Does Zoloft (sertraline) cause weight gain?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Jan 26, 2022.

Zoloft (sertraline) may lead to a small weight gain ranging from 1% to 1.6% of initial body weight when used over 6 months to 1 year. For example, in a 150 lb (68 kg) person, this would equal an added 1.5 to 2.4 lbs (0.7 to 1.1 kg) of weight. Shorter-term treatment in adults usually does not lead to substantial weight gain, but most patients need to take Zoloft for an extended period of time.

In children, weight loss has been reported with Zoloft possibly due to side effects like nausea or loss of appetite. In 281 children treated with Zoloft, at least 2% reported decreased weight, at a rate that was twice that of placebo (an inactive pill).

Zoloft is a selective serotonin reuptake inhibitor (SSRI) approved to treat

• Depression
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder
• Social anxiety disorder
• Premenstrual dysphoric disorder

How does weight gain with Zoloft compare to other SSRIs?

Of the SSRIs, Zoloft (sertraline) and Prozac (fluoxetine) appear to cause the least amount of weight gain.

Weight gain with SSRI treatment can vary. In general, weight gain is ranked:

• lowest with fluoxetine
• slightly higher with sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine (Luvox)
• highest with paroxetine (Paxil).

In a 26 to 32 week double-blind study, 284 patients with major depressive disorder were randomly assigned to long-term treatment with fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil).

• Of the three SSRIs, paroxetine-treated patients had a significant weight gain, sertraline-treated patients had a modest but nonsignificant weight gain, and those receiving fluoxetine had a nonsignificant weight loss.
• The number of patients whose weight increased 7% or more from the start of the study was significantly greater for paroxetine-treated patients than for those receiving either fluoxetine or sertraline.

In another 2.5 year open-label study of 138 patients treated for obsessive-compulsive disorder (OCD), weight changes were assessed for several SSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, or sertraline), as well as the tricyclic antidepressant (TCA) clomipramine.

• In all groups except fluoxetine, a significant weight gain was reported. Clomipramine (a TCA) was associated with the greatest weight gain. TCAs are well known to cause more weight gain than SSRIs.
• Of the SSRIs, fluoxetine (Prozac) and sertraline (Zoloft) had the lowest weight gain.
• Zoloft and Prozac also had the lowest percentage of patients with a weight gain of 7% or more over their initial body weight (4.5% for Zoloft and 8.7% for Prozac).

Do all antidepressants cause weight gain?

Treatment with antidepressants and selective serotonin reuptake inhibitors (SSRIs) in general tend to cause weight gain with long-term treatment (more than one year). Overall weight changes depend upon which antidepressant you use. Most antidepressants lead to only modest weight gain which can be addressed with diet and exercise.

• Older antidepressants like the tricyclic antidepressants (TCAs), for example amitriptyline or doxepin, cause more weight gain than the SSRIs but are infrequently prescribed today for depression.
• Mirtazapine (Remeron), a tetracyclic antidepressant, is known to be associated with significant weight gain. In studies, appetite increase was reported in 17% of patients treated with Remeron, and 7.5% of patients had a weight gain of at least 7% compared to the start of the study.
• In contrast, bupropion (Wellbutrin SR, Wellbutrin XL), an atypical antidepressant, is often linked with weight loss. In studies, between 14% and 19% of patients taking bupropion loss at least 2.2 kg (5 lb) compared to 6% on an inactive placebo.

A large cohort study (136,762 men and 157,957 women) in the United Kingdom looked at electronic health records to evaluate the long-term association between antidepressant prescribing and weight gain. Over 90% of patients had a diagnosis of depression.

Researchers looked at data over a 10-year period to determine the incidence of at least a 5% increase in body weight, and the number who transitioned (based on body mass index) to a status of overweight or obese.

• In the year of study entry, 13% of men and 22.4% of women (mean age of 51.5 years) were prescribed antidepressants, but may have had other diagnoses besides depression.
• Over the follow-up period, those prescribed an antidepressant had an increased risk of at least a 5% gain in body weight compared to those who were never prescribed an antidepressant.
• Weight gain substantially increased in the second and third years of treatment. During the second year of treatment, the risk of at least a 5% weight gain was found to be 46.3% higher than in a general population comparison group. Those originally classified as normal weight were more likely to transition to an overweight or obese category.
• Researchers concluded that antidepressant treatment was associated with a sustained increase in risk of weight gain over at least 5 years.

Why does Zoloft cause weight gain?

• It is not fully clear if weight gain with antidepressants and Zoloft in particular is due to an increased appetite after recovery from a mental health disorder, due to the medicine itself, or some other factor.
• Antidepressants may cause weight gain by interfering with serotonin or histamine neurotransmitters in the brain that control appetite.
• Some antidepressants may cause drowsiness or fatigue that lower levels of activity, leading to weight gain.

References

• Zoloft (sertraline) prescribing information. 9/2021. Pfizer Inc. New York, NY. https://labeling.pfizer.com/ShowLabeling.aspx?id=517#page=1
• Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years’ follow-up: population based cohort study. BMJ. 2018;361:k1951. Published 2018 May 23. doi:10.1136/bmj.k1951
• Maina G, Albert U, Salvi V, et al. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004 Oct;65(10):1365-71. doi: 10.4088/jcp.v65n1011.
• Fava M, Judge R, Hoog SL, et al. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000 Nov;61(11):863-7. doi: 10.4088/jcp.v61n1109.
• Hirsch M, Birnbaum R, et al. Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. Up to Date. Accessed Jan. 26, 2022 at https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitors-pharmacology-administration-and-side-effects
• Bupropion prescribing information (FDA). Drugs.com. Accessed Jan. 26, 2022 at https://www.drugs.com/pro/bupropion.html

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Medical Disclaimer

Does Zoloft cause weight gain?

Learn how to minimize Zoloft weight gain and compare the symptoms to those of other popular SSRIs

Zoloft (sertraline) is a prescription medication that belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants. Zoloft is often prescribed as part of a treatment plan, which may include other methods such as cognitive behavioral therapy, to treat major depressive disorder (depression) or other mental health conditions, including:

• Obsessive-compulsive disorder (OCD)
• Panic disorder (PD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder (SAD)
• Premenstrual dysphoric disorder (PMDD)

Zoloft is a popular antidepressant medication. As of 2020, more than 38 million prescriptions have been written for this medication. Many patients want to know if Zoloft will cause weight gain. In fact, one of the most common reasons why people stop taking SSRIs is because of weight gain. Zoloft may cause weight gain with long-term use. It may also cause a slight weight loss in children. Continue reading to learn more about Zoloft and its effect on body weight.

Does Zoloft cause weight gain?

Because everyone is different in their symptoms of depression or anxiety, as well as side effects and response to medication, weight changes due to Zoloft will vary by individual. One person may gain weight while another may lose. Some people eat more when they are depressed, and when they start taking Zoloft and feeling better, they may return to a normal diet and lose weight. On the other hand, some people experience appetite loss when depressed and eat less. Then, when taking Zoloft and starting to feel better, they may start to eat more and gain weight. 

While it is difficult to know how each person will respond to Zoloft in terms of weight gain, we can look at the results of some clinical studies. 

• A 2016 study looked at weight gain in adults after two years of antidepressant use. In this study, people who took sertraline gained an average of 5.9 pounds after two years.
• A review of many studies published in 2017 noted that a small weight loss may occur with short-term use of SSRIs, including Zoloft—in an 8-week study, individuals who took Zoloft lost an average of 1.58 pounds. However, short-term use of SSRIs is very unusual, because most people take SSRIs for at least 6 months—or much longer. The review noted a 2000 study, which looked at people who took an SSRI for up to 32 weeks and found sertraline to cause a weight gain of 1% (this would equate to a 1.8-pound weight gain for someone who weighs 180 pounds). And 4.2% of individuals who took Zoloft gained more than 7% of body weight (which would equate to at least 12.6 extra pounds for someone who weighs 180 pounds). 

In terms of children, Zoloft may affect growth hormones, which may slow growth and cause weight loss. Children who take Zoloft will have their height and weight monitored regularly.

Why does Zoloft cause weight gain?

Weight gain due to Zoloft (or any SSRI antidepressant) is thought to possibly be due to several factors, including: 

• By affecting serotonin receptor activity, which may regulate appetite and weight
• By increasing appetite, especially carbohydrate cravings
• By improving symptoms of depression, and helping appetite return to normal in those who had appetite loss

Other SSRIs and weight gain

SSRI weight gain can occur with other SSRIs besides Zoloft. A 2018 study in the British Medical Journal (BMJ) looked at the long-term use of antidepressants and weight gain. The study found that those who took an antidepressant had an increased risk of at least a 5% increase in weight, as opposed to individuals who did not take an antidepressant. Weight gain increased in the second and third years of treatment. The study researchers concluded that antidepressant use increased the risk of weight gain over at least 5 years. 

A 4-year study published in 2017 concluded that SSRI use was associated with weight gain—in combination with certain lifestyle factors including a Western diet, lack of activity, and smoking.  

The 2017 review of studies (mentioned in the section above) noted that some individuals gain what is considered to be an “extreme” amount of weight, which is more than 7% of body weight. Paxil (paroxetine) caused the most weight gain. In the study, 25.5% of people who took Paxil, 6.8% of people who took Prozac (fluoxetine), and 4. 2% of people who took Zoloft (sertraline) gained more than 7% of body weight.  

Another study also concludes that Paxil (paroxetine) may be most likely to cause greater weight gain than other SSRIs during long-term treatment. Interestingly —bupropion, which is not an SSRI, also known by its brand name, Wellbutrin, is an antidepressant that may cause weight loss—and is one ingredient in the weight-loss drug Contrave. 

One study examined adults using antidepressants for 6 to 36 months and found that 55% of people gained weight. Of these, almost 41% gained 7% or more of their weight compared to baseline. The study found Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Zoloft (sertraline) to be associated with significant weight gain—but not Prozac (fluoxetine). The study also found some serotonin-norepinephrine reuptake inhibitors (SNRIs) to cause weight gain, including Cymbalta (duloxetine) and Effexor (venlafaxine).  

Although SSRIs and SNRIs may cause weight gain, other types of antidepressants may cause weight gain as well. For example, tricyclic antidepressants such as Elavil (amitriptyline) or Pamelor (nortriptyline) are well-known for causing weight gain. And Remeron (mirtazapine), which is classified as a tetracyclic antidepressant, is known for causing significant increases in body weight and body fat. 

How to avoid Zoloft weight gain 

Not everyone will gain weight when taking Zoloft or an SSRI, especially if you are aware and proactive. Here are some tips to help avoid weight gain while taking Zoloft—or any antidepressant: 

• First, do not stop taking Zoloft suddenly, even if you start to gain weight. Stopping an SSRI suddenly can cause withdrawal symptoms—as well as worsen depression or anxiety. If you have any concerns about your medication, consult your doctor first. You and your healthcare professional will need to consider all options regarding which medication is best and the possibility of weight gain. For example, a weight gain of 3 pounds over several years can be considered insignificant when compared to living with symptoms of depression. However, a larger weight gain caused by an antidepressant could lead to other health problems like high blood pressure, which could require either lifestyle changes or a change to a different drug.
• If you have gained weight, ask your healthcare professional if there could be another cause. The SSRI may not necessarily be the culprit of weight gain. Another medical condition could be the cause.
• Talk to your healthcare professional, or consult a registered dietician, about lifestyle changes, such as incorporating a healthy diet of nutritious foods and an exercise plan that will fit into your life. According to the Centers for Disease Control and Prevention (CDC), adults should get at least 150 minutes of moderate-intensity physical activity every week, plus two strength-training sessions. This can be done, for example, by walking for 30 minutes, 5 days per week, and adding in two strength-training workouts. You can walk outside, or even around a mall—or check YouTube for thousands of free exercise videos, including walking videos. In addition to helping avoid weight gain, this benefits overall health, too.
• Keep track of your weight while taking Zoloft. This way, you can see if there is a pattern of weight gain, and make changes if necessary.
• If weight gain becomes a problem, or you do not want to take a medication that may make you gain weight, ask your healthcare provider for medical advice about trying a different medication—such as bupropion—with a lower risk of weight gain. 

Ask your healthcare professional for other ideas that are personalized to your individual needs. Working together with your healthcare team, you will be able to find the treatment that works best for your depression or anxiety—while also minimizing weight gain. 

Seralin (sertraline) in the treatment of depression | #10/05

The prevalence of depressive disorders, the variability of their structure, combination with other neurotic or psychotic disorders, connection with personal attitudes, somatic and social factors give rise to a large number of clinical forms of depression and, therefore, require the use of a variety of therapeutic agents.

Affective disorders occur during the life of every fifth person. The risk of developing depression reaches a level of 20%, 1% of cases are diagnosed initially each year, depression recurs in 55% of individuals, and becomes chronic in 12–15%. More than 60% of patients with depression do not fall into the field of view of psychiatrists, since atypical clinical forms predominate in the structure of morbidity.

Only 10-15% of patients with depression receive treatment, and only 0.1% of patients are admitted to psychiatric hospitals. According to WHO estimates, major depression is now the 4th leading cause of reduced life expectancy, taking into account reduced work capacity.

30-40% of patients with depression remain resistant to adequate thymoanaleptic therapy. In this case, resistance to the first drug reaches 40-60%.

Modern requirements for an antidepressant, along with a sufficiently effective thymoanaleptic effect, include good tolerability and a favorable side effect profile, as well as the absence of “behavioral toxicity”.

In this regard, there is a constant search for drugs that would optimally combine both high thymoanaleptic efficacy and a sufficient degree of safety.

Antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs) are the most widely used in the world psychiatric and general medical practice. Their therapeutic effect is associated with inhibition of serotonin reuptake both in the central nervous system and in the peripheral nervous system. At the next stage, the blocking function of serotonin IA receptors located in the somatodendritic part of neurons in the raphe region of the midbrain is disrupted. At the same time, the side effects of the drug that occur at the 1st stage are mitigated, and signs of a therapeutic antidepressant effect appear. Serotonin neurons are disinhibited (disinhibited), and serotonin begins to rapidly release from the axons leading to different brain structures. SSRI preparations do not have pronounced “behavioral toxicity”, anticholinergic side effects, adverse hepato-, cardiotropic effects and teratogenicity. They are convenient to use, as they have a prolonged action up to a day, can be used without dose titration, do not cause dependence and withdrawal syndrome.

This group of drugs includes sertraline (zoloft, seraline). However, it has its own specific features that predetermine its relevance in clinical practice.

Firstly, it is a balanced type of drug that does not cause an exacerbation of anxiety and emotional tension, which makes it possible to expand the scope of its application.

Secondly, it can be attributed to the SSRIs of the second generation, since the geometry of the antidepressant at the molecular level has been changed in its structure, as a result of which it was possible to achieve a more “precise” interaction with the receptor. So, when comparing the S- and R-enantiomers, it turned out that the S-enantiomer of the active substance is 30 times more potent serotonin reuptake inhibitor than its optical antipode.

Thirdly, sertraline is one of the few antidepressants approved for use in pediatric practice, which, apparently, may indicate the level of its safety.

Fourthly, this drug has proven itself in the treatment of depression with comorbid mental disorders, which expands the range of its use both in psychiatry and in general medical practice: chronic pain syndrome, bulimia, obesity, alcoholism, obsessive-compulsive disorders, attention deficit disorder with hyperactivity, panic disorders, etc.

Side effects of the drug are associated with hyperstimulation of the serotonin system: gastrointestinal disorders, loss of appetite, dizziness, nausea, diarrhea, hyperreflexia.

Sertraline hydrochloride is a bicyclic drug, a derivative of naphthylamine. It is a potent selective inhibitor of serotonin reuptake, does not cause blockade of muscarinic, serotonin, adrenergic and GABAergic receptors. The drug has practically no anticholinergic, cardiotoxic and sedative properties. The basis of its action profile is a distinct thymoleptic effect with a weak stimulating component. Relieving depressive symptoms, the drug also successfully affects the parameters of the immune, neurotransmitter and hormonal systems.

A number of works by modern authors are devoted to the clinical evaluation of the use of sertraline for the relief of depression in patients [1, 2, 3, 4, 5, 6, 7, 8, 9].

Our study pursued the following objectives: to confirm the antidepressant activity of the drug seralin ^* ; determine the effectiveness of the drug depending on the complexity, depth of the structure of depressive disorders; clarify the spectrum of psychotropic activity of the drug, identify the side effects.

The study involved 40 patients (14 men, 26 women), whose clinical picture revealed depressive conditions within a single or recurrent depressive episode (F-33.1; F-33.2), bipolar affective disorder (F-31, 3; F-31.4), cyclothymia with comorbid anxiety-phobic personality disorders (F-60.1; F-60.3).

The selection criteria were: the leading mental disorder — depressive syndrome; relative monomorphism of the disorder.

Exclusion criteria: children’s and senile age; severe somatoneurological pathology; the severity of the schizophrenic defect; substance abuse.

The patients’ age ranged from 20 to 61 years. The duration of the disease ranged from 1 week to 18 years. The mental state of patients at the start of therapy was determined by depressive symptoms of varying depth and structure.

The patients were diagnosed with the following syndromes: typical classical depression; anxious depression; apathetic depression; obsessive-phobic syndrome; depressive delusional syndrome.

Comorbid anxiety-phobic disorders were represented by panic attacks in 21 patients, manifestations of the type of generalized anxiety – in 14, obsessive-compulsive disorders – in 5 patients. The duration of treatment was 6 weeks. The initial daily dose was determined individually (50 or 100 mg/day). The maximum dose is up to 150 mg / day. The drug was administered orally in the morning, along with food; combinations with other antidepressants were avoided whenever possible. However, the peculiarities of the mental state of patients dictated the need to prescribe sedative or hypnotic drugs. Therefore, we used clonazepam, phenazepam and small doses of neuroleptics: sonapax, chlorproxen. During the follow-up period, 5 patients dropped out of the study for various reasons: 2 of them were discharged from the hospital due to family reasons against the background of some improvement in their condition; in 2 clinical cases, there was a transition to another phase (affect inversion).

Feeling of nausea, mild diarrhea, increased heartburn, loss of appetite was noted by 1 patient.

The therapeutic effect of seralin was determined by the degree of reduction in the total score of the Hamilton scale (HDRS) to assess depressive symptoms at different periods of treatment. The total score was recorded during five visits: H0 — at inclusion in the study; H1 – 1 week after the start of the drug; H2 – after 2 weeks; H3 – after 4 weeks; H6 – after 6 weeks after the start of taking seralin.

The criterion for the effectiveness of therapy was a 50% reduction in symptoms according to HDRS. An additional assessment of the effectiveness of therapeutic measures was performed on the basis of the CGI scale of general clinical impression. All patients were examined daily by a doctor. The dynamics of the state was reflected in extended diaries according to rating scales and the results of paraclinical studies.

When analyzing the results of the study, attention is drawn to the dynamism and relative harmony of the reduction of depressive symptoms, the absence of a period of hyperstimulation, increased anxiety, agitation, and activation of suicidal tendencies. This is especially important for depressed patients with obsessive-phobic disorders in the form of panic attacks, since the initial level of anxiety in them at the beginning of therapy significantly exceeded the level of anxiety in other patients. At the 1st stage of treatment, the actualization of anxious fears decreases, a more relaxed attitude towards phobias is formed, hypochondriacal manifestations fade, by the end of the 2nd week, the manifestation of anxiety and somatization decreases in patients, the level of anxiety harmoniously decreases and mood improves.

Obsessive-phobic symptoms cease to dominate in consciousness, manifestations of avoidant behavior soften, obsessions and phobias cease to be painfully painful, their significance decreases. On the 4th week of therapy, patients have plans for the future, interest in cognitive and work activities awakens, they move more easily, communicate and gradually return to their usual way of life. Patients develop a positive attitude towards the drug and an understanding of the need for long-term maintenance therapy.

Dynamics in the form of a dissociated variant of the reduction of symptoms was observed in those clinical cases when melancholy or apathy was the predominant affect in the structure of the depressive syndrome, and comorbid symptoms were represented by a generalized anxiety state or “depressive alienation” of mental functions (apathy, anhedonia, abscess in the form of influxes of painful reasoning, without a pronounced somatovegetative component, adynamia, etc.). At the 1st stage of the study, anxiety and the relevance of painful experiences decreased, and at the 2nd stage, mood improved and vital activity appeared.

At the end of the study, the results of therapy showed that 22 patients had a “marked improvement” (according to the CGI scale), 11 patients had a “moderate improvement”, 4 patients had a “slight improvement”, 2 patients had an “undetermined antidepressant effect” ( short-term improvement, without stabilization of the condition) and 1 – no change.

The pronounced thymoleptic activity of the drug was confirmed by the dynamics of the HDRS depression scale indicators: a pronounced therapeutic effect (a decrease in indicators by more than 50%) was registered at the transition from the 3rd to the 4th week of the study. By the end of therapy, a decrease in the average score on the HDRS scale by 34% from the baseline was noted.

In all patients, the stimulating effect appeared on the 4th week of therapy.

In the course of the study, side effects were identified in 5 patients. On the 3rd day, 1 patient developed anxiety, an excited state, which, apparently, is associated with the still insufficiently formed anxiolytic effect of the drug. In three clinical cases, transient symptoms of nausea were observed. In 1 patient, there was a short-term urinary retention, which resolved without discontinuation of the drug and dose reduction. Side effects described in the literature (L. Ziplinski et al., 1989; H. Gommans, 1990) were not registered in our study.

