Ask a doctor on the topic of Neurology

Combination of Sertraline and Trazodone

July 8, 2011 | 15,00 EUR | answered by Dr. med. Ralf Berg

I have been taking Sertraline for 3 1/2 years, and occasionally Opipramol in the evening to help me fall asleep. From October 2010 until about 1 month ago, I tapered off continuously. Now, for the past 2 weeks, I have been experiencing a relapse (depression). I went to see my doctor and started taking half a tablet of Sertraline for 1 week, and then a whole tablet of Sertraline for the past 13 days, along with Opipramol 50-150 mg in the evening. For the past 3 days, I have noticed an increased tendency towards anxiety, feelings of insecurity outside, and inner restlessness. This was not the case during the first 10 days. Could these be side effects of Sertraline, or is the Sertraline no longer effective for me because I have been taking it for so long? The Opipramol also does not really help me sleep through the night. Unfortunately, it is very difficult to reach my doctor by phone, and my next appointment is in over 1 month. I used to take Trittico to help me sleep, which worked better, but I felt like my circulation was dropping too low, so it was discontinued. Now I am reading new studies on Trazodone (Trittico in Austria), which show that it works very well for anxiety, restlessness, and sleep, and I am considering asking my GP to prescribe it instead of Insidon. My questions would be: What should I do with the Sertraline going forward? Can I ask for Trazodone instead of Opipramol for my sleep disturbances? Do I need to taper off Opipramol? I have been taking it for about 11 days. Is Trazodone compatible with Sertraline? Thank you in advance for your help.

Would the Anthroposophic preparation Neurodoron be an alternative? There is already a study showing that it is very effective for anxiety, restlessness, and depression.

I apologize for asking so many questions at once.

Dr. med. Ralf Berg

Hello,

Many questions, many answers.
1. Let's start with the easiest one:
The anthroposophic preparation Neurodoron, you can definitely take in addition to Sertraline and Opipramol, this also applies to the homeopathic remedy Neurexan. Advantage: no known interactions with your psychopharmaceuticals.

2. I would advise you not to replace, but to add a sleep aid to the basic medications temporarily (for 14-28 days). The advantage is that you don't have to taper off anything, the effect of classical sleep aids kicks in almost immediately, while with psychopharmaceuticals it always takes time to adjust.
Please discuss this with your attending physician.
(Possible options are benzodiazepines or anxiolytics.)

3. Generally speaking, from your description, it seems that this episode is more severe and intense than before. There is usually no tolerance to Sertraline, but we know that in severe cases, it may be necessary to increase the dosage for 4-8 weeks until the desired effect is achieved.
So my advice: do not discontinue Sertraline but maybe consider increasing the dosage. You can communicate this request to your doctor or their assistants either over the phone or in writing and request a response/call back, which should be feasible.

Best wishes for your recovery,
Dr. R. Berg