Zoloft and appetite: 12 Zoloft Side Effects – SSRI Uses & Common Interactions To Know
12 Zoloft Side Effects – SSRI Uses & Common Interactions To Know
Remember the original Zoloft commercial? The one where a sad little blob rolled around on screen with a rain cloud hovering over its head?
That commercial first debuted back in 2001, and since then Zoloft, or Sertraline hydrochloride, has become one of the top psychiatric drugs used by American adults, according to one recent study.
“Zoloft is one of the first-line antidepressant medications prescribed for both depression and anxiety, meaning it’s one of the most likely to work,” says Alison Hermann, MD, a clinical psychiatrist at Weill Cornell Medicine and New York-Presbyterian Hospital.
Zoloft is part of a class of drugs called SSRIs, or selective-serotonin reuptake inhibitors. “Their main effect has to do with changing the signaling of one of the main neurotransmitters in the brain, serotonin, which modulates mood,” explains James Murrough, MD, the director of the Mood and Anxiety Disorders Program at the Icahn School of Medicine at Mount Sinai. “These medicines tend to increase the availability of serotonin in the brain, which can help boost your mood.”
And that’s the goal, right?
In general, antidepressants are well tolerated. But, like with all drugs, there are Zoloft side effects—some of which are merely annoying and some of which can actually be dangerous. “I generally start my patients on the lowest milligram pill and have them cut it in half for the few few doses just to make sure you’re tolerating it before bumping it up,” says Dr. Hermann.
So if you’re prescribed Zoloft, here’s what to look out for.
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Changes in Weight or Appetite
People taking Zoloft gained nearly two pounds over the course of a year, according to one study published in the journal JAMA Psychiatry. It’s not the only SSRI linked with weight gain, but if that’s a concern for you, talk to your doctor about your options.
“Interestingly, there’s actually a lot of serotonin in the gastrointestinal tract, so people on Zoloft can experience changes in GI function,” says Dr. Murrough. “That could mean an upset stomach, nausea, or changes in bowel habits like constipation or diarrhea.” Dr. Murrough suggests starting on the lowest possible dose to avoid these issues, then increasing the dosage as your system acclimates to the extra serotonin.
Sexual Side Effects
This is one of those side effects no one wants to talk about, but it can affect at least a third of patients on SSRIs, says Dr. Murrough. “We don’t know why drugs like Zoloft have sexual side effects, but people can experience things like difficulty orgasming, a lack of sex drive, or the inability to get or maintain an erection. ” For some people, the benefits of the medicine will outweigh the negative effects on their sex life; for others, a change in medication may be necessary.
Another one of the more common Zoloft side effects is called akathisia. “It’s like feeling amped up or restless, like you need to move, or like you’re unable to calm down,” explains Dr. Hermann. In some cases, akathisia can even feel like a panic attack. But akathisia can be mitigated by starting on a really low dose and slowly working your way up, she adds.
Mood or Behavior Changes
Obviously, you want your mood to change while taking an antidepressant or anti-anxiety drug. “But the mood or behavior change that we’re most worried about as mental health professionals is increased depression or suicidal thoughts or a switch from depression to mania,” says Dr. Hermann. “Any antidepressant intervention has the potential to flip someone who’s vulnerable, who has bipolar disorder rather than depression, into a mania, which is why it’s so important to make sure you have the right diagnosis before starting medication. ”
“Nighttime sweating is a common side effects of SSRIs, and Zoloft is one of the drugs where it’s more common,” says Dr. Hermann. “It’s not dangerous at all, provided that the person is seeing an internist regularly and has had a physical exam and lab work within the year to indicate there’s nothing else responsible for it.” It is uncomfortable, though, so Hermann recommends wearing sweat-wicking materials to bed and keeping your bedroom cool enough at night.
“This is a catch-all term for what happens when there’s too much serotonin in the body,” says Dr. Murrough. “It affects your blood pressure, can cause severe GI symptoms, and can even lead to confusion, fevers, and seizures—in extreme cases, it’s life-threatening.”
The risk is very low for people who are just taking one medication, but if someone is on several medications that affect serotonin levels, the risk level rises. “Sometimes, people describe this as a bad flu—so on the off chance that happens, call your doctor right away,” says Dr. Murrough. “The treatment is to simply stop the medication.”
In most cases, antidepressants and anti-anxiety meds help people sleep better. But, occasionally, “people report unusual dreams, restlessness during sleep, or feeling like their sleep is altered in some way,” says Dr. Hermann.
This is a potential risk of taking something that affects your brain, says Dr. Hermann, and if it’s disruptive enough to your life, your doctor might try you on a different drug.
Sometimes people can develop rashes or increased skin sensitivity while taking Zoloft, says Naema Qureshi, MD, a psychiatrist at Brooklyn Minds. It’ll usually go away on its own, and you can find relief in the mean time with an over-the-counter anti-itch cream.
“However, if you show signs of an allergic reaction, such as hives, itchiness, or throat swelling shortly after you start Zoloft, you should stop taking it and report these symptoms to your doctor immediately,” says Dr. Qureshi.
Headaches are common when you first start taking Zoloft, or when you increase the dose, says Dr. Qureshi.
“For most people, headaches go away after a week or two as your body adjusts to the medication,” she explains. “If you experience occasional headaches while starting the medication, you can try common over-the-counter pain relievers such as Tylenol.”
If your headaches are persistent, Dr. Qureshi recommends talking to your doctor, as it’s possible you may tolerate a different medication better.
Dry mouth is another common side effect of Zoloft which can sometimes persist, says Dr. Qureshi.
“It’s important to pay attention to dry mouth because it can increase your risk of cavities and other oral issues,” she says. “In addition to maintaining good oral hygiene and hydration, you could consider trying a toothpaste or mouthwash specifically designed for dry mouth.”
Rare Side Effects
While most people tolerate Zoloft well, patients can experience rare but serious side effects such as vision changes, seizures, confusion, and dizziness while taking it, says Dr. Qureshi. Talk to your doc about any underlying conditions you have before you start any new meds, how Zoloft might interact with anything you’re already taking, and seek immediate help if you start experiencing any of these uncommon side effects.
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How Different Antidepressants Affect Appetite
Being advised to try antidepressants by a doctor, but uncertain about which one might be right for you? You’re not alone. After all, there’s a big range on the market — and they’re often prescribed for things other than depression, from sleep problems to trying to quit smoking, so you may be given the choice of an antidepressant for an issue that doesn’t even have to do with mood. One of the most interesting side affects of taking antidepressants, though, has to do with appetite — our neurological craving for food, essentially — and how different antidepressants affect your appetite in different ways. It turns out that your choice of antidepressant can alter your appetite radically, either through increase or depletion.
Appetite isn’t just “tummy rumbles” — that’s a symptom, not the essence of hunger. In 2014, a Harvard team actually tracked down the specific parts of the brain that send signals about food cravings, a discovery that could lead to revolutionary treatments of obesity and diseases that involve uncontrollable appetite, like Prader-Willi Syndrome. Understanding the brain-based nature of hunger is key to sorting out which antidepressant does what to your appetite.
A note: antidepressants should never be prescribed or obtained purely for weight loss, except in the case of severe obesity. These are not magic pills for keeping off the pounds or putting them on, so don’t view them as potential dietary supplements, or choose an antidepressant based on this factor alone. These are powerful neurological agents — which is why you need as much information about them as possible.
SSRIs, or selective serotonin re-uptake inhibitors like Zoloft, function by blocking the absorption of the neurotransmitter serotonin into the brain’s cells, allowing it to flood the brain — and, the science goes, raise mood. But this serotonin flood looks like it also has an affect on appetite — though it’s not the same for everybody, or indeed for most people who take it.
One of the first side affects of SSRIs is actually a temporary loss of appetite, but consistent use is linked to increased appetite and a corresponding small weight gain. The average weight gain of people on SSRIs, according to a JAMA Psychiatry study, rarely goes above two and a half pounds. But the phenomenon is a recognized one — and scientists think that some of that weight gain can be explained by better mood, which can naturally lead to something called “social eating” (going out with friends for dinner, for example, is more likely if you’re not feeling depressed). But there’s also another component, and it has to do with how that serotonin flood affects our brain.
The key thing to understand about serotonin is that it actually affects the part of the brain that controls appetite. Large, natural amounts of it have actually been linked to appetite suppression, but the artificial serotonin fiddling done by SSRIs seems to disrupt how the neurotransmitter interacts with the brain’s appetite-bits. The result? Serotonin’s natural appetite-suppressing qualities are dampened, and we end up with more hunger.
Wellbutrin, or bupropion, is an example of an atypical depressant, falling outside the normal lines of the industry. It’s unique because it doesn’t focus on serotonin levels. Instead, it stops the brain’s re-uptake of norepinephrine and dopamine. And that combination seems to turn it in the opposite direction to SSRIs when it comes to appetite.
Norepinephrine is, like serotonin, a hormone that works in the brain, but it’s more focused on stress reactions. If you need to react to something quickly because it’s a threat, norepinephrine will be right on it. And it turns out that bupropion’s interaction with that hormone, and possibly its interaction with dopamine too, does the opposite of SSRIs: it dampens appetite, so much so that Wellbutrin is sometimes prescribed as an appetite suppressant for the severely obese.
Norepinephrine’s appetite-suppressing nature has been known for a while. It’s one of the brain’s signals of satiety, or “fullness,” and also seems to help keep metabolisms ticking over at healthy high rates. Stanford found that up to 28 percent of people who take bupropion had what they describe as a “significant” weight loss — which means over five pounds.
SNRIs like Cymbalta and Effexor try to have the best of both worlds: they disrupt the brain’s re-uptake of both serotonin and norepineprhine. Interestingly, however, they often seem to fall into the same pattern as SSRIs, with up to 29.6 percent of patients experiencing weight gain while on an SNRI, according to the Journal of Pharmacology.
One of the possible explanations for this, and for all weight gain on anti-depressants, may be a side affect of a better mood: a 2006 study at the University of Bristol found that antidepressants actually improved the sense of taste in depressed people, who’d formerly been less sensitive to bitter, sweet and sour tastes. So it’s theorized that antidepressant taste boosts, plus the artificial influence on cravings, may contribute to a greater appetite and more weight gain.
Tricyclics are one of the earlier discoveries in the antidepressant field, and are less prescribed than SSRIs or SNRIs, but they’re still popular in their own way, and are often used for treating things other than depression, like ADHD. They’re very similar to SNRIs, but they have a few differences: tricyclics have a different chemical structure, which means that they interact with the neurology of the brain differently — they effect more of the brain’s neurotransmitters, and are associated with more nasty side affects.
Studies of tricyclic antidepressants have shown that, like SNRIs, they’re also linked to increased appetite, lowered metabolism, and weight gain, and that, depressingly, gaining too much weight is one of the most common reasons that people demand to change prescriptions or stop taking the medication altogether.
These are the dinosaurs of the anti-depressant world, and they’re exceptionally powerful. They’re the last resort, and are very rarely prescribed nowadays, because they do some pretty drastic things to the brain’s neurotransmitters. It’s pretty common lore in depression studies that, for all their blunt-force action, they’re actually less likely to cause weight gain than tricyclics or SNRIs — but we’re not sure exactly why, or what it does to appetite.
One possible, and slightly upsetting, reason is that MAOI antidepressants are commonly associated with severe nausea — which obviously is a serious appetite suppressant. It likely also damages the brain’s hormonal ability to listen to hormonal messages about appetite.
The Bottom Line
While a medication might sometimes cause a certain side-effect with appetite, there are often counter-cases where it does the precise opposite, because the balance of neurotransmitters in the brain is a highly individual thing. You never truly know how your body will react — which is why you shouldn’t make a decision about which anti-depressant to take based on its potential influence on your appetite alone.
Images: Charlie Brown, Draconian Rain, E-Magine Art, Thomas Thomas, Sean Winters/Flickr
Antidepressants and Weight Gain
Many individuals have the experience of weight gain while receiving treatment with an antidepressant, and often wonder if selective serotonin reuptake inhibitors (SSRIs) are associated with weight gain. This is an excellent, complex, and clinically important question.
Depression, anxiety, appetite, and weight: There is a relationship between appetite and depression, with changes in appetite representing a core symptom of major depressive disorder. Many individuals with anxiety disorders also note appetite changes when their anxiety symptoms are not well controlled. Some individuals lose weight when they are experiencing depression or anxiety, and some notice increased appetite and weight gain. Therefore, at the time of starting an antidepressant, some individuals may be at either a lower or higher weight than they would be at in the absence of a mood or anxiety disorder.
Drugs with known weight gain: Some medications used commonly in psychiatry have well established side effects of weight changes. For example, valproic acid, some of the atypical antipsychotic medications, lithium, the antidepressant mirtazapine (Remeron), and tricyclic antidepressants are associated with weight gain. There has been little systematic long-term data regarding weight effects of SSRI antidepressants (which include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and fluvoxamine (Luvox), and the SNRIs venlafaxine (Effexor) and duloxetine (Cymbalta), although some studies suggest weight gain may occur and may vary by gender, specific medication, and other patient variables. Bupropion (Wellbutrin) is usually considered weight neutral.
Whether or not a study was short- or long-term – or clinically how long a patient has been on a medication – may influence the likelihood of weight changes. A recent meta-analysis assessed studies with available data (Serretti and Mandelli, 2010). In acute studies (4-12 weeks duration), most SSRIs, SNRIs, and bupropion have been associated with weight loss. In longer term studies (longer than four months), most antidepressant medications with available data did not have significantly associated weight gain, and the most was seen with paroxetine and the older antidepressant amitriptyline (mean weight gain about 5-6 lbs). Only bupropion was associated with significant weight loss (about 4 lbs).
SSRIs: Data that inform risk of weight gain and how specific medications compare to each other
There have been a few studies to provide head-to-head comparisons of weight gain amongst those treated with specific SSRIs. For example, Fava and colleages (2000) completed a study in which patients with major depression were randomly assigned to either fluoxetine, sertraline, or paroxetine. Only those that completed the 26-32 week trial were included in the final analysis of weight gain. Those who received paroxetine experienced a statistically significant weight gain from baseline to end point. Those who received fluoxetine had a trend for weight loss (not statistically significant), and those who received sertraline had a trend for moderate weight gain (not statistically significant).
Those that received paroxetine were also significantly more likely than those who received fluoxetine or sertraline to gain >7% of their original body weight, the threshold used in many studies to indicate clinically important weight gain. Mean percent changes in weight from the beginning of the study to the end were: 0.2% weight loss with fluoxetine, 1% weight gain with sertraline, and 3.6% weight increase with paroxetine. Therefore, if the typical participant weighted 150 lbs, the weight gain would be about 5.4 lbs with paroxetine and 1.5 lbs with sertraline, and the weight loss would be less than 1 pound with fluoxetine. While these are overall modest differences from the baseline weights, they are means, so some individual patients could certainly have had very different experiences than the mean.
In another study (Maina 2004), researchers assessed patients in an anxiety disorder clinic for weight changes with the tricyclic antidepressant clomipramine or SSRIs over a 2.5 year period. The group included 138 patients with obsessive compulsive disorder. They were not randomly assigned to medication. On average, the patients as a group gained 2.5% of their baseline weight (1.58 kg or 3.5 pounds over 2.5 years of treatment). 14.5% of the sample gained >7% of their initial body weight. For all medications except fluoxetine, which did not have significant weight gain, the others (clomipramine, citalopram, fluvoxamine, paroxetine, and sertraline) were associated with statistically significant weight gain over the 2.5 year duration of study. Clomipramine had the greatest percentile of patients who gained >7% of body weight, while fluoxetine and sertraline had the lowest. Women were more likely to gain weight than men.
Wisner and colleagues (2005) specifically looked at the weight impact of treatment with nortriptyline, sertraline, or placebo in women with histories of postpartum depression (PPD) who took medication after childbirth to prevent having PPD again. Mean weights after 17 weeks of treatment were not significantly different between the treatment groups. On average, women lost about 1.8 pounds over the course of the study. Because the study was a depression prevention study, women were not experiencing depression at the time of study entry, so the treatment of depressive symptoms would not be a driving factor for weight change.
The Bottom Line
Antidepressant medications can potentially contribute to weight gain, and certain antidepressants may carry a higher risk. Specifically among SSRIs, from these studies data suggest paroxetine carries the highest risk of weight gain and fluoxetine the lowest risk in the class. Additionally, recovery from depression and anxiety disorders may also contribute to increased appetite and weight. Not everyone will experience the same benefits or side effects to specific drugs. If over time, weight gain occurs and it appears that the antidepressant appear to be a major contributor to weight gain, one might consider switching to another medication or non-pharmacologic treatments.
Marlene Freeman, MD
Serretti A & Mandelli L. Antidepressants and Body Weight: A Comprehensive Review and Meta-Analysis. J Clin Psychiatry 2010;71(10):1259–1272.
Wisner et al. Weight changes in postpartum women with remitted depression. J Clin Psychiatry. 2005; 66(3):291-3.
Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000; 61(11):863-7.
Maina G, Albert U, Salvi V, Bogetto F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry. 2004; 65(10):1365-71.
Are there antidepressants that don’t cause weight gain?
Antidepressants might work to help ease the symptoms of depression, but a new study published in The BMJ found that one not-so-wanted side effect of antidepressants is weight gain.
“Patients who were normal weight were more likely to transition to overweight, and overweight patients were more likely to transition to obesity if they were treated with antidepressants,” study co-author Rafael Gafoor, a primary care and public health researcher at King’s College London, told Time.
Antidepressants and weight gain
For the study, Gafoor and his team evaluated 295,000 health records taken from the U.K. Clinical Practice Research Datalink. They monitored the records over 10 years and found that those who started taking antidepressants during the first year of the study were 21 percent more likely to gain at least 5 percent of their starting body weight than those who didn’t take the drugs — and most of that weight gain came in the second or third year of the study.
According to the study, people who took citalopram (brand name Celexa) or mirtazapine (Remeron) were more likely to gain weight. Though mirtazapine is not widely prescribed anymore, citalopram is — and it was associated with a 26 percent higher risk of weight gain.
The problem is figuring out the connection between antidepressants and weight gain.
“It is possible that the actually antidepressants may cause metabolic changes that result in some minor weight gain,” psychiatrist Dr. Alex Dimitriu told Metro. “This may occur by boosting our appetite (especially for carbs), or by altering our metabolism — how our body handles the foods we consume.”
A previous study suggested that antidepressant medication — including mirtazapine and paroxetine hydrochloride (Paxil) — might affect serotonin, a neurotransmitter that, in part, helps control appetite.
“Paroxetine (Paxil) and Mirtazapine (Remeron) are well known to cause weight gain in users,” added Dr. Dimitriu. “In my experience, patients on these [antidepressants] actually report increased hunger and carb cravings.”
Are there antidepressants that don’t cause weight gain?
“Venlafaxine (an SNRI) and sertraline (Zoloft) have been associated with less weight gain than others in the group,” said Dr. Dimitriu. “A newer antidepressant, vortioxetine (Trintellix) may also have less weight gain risk.”
Bupropion (Wellbutrin), amitriptyline (Elavil), and nortriptyline (Pamelor) are also shown to have less of an impact on weight.
Choosing — or asking your doctor — for specific antidepressants that don’t cause weight gain isn’t necessarily the answer, though.
“I prioritize treating the mood and anxiety symptoms first and foremost,” Dr. Dimitriu told Metro.
Exercise and monitoring of what foods we eat can help keep weight gain at bay, even on antidepressants, he added. “Adequate sleep also plays a major role in our metabolism, with evidence that sleep deprivation can also cause weight gain and especially carb craving,” he said.
“Once we get someone better, we can always make changes to dose or even a different medication. But the goal is to get the person better as fast as possible.”
Sertraline (Oral Route) Side Effects
Drug information provided by: IBM Micromedex
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Decreased sexual desire or ability
failure to discharge semen (in men)
Less common or rare
breast tenderness or enlargement
dryness of the mouth
fast talking and excited feelings or actions that are out of control
inability to sit still
increase in body movements
lack of energy
loss of bladder control
mood or behavior changes
muscle spasm or jerking of all extremities
red or purple spots on the skin
skin rash, hives, or itching
sudden loss of consciousness
unusual or sudden body or facial movements or postures
unusual secretion of milk (in females)
Incidence not known
Abdominal or stomach pain
blistering, peeling, or loosening of the skin
blood in the urine
bloody, black, or tarry stools
blue-yellow color blindness
chest pain or discomfort
cough or hoarseness
decreased urine output
difficulty with breathing
difficulty with speaking
difficulty with swallowing
dry skin and hair
feeling of discomfort
feeling, seeing, or hearing things that are not there
general feeling of discomfort, illness, tiredness, or weakness
high or low blood pressure
hoarseness or husky voice
increased clotting times
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of balance control
loss of bladder control
lower back or side pain
muscle cramps and stiffness
muscle trembling, jerking, or stiffness
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid weight gain
red, irritated eyes
red, sore, or itching skin
right upper stomach pain and fullness
severe mood or mental changes
severe muscle stiffness
sores, ulcers, or white spots in the mouth or on the lips
sores, welting, or blisters
stiffness of the limbs
swelling of the face, ankles, or hands
swollen or painful glands
talking or acting with excitement you cannot control
tightness in the chest
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
unexplained bleeding or bruising
unpleasant breath odor
unusual tiredness or weakness
vomiting of blood
yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Acid or sour stomach
decreased appetite or weight loss
diarrhea or loose stools
sleepiness or unusual drowsiness
stomach or abdominal cramps, gas, or pain
Agitation, anxiety, or nervousness
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
changes in vision
difficult, burning, or painful urination
flushing or redness of the skin, with feeling of warmth or heat
frequent urge to urinate
pain or tenderness around the eyes and cheekbones
stuffy or runny nose
Incidence not known
Flushed, dry skin
fruit-like breath odor
redness or other discoloration of the skin
swelling of the breasts (in women)
unexplained weight loss
unusual secretion of milk (in women)
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: May 01, 2021
Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.
Sertraline (Zoloft) | NAMI: National Alliance on Mental Illness
Brand name: Zoloft®
- Tablets: 25 mg, 50 mg, 100 mg
- Liquid: 20 mg/mL
Generic name: sertraline (SER tra leen)
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
What Is Sertraline And What Does It Treat?
Sertraline is an antidepressant medication that works in the brain. It is approved for the treatment of major depressive disorder (MDD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder, and social anxiety disorder. It is also approved to treat obsessive-compulsive disorder (OCD) in adults, children and adolescents aged 6-17 years.
Symptoms of depression include:
- Depressed mood – feeling sad, empty, or tearful
- Feeling worthless, guilty, hopeless, and helpless
- Loss of interest or pleasure in your usual activities
- Sleep and eat more or less than usual (for most people it is less)
- Low energy, trouble concentrating, or thoughts of death (suicidal thinking)
- Psychomotor agitation (‘nervous energy’)
- Psychomotor retardation (feeling like you are moving and thinking in slow motion)
- Suicidal thoughts or behaviors
PTSD occurs when a person experiences a traumatic event (e.g., assault, combat experience) and then later feels on edge; avoids situations that remind them of the event; and experiences flashbacks or nightmares.
PMDD is a condition where a woman experiences depression, tension, and irritability for a few days prior to menstruation that end when menstruation begins. These symptoms are more severe than those of premenstrual syndrome (PMS).
Panic Disorder occurs when a person experiences unexpected and repeated episodes of intense fear. These episodes have physical symptoms including chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea. Fear of future episodes is also part of panic disorder.
Obsessive Compulsive Disorder (OCD) occurs when a person experiences the following symptoms at the same time:
- Obsessions (unwanted, recurrent, and disturbing thoughts)
- Compulsions (repetitive, ritualized behaviors that the person feels driven to perform in order to lessen the anxiety produced by the obsessions)
Social phobia/social anxiety disorder is a fear of situations where one may feel as if they are being judged by others. Symptoms include:
- Difficulty talking
Sertraline may also be helpful when prescribed “off-label” for binge-eating disorder, bulimia nervosa, and generalized anxiety disorder (GAD). “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending any “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.
What Is The Most Important Information I Should Know About Sertraline?
Do not stop taking sertraline, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine.
Missing doses of sertraline may increase your risk for relapse in your symptoms.
Stopping sertraline abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).
Depression is also a part of bipolar illness. People with bipolar disorder who take antidepressants may be at risk for “switching” from depression into mania. Symptoms of mania include “high” or irritable mood, very high self-esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).
Medical attention should be sought if serotonin syndrome is suspected. Please refer to serious side effects for signs/symptoms.
Are There Specific Concerns About Sertraline And Pregnancy?
If you are planning on becoming pregnant, notify your health care provider to best manage your medications. People living with MDD who wish to become pregnant face important decisions. Untreated MDD has risks to the fetus, as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers. For women who take antidepressant medications during weeks 13 through the end of their pregnancy (second and third trimesters), there is a risk that the baby can be born before it is fully developed (before 37 weeks).
For mothers who have taken SSRIs during their pregnancy, there appears to be less than a 1% chance of infants developing persistent pulmonary hypertension. This is a potentially fatal condition that is associated with use of the antidepressant in the second half of pregnancy. However, women who discontinued antidepressant therapy were five times more likely to have a depression relapse than those who continued their antidepressant. If you are pregnant, please discuss the risks and benefits of antidepressant use with your health care provider.
Caution is advised with breastfeeding since sertraline does pass into breast milk.
What Should I Discuss With My Health Care Provider Before Taking Sertraline?
- Symptoms of your condition that bother you the most
- If you have thoughts of suicide or harming yourself
- Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects
- If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.
- Any other psychiatric or medical problems you have, including a history of bipolar disorder
- All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have
- Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breastfeeding
- If you drink alcohol or use drugs
How Should I Take Sertraline?
Sertraline is usually taken one time per day with or without food.
Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
The dose usually ranges from 50 mg to 200 mg. Only your health care provider can determine the correct dose for you.
If you are taking it for PMDD, sertraline can be taken once daily (everyday) or intermittently (usually starting 14 days prior to menstruation through the first full day of menses of each cycle).
The liquid should be measured with an oral syringe or dropper which you can get from your pharmacy. It should be added to 4 ounces of water, ginger ale, lemon/lime soda, lemonade, or orange juice immediately prior to taking the medication. It should not be mixed in advance.
Consider using a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member or friend to remind you or check in with you to be sure you are taking your medication.
What Happens If I Miss A Dose Of Sertraline?
If you miss a dose of sertraline, take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.
What Should I Avoid While Taking Sertraline?
Avoid drinking alcohol or using illegal drugs while you are taking antidepressant medications. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.
What Happens If I Overdose With Sertraline?
If an overdose occurs, call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1-800-222-1222.
A specific treatment to reverse the effects of sertraline does not exist.
What Are The Possible Side Effects Of Sertraline?
Common side effects
- Headache, nausea, diarrhea, dry mouth, increased sweating
- Feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia)
These will often improve over the first week or two as you continue to take the medication.
Sexual side effects, such as problems with orgasm or ejaculatory delay often do not diminish over time.
Rare/serious side effects
Low sodium blood levels (symptoms of low sodium levels may include headache, weakness, difficulty concentrating and remembering), teeth grinding, angle closure glaucoma (symptoms of angle closure glaucoma may include eye pain, changes in vision, swelling or redness in or around eye).
Serotonin syndrome (symptoms may include shivering, diarrhea, confusion, severe muscle tightness, fever, seizures, and death), seizure
SSRI antidepressants including sertraline may increase the risk of bleeding events. Combined use of aspirin, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), warfarin, and other anti-coagulants may increase this risk. This may include gums that bleed more easily, nose bleed, or gastrointestinal bleeding. Some cases have been life threatening.
Are There Any Risks For Taking Sertraline For Long Periods Of Time?
To date, there are no known problems associated with long term use of sertraline. It is a safe and effective medication when used as directed.
What Other Medications May Interact With Sertraline?
Sertraline should not be taken with or within two weeks of taking monoamine oxidase inhibitors (MAOIs). These include phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), rasagiline (Azilect®), and selegiline (Emsam®).
Although rare, there is an increased risk of serotonin syndrome when sertraline is used with other medications that increase serotonin, such as other antidepressants, migraine medications called “triptans” (e.g., Imitrex®), some pain medications (e.g., tramadol (Ultram®)), and the antibiotic linezolid (Zyvox®).
Sertraline should not be taken with pimozide (Orap®).
Sertraline may increase the effects of other medications that can cause bleeding (e.g., ibuprofen (Advil®, Motrin®), warfarin (Coumadin®) and aspirin).
Sertraline liquid should NOT be taken in combination with disulfiram (Antabuse®) due to the alcohol content of the concentrate.
How Long Does It Take For Sertraline To Work?
Sleep, energy, or appetite may show some improvement within the first 1-2 weeks. Improvement in these physical symptoms can be an important early signal that the medication is working. Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve.
Summary of FDA Black Box Warnings
Suicidal thoughts or actions in children and adults
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications. This risk may persist until significant remission occurs.
In short-term studies, antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and older taking antidepressants have a decreased risk of suicidality. Patients, their families, and caregivers should be alert to the emergence of anxiety, restlessness, irritability, aggressiveness and insomnia. If these symptoms emerge, they should be reported to the patient’s prescriber or health care professional. All patients being treated with antidepressants for any indication should watch for and notify their health care provider for worsening symptoms, suicidality and unusual changes in behavior, especially during the first few months of treatment.
©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.
This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.
Weight gain differs with various antidepressants
By Ronnie Cohen, Reuters Health
NEW YORK (Reuters Health) – People who take antidepressants tend to put on a few pounds, a new study confirms, and some of the drugs are linked to more weight gain than others.
Using health records from one New England healthcare system, researchers studied 19,244 adults treated with antidepressants, recording their weights over the course of a year.
The results showed that people taking citalopram (Celexa), from a class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, gained more than two and a half pounds, on average.
Other SSRIs were associated with weight gain similar to citalopram, with people taking fluoxetine (Prozac) gaining on average a pound and a half and those taking sertraline (Zoloft) gaining nearly two pounds, the authors write in JAMA Psychiatry.
On the other hand, people taking bupropion (Wellbutrin) lost on average nearly half a pound. The tricyclic antidepressants nortriptyline and amitriptyline were also linked with significantly less weight gain than the SSRIs.
“Our study provides more support for the idea that if weight is a major concern, Wellbutrin is a good option,” senior author Dr. Roy Perlis told Reuters Health. Perlis is a psychiatrist at Harvard Medical School and director of the Center for Experimental Drugs and Diagnostics at Massachusetts General Hospital in Boston.