Analyzing clinical observations, we can draw the following conclusions.

• Seralin (sertraline) has a pronounced thymoleptic effect.
• The profile of the therapeutic activity of the antidepressant seralin consists of a harmonious, sequentially formed anxiolytic, thymoleptic and stimulating effects.
• Seralin can serve as the drug of choice in the treatment of depression with a predominance of anxiety, especially with comorbid obsessive-phobic disorders.
• The peculiarity of the therapeutic profile of the drug makes it possible to avoid an increase in suicidal risk in the early stages of depression treatment.
• The drug seralin is well tolerated, side effects are minor, quickly stopped and do not interfere with therapy.
• The antidepressant seraline (sertraline) is characterized by a balanced therapeutic effect with sequentially occurring anxiolytic, thymoleptic and weak stimulant effects.

For literature, please contact the editor.

B. A. Tashmatov , Doctor of Medical Sciences, Professor
N. Bulycheva, Associate Professor
1st Tashkent State Medical Institute , Tashkent

^* The drug is registered in Ukraine, Kazakhstan, Uzbekistan and a number of other CIS countries; in Russia passes the stage of registration.

how to take drugs, effect, can you drink without a prescription and with alcohol

Medicine and health

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group – these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my disease.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation – the so-called causeless motor agitation, the inability to sit still. It’s not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome – a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic – I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

8 myths about antidepressants

I never had such panic attacks before taking medication — my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I was already waiting for these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient “sertraline”, the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage – NHS

What doses of antidepressants will be optimal – an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember – this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression – BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned – even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy – they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs – tricyclic antidepressants and monoamine oxidase inhibitors – cause more side effects. Doctors usually use them when milder first-line drugs don’t work or when they can’t be prescribed.

Side effects of antidepressants – NHS

Side effects of different antidepressants – UpToDate

Side effects of antidepressants and their impact on the outcome of treatment of major depressive disorder – Nature

Selective reuptake inhibitors with erotonin – UpToDate

How to deal with side effects effects of antidepressants – advice from the staff of the Mayo Clinic

The choice of an SSRI drug does not guarantee the absence of side effects – many people tolerate treatment easily, but sometimes a change of drug may be necessary.

The first couple of weeks of taking there is a risk that the state of health will be so-so – it’s worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

• nausea – about 25% feel it;
• diarrhea – it happens in 15% of people, and 5%, on the contrary, will have constipation;
• about 20% of people have sweating and feeling hot;
• sexual dysfunction, decreased libido may occur in 80% of cases;
• insomnia – in 11% of cases;
• headache and dizziness – in about 10-11% of cases;
• weight gain – not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was “lucky”, and I faced one such – a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened – it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated – if something is very disturbing, frightening or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually – this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy – UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years – it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant “Zoloft” is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R – maybe more or less, depending on which drug is selected.

Psychotherapy review – UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance – it’s free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

How psychotherapy works

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors – Journal of Clinical Psychiatry

How difficult it is to quit antidepressants – American Psychological Association

Stopping antidepressants in adults – UpToDate

for some reason they changed their minds about taking the pills or the term has expired treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days – it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant – sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults – UpToDate

Serotonin syndrome – MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects – the same or different. We will have to wait again until they pass.

You won’t be able to change the drug on your own, since all antidepressants are sold only by prescription – and that’s good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors – due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

How to choose a psychotherapist

Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

Psychoneurological complications after covid: memory problems and depression

As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug – and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Sertraline

Original

Zoloft

Original price

About 700 R, tablets 100 mg

90 002 Generics

Serenata, Serlift

Cost of generics

500-600 R , tablets 100 mg

Escitalopram

Original

Cipralex

Original cost

3000 R, tablets 10 mg

Generics

Selektra, Elycea

Cost of generics

500-1300 R, tablets 10 mg

Fluoxetine

Original

Prozac

Original price

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100-200 R, tablets 20 mg

My pills: I bought several packs of Serenata at once, so one remained unclaimed ovannoy

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn’t mix antidepressants and alcohol – Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet – it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

How I Treated Generalized Anxiety Disorder under CHI

Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

Antidepressant Warnings – NHS

Drug Compatibility Test – Drugs.com

It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.