Zoloft | Usage | Side Effects & Dosage

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WHAT IS ZOLOFT?

With different depression and anxiety medications available as prescription pills, it is important to know how they function. Zoloft is one of the most common medications for anxiety and mood disorders. Due to the challenging symptoms of anxiety, it is imperative to opt for the right treatment method, including antidepressants like Zoloft. ¹

Zoloft is a brand name for the generic name sertraline hydrochloride. It is an approved medication for treating social anxiety disorder, a type of anxiety disorder. It helps individuals improve from the previous irrational fear of judgment or self-humiliation symptoms.

IS ZOLOFT AN SSRI?

As a selective serotonin reuptake inhibitor, the drug functions by slow reabsorption of serotonin. Note that serotonin is a neurotransmitter that plays an important role in mood regulation and anxiety. It helps treat various health conditions, including major depressive disorder, obsessive-compulsive disorder, and post-traumatic stress disorder (PTSD).

How Does Zoloft Make You Feel?

An appropriate dosage of the medication makes people feel less anxious or fearful. It also reduces the urge for compulsive behaviors. In addition, the antidepressant helps improve overall sleep quality, energy levels, and unwanted thoughts.

Since the drug may make individuals experience headaches, fatigue, and nausea during the first week, doctors may initially prescribe low doses. It is advisable to increase the dosage with time, based on the health professional’s advice.

Does Zoloft Work for Anxiety?

Zoloft is an approved antidepressant for the treatment of social anxiety disorder. In some cases, it is also suitable for treating generalized anxiety disorder (GAD). Compared to some other types of antidepressants, using Zoloft for anxiety works, and it typically improves symptoms of different types of anxiety disorders.

Since the medication does not work immediately, you must continue intake until symptoms improve. It takes between two to six weeks for anxiety symptoms to improve in individuals using the medication.

ZOLOFT DOSAGE, USES, AND WITHDRAWAL

When using the medication, it is imperative to follow the appropriate dosage for the appropriate results. Understanding the uses of the antidepressants and withdrawal effects of the condition is also imperative. Here’s what to know:

Zoloft Uses

Among other uses of sertraline, it can help treat depression, panic attacks, obsessive-compulsive disorder, and social anxiety disorder is common. It also helps improve one’s mood, sleep, energy levels, and appetite. With the right dosage, it can restore interest in certain activities. It may aid in decreasing unwanted thoughts, fear, panic attacks, and anxiety.

Other common mental health conditions that the medication may treat include premenstrual dysphoric disorder (PMDD), post-traumatic stress disorder, and in some cases, eating disorders.

Zoloft Dosage

The appropriate Zoloft dosage depends on the mental health condition to treat. However, the best time of the day to take Zoloft for anxiety is either morning or night. Here are the different dosages of Zoloft for anxiety and other disorders:¹

• Panic disorder and post-traumatic stress: Is 25mg enough for anxiety? The initial Zoloft dosage is 25mg orally every day (once a day) for panic disorder and post-traumatic stress. After a week, the dosage should increase to 50mg orally every day (once a day). The maintenance dose falls between 50mg to 200mg orally every day (once a day).
• Premenstrual Dysphoric Disorder: The dosage falls into two different categories; the continuous and the cyclic regimen. For the continuous, the initial dose is 50mg a day during menstruation, while the maintenance dose is between 50mg to 150mg once a day orally during the cycle.For the cyclic regimen, individuals take 50mg of the medication orally every day (fourteen days before the start of menstruation down to the first full day of the cycle). With each new cycle, the same dosage applies. The maintenance dose is between 50mg to 100mg orally every day.
• Adult Obsessive-Compulsive Disorder: The appropriate Zoloft dosage for anxiety follows an initial dose of 50mg orally daily, while the maintenance dose is between 50mg to 200mg orally every day.
• Pediatric Obsessive-Compulsive Disorder: For children within the ages of six to twelve years, the initial dose of the medication should be 25mg orally once every day. The maintenance dose should be between 25mg to 200mg orally once every day. Older children between the ages of thirteen and seventeen should take an initial dose of 50mg orally once a day. The maintenance dose should be 50mg to 200mg orally daily.

Zoloft Withdrawal

An abrupt stop in the usage of sertraline results in various withdrawal symptoms, which is also the “discontinuation syndrome.” Chances of developing a withdrawal symptom due to the drug may relate to its half-life.

Half-life means the period it takes for the body to metabolize 50% of a medication’s active elements and flush them from the body. Most withdrawal symptoms of Zoloft fall within three to six weeks.

Some of the common Zoloft withdrawal symptoms:

• Nausea

• Irritability

• Dizziness

• Vomiting

• Headache

Common Side Effects

Side effects of sertraline may range from mild to severe, depending on dosage and sometimes age. If any side effects are frequent and severe, speak to the doctor for immediate help.

Note that for some Zoloft side effects first week experiences, individuals do not feel them for long. According to health experts, Zoloft weight gain may be inevitable as up to 25% of people who take antidepressants increased in weight.²

Here are the different categories of the Zoloft side effects in women and men:

Short-term Effects

Some of the prevalent side effects of Zoloft among young adults and older individuals include:

• Nausea

• Drowsiness

• Low appetite

• Sweating

• Insomnia

• Dizziness

• Diarrhea

Serious Effects

Severe side effects of Zoloft include:

• Persistent vomiting
• Seizures
• Abdominal pain
• Changes in stool or urine
• Tremors
• Suicidal thoughts
• Yellowing of the skin or eyes
• Nervousness
• Agitation

Sexual Side Effects

Zoloft causes sexual side effects that may require changing dosage plans or opting for an alternative medication. Here are the common Zoloft sexual side effects sexually:

PRECAUTIONS AND WARNINGS

Most doctors prescribe lower dosages from the start and increase later. In most cases, it should take up to a week before increasing the dose. Speak to a licensed doctor to know the appropriate dosage increase to follow.

Any dosage above the recommended 50mg to 200 mg of use is too high and can result in severe side effects. According to credible Zoloft for anxiety reviews, overdosing on the medication may cause nausea, lethargy, and tremor.

Before using a medication like sertraline, speak to the doctor about past medical history, especially relating to liver disease, thyroid disease, or any family history of glaucoma. The drug may result in QT prolongation, which causes a fast or irregular heartbeat.

Most liquid forms of the sertraline brand contain alcohol. For this reason, individuals with diabetes, alcohol dependence, or liver disease should speak to the doctor. Even though the medication is safer for pregnant women compared to other antidepressants, it’s imperative to use it when only required.

As a pregnant woman, the doctor may advise some alternatives to the medication, which include talk therapy or lifestyle changes.

Zoloft Interactions with Other Drugs

While taking the medication, it’s unadvisable to consume alcohol. Combining the antidepressant with alcohol will make someone feel very drowsy, which is dangerous. Mixing both substances also raises the risk of developing other unpleasant side effects of the drug. Individuals may observe increased signs of anxiety, nausea, depression, headaches, and drowsiness.

The US Food and Drug Law Administration advises avoidance of alcohol when using the sertraline brand.³

Other drugs to avoid interaction of the sertraline with include:

• Fentanyl
• Antipsychotic medications
• Monoamine oxidase inhibitors
• Certain serotonin reuptake inhibitors
• Non-steroidal inflammatory drugs (NSAIDs)
• Lithium
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Storage and Handling

It’s important to store the drug in its original container at room temperature. Similar to typical medications, it should be away from heat and moisture and also out of the reach of children. Do not share the medication with other people, even when they display any symptoms of anxiety.

Risks for Taking Zoloft for Long Periods

The risks of taking sertraline are low when managed for that long period of time. Most antidepressants have long-term risks of sexual problems, weight gain, emotional numbness, reduced positive feelings, and feelings of addiction.⁴

What Should I Avoid When Taking Zoloft?

It’s vital to avoid any substance, food, or drink that may cause a bad interaction affecting Zoloft and anxiety treatment. Besides alcohol, some other major foods or drinks to avoid are chocolate and caffeine-containing food items. Combining those with sertraline may result in high fever, nausea, trembling, sweating, and agitation.

ZOLOFT PROS AND CONS

As an antidepressant, the benefits of using Zoloft are evident. However, there are a few downsides to the medication from Zoloft reviews. Here are the pros and cons relating to Zoloft and anxiety:

PATIENT TIPS AND MEDICATION GUIDE

If you are experiencing any feelings of intense and unwanted symptoms of anxiety, consult the doctor to avoid self-medication. While taking the antidepressant, it is imperative to avoid consuming illicit drugs and alcohol. It is also important to stay mindful of any changes to the body within six to eight weeks of starting the medication.

Zoloft for anxiety; Dosages, interactions, and more

Zoloft for anxiety | Dosage | How long does it take Zoloft to start working? | Side effects | Warnings | Interactions | Alternatives

Living with anxiety can make daily life difficult. Fortunately, there are many treatment options available for anxiety that can help people find relief from their symptoms. Zoloft is one medication that may help. In this guide, we’ll explain to you what Zoloft is and how to take it for anxiety.

Taking Zoloft for anxiety

Anxiety is a prevalent condition that affects people all over the world. An estimated 31% of all adults will experience an anxiety disorder at some point in their life, and SingleCare’s anxiety survey found that 62% of respondents experienced some degree of anxiety. Zoloft is the brand name of a generic medication called sertraline. It’s a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that treats anxiety by slowing down the reabsorption of serotonin. Zoloft treats several mental health conditions:  

• Social anxiety disorder
• Panic disorder
• Depression (also known as major depressive disorder) 
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Premenstrual dysphoric disorder

Zoloft may treat anxiety if psychological treatments, like cognitive behavioral therapy, aren’t working or if your healthcare professional/psychiatrist thinks it will improve your quality of life in combination with other methods like therapy.  

What’s the right Zoloft dosage for anxiety?

The right dosage of Zoloft for anxiety varies by the severity of anxiety and whether the patient has other medical conditions. In general, though, the initial therapeutic dosage of Zoloft for anxiety is 25 mg or 50 mg per day.  

Zoloft tablets are available in three dosage strengths: 25 mg, 50 mg, and 100 mg. The maximum dose of Zoloft is 200 mg per day (which can be taken as two 100 mg tablets).   

Most studies suggest that the most effective dose of Zoloft is 50 mg per day. This dose is proven to be the most effective and tolerable dose for most patients. People who don’t respond to 50 mg per day may be advised by their doctor to increase their dose of Zoloft by 50 mg per day at weekly intervals to a maximum of 200 mg per day. For example, a doctor might recommend taking 50 mg daily for one week, then 100 mg daily for one week, etc. Always follow your healthcare provider’s instructions for use—and only change doses under the guidance and direction of your provider. Do not initiate dosage changes on your own. 

Zoloft is also available in liquid form as an oral solution. The oral solution comes as a clear, colorless solution with a menthol scent that contains 20 mg of sertraline per mL, at 12% alcohol. It comes in a 60 mL bottle with a calibrated dropper with 25 mg and 50 mg measuring marks. Zoloft oral solution must be mixed (just before taking) into 4 ounces (one-half cup) of water, orange juice, lemonade, ginger ale, or lemon or lime soda before consumption.   

Always follow your healthcare provider’s instructions for use and do not change the dose of Zoloft on your own. Symptoms of a Zoloft overdose may include seizures, coma, heart problems, high blood pressure, and serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition that can occur from the buildup of excess serotonin and requires emergency medical attention. If you think you overdosed on Zoloft, you can call Poison Control at 1-800-222-1222, but if your symptoms seem severe or life-threatening, you should call 911 and go directly to the emergency room.  

When does Zoloft start working for anxiety?

Zoloft doesn’t work immediately, so don’t stop taking Zoloft if your symptoms don’t improve right away. It takes two to six weeks to start reducing anxiety symptoms. Some people may feel a reduction in their anxiety symptoms within the first week of taking Zoloft, but this shouldn’t be expected for everyone. 

How does Zoloft make you feel?

According to the National Alliance on Mental Illness, some of the earliest signs that Zoloft is working are improvements in sleep, energy, or appetite. These improvements could happen one to two weeks into taking the medication. 

More significant changes, like feeling less depressed or regaining interest in daily life, may take six to eight weeks to occur. Over time, many people will notice a substantial difference in their anxiety symptoms, and some people may eventually have no symptoms at all.

Side effects

Here are the most common side effects of Zoloft you may experience when you start taking it: 

• Dizziness 
• Loss of appetite
• Lightheadedness 
• Dry mouth
• Nausea
• Diarrhea
• Increased sweating
• Restlessness
• Sexual side effects like sexual dysfunction
• Fatigue
• Trouble sleeping
• Nervousness 

Some side effects may be more noticeable at first, but then disappear as your body gets used to the medicine.  

Sexual side effects

Sometimes, individuals who take an antidepressant like Zoloft may experience sexual side effects. In men, symptoms may include delayed ejaculation, decreased sex drive, and/or problems getting or maintaining an erection—and in women, decreased sex drive and problems having an orgasm. Patients who are experiencing sexual side effects should consult their healthcare provider. Although it may feel uncomfortable to talk about these issues with your prescriber, it is very common and there are solutions available. 

Serious side effects

Although it’s rare, Zoloft may cause more serious side effects like unusual weight loss, low sodium blood levels, increased risk of bleeding (especially when combined with certain drugs like blood thinners or NSAIDs), seizures, and serious allergic or skin reactions. 

Serious allergic or skin reactions

While rare, having a serious allergic or skin reaction can be life-threatening and cause death. People with symptoms of an allergic reaction (hives, difficulty breathing, swelling of the face, lips, tongue, or throat) should get emergency medical help right away. Likewise, those with symptoms of a serious skin reaction (hives, blistering or peeling skin, red or purple rash, fever, burning eyes, sore throat) should seek emergency medical attention. 

Increased risk of bleeding

SSRI drugs, including Zoloft, can increase the risk of bleeding (which may range from mild to life-threatening), especially when taken with certain other medications. Examples of these medicines include:

• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex (celecoxib), Mobic (meloxicam), or Motrin (ibuprofen)
• Anticoagulants such as Coumadin (warfarin)
• Antiplatelet drugs such as Plavix (clopidogrel)

Patients should discuss all the drugs they take with their healthcare professionals before taking Zoloft. This includes prescription and OTC drugs, vitamins, and supplements.

Warnings

Zoloft also comes with a black box warning for suicidal thoughts and behaviors. A black box, or boxed, warning, is the strongest warning required by the US Food and Drug Administration (FDA). Short-term studies have shown that antidepressants increased the risk of suicidality in children, adolescents, and young adults compared to a placebo. However, people of any age who take Zoloft should be monitored, so seek medical advice right away if you’re taking Zoloft and start to have mood changes and/or suicidal thoughts or behaviors.

Contraindications

Zoloft is not safe for everyone. Zoloft should not be used in:

• People who are allergic to sertraline or any SSRI medication such as Paxil (paroxetine), Prozac (fluoxetine), or Lexapro (escitalopram)
• People who have taken an MAOI drug in the last 14 days
• People with moderate to severe liver problems (Child-Pugh Class B-C)

Additionally, Zoloft should never be stopped abruptly (with few exceptions, such as in the event of a life-threatening reaction). When it is time to stop taking Zoloft, the healthcare professional will provide a tapering schedule so that the medication is stopped safely and slowly, over a period of time. Stopping Zoloft abruptly can cause withdrawal symptoms such as nausea, sweating, vertigo, shock sensations, confusion, sleep problems, and seizures. 

There are also certain instances when Zoloft may be used with caution and close monitoring. Before taking Zoloft, tell your prescriber about all of the medications you take and all of your medical conditions, especially if you:

• Consume alcohol
• Are at risk of bleeding
• Have liver problems
• Have mental health conditions or a history of mental health conditions
• Have glaucoma
• Have electrolyte abnormalities
• Have (or have a history of) heart or heart rhythm problems 
• Have a history of seizures 

Interactions

Talk to your doctor about how to take Zoloft if you’re taking any of the following medications:

• Other medications that increase serotonin because of the risk of serotonin syndrome (such as other antidepressants, opioid pain medications, muscle relaxants, cough suppressants, or migraine medications in the triptan drug class)
• Disulfiram
• Blood thinners such as warfarin 
• NSAIDs such as ibuprofen 
• St. John’s Wort 
• Lithium 
• Nardil (phenelzine) 
• Parnate (tranylcypromine) 
• Marplan (isocarboxazid) 
• Azilect (rasagiline) 
• Emsam (selegiline)
• Orap (pimozide) 

Zoloft taken with monoamine oxidase inhibitors (MAOIs) or other drugs that increase serotonin (such as other antidepressants, triptans, and dextromethorphan which is found in cough and cold products) could cause serotonin syndrome, a life-threatening emergency that can cause hallucinations, seizures, comas, tremors, delirium, and other serious side effects.   

RELATED: Is it safe to take anti-anxiety medication with alcohol?

What is the most effective antidepressant for anxiety?

There is no single antidepressant that’s best for treating anxiety. What works for one person may not work for another. Depression symptoms will completely go away for about 1 out of every 3 people who take SSRIs, but more research still needs to be done on why SSRIs work for some people and not for others. Your healthcare provider is the best person to ask which antidepressant will be most effective for you.  

“Other SSRI medications can be effective for anxiety such as Prozac or Celexa or Paxil, yet each has some side effects—notably lowered libido and weight gain,” says Uma Naidoo, MD, a psychiatrist at Mass General Hospital in Boston. “Benzodiazepines are very effective in the short term while under the care of a doctor, but these are potentially addicting medications and must be used with immense caution and only as a short-term measure, e.g., grief following the death of a family member,” says Dr. Naidoo. Benzodiazepines are controlled substances, and have the potential for abuse and dependence, and include drugs such as Klonopin (clonazepam) and Xanax (alprazolam). 

As mentioned earlier, your healthcare provider is the best person to ask about how to treat anxiety. Medications can be effective in treating anxiety, but Dr. Naidoo says you may have other options as well. Some additional ways to combat anxiety, in combination with your prescription medication, may include:

• Talk therapy: Patients with anxiety can benefit from regular sessions with a therapist.
• Physical exercise: Regular physical exercise (as approved by your doctor) can be helpful to many people, improving symptoms of anxiety and helping you sleep better, in addition to improving overall health. Talk to your doctor about an exercise plan that is appropriate for you. 
• Mindfulness and breathing exercises: Mindfulness can help people focus on the present and help reduce anxiety and depression. 
• Dietary changes: Eating regular, healthy meals will help keep your blood sugar steady, avoiding that jittery feeling from low blood sugar, which may add to anxiety. A registered dietician is often covered by insurance and can be a very helpful resource in instituting dietary changes. 

Your physician can help you come up with a treatment plan that will fit well into your life.   

When to see a doctor

If you are experiencing anxiety that is interfering with your quality of life, do not hesitate to seek treatment. Start with your primary care provider, who can often recommend some lifestyle changes, start you on a medication, and/or provide recommendations for a therapist. You will be on your way to feeling better soon, and you will be glad you reached out for help. 

Treatment of comorbid obsessive-compulsive and depressive disorders in childhood

The problem of treating mental disorders in childhood is one of the most urgent and complex. This is due, on the one hand, to the complexity of their differential diagnosis in this age group and, accordingly, the choice of adequate therapy, and, on the other hand, to special care that must be taken when prescribing pharmacotherapy [5]. The latter is largely determined by the features of pharmacokinetics in an ontogenetically formed organism. The difference from adults is that in children the process of absorption of the drug, getting into the blood and its excretion is accelerated. It is also important to note a lower level of drug binding to blood proteins and, as a result, an increased amount of free fractions in the blood. This leads to a faster onset of both therapeutic effect and adverse events. In addition, drugs used in pediatric practice should have a wide “therapeutic window” so as not to pose a threat to life in case of overdose, especially in adolescents who are at risk for suicidal activity [1, 3] The incidence of side effects in drugs for pediatric practice should be minimal and they should be as mild and quickly passing as possible [3].

Given the high prevalence of depressive disorders in childhood, the issues of their treatment are especially relevant [4]. Over the past decades, there has been a steady increase in the frequency of these disorders, outstripping the general trend in the growth of mental disorders [2]. Depression leads to impaired social functioning and school performance. Adolescents suffering from depression are significantly more likely to commit suicide attempts, use psychoactive substances, are characterized by deviant behavior, difficult relationships with family and environment, and later in life have more problems in family, social and professional spheres. In the age group of 10-14 years, completed suicide is the fourth most common cause of death, and in the age group of 14-19years comes in third place [16]. All this determines the importance of early diagnosis and active treatment of depression in children and adolescents. The sooner depression is recognized, the less severe its consequences will be. The earlier treatment is started, the less effort and time it will require, and the better the result will be.

The clinical picture of mental disorders in childhood is characterized by pronounced polymorphism, which is largely associated with the combination of several psychopathological syndromes [2], which often requires the appointment of combined therapy with antidepressants, anxiolytics and neuroleptics. Therefore, drugs used in pediatric practice need a favorable profile of drug interactions with a minimum of undesirable symptoms that occur when several drugs are co-administered [9-eleven]. In childhood, depression is most common with a predominance of somatic equivalents, as well as in combination with obsessive-compulsive disorders (OCD) and anxiety disorders, therefore, antidepressants with thymoleptic and simultaneously with anxiolytic properties that do not cause undesirable effects should be the most optimal for the treatment of depression in childhood. side effects [16]. The emergence of selective serotonin reuptake inhibitors (SSRIs) has significantly expanded the range of possibilities for treating OCD and depressive disorders in childhood. However, the existing age restrictions associated with the lack of relevant clinical trials are still an obstacle to providing the safest and most adequate therapy using these agents.

Thus, the problem of an adequate choice of antidepressant therapy in children, taking into account the age specificity of the psychopathological picture of depression, remains relevant. An important aspect of therapy in childhood should include the possibility of treatment with drugs that are sufficient to be taken once a day, which significantly improves patient compliance. These drugs include an antidepressant from the SSRI class Zoloft (sertraline) from Pfizer [5]. Due to the selective inhibition of serotonin uptake, it has a very weak effect on the reuptake of norepinephrine and dopamine, has no affinity for muscarinic cholinergic receptors, serotonin, dopamine, histamine, GABA-, benzodiazepine and adrenoreceptors and therefore does not have a stimulating, sedative or anticholinergic effect. Sertraline does not cause drug dependence and weight gain with long-term use. Data obtained in previous clinical trials on the high efficacy and safety of sertraline in the treatment of depression in children and adolescents substantiate the possibility of its use in this age group [8, 12-14, 17].

One of the largest is an international multicentre, double-blind, placebo-controlled study of the effectiveness of sertraline treatment of depression in children and adolescents, conducted by S. Sharp and J. Hellings [16], who studied 376 people aged 6-17 years, whose diagnosis according to the DSM -IV met the criteria for major depressive disorder. Patients included in the main group took sertraline (zoloft) at a dose of 50 to 200 mg per day for 10 weeks. The Children Depression Rating Scale-Revised (CDRSR) and Clinical Global Impression (CGI) scales were used as assessment tools. A significant improvement in performance in children taking sertraline began to be observed already by the 7th day of admission. Side effects in the form of diarrhea, nausea and agitation were observed in only 7 people, 6 of whom belonged to the placebo group, which illustrates only the extremely high placebo reactivity characteristic of childhood.

In other studies, side effects were also considered to be non-serious. So S. Donnely et al. [12], evaluating the efficacy and safety of sertraline in the treatment of 189 outpatients aged 6 to 17 years with a diagnosis of major depressive disorder, double-blind for 10 weeks, showed that sertraline is well tolerated: only 8% of patients interrupted treatment because of – for side effects (2.1% – in the placebo group). Adverse events included diarrhea, anorexia, and agitation. E. Tierney et al. [17] retrospectively assessed the therapeutic and side effects of sertraline used at doses of 25-200 mg per day in 33 patients aged 8 to 18 years with a diagnosis of major depressive disorder and identified side effects in 16 patients, while 8 patients discontinued therapy due to for these manifestations. Changes in behavior were observed in 7 patients (2 patients developed hypomania). M. Nixon et al. [14] followed 21 outpatients aged 12 to 18 years in an open 6-month study and found only minor side effects in the form of headaches.

Zoloft (sertraline) is the drug with the most extensive pharmacokinetic profile in childhood and adolescence of all SSRIs. The half-life of sertraline in children and adults is approximately the same, and the maximum concentration (Cmax) and clearance in the blood in children are slightly higher, and in adolescents somewhat lower than in adults, which is reflected in the dosing regimens of the drug in patients of different age categories [ 7] (Fig. 1) . Figure 1. Pharmacokinetic characteristics of sertraline in pediatric practice. However, in the Russian Federation, in children and adolescents aged 6 to 17 years, Zoloft is recommended for the treatment of only OCD, but not depression, despite the clinical experience obtained both in our country and abroad [6, 15], which shows a high antidepressant effect. effectiveness of Zoloft in this age group.

Purpose of the study conducted in 2011-2012 in the Department for the Study of Child Psychiatry with the Childhood Autism Research Group of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences, consisted in assessing the clinical efficacy, tolerability and safety of Zoloft in the treatment of comorbid OCD depression in pediatric patients. Zoloft was prescribed to patients on a planned basis as the drug of choice for the treatment of obsessive-compulsive symptoms. Studying the reduction of OCD symptoms was not part of the aim of the study.

Material and methods

We analyzed the condition of 26 inpatients aged 7 to 14 years (mean age 10.0±1.6 years) who had a combination of OCD and depressive disorders in the clinical picture. The picture of depression met the ICD-10 criteria for a depressive episode of moderate and mild severity (F-32). These disorders were observed in the structure of mood disorders (F3x) in 6 people, schizotypal disorder (F21x) – in 8, schizoaffective disorder (F25x) – in 5, OCD (F4x) combined with mood disorders – in 7. Patients with schizotypal and schizoaffective disorders disorders received zoloft in combination with antipsychotics. Patients with comorbid depressive disorders and OCD received Zoloft monotherapy.

Zoloft was administered once in the evening, starting at 25 mg. In the absence of individual intolerance, the next day the dose was increased to 50 mg per day. Subsequently, the dose was increased in steps of 25-50 mg per week until a therapeutic effect was achieved. The average effective dose of Zoloft was 100 mg per day (75 to 150 mg). The maximum dosage used mainly in children over 12 years of age was 150 mg per day. The dynamics of the condition was assessed weekly for 6 weeks of therapy using the Hamilton Depression Rating Scale (HAM-D 21), the Beck Subjective Depression Rating Scale, the Global Clinical Impression of Change (CGI-I), and the severity (CGI-S) mental state scales.

According to the structure of depressive symptoms, the patients were distributed as follows: 12 patients – depression with a predominance of anxiety; 5- melancholic depression; 9 – dysphoric depression (depression with behavioral disorders).

The severity of the depressive state of the patients included in the study before the start of Zoloft therapy corresponded to mild (4 patients), moderate (14), and severe (8) depression. The average score on the HAM-D scale was (16.4±3.2).

Results and discussion

All 26 patients included in the study completed the course of therapy, which is a high indicator of thymoanaleptic activity and tolerance to the drug. The proportion of patients receiving the maximum therapeutic dosage of the drug (150 mg per day) was 35% (9 patients), which also positively characterizes the tolerability of the drug.

The dynamics of depressive disorders during Zoloft therapy was characterized by a rapid onset (already on the 2nd week) of a positive therapeutic effect (a decrease by an average of 3.8 points on the HAM-D scale) and a further gradual reduction in depressive symptoms by the 6th week (fig. 2) .Figure 2. Dynamics of depressive symptoms according to the Hamilton scale. As the most common depressive symptoms in pediatric patients, manifestations of anxiety and sleep disturbances, as well as somatic symptoms, came to the fore. The effectiveness of Zoloft in relation to anxiety disorders was assessed by sections of the scale: mental anxiety, sleep disorders, general somatic symptoms and general depressive mood. First of all, positive changes concerned the general depressive mood and insomnia. Patients noted the disappearance of difficulties falling asleep, the restoration of the duration and depth of night sleep already from the end of the 1st – the beginning of the 2nd week of therapy, which made it possible to dispense with the additional prescription of tranquilizers with a hypnotic effect. At 2-4 weeks of therapy, anxiety, restlessness, separation anxiety, which easily occurs at the moment of separation from the mother or other significant people, decreased. The focus on anxious experiences lost its relevance, anxiety, fears of possible failures disappeared. Patients stopped complaining about the fear of the dark, being without parents, unfamiliar people or places. These changes were reflected in the reduction of scores in the mental anxiety section of the HAM-D scale. The general somatic symptoms of depression were reduced somewhat later – on the 4-6th week of therapy, which was expressed in the disappearance of complaints of abdominal pain, headache, feelings of lethargy and loss of strength.

The high overall effectiveness of treatment is reflected in the scores on the scales of the overall clinical impression – CGI-I and CGI-S. So, already from the 7th day of treatment, the value of the indicator of the severity of the disease decreased. According to the reduction of the indicator of the global assessment of the dynamics of the mental state, the significance was achieved by the 4th week of treatment. In terms of the effectiveness of therapy, there was a similar dynamics of changes in the state of patients (Fig. 3) . Figure 3. Dynamics of indicators on the CGI-I, CGI-S scales. The starting average total CGI-S score of 4.2 decreased to 2 points after 6 weeks of therapy. The mean CGI-I total score at the final visit (week 6) was 1.5 (significant improvement).

Clinically, as early as the 1st week of treatment, all children showed a significant improvement in well-being. The tearfulness disappeared rather quickly. At the 2nd week of therapy, the ability to express joy, appetite improved, and suicidal thoughts were deactivated. On the 3rd week, against the background of a gradual improvement, working capacity and social activity increased – the children willingly joined rehabilitation classes and began to attend classes.

Most of the patients included in the study did not experience adverse events while taking Zoloft. One patient noted increased morning sleepiness during the first 3 days of taking Zoloft at a dose of 50 mg per day, which disappeared on the 4th day with continued use of the drug at the same dose. After the 1st week of therapy, 2 patients with a diagnosis of schizotypal disorder developed signs of hypomania with behavioral disorders when the dose of Zoloft was increased to 100 mg per day. After reducing the dose of Zoloft to 50 mg per day and introducing a behavior-correcting drug (neuleptil – 3 mg per day), the condition returned to normal over the next week. In 1 patient, when the dose was increased to 150 mg per day, tremor of the fingers and tongue was noted, which was reduced when the dosage was reduced to 100 mg per day.

In 2 cases, short-term episodes of nausea were noted during the 1st week, which did not recur later.

On the ECG and in the general clinical analyzes for a period of 6 weeks of therapy, no abnormalities were detected. There were no subjective complaints about side effects from the gastrointestinal tract and the autonomic nervous system (persistent nausea, vomiting, hypersalivation, diarrhea, accommodation disorders, excretion disorders). Common side effects of antidepressants, such as hypotension, tachycardia, and syncope, have also not been identified. All patients continued to take Zoloft after the end of the study – both inpatient (12 people) and outpatient. Data on the evaluation of adverse events are in good agreement with the results of previous studies and indicate a favorable tolerability and safety profile of Zoloft in pediatric patients with depression.

The data obtained on the efficacy and tolerability of Zoloft in the treatment of various types of depression in childhood and the possibility of its use in the combined therapy of depressive symptoms, including schizophrenic disorders, indicate the need for further study of modern antidepressants in order to expand age limits and provide children with the most modern pharmacological preparations.

Zoloft – consequences of use and methods of treatment of addiction

Sertraline is widely used in psychiatry and is most commonly known as Zoloft. This drug is usually recommended for the treatment of depression. However, if taken without proper control, pharmacy addiction may occur.

After this, the patient will no longer be able to do without the drug and will constantly need to increase the dose in order to maintain a positive effect.

Description, composition, effect and properties of Zoloft

Zoloft is not a narcotic drug, but a pharmaceutical agent that belongs to the group of antidepressants used to treat various mental and emotional disorders. Its action is based on the inhibition of serotonin reuptake. However, improper use of Zoloft can lead to unwanted side effects and addiction to the drug. In this regard, it is very important to follow the doctor’s recommendations for the duration of the course of treatment and dosage.

The selection of the treatment regimen is made for each patient individually, taking into account his condition and diagnosis.

Zoloft has a predecessor – tametralin, which is an inhibitor of the reuptake of neurotransmitters responsible for a positive emotional background. Therefore, the substance acted as a barrier to deactivate the “happiness hormones”. Initially, tametralin was developed as an effective antidepressant, but did not achieve the expected results. Although clinicians were satisfied with the results of the studies, the use of the drug revealed properties that are characteristic of most prohibited substances.

• Having a negative impact on the functioning of many internal organs.
• Withdrawal symptoms on drug withdrawal;
• Development of persistent drug dependence;

Pharmacists were persistent in their search for an effective drug and, based on tametralin, a drug called sertraline was developed. The chemical composition of the substance is almost identical, but chlorine atoms are added to it. The therapeutic properties remain unchanged, but differences have been identified – unlike tametraline, sertraline acts selectively on serotonin.

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The main pharmacological properties of the drug Zoloft include:

• Prevention of the reuptake of the “hormone of happiness”;
• Ability to increase the action of serotonin;
• Some, not too pronounced, obstruction of dopamine and norepinephrine reuptake;

These properties are due to the fact that when using this antidepressant, there are no certain effects that are characteristic of other types of antidepressants:

• no excess weight;
• no effect on allergic manifestations.
• no possibility of developing a manic syndrome;
• lack of effect on depressive disorders associated with a lack of dopamine;

The effect of the drug on the human body

Zoloft works by blocking the uptake of serotonin, but has little effect on norepinephrine and dopamine. Although less potent than tametralin, Zoloft causes far fewer side effects. Its sedative, stimulant, and anticholinergic effects appear gradually as the substance accumulates in the body. Patients notice an improvement in their condition 7-10 days after the start of therapy, when taking a drug dose. The therapeutic effect increases within a month, and the maximum effect is achieved after 90 days after starting the pills.

When using medication, remember that all types of antidepressants are psychotropic substances. They effectively fight the symptoms of depression and well reduce various neurasthenic deviations. However, for the treatment of mental disorders, they must be used with caution and only under medical supervision to minimize the risk of addiction and serious complications.

Zoloft has a serotonergic effect that helps to cope with such pathologies as:

• Ideas of persecution
• Symptoms following traumatic events
• Depressive disorders
• Panic episodes
• Neurological and compulsive conditions
• Obsessive thoughts and behavior disorders
• Behavioral abnormalities

Sometimes the drug is used to reduce symptoms associated with the withdrawal of substance use. If the patient experiences apathy, mood deterioration, loss of energy and other adverse manifestations, then Zoloft does a good job of mitigating them.

The drug causes pleasant emotions in patients, promotes relaxation and carelessness. However, drug dependence occurs with continuous use. A person cannot do without medicine, because its absence causes a lack of positive emotions. As the body gets used to the dosage, the sensitivity to the drug decreases, and the patient can independently increase the dosage, which can lead to serious consequences.

Dependence on the use of Zoloft

Usually antidepressants are prescribed for 7-8 weeks, and changing this period is considered unjustified. Do not stop therapy, even if the patient begins to feel better after 60 days. After completing the course of treatment with Zoloft, it is necessary to gradually reduce the dose, otherwise withdrawal symptoms may develop. The risk of this syndrome increases in case of the following factors:

• Increased patient anxiety
• Co-administration of Zoloft with antipsychotics and antihistamines.
• Long-term pills over 8 weeks
• Rapid drug withdrawal

Antidepressants affect the brain, so stopping abruptly can cause serious complications. Usually the dosage is gradually reduced by 25 mg every 2 weeks. Discontinuation of the drug is necessary not only when a stable remission is achieved, but also in case of serious side effects from Zoloft or low effectiveness of treatment.

The following are signs that may indicate treatment failure:

• Excessive irritability and anxiety
• Thoughts of suicide
• Feelings of pain
• Loss of interest in usual activities
• Loss of appetite
• Decreased concentration
• Force reduction

Reducing the dosage of Zoloft is a process that requires considerable time and depends on the initial dose of the drug and the patient’s well-being. If the drug is quickly discontinued, the body will not be able to quickly adapt to the changed conditions. Symptoms of Zoloft withdrawal syndrome may appear as early as 3 days after discontinuation, but may also occur when the next dose is missed. During this period, the patient may feel even worse than at the beginning of the course of therapy.

The following are symptoms of Zoloft withdrawal syndrome:

• Sleep and coordination disorders
• Alarm
• Anxiety
• Numbness or trembling in limbs
• Gastrointestinal symptoms: diarrhoea, nausea, vomiting

Most patients experience mild discomfort from these symptoms and are able to continue working as usual. However, in some severe cases, patients may be hospitalized for several days. Withdrawal symptoms can last from 7 to 14 days. The appearance of these symptoms is associated with the adjustment of the activity of brain neurons when taking the drug. After some time after drug withdrawal, it takes time to restore the normal function of the nervous system.

If the dosage of the drug was high and the course of treatment was long, the recovery process may be more difficult and protracted. Until the blood flow is completely cleared of the metabolites of the drug, the negative manifestations of the withdrawal syndrome will not disappear. Among these manifestations may be apathy and weakness. In order to distinguish symptoms from relapse, it is important to carefully monitor the dynamics of well-being. If the patient’s condition improves within 2-4 weeks, this indicates a possible failure of treatment.

Side effects of this drug.

