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Suffering From Anxiety, Weight Loss, Disturbed Sleep And Loneliness. Is Sertraline And Clonax Safe?

Posted on Fri, 4 Jan 2013

Question: My mother has been suffering from a constant feeling of anxiety, loneliness, no interest in food which has in fact led to weight loss, disturbed sleep etc. for past several months. She also frequently complains of trembling knees, legs, feet and tearfulness from time to time. She consulted a local general physician for her symptoms and underwent check-ups for any underlying diseases. She was prescribed sertraline 100 mg every morning and clonax 0.5 mg. She was highly reluctant to take the medicines for fear of side effects. However, after a lot of coaxing from us she took both the pills at the same time (at around 9 PM). She could not sleep all night, was feeling drowsy, weak, nauseated and jittery the next day till late evening so much so that she had to take the day off from work (She is a professional and needs to be attentive at least from 8AM to 1PM). My questions to you are these:

1.     In your opinion, are sertraline and clonax the right combination for her?
2.     If yes, what would be the best time for her to take these meds, considering her job profile?
3.     Is 100 mg sertraline a bit too much to start with? Would it be better if she starts with a lower dose and goes up to a higher dose?
4.     She has taken alprax in the past and says it makes her feel better. Can she substitute the clonax with alprax?
5.     How many days/ weeks might it take for the side effects to settle down. Is it safe for her to continue the medicines?

Answered by Dr. Ashish Mittal (4 hours later)

Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

From description it appear that she is having anxiety disorder. Anxiety occur due to neurotransmitters imbalance in brain most commonly involving serotonin neurotransmitter.

In drug treatment two types of medicine used. For immediate relief of anxiety benzodiazepines group (clonax) of medicines are used and for long term relief most commonly SSRI (selective serotonin reuptake inhibitors) (like sertraline) are used. SSRI takes around 3-4 weeks to show its effect. Non drug treatment like cognitive behaviour therapy (form of psychotherapy) also takes weeks to show its effect.

With this background lets answer your question.

1. In your opinion, are sertraline and clonax the right combination for her?
Ans. Yes

2. If yes, what would be the best time for her to take these meds, considering her job profile?
Ans. Take sertraline in morning and clonax in night.

3. Is 100 mg sertraline a bit too much to start with? Would it be better if she starts with a lower dose and goes up to a higher dose?
Ans. 100mg is very high dose. Start with 25 mg and after 5 days increase it to 50 mg per day. Then dose change should be done (after 3 week) in person examination of patient by psychiatrist.

4. She has taken alprax in the past and says it makes her feel better. Can she substitute the clonax with alprax?
Ans. Clonax 0.5mg can be subsituted with 0.25mg of alprax. But clonax is better.

5. How many days/ weeks might it take for the side effects to settle down. Is it safe for her to continue the medicines?
Ans. Current side effects will subside in 2-3 days. Follow upper dose regime, there are negligible chance of side effect with above doses.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,
Dr Ashish XXXXXXX Mittal

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar