Dear TigerLilly,

Glad to be of help

I would talk to your epi again... perhaps simply saying you feel very anxious about this new med, and you would be much more comfortable titrating the Zoloft very slowly, at least initially. With this approach, he will not feel challenged medically, and may work with you on this.

Slow titration is ALWAYS best, with ANY med, first and foremost to catch any adverse reaction early, but also to reduce any transient side effects that may occur when initiating the med.

Zoloft takes about a week to reach steady state upon a dosage change, so increases should only be made on a week by week basis or longer.

The first time I started on Zoloft, my pdoc started me at 12.5 mg per day when i started taking it for the first time. after that he would increase or decrease me by 25 at a time.

my titration schedule at the time (doses in mg) was
week 1 - 12.5
week 2 - 25
week 3 - 37.5
week 4 - 50
week 5 - 75
week 6 - 100 (my target dose)

here in europe they do it by 50, but i cheat - and do my increases adding only 25mg if i am afraid of a manic switch (that is my risk as opposed to sz.) Here they have a real bad trend of slapping one on high doses right off the bat, and when you feel bad, they just tell you - oh, it's just an initial effect... it will pass, when, if they would titrate slowly, these effects are usually not noticeable.

if i'm really badly depressed i will increase by 50, partly because i know the med by now and that i tolerate it very well, and partly because i have been full of divalproex and lamotrigine, as anti-manics. i also take a long-acting benzo... delorazepam regularly and as needed, and have lorazepam orosoluble as needed too... so i am basically am under an AED umbrella that could cover a football stadium!

What Sue is saying about Zoloft having potentially bad effects, is true. Of course that is with many meds, though, including AEDs. (Lamictal... Stephen Johnson's Syndrome anyone?) Each individual reacts to meds differently.

Zoloft is activating and increases aggression - the latter is necessary and useful, within measure. Depressed individuals generally lack that healthy measure of the latter! OK... so not to frighten you more... i will explain... there is a blackbox warning on all SSRI's about an increase in suicidality.There is uncertainty in the literature as whether, during the delicate period as the depression starts to lift, a person who is already suicidal has more energy and impetus to act on it, or whether simply due to an unhealthy increase in aggression from the med, then turned upon oneself. The med companies HAVE to warn of this, but this is a great minority of cases.

I am not discounting what Sue said about her dad in the least bit. Many meds can be really bad for certain individuals, and with this i stress the need for slow titration and clinical monitoring.

~ waves ~ from across the ocean

p.s. Tegretol XR and Zoloft was my very first combination of meds! lol
p.p.s. after writing my last post, i moved the paragraphs about some, and the asterisk by divalproex says 'see below' - but the info i was referring to is actually the quoted paragraph on divalproex, ABOVE my meds. i guess i will fix the post for others, but just figured i'd mention it to you.