Herr Doktor (she's Swiss) decided to put me on Hydroxyzine (Vistaril), and Sertraline (Zoloft) for my anxiety. Never, ever, taken any sort of psychological medication before. Any idea of what to expect?
DISCLAIMER: This is not - under any circumstances - meant to replace the recommendations of your doctor. It is merely some additional information to help you think about and participate in your medical treatment, not to replace it. Do not make ANY changes to what you are already taking without discussing it with your doctor first!
That said, I'll over-extend myself because this is important; and because while I hope it is interesting and informative to you, hopefully it'll help anyone else who reads it who may have a similar experience in the future. [My choice to over-extend myself: do not feel guilty for it, it is my choice and any results are 100% my responsibility (as the results of my actions always are).]
I'm not that familiar with Vistaril (or, to be clearer: I'd never heard of it til your post; likely a pharmaceutical released in the last 14-15 years or so, since I last worked). [I did some brief reading on it before writing.] Since Zoloft was around 'back in my day', I can tell you a little about it.
With Zoloft, to begin with, for the first 10 days to two weeks or so you may actually feel more anxious. Because, contrary to what doctors (and virtually everyone else) says, the cellular biology of the brain that reacts to 'more serotonin' causes anxiety (that connection is likely why it is being prescribed), not an uplifted mood. It takes cells 'OD'ing on a neurotransmitter about 10 days to two weeks to shut down receptor sites on the uptaking neurons. So, ultimately, consistently flooding the synapse with extra neurotransmitter results in a net DECREASE in what the receiving cells take up.
With Prozac, Zoloft, etc., it is two weeks after starting that people start to get the antidepressant effects, and, as is anticipated for you, anti-anxiety effects. (Though I've seen nothing written to that effect, it seems likely that its long-term usefulness as an anxiolytic for you may be in direct proportion to how much extra anxiety you feel peaking at about 5-10 days or so.) [Apparently most people prescribing it (and discussing it) apparently didn't take Physiopsychology/Biopsychology graduate level classes to understand the mechanism of neuronal receptor shutdown, so they think "reuptake inhibitor? OK, that means that 'not enough serotonin' causes depression." The description I gave of how serotonin re-uptake inhibitors (like Zoloft) work is likely 'more correct', unless by some bizarre fluke in the brain, those cells that receive serotonin transmissions don't have the capacity to shut off receptors or don't act like most every other neuron in the brain. (In all the time I was studying this stuff, the profs never said there were any exceptions to the receptor sites closing off with too much transmitter present, so I kinda' doubt that. ...Besides, the 10 day to two week time frame is too similar to be anything but receptor sites shutting down somewhere downstream of serotonin receptors.)]
Even though it may be 10 days to two weeks before you start to feel the effects, it may take 4-6 weeks or more before your body actually stabilizes on a dose. This is because of the domino effect: each neurotransmitter system 'downstream' of one using serotonin has to go through the same adjustment, either to an increase or decrease in the neuronal transmissions it receives. With any increase in dose, it will take another 4-6 weeks to adjust to that. But decreasing doses may take far longer to fully normalize from, depending on your system and how long you'd taken it (the longer someone takes something, the longer it takes to normalize again when weaned off). Never, under any circumstances, if a medication says, "do not stop this medication without discussing it with your physician," and if one has taken a psychoactive med long enough to get used to it, should anyone go cold turkey on whatever it may be. [Apologies to Mrs. Dick Courier for not being able to write more when you were talking about your experience recently.]
I am sorry to say, I do have a strong reservation about what is happening, as a scientist (that you were prescribed two things to start at the same time). Classic scientific method says that you change only ONE thing at a time in any experiment. [And, sad to say, modern pharmacological treatment of the brain is an experiment, as each brain functions and reacts to meds differently.] In an experiment, if you change more than one thing at a time, you can never tell which thing had the effects you will then see (or if it was from an interaction between them). Prescribe two things and you improve? OK: which one did it? If you improved, you can't take the chance of taking either away without significant withdrawal effects potentially over long periods of time making you feel like hell, so you're stuck with indefinitely taking both regardless of whether both are helping. And let's say you improved some, but some of the side-effects were unbearable. So: which med did the improvement come from? Which one's side-effects were problematic? Was the improvement - or the side-effects - from an interaction of the combined medications with your particular biochemistry? There would simply no way to tell at that point unless you wean off of both, wait for your brain chemistry to stabilize (possibly months), then try the meds again, one at a time. Better to do it that way from the beginning.
In addition to 'confounding variables', you chemically stress the brain and body if you are taking more medications than what you need, and potentially ones that may give you no benefit, so nothing but negative side-effects. With anxiety disorders, your body is already stressed. It doesn't need more.
My approach, always, with clients (and when consulting with their psychiatrists) was to suggest starting with the most urgently-needed medication first - the one thought most likely to give the best response. This was what was done for me by the head-injury-specializing psychiatrist who ultimately found the proper medication assortment for me: try one, wait for its effects, and wait for my body to get used to it, then try the next. If the next made things worse, it could be dropped without disturbing the first; if it made things better, it could be added and once I stabilized on it, we might try a third, and so on. That was how I knew that my psychiatrist was exceptional.
Before getting well underway with the two meds, maybe ask your psychiatrist if it would be possible to start with the one she thinks is most needed first, and wait to get used to it before adding more. Particularly with (having looked up vistaril) the possibility of drowsiness from it. Drowsiness from Zoloft is, unfortuantely, a given until one gets used to it, and sometimes
after one gets used to it (yes: drowsiness and possible anxiety from it while your brain adapts to it, a bizarre combination).
If she prescribed the Vistaril short-term, to cover the potential increased anxiety of the Zoloft for the first couple weeks, and doesn't intend for it to continue past that point, then I don't see a problem. [Just as short term benzodiazepine prescriptions may be used for a similar situation.]
DISCLAIMER: This is not - under any circumstances - meant to replace the recommendations of your doctor. It is merely some additional information to help you think about and participate in your medical treatment, not to replace it. Do not make ANY changes to what you are already taking without discussing it with your doctor first!
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