“There’s no question we see less weight gain with Wellbutrin,” he said. “But in absolute terms, the difference is rather small.”
On average, people taking antidepressants “will gain a very modest amount of weight . . . between half a pound and perhaps two pounds if they stayed on the medicine for about a year,” he said. But some people will gain much more, he said.
About one in 10 Americans takes antidepressants, according to the Centers for Disease Control and Prevention (CDC). Use of the drugs rose 400 percent over the past two decades, making them the most frequent prescription for Americans ages 18 to 44.
At the same time, the obesity rate has swelled, with more than one-third of U.S. adults now considered obese.
“We in practice have long since watched the effect of antidepressants on weight,” Dr. Anne Peters told Reuters Health. “The key to this medicine is don’t overmedicate; don’t use drugs unless there’s a good reason.”
Peters directs the University of Southern California Clinical Diabetes Program in Beverly Hills and was not involved in the current study.
In addition to depression, a substantial percentage of study participants were prescribed antidepressants for anxiety or pain or as an aid to quit smoking. People who take antidepressants for reasons other than depression and are prone to weight gain may want to consider alternatives, Peters said.
“We’ve got to individualize this and not keep people on antidepressants forever,” she said. “People shouldn’t stay on these drugs if they’re contributing to their weight gain and they’re no longer needed.”
On the other hand, she said, “Nobody wants to gain weight, but I sure don’t want to see people depressed.”
More than 60 percent of Americans taking antidepressants have been on them for two years or longer, and 14 percent have taken the drugs for 10 years or more, according to the CDC.
Peters noted that Wellbutrin can agitate anxious people and therefore may be a poor match for some people with depression.
Wellbutrin affects different brain chemicals than do SSRIs, and some of those chemicals may play a role in appetite. Researchers don’t know all the reasons why some antidepressants appear to cause weight gain and others do not, Perlis said.
Some people gain weight and others lose weight as a result of depression. Consequently, researchers have trouble untangling the effects of medication and the effects of depression on weight, Perlis said.
The new study also can’t prove the antidepressants were responsible for weight gain.
“A one-size-fits-all solution isn’t right,” Perlis said. “We desperately need newer, better antidepressants in terms of effectiveness.”
Perlis and one of his co-authors have consulted for and received funding from numerous antidepressant drug manufacturers. But Perlis said all the drugs he studied are now available as generics.
SOURCE: bit.ly/1p2CpwS JAMA Psychiatry, online June 4, 2014.
90,000 media outlets reported on the shortage of a popular antidepressant in Russian pharmacies :: Society :: RBK
Photo: AGN “Moscow”
The antidepressant “Zoloft” is running out in pharmacies, “Pharmaceutical Bulletin” reports.
According to the publication, this drug is difficult to find in online pharmacies in Moscow, Omsk, Nizhny Novgorod, Vladivostok and other cities.
Pharmacy Chain 36.6 confirmed the absence of Zoloft. In turn, Vadim Kopylov, Commercial Director of Pulse, a pharmaceutical distributor, said that the delivery is expected in the coming days.
Pharmacies and doctors report a shortage of a popular antidepressant
“The drug Zoloft (INN sertraline) in the form of tablets at a dosage of 50 mg and 100 mg No. 28 is temporarily out of stock of our company,” the press service of the Viatris company in Russia, which owns the Zoloft brand, reported.
Antidepressant Pfizer Zoloft – reviews
Insomnia !!!!!, depression, depression or, the appearance of a feeling of fear, the state of a zombie, nausea first
It just so happened that after breaking up with my ex, I was attacked by depression, accompanied by tearfulness, irritability, unwillingness to enjoy life, etc. The doctor attributed “zoloft”, an antidepressant or tranquilizer, which was supposed to help my psyche. So, the dosage 100 mg.per day, it was necessary to start with 50 mg, the first 10 days. Then it was supposed to increase the dose to 100 mg.
1 day of taking the drug. 16.00. I drank a pill and went to work, driving, which I later regretted three times … Although the doctor assured that the “happiness” pill did not affect driving a vehicle. After 45-60 minutes I suddenly felt like sleeping, so much so that my eyes involuntarily closed. The first thought was, I didn’t get enough sleep … I fell asleep as soon as I entered the house. I woke up a few hours later, wet from head to toe, I felt chills, my teeth were shaking a little, my heart was beating fast, although I never suffered from tachycardia.
Day 2. The feeling of fear, even in my usual environment, did not leave. Dizziness, an absolute lack of appetite, when thinking about food, a gag reflex. It is impossible to work, I constantly wanted to sleep.
Day 3. There is still no appetite. But realizing that I hadn’t eaten anything for 2 days, I decided to eat yogurt and processed cheese. Once three times it (cheese) ended up somewhere in my throat ((((More on this day I didn’t try to eat. Insomnia. Well, just fantastic. Until 6 in the morning I did not fall asleep for a minute (((Feeling of fear and panic attacks did not go away.
4th day. I took a few days at my own expense, for “I am sick with a terrible disease.” I want to sleep, I count sheep and elephants, I drank green tea, a couple of drops of valerian. I have no sleep. Night falls. I scream at the moon, count the stars. Sweating appears, and with it, for some reason, chills. It is insanely hot, then terrible cold, like it’s January outside.
5th day. Allergy. Redness of the cheeks, tooth (thank God. Not strong) milli on the cheeks and on the forehead. I endure, I bought a cream for acne. Night falls, I no longer howl at the moon, but I buy “Sonex” (about it a little later ).
6th day. People around are monsters, everything is annoying, I want to kill at least someone, preferably slowly and painfully. Night. My friend is now “Sonex”)
7 day. Minus 4 pounds on the scales. Minus 4 cm in the waist and the same amount in the hips.
Day 8. Thanks to “Sonex” and the opportunity at least to help the body sleep, I decide to resume training in the gym after a week’s break. Weakness, slight drowsiness. I constantly yawn, every 5-7 minutes. I crawl into the gym and lo and behold! ! I can do anything! I could lift 10-15 kilos more than a week ago before “Zoloft”.I don’t get tired! 2 hours flew by like an instant! I lost a few sweats! The first time in a year of playing sports, I regretted it. that she did not take a hairdryer with her, since she literally squeezed her hair (long) after class.
The remaining 12 days of my torment I ate “Sonex” because of the inability to sleep without it, cottage cheese (which did not make me sick), yoghurt and water. cancellation), milliums on my face and allergies that made my face look like … Damn, it definitely looked like something).
My life after cancellation. After 7-10 days, pimples disappeared, sleep returned without sleeping pills on the 9th day, the feeling of fear passed on the 4-5th day, appetite returned on the 2nd day, sweating and terrible heartbeat stopped by 3-5 days.
I do not know if the following that I will write can be called the advantages of the drug, but !!!: the antidepressant “Zoloft”, which with a clear conscience can be called “Depressant”, is a tremendous means for losing weight. It completely kills appetite, increases physical endurance. loads.And second, I forgot to think about the former, “hooked” on this permitted “LSD”. No wonder they say: if you want to forget about all your problems, buy shoes 2 sizes smaller. My “shoes” kind of did the trick.
“Zoloft” I do not recommend. Although someone is delighted with it. But who?
Zoloft tab. p / pl. about. 50mg No. 14 – instructions for use, description, contraindications, side effects, overdose, composition
Simultaneous use of sertraline and the following drugs is contraindicated
Irreversible MAO inhibitors (e.g. selegiline)
Sertraline should not be used concomitantly with irreversible (non-selective) MAO inhibitors such as selegiline.Sertraline should not be used for at least 14 days after discontinuation of irreversible (non-selective) MAO inhibitors. You should stop taking sertraline at least 7 days before starting therapy with irreversible (non-selective) MAO inhibitors.
