve the patient's symptoms, and the side effects are intolerable. In your case, neither is the reason. Therefore, continue it.

Usually, mild weight gain and mild tremors are associated with SSRIs (selective serotonin reuptake inhibitors), but they improve with the passage of time.

Psychotherapy (cognitive behavioral therapy) is equally effective to medicine and should be augmented for maximum and long-term benefits. It works on the dysfunctional thoughts and behaviors that will help you in the long run. It will help you manage the maintenance factors, such as poor coping skills and conflicts.

Monitor your symptoms through the Beck depression inventory, and it will help you know the improvement objectively. It is readily available on the internet.

If symptoms drop below 50 percent from the baseline, then the antidepressant is effective, but the dose should be adequate.

Other lifestyle modifications are also important, such as evening walk, following sleep hygiene, as sleep disturbance interferes with symptom improvement, and reducing caffeine and sugar or other substances.

Check CBC (complete blood count), anemia, vitamin B12, and ferritin levels, as they can also interfere with response.

Usually, anxiety disorder is a common comorbidity with depression, which makes it difficult to manage depression. Therefore, proper screening for anxiety is also necessary.

If you have other questions, please feel free to ask.

I hope this helps.

Thank you and take care.

Regards.