Effect of Sertraline

After stopping fluoxetine, even though I felt more energetic and less depressed, I felt more irritability and gasping for breath which affected my lecturing ability.

So, I checked with a doctor about this. The doctor prescribed sertraline 50 mg once daily along with asenapine 5 mg (sub lingual once daily) and olanzapine 10 mg once daily.

I started with sertraline first at the night time after dinner before going to bed. Initially for the few days, I felt good mood and energetic. So, I added asenapine 5 mg. I felt dizziness, slurred speech, heavy discomfort and internal unrest. So the next day, I stopped asenapine. I did not start with olanzapine because I was afraid  of extrapyramidal side effects, possible weight gain and risk of diabetes.

So, I decided to continue only with sertraline 50 mg once daily at the night. After 3-4 days, diarrhea occurred. Everyday, two times. Especially, after waking up in the morning, severe urgency to defecate occurred with unable to control feeling. However, this was not like normal diarrhea and somewhat different.  The diarrhea was difficult to tolerate especially during the working hours in the office. And also, some feelings of compulsory activity (eyesight following the lines of an object, eyesight following a symmetrical lines in an object) and internal unrest occurred.

So, I decided to reduce the dose to half tablet (~25 mg) and change the timing to morning. So, for the last two weeks, I took the half tablet in the morning. No diarrhea occurred the next day and no more diarrhea. And the compulsory feelings and internal unrest also got reduced much. However, after one week, sluggishness and slowness of mind happened. I was unable to motivate myself to do the things which I had planned earlier. I also had stomach bloating and sleep debt. I felt there is something wrong with the food I am taking. I used to take coffee with milk powder and sugar (3 cups of coffee per day, morning before breakfast, after lunch and in the evening around 7.30 pm). So, I decided to stop the milk powder. The next day, I felt more energetic, more clear minded, less stuttering during the lecture. I think, the milk peptides from the milk powder may increase the GABA levels and might have caused this. I need to check this for few more weeks.

Overall, the effect of sertraline can be summarized as follows:

	Sertraline 50 mg	Sertraline 25 mg
Effects on anxiety	Reduced general anxiety and reduced anxiety of stuttering	Reduced general anxiety and reduced anxiety of stuttering
Effects on depression	No low mood at all; very bright mood	No low mood but some lethargy is there
Effects on stuttering and voice	Mild stuttering; reduced loudness of voice; Unable to make a good lecture	Very mild stuttering; Able to deliver a good lecture; moderate loudness of voice < that achieved with fluoxetine
Effects on motivation	Good motivation	Reduced motivation with milk powder in coffee. After stopping the milk powder, the motivation seems to be slowly onsetting.
Effects on telephonic conversation	Vocal blocks happened, unable to ask questions	less vocal blocks and fairly smooth conversation
Effects on affection and social life	Very good affection towards the wife and children	Average affection towards wife and children. Seems to be improving after stopping the milk powder.
Effects on sleep	Slightly increased sleep duration; but after waking up felt energetic and motivated to engage in works	Slept for more hours; sleep debt occurred; not refreshing after waking up; seems to be improving after stopping the milk powder.
Effects on libido and sex	Increased libido and erections; no premature ejaculations	Decreased libido
Effects on eye vision	Blurred vision occurred especially when taking multivitamins Supradyn recharge	Not much blurred vision; seems to be improving after stopping the milk powder.
Effects on driving	Apparently no effect	Apparently no effect
Effects on body temperature and sweating	Felt less heat in the body; felt cold; Significantly reduced sweating	No feelings of coldness in the body; Significantly reduced sweating
Other effects	Internal unrest; Diarrhea	No diarrhea; no internal unrest

I need to monitor the motivation levels and quality of sleep after stopping the milk powder.

Update on 31/12/2012

Eyelid Twitching

After I stop the milk powder, my energy level increased and motivation levels became normal. However, my stuttering was there on and off. So, I tried, L-methylfolate 7.5 mg tablet in the night. After few days itself, my mood flattened. After two weeks, I developed eyelid twitching. Both my eyelids started twitching involuntarily. This twitching occurred during the wakeful period. During sleeping, it did not occur. It was really embarrassing while talking to others. During the twitching, the upper eyelid moved horizontally. Sometimes, lower eyelid also twitched horizontally. Then, I stopped taking sertraline and L-methylfolate. The eyelid twitching gradually reduced in another two weeks. I realized that it is the effect of L-methylfolate when combined with the sertraline and possibly due to the increased dopamine at the basal ganglia which controls the eyelid movement. During this time, I took Ginkgo Biloba extract and omega 3. After another two weeks, the twitching stopped completely. No more involuntary twitching happened.