Reversible selective MAO-A inhibitors (moclobemide)
Due to the risk of developing serotonin syndrome, it is not recommended to take simultaneously reversible selective MAO inhibitors, such as moclobemide, and sertraline. After the use of reversible MAO inhibitors, a period shorter than 14 days can be maintained before starting sertraline.Sertraline should be discontinued at least 7 days before starting therapy with irreversible (non-selective) MAO inhibitors.
Reversible non-selective MAO inhibitors (linezolid and methylene blue)
The antibiotic linezolid is a weak, reversible, non-selective MAO inhibitor. It should not be used in patients receiving sertraline therapy.
Severe adverse reactions have been reported in patients who recently discontinued MAO inhibitor therapy and started taking sertraline, or who recently stopped taking sertraline and started therapy with MAO inhibitors.These reactions included tremor, myoclonus, diaphoresis, nausea, vomiting, rigidity, “hot flashes” of blood to the skin of the face, dizziness and hyperthermia with symptoms resembling neuroleptic malignant syndrome, lability of the autonomic nervous system (rapid fluctuations in the parameters of the respiratory and cardiovascular systems ), changes in mental status, including increased irritability, pronounced agitation, confusion (which in some cases can turn into a delirious state and coma), convulsions and, in some cases, death.
With the combined use of sertraline (at a dose of 200 mg / day) and pimozide (2 mg once), there was an increase in the concentration of pimozide (approximately 35%), which was not associated with any changes in the ECG. Since the mechanism of this interaction is unknown, and pimozide has a narrow therapeutic index, the simultaneous administration of pimozide and sertraline is contraindicated.
The simultaneous use of sertraline and the following drugs is not recommended
Despite the fact that with the simultaneous use of sertraline at a dose of 200 mg daily and ethanol there was no potentiation of the effect of ethanol, the use of alcoholic beverages and preparations containing ethanol during treatment with sertraline is not recommended.
Medicines that depress the central nervous system
The simultaneous use of sertraline and substances that depress the central nervous system requires close attention. Potentiation of the effect with the simultaneous use of sertraline at a dose of 200 mg daily and carbamazepine, haloperidol or phenytoin on cognitive and psychomotor function in healthy people was not observed.
Drugs affecting serotonergic transmission
Caution must be exercised when using sertraline with other drugs that enhance serotonergic neurotransmission, such as tryptophan, fenfluramine, 5HT agonists, tramadol or St. John’s wort.Such joint use, if possible, should be excluded, given the likelihood of pharmacodynamic interactions.
Care should also be taken with the concomitant use of fentanyl, other serotonergic drugs (including serotonergic antidepressants, triptans), other opioids and sertraline.
The simultaneous use of sertraline and the following drugs should be carried out with caution
Pharmacokinetics of lithium does not change when used simultaneously with sertraline.However, an increase in tremor was noted, which may indicate a possible pharmacodynamic interaction. With the simultaneous use of sertraline with lithium preparations, patients should be constantly monitored, as well as the concentration of lithium in the blood plasma should be monitored in order to adjust the dose of the drug.
Long-term use of sertraline at a dose of 200 mg / day does not have a clinically significant effect on phenytoin metabolism. There are isolated reports of an increase in the concentration of phenytoin while using it with sertraline.In this regard, it is recommended to carefully monitor the concentration of phenytoin in the blood plasma (especially in patients with concomitant diseases or at the same time receiving other therapy) from the moment of administration of sertraline with an appropriate adjustment of the dose of phenytoin. In addition, phenytoin can reduce the concentration of sertraline in blood plasma.
It is also impossible to exclude the ability of other inducers of the CYP3A4 isoenzyme (for example, phenobarbital, carbamazepine, St. John’s wort, rifampicin) to reduce the concentration of sertraline in blood plasma.
There are rare cases of weakness, increased tendon reflexes, impaired coordination of movements, confusion, anxiety and agitation in patients simultaneously taking sertraline and sumatriptan. Symptoms of serotonin syndrome can also occur with the simultaneous use of sertraline with other drugs of the same class (triptans). If necessary, the simultaneous use of sertraline and triptans is recommended to monitor patients.
Indirect anticoagulants (warfarin)
With the simultaneous use of indirect anticoagulants with sertraline (at a dose of 200 mg / day), there is a slight, but statistically significant increase in prothrombin time (see the section “Special instructions”), which in some cases can lead to an imbalance in INR values. In this regard, prothrombin time should be carefully monitored during the period of initiation of sertraline therapy and during the period of drug withdrawal.
With the simultaneous use of sertraline does not change the beta-blocking action of atenolol.
Glibenclamide and digoxin
With the introduction of sertraline in a daily dose of 200 mg, drug interactions with these drugs have not been identified.
Simultaneous use significantly reduces the clearance of sertraline.
Drugs affecting platelet function
With the simultaneous use of SSRIs, including sertraline, and drugs that affect platelet function (for example, NSAIDs, acetylsalicylic acid and ticlopidine) or drugs that may increase the risk of bleeding, there may be an increased risk of bleeding.
Drugs that increase the QT interval c
With the simultaneous use of sertraline and drugs that increase the QT interval from , the risk of lengthening the QT interval from and the development of arrhythmias of the ventricular tachysystolic type “pirouette” increases.
Sertraline binds to blood plasma proteins. Therefore, it is necessary to take into account the possibility of its interaction with other drugs that bind to proteins (for example, diazepam, tolbutamide and warfarin), although no interaction was noted in the studies conducted.
Medicines metabolized by the isoenzyme CYP2D6
Long-term treatment with sertraline at a dose of 50 mg / day increases (on average by 23-37%) the equilibrium plasma concentration of desipramine (a marker of CYP2D6 isoenzyme activity). A clinically significant interaction is also noted with simultaneous use with drugs with a narrow therapeutic index, in the metabolism of which the CYP2D6 isoenzyme participates (tricyclic antidepressants, typical antipsychotics, antiarrhythmic drugs of the IC class – propafenone, flecainide) (see.section “Special instructions”).
Medicines metabolized by other cytochrome P450 isoenzymes (CYP3A3 / 4, CYP2C9, CYP2C19, CYP1A2)
Sertraline does not clinically significantly inhibit the isoenzymes CYP3A4, CYP2C9, CYP2C19 and CYP1A2.
CYP3A3 / 4 isozyme
It was shown in vitro that with long-term simultaneous use at a dose of 200 mg / day, sertraline does not inhibit the metabolism of carbamazepine, terfenadine, as well as the beta-hydroxylation of endogenous cortisol, carried out by the isoenzyme CYP3A3 / 4.In addition, sertraline at a dose of 50 mg / day does not inhibit the metabolism of alprazolam.
It has been found that taking three glasses of grapefruit juice daily increases plasma sertraline concentration by approximately 100%. Therefore, concomitant use of sertraline and grapefruit juice should be avoided.
Based on studies of the interaction of sertraline and grapefruit juice, it cannot be excluded that the simultaneous use of sertraline and powerful inhibitors of the isoenzyme CYP3A4 (for example, protease inhibitors, ketoconazole, itraconazole, pos
29 reviews, instructions for use
Application during pregnancy and lactation
There are no controlled results of the use of sertraline in pregnant women, therefore, it is possible to prescribe Zoloft ® during pregnancy only if the expected benefit to the mother outweighs the potential risk to the fetus.
Women of reproductive age should use effective contraception during treatment with sertraline.
Sertraline is found in breast milk, and therefore the use of Zoloft ® during lactation is not recommended. In this case, there is no reliable data on the safety of its use. If the appointment of the drug is necessary, then breastfeeding should be discontinued.
In the case of the use of sertraline during pregnancy and during breastfeeding, some newborns whose mothers took antidepressants from the group of selective serotonin reuptake inhibitors, including serotonin, may experience symptoms similar to the reaction to drug withdrawal.
