![]() ![]() She reported that she had been taking alprazolam for anxiety for 11 years, and felt that her symptoms were well controlled on this before hospitalization. She otherwise denied any history of sleep problems or sleep medications. She reported that she had briefly taken doxazosin for difficulty sleeping while at an inpatient drug rehab facility in the past this had provided full relief of symptoms at the time. She denied experiencing nightmares or flashbacks. She reported that while her current mood was “terrible” from lack of sleep, she felt that her depression was well controlled as an outpatient on bupropion 300 mg. ![]() She described feeling exhausted, irritable, and extremely anxious as a result. On interview, the patient reported that while she typically slept about 10 hours per night outside of the hospital, she had been unable to sleep at all since admission to the outside hospital one week ago. The psychiatric consultation liaison service was consulted to provide medication recommendations. They had attempted to treat these symptoms with trazodone and zolpidem, without success. Her initial presenting symptoms of weakness, shortness of breath, dysphagia, and muscle spasms had improved significantly with intravenous immunoglobulin and solumedrol however, the primary team was concerned that persistent anxiety and insomnia were preventing a full recovery. If your symptoms don't begin to get better after a few weeks, be sure to speak with your doctor.The patient is a 31-year-old woman with a history of myasthenia gravis and reported anxiety, depression, attention deficit hyperactivity disorder, posttraumatic stress disorder (PTSD), and polysubstance abuse who presented to the neurology service as a transfer from an outside hospital in myasthenic crisis, likely precipitated by drug use and sleep deprivation. The side effects you mention in your question are fairly common when starting Zoloft and tend to dissipate with time. This interaction doesn't explain your feeling of restlessness though, which is most likely simply an adverse reaction to the initiation of Zoloft therapy. However, there may be cases where the combination is OK to use and should be discussed with your doctor. It is generally recommended to avoid using Zoloft with others drugs known to potentially cause QT prolongation such as Plaquenil. ![]() Both medications may increase your risk of an arrhythmia known as QT prolongation. While Zoloft is considered safe to take with Zyrtec, there is a potential interaction between it and Plaquenil (hydroxychloroquine). In addition, very rarely are SSRI medications associated with movement disorders such akathisia (i.e. Most of the time, these effects are fleeting and get better after two to three weeks of treatment. Zoloft has been reported to initially exacerbate headaches disorders. A change in medication or a sexual performance drug may be necessary if sexual side effects occur. This side effect appears to be dose dependent and if it occurs, may not dissipate over time. Sexual side effects can refer to anything from erectile dysfunction to anorgasmia (i.e. Starting at the lowest possible dose and increasing slowly to effect is the most prudent approach to avoid this side effect. These side effects often decrease with time. Zoloft in particular can exacerbate current restlessness, and sleep disorders. Theses GI effects tend to disappear around week 2 to 3 of therapy.Ī feeling of restlessness, especially in the evening, is a common initial side effect of SSRI medications. The most common complaint when starting on SSRI medications are GI effects, such as nausea and vomiting. In fact, up to two-thirds of patients end up switching from their first medication choice due to side effects or failure to achieve remission. However, some can remain and necessitate a change to a different medication. Most of these side effects tend to dissipate after a few weeks of therapy. The most common adverse reactions when starting therapy include: Side Effects Problems When Starting Zoloftįirst and foremost, initiating therapy with SSRI medications, such as Zoloft, can cause a variety of issues with patients. There could be a few issues that are causing the problems you are having with initiating therapy on Zoloft (sertraline), a SSRI (selective serotonin reuptake inhibitor) medication. Could this be why I am having this response to the Zoloft? Or is this common, at first? Also, is it safe to take a Zyrtec, at night until the side effects of the Zoloft settle down? Answer My questions are, since I last took Zoloft I have been put on 400 mg of Plaquenil for R.A. I took a Zyrtec last evening to calm the jitters and help me to fall asleep. I took 1 dose of 25 mg yesterday and was extremely jittery and nervous all day. I had taken Zoloft previously without any issues. I was prescribed Buspar for anxiety, however, It did not help much. ![]()
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