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Zoloft and Effexor

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I suffer from panic disorder/anxiety. I have been on Zoloft (Setraline) 100mg for a while. I started feeling depressed in the last couple of weeks (had some depression for a long time). Because of the depression, the doctor put me on Effexor XR 75mg. I have been on this combo for about 7 days now. I don't feel depressed really but my anxiety is a bit heightened and I feel a little hyper at times. Is this normal with the combination. I am worried that this medication will make me MANIC or something. Never had mania before, but I am always worried about this and serotonin syndrome. Please advise.

Thank you,


Category: Psychiatrist

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Thanks for using Doctor Spring for posting your query.
I have gone through your question is detail and I can understand what you are going through.
I understand that you predominantly have an anxiety disorder complicated by an episode of depression as well. I see many such patients in my clinic and its not a rare phenomenon. Now try to understand that both sertraline as well as effexor are both anti-depressant as well as anti-anxiety drugs and there is no chance that the combination can increase your anxiety disorder. Coming to your suspicion of serotonin syndrome, you are on a low dose of effexor i.e. 75 mg and at this dose with sertralin at 100mg, the possibility of serotonin syndrome is rare. Moreover you only have anxiety symptoms and probably its the primary anxiety disorder that you are still suffering.
Along with your current medications, you can reduce the anxiety symptoms by adding up clonazepam or etizolam or propranolol. These drugs will symptomatically reduce the anxiety while the combination of sertralin and effexor cure your serotonine imbalance. If it still doesnt help then your antidepressants probably need to be changed to either paroxetine, bupropion or mirtazapine etc.
Also there is an option of cognitive behavioural therapy (CBT). This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
Wish you good health,
Kind regards
Dr. Srikanth Reddy M.D

Patient replied :


Thanks for your response, however, I still have some follow up:
1) why do I have a slight feeling a being hyper? Is that the serotonin boost? or is that mania? especially when I drink coffee, I feel more anxious and slightly euphoric?
2) Does that feeling of euphoria mean I am actually bipolar?

Please advise.

Thank you,



Thanks for the follow-up query. I will try to address them one by one

Depression and anxiety both are cased by serotonin imbalance and increasing serotonin levels improves both depression and anxiety as well. Drinking coffee increases anxiety in patients with anxiety disorder.

Your suspicion of being bipolar mood disorder is very much justified. However to quantify a mood swing as a hypomania the symptoms have to persist for atleast 48 hours at a stretch. If it is less than that then probably it is more of an anxiety symptoms.

Hope I am able to clear your concerns. Would be glad to answer any follow-ups.

Dr. Srikanth Reddy MD

Dr. Srikanth Reddy
Category: Sexologist
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
Dr. Srikanth Reddy and 4 other Medical Specialists are ready to help you

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