Application for violations of liver function
The drug should be used with caution in patients with liver disease. In patients with hepatic impairment, lower doses should be used or the interval between doses of the drug should be increased.
The drug should be prescribed with caution in liver failure.
Application for impaired renal function
Given the insignificant renal excretion of sertraline, its dose adjustment depending on the severity of renal failure is not required.
The drug should be prescribed with caution in renal failure.
Use in children
The use of the drug is contraindicated in children under 6 years of age.
In children and adolescents aged 13-17 years with OCD, treatment with Zoloft ® should be started with a dose of 50 mg / day. In children aged 6-12 years, OCD therapy begins with a dose of 25 mg / day, after 1 week it is increased to 50 mg / day. Subsequently, if the effect is insufficient, the dose can be increased in steps of 50 mg / day to 200 mg / day as needed.To avoid overdose, when the dose is increased over 50 mg, it is necessary to take into account the lower body weight in children compared to adults. The dose should be changed at intervals of at least 1 week.
Use in elderly patients
In elderly patients, the drug is used in the same doses as in younger patients.
Sertraline should not be administered in conjunction with MAO inhibitors, as well as within 14 days after stopping treatment with MAO inhibitors.Similarly, after discontinuation of sertraline, MAO inhibitors are not prescribed for 14 days.
Serotonin syndrome and neuroleptic malignant syndrome
When using selective serotonin reuptake inhibitors (SSRIs), cases of serotonin syndrome and neuroleptic malignant syndrome (NMS) have been described, the risk of which increases when SSRIs are combined with other serotonergic triptans (including ), as well as drugs that affect the metabolism of serotonin (incl.including MAO inhibitors), antipsychotics and other antagonists of dopamine receptors. Manifestations of serotonin syndrome can be changes in mental status (in particular, agitation, hallucinations, coma), autonomic lability (tachycardia, fluctuations in blood pressure, hyperthermia), changes in neuromuscular transmission (hyperreflexia, impaired coordination of movements) and / or disorders of the gastrointestinal tract ( nausea, vomiting and diarrhea). Some manifestations of serotonin syndrome, incl. hyperthermia, muscle stiffness, autonomic lability with the possibility of rapid fluctuations in the parameters of vital functions, as well as changes in mental status, may resemble the symptoms that develop with NNS.It is necessary to monitor patients for the development of clinical manifestations of serotonin syndrome and NNS.
Other serotonergic drugs
Care must be taken when concomitant administration of sertraline with other drugs that enhance serotonergic neurotransmission, such as tryptophan, fenfluramine or 5-HT agonists. If possible, such a joint appointment should be excluded, given the likelihood of pharmacodynamic interaction.
Switching from other SSRIs, antidepressants or antiobsessive drugs
Experience in clinical trials aimed at determining the optimal time needed to transfer patients from other antidepressant and antiobsessive drugs to sertraline is limited.Care must be taken with this transition, especially with long-acting drugs such as fluoxetine. The required interval between the cancellation of one SSRI and the start of taking another similar drug has not been established. It should be noted that in patients undergoing electroconvulsive therapy, there is no sufficient experience with the use of sertraline.
The possible success or risk of this combination therapy has not been studied. There is no experience with the use of sertraline in patients with convulsive syndrome, therefore, its use in patients with unstable epilepsy should be avoided, and patients with controlled epilepsy should be carefully monitored during treatment.If seizures appear, the drug should be discontinued.
Patients with depression are at risk for suicide attempts. This danger persists until remission develops. Therefore, from the beginning of treatment and until the optimal clinical effect is achieved, constant medical supervision should be established for patients.
Activation of mania / hypomania
In clinical studies prior to the introduction of sertraline on the market, hypomania and mania were observed in approximately 0.4% of patients receiving sertraline.Cases of activation of mania / hypomania have also been described in a small proportion of patients with manic-depressive psychosis who received other antidepressant or antiobsessive drugs.
Application in case of liver failure
Sertraline is actively biotransformed in the liver. According to a pharmacokinetic study, with repeated administration of sertraline in patients with stable mild liver cirrhosis, there was an increase in T 1/2 of the drug and an almost threefold increase in AUC and C max of the drug compared with those in healthy people.There were no significant differences in binding to plasma proteins in the two groups. Sertraline should be used with caution in patients with liver disease. When prescribing the drug to a patient with impaired liver function, it is necessary to discuss the advisability of reducing the dose or increasing the interval between taking the drug.
Application for renal failure
Sertraline undergoes active biotransformation, therefore, unchanged in the urine, it is excreted in an insignificant amount.In patients with mild to moderate renal failure (CC 30-60 ml / min) and patients with moderate or severe renal failure (CC 10-29 ml / min) pharmacokinetic parameters (AUC 0-24 and C max ) sertraline after repeated administration did not differ significantly from the control group. In all groups, T 1/2 of the drug was the same, as well as there were no differences in binding to plasma proteins. The results of this study indicate that, as expected, given the insignificant renal excretion of sertraline, dose adjustment depending on the severity of renal failure is not required.
Pathological bleeding / hemorrhage
It is recommended to be careful when prescribing selective serotonin reuptake inhibitors in combination with drugs with an established ability to change platelet function, as well as in patients with a history of hemorrhagic diseases.
Transient hyponatremia may occur during treatment with sertraline. It develops more often in elderly patients, as well as when taking diuretics or a number of other drugs.A similar side effect is associated with the syndrome of inappropriate secretion of ADH. With the development of symptomatic hyponatremia, sertraline should be discontinued and adequate therapy should be prescribed to correct the level of sodium in the blood. Signs and symptoms of hyponatremia include headache, impaired concentration, memory impairment, weakness, and unsteadiness, which can lead to falls. In more severe cases, hallucinations, fainting, seizures, coma, respiratory arrest, and death may occur.
Influence on the ability to drive vehicles and control mechanisms
Appointment, sertraline, as a rule, is not accompanied by impaired psychomotor functions. However, its use simultaneously with other drugs can lead to impaired attention and coordination of movements. Therefore, it is not recommended to drive vehicles, special equipment or engage in activities associated with an increased risk during treatment with sertraline.
Antidepressants in the practice of a gastroenterologist uMEDp
Antidepressants are widely used in modern gastroenterology.The article discusses the indications for prescribing antidepressants to patients with disorders of the digestive system, discusses the features of antidepressant therapy in gastroenterological patients with comorbid pathology of the cardiovascular system. The main groups of antidepressants – selective serotonin reuptake inhibitors and tricyclic antidepressants – were compared in terms of their therapeutic effects and potential side effects.
Pharmacological effects and clinical manifestations of potential side effects of TCA
Antidepressants are a large group of drugs, the mechanism of action of which (with rare exceptions) is determined by a direct effect on the metabolism of neurotransmitters, primarily serotonin, as well as norepinephrine and, less often, dopamine .
The main therapeutic effect of antidepressants is achieved due to their ability to affect the pathologically low mood – depression. In this regard, the main indication for the appointment of antidepressants are depressive conditions, which in somatic medicine (including in the practice of a gastroenterologist) include primarily endoform and somatogenic depressions, pathogenetically associated with a somatic illness, as well as depressive reactions to the situation of the disease [2 ].
In gastroenterological practice, the anti-anxiety effect is of no less importance. Drugs in this group can be used as monotherapy for anxiety disorder or combined with gastroenterological agents in cases where disorders in the digestive system are somatic manifestations of anxiety or somatoform disorder.
An indication for the appointment of antidepressants may be the relief of symptoms of the intersection of chronic diseases of the digestive system and depression, manifested by various algic syndromes.For example, they include bulimia nervosa and anorexia, which often provoke a malfunction of the digestive system.
