Adjusting Anxiety Medications
As a 31-year-old woman standing 5’4” and weighing 230 pounds, I've been prescribed 25mg of sertraline for over a year, alongside a dosage of 300mg of bupropion that I've maintained for an even longer duration. Recently, I've been experiencing adrenaline spikes that lead to feelings of panic, nausea, and trembling. Following a referral from my therapist, I am now under the care of a psychiatric nurse practitioner who is planning to increase my sertraline to 100mg while reducing my bupropion to 150mg. It's been 12 days since I began taking 50mg of sertraline, and today, coinciding with the start of my menstrual cycle, I found myself in a difficult situation. I woke up feeling unwell, with my heart racing at 115 beats per minute, a slight tremor in my hands, and an urgent need to find a restroom, followed by a familiar surge of adrenaline. Surprisingly, this episode didn’t escalate into a full-blown panic attack. I did shed some tears, but it felt more like a release of frustration paired with a longing for my previous sense of normalcy, rather than a reaction driven by fear or a feeling of losing control. At this point, I am seeking reassurance about the efficacy of sertraline and any strategies that might assist in managing my morning anxiety during this adjustment period. I have a prescription for Propranolol 10mg, but I’m uncertain about the appropriate timing for its use. Additionally, I possess .5mg clonazepam, though I prefer to avoid this unless I find myself in an acute panic situation. I would greatly value any advice or insights you might have!
Answers (1)
12/13/2025, 10:30:47 PM
OpenHealth AI
It's understandable to feel anxious during medication adjustments, especially with your experience of increased anxiety symptoms. You're in a transitional phase with your medications, which can impact how you feel, but it's great that you're taking steps to manage your mental health.
Main Points:
- Medication Efficacy: Sertraline can be effective for anxiety, but it may take some time to stabilize, especially during dosage adjustments.
- Managing Symptoms: There are strategies to help you cope with anxiety spikes and morning anxiety.
- Propranolol Timing: It can help with physical symptoms of anxiety like a racing heart.
Explanation:
Sertraline, a selective serotonin reuptake inhibitor (SSRI), is commonly prescribed for anxiety and can take several weeks to stabilize in your system, especially at higher doses. You might experience ups and downs during this adjustment, but it’s often part of the process before you feel the full benefits.
Your symptoms of racing heart, trembling, and feeling unwell could be a response to both the medication adjustment and hormonal changes due to your menstrual cycle. It's not uncommon for women to experience increased anxiety during this time.
Next Steps:
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Monitor Symptoms: Keep track of when these spike in anxiety occurs, noting the intensity and how long they last. This will help you and your healthcare provider adjust your treatment if needed.
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Use Propranolol as Needed: For the racing heart and physical symptoms of anxiety, taking Propranolol 10mg can help. It can be effective shortly after you notice symptoms starting, such as during your morning routine if that's when you feel anxious. Always follow the specific directions provided by your prescriber regarding timing and dosage.
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Practice Relaxation Techniques: Engage in deep breathing, mindfulness, or gentle stretching in the morning to help calm your body and mind. Apps for guided meditation can be helpful.
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Limit Stimulants: Reduce caffeine and sugar intake, especially in the morning, as they can exacerbate anxiety symptoms.
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Communicate with Your Provider: Share your experiences and symptoms with your psychiatric nurse practitioner, especially if you notice patterns or worsening symptoms. Adjustments to medication can be made based on your feedback.
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Save Clonazepam for Acute Situations: It’s good that you prefer to save clonazepam for intense situations. Use it only as prescribed for panic attacks, as it can be habit-forming.
Remember, it’s a process, and it’s okay to seek reassurance. You're not alone in this, and your proactive approach is a positive step towards feeling better. If you ever feel overwhelmed or have thoughts of harm, it's crucial to reach out for immediate help. Take care, and I hope you find some stability and relief soon.
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