Symptoms associated with the use of Zoloft depend on the dosage of the drug, the duration of the course, the general condition of the patient and the diagnosis. Almost all patients using Zoloft may experience some side effects such as fatigue, extreme thirst, swelling and muscle weakness. The central nervous system (CNS) most often suffers from prolonged use of Zoloft. Some patients may also experience the following complications:

• Loss of consciousness
• The appearance of nightmares
• Hallucinations
• Paranoia
• Headache
• Decreased concentration
• Confusion
• Dizziness
• Sleep disorders
• Alarm

One of the most dangerous consequences of the continuous use of Zoloft is the formation of dependence. It is impossible to determine the exact moment when the narcotic effect will occur, since it depends on many factors, including the individual characteristics of the patient, dosage and frequency of taking the pills. The process of addiction formation is slow, but getting rid of it is very difficult. Treatment and rehabilitation in a specialized clinic may be required for a long period of time.

Abuse of Zoloft not only negatively affects the central nervous system, but also harms the physical health of the patient. Some of the most common complications experienced by abusers include:

• Vision and hearing problems that can manifest as increased tearing, glaucoma, and ear pain.
• Disorders of the cardiovascular system, which may manifest as tachycardia, rapid pulse and changes in heart rate.
• Abnormalities in the functioning of the respiratory system, which may manifest as shortness of breath, bronchospasm and nosebleeds.
• Abnormalities in the functioning of the gastrointestinal tract, which can manifest as pain in the abdomen, vomiting, constipation and flatulence.
• Reproductive disorders, which may manifest as menstrual irregularities, loss of libido and decreased ejaculation.
• Disorders of the urinary system, which may manifest as enuresis and frequent urination.

Regular use of this drug may lower your immune system and increase your risk of getting infections.

The combination of antidepressants with alcoholic beverages is not allowed. A mixture of Zoloft and alcohol is dangerous, as this greatly enhances the effect of the active components of the drug. This can cause overstimulation of the central nervous system due to the increased production of adrenaline, which increases the likelihood of serious complications. If the patient drinks alcohol while taking Zoloft, this may reduce the effectiveness of the drug. Increasing the dose to achieve the desired effect may increase the risk of heart attack, kidney and liver damage, and poisoning of the body.

There is no lethal dose for this drug, however an overdose of Zoloft is possible when consumed in excess of 13.5 g. Combining medication with alcohol or other drugs may increase the risk of death. The main symptoms of overdose include:

• Convulsive manifestations.
• Trembling of limbs.
• Unreasonable increase in physical activity.
• Rapid heartbeat.
• Vomiting reactions.
• Feeling sleepy.

Sometimes the patient may go into a coma while using the drug. To avoid adverse effects, it is not recommended to combine Zoloft with drugs that stimulate neuronal metabolism. You should also be careful when combining the drug with drugs that suppress the central nervous system.

Treatment

To prevent the development of tolerance to Zoloft, therapy with the use of this drug should be carried out under the strict supervision of a physician. The selection of the dosage and class of medications depends on the medical history, age and severity of the underlying disease of the patient. The treatment regimen should also be corrected only by a qualified specialist. Particular attention should be paid to people who are prone to mental disorders.

Patients taking Zoloft should be constantly monitored and monitored for their health status. The physician must ensure that the drug is taken as recommended and respond immediately to any changes in the patient’s behavior. Zoloft can cause psychological dependence, so it is difficult for patients to resist the urge to take it. This often happens to people who have experienced mental turmoil. The drug helps them feel better, but patients don’t always realize the risks associated with addiction.

To achieve stable remission, not only drug treatment is necessary, but also sessions with a psychotherapist. The doctor can conduct individual and group trainings, using various techniques to identify and eliminate psychological vulnerabilities in the patient. In the classroom, patients understand that there are safer and more effective ways to get positive emotions than simply using drugs.

In addition to the physician, the patient’s family and friends should also support the patient during therapy. Communication can be a good way to take your mind off negative thoughts. If a patient notices sudden changes in mood while taking antidepressants, it is necessary to inform the doctor about this in order to exclude (or confirm) the presence of bipolar disorder through differential diagnosis.

Experts recommend following a few simple rules to prevent possible development of dependence on Zoloft:

• Follow a normal daily routine, sleep at least 7-8 hours a day.
• Tell your doctor about any unpleasant symptoms that occur during treatment.
• Avoid drinking alcohol during therapy, as this may increase the effect of drugs and cause adverse reactions.
• Avoid alcohol and caffeine, increase time spent outdoors.
• To undergo drug treatment under the supervision of a specialist, without changing the regularity of intake and dose size on your own.
• Adjust your diet to include kale, spinach, sea fish and walnuts, which can help restore mental health.
• Avoid concomitant use of the drug with MAO inhibitors, as this may lead to complications.
• Follow all doctor’s recommendations, including taking a course of psychological studies if necessary.

It should be remembered that antidepressants are not a universal solution for all problems and their prescription must be justified. Following the doctor’s recommendations will help to avoid many problems. If the patient was prescribed Zoloft for prophylaxis after recovery, then the dose reduction should occur gradually and under the supervision of a specialist.

References:

1. Butko, D. Yu., Strelnikov, A. A., Kotelnikova, T. L., Davydov, A. T., & Zagrebelny, I. A. (2007). Clinical use of sertraline and afobazole in patients with comorbid depression and anxiety in the post-stroke period. Psychopharmacology and Biological Narcology, 7(1), 1464-1470.
2. Pankova, O. F. (2020). Modern psychotropic drugs used in psychiatry: a teaching aid. Moscow: FGAOU VO RNIMU im. N. I. Pirogov of the Ministry of Health of Russia.
3. Maksimova, N.