Since the middle of the last century, many antidepressants with various mechanisms of action have been synthesized, and their number continues to grow. The main criteria for choosing an antidepressant, along with therapeutic efficacy, are safety, good tolerance, the absence of severe side effects, and the minimum risk of unwanted interactions with somatotropic drugs .
Currently, it is accepted to divide antidepressants into three groups .
First generation antidepressants include tricyclic antidepressants (TCAs) – amitriptyline, imipramine, pipofezin; as well as irreversible nonselective monoamine oxidase inhibitors – pirlindole. The drugs of this group have a powerful and undifferentiated effect on the multiple receptor systems of the body. This mechanism of action leads to a high likelihood of side effects of antidepressants in this group.
Second-generation drugs are selective serotonin reuptake inhibitors (SSRIs) – fluoxetine, fluvoxamine, sertraline, citalopram, as well as selective serotonin and norepinephrine reuptake inhibitors (SSRIs) – duloxetine.
Drugs of subsequent generations include drugs with other and (or) mixed mechanisms of action, which are currently used relatively rarely by gastroenterologists.
Thus, in somatic practice, the use of second-generation drugs is preferable [3-5].
Application of SSRI
SSRI drugs meet all of the above criteria for the preference of choice.
The ratio of the severity of various effects (actually antidepressant, stimulating, anti-anxiety, sedative, anticholinergic) differs in different drugs of the group. The most important is the degree of stimulating and anti-anxiety effects, which serves to separate SSRIs [6, 7] into drugs with a predominantly stimulating effect (fluoxetine, paroxetine), drugs with a predominantly anti-anxiety effect (fluvoxamine) and drugs with balanced action (sertraline, citalopram).
This distinction is important in determining the indications for the choice of a particular drug, depending on the clinical features of depression in a particular patient. In addition, drugs with a pronounced stimulating effect at the beginning of treatment cause an increase in anxiety, therefore, in the first two (sometimes four) weeks of treatment, it is necessary to prescribe anxiolytic drugs to prevent this undesirable effect.
Further, when describing drugs of the SSRI group , their international names are indicated, and in brackets – the most common trade names.
Fluoxetine (Prozac) is the most potent of the stimulant drugs, so anxiolytics must be added in the first two to four weeks of treatment. The intrinsic anti-anxiety effect of fluoxetine is relatively weak and begins to manifest itself no earlier than two weeks later. Due to the effect on appetite in the direction of its decrease, fluoxetine helps to reduce body weight, which is the purpose of its appointment for bulimia and obesity. The advantages in gastroenterological practice include the absence of nausea and constipation, the disadvantages are the prolongation of the time to reach orgasm (in about 40% of patients).
Paroxetine (Paxil, Reksetin) has a strong stimulating effect, as a result of which it can significantly increase anxiety at the beginning of therapy. In addition, this drug has the strongest effect on mood, up to its pathological increase. For this reason, gastroenterologists are not advised to prescribe paroxetine without co-supervision of the patient with a psychiatrist.
Fluvoxamine (Fevarin) differs from all drugs of the group in the strongest sedative effect with the weakest stimulating effect.As such, it is considered the drug of choice for anxiety depression or antidepressant prescription for anxiety disorder. In this case, it is used as monotherapy without additional intensification of therapy with anxiolytics. The benefits include a minimal negative effect on sexual function in comparison with other drugs in this group.
Sertraline (Zoloft, Stimuloton, Asentra) is one of the most widely used antidepressants in the world. Along with a pronounced antidepressant effect, the drug has an anxiolytic and mild stimulating effect.It is well tolerated and therefore can be used in elderly patients without dose reduction. Relatively rarely affects a decrease in libido (
Citalopram (Cipramil, Siozam, PRAM) and escitalopram (Cipralex, Elicea, Selektra) are the weakest SSRI drugs in terms of their antidepressant effect. The positive aspects are the best tolerance, safety when used with somatotropic drugs, and the absence of cardiotoxicity. These drugs are recommended in the treatment of depression in somatic patients because they are balanced and rarely increase anxiety.
Based on the above, a differentiated approach to prescribing an antidepressant is as follows:
- fluvoxamine is the drug of choice for anxiety depression, since it has the most pronounced anti-anxiety effect;
- when apathy and asthenia predominate in the clinical picture, it is advisable to prescribe fluoxetine, since its stimulating effect is manifested literally from the first days of administration;
- for anxiety-depressive disorder, antidepressants with a balanced effect should be recommended;
- for algic syndrome, a drug from the SSRI group duloxetine (Simbalta) is more effective (compared to SSRIs).
When choosing a drug for antidepressant therapy in gastroenterological practice, in addition to the generally accepted ones, the following clarifications should be made:
- Nausea is a fairly common early side effect of SSRI drugs. It is worth warning the patient about this, adding that most often this symptom is mild and transient. Otherwise, the patient may assume an exacerbation of his gastroenterological disease and refuse to take the antidepressant.A much rarer side effect may be vomiting;
- nausea is most severe with fluvoxamine treatment. If this symptom is present as a sign of an exacerbation of a gastrointestinal disease, it is better to initially choose a different antidepressant;
- Many SSRI drugs make constipation worse. For persistent constipation, fluoxetine is the drug of choice;
- A long-term side effect of antidepressants of importance in gastrointestinal practice is dry mouth.When carrying out antidepressant therapy, it is necessary to control the intensity of this symptom. Since dry mouth is a manifestation of an excessive anticholinergic effect of an antidepressant, with a significant severity of this symptom, it is necessary to reduce the dose of the antidepressant if possible;
- the hepatoprotector ademetionine (Heptral) used in patients with chronic liver diseases has an antidepressant effect, but the strength of this effect is insignificant.
Before starting treatment with drugs of the SSRI group, the patient must be explained the advisability of prescribing an antidepressant, possible side effects and the duration of treatment.When prescribing a drug with a stimulating effect, it is necessary to justify the need for additional administration of a drug with anxiolytic effect. In addition, it should be emphasized that the expected effect occurs no earlier than four to six weeks of taking the drug in a therapeutic dose. Unaware of this feature, the patient may stop taking the antidepressant without waiting for a therapeutic response.
SSRI antidepressant therapy includes three stages [3, 8].
The first step is to select a therapeutic dose.The first dose of the drug is 1/4 or 1/2 of a single dose, followed by a gradual increase, depending on tolerance. Individual sensitivity to the drug may play a role, but it is difficult to predict before starting therapy.
Therapy is considered ineffective if there is no clear improvement after four to six weeks of taking a sufficient dose of the drug. In this case, the question arises about replacing the drug. In most cases, by 10-12 weeks of treatment, the symptoms of depression have completely disappeared.As practice shows, some patients perceive this as a cure, which is the reason for self-withdrawal of the drug.
At the second stage, supportive therapy is carried out. Numerous clinical observations indicate that interruption of antidepressant therapy immediately after improvement of health in 80–90% of cases leads to a relapse of the disease. Contrary to popular belief, antidepressants are not associated with the risk of drug dependence, so treatment for depression and panic disorder should be long-term.The course of maintenance therapy should be carried out for at least six to nine months. It is quite obvious that the patient will comply with these recommendations only if the drug is well tolerated.
The third stage is to discontinue the drug. The general rule is the gradual withdrawal of any drug. It is recommended to first take half the dose for a month, then half the dose every other day. If symptoms of depression return, treatment should be continued.
Application of TCA
The therapeutic effect of TCAs is manifested by powerful antidepressant and anti-anxiety effects.In addition, their advantage is a strong analgesic effect, which is more pronounced in comparison with SSRIs [3, 8].
It is very important to emphasize the interaction of TCAs with various receptor structures and, as a consequence, the development of multiple effects (anticholinergic, adrenolytic, adrenomimetic). With significant severity, these effects are manifested by side effects of TCAs [3, 4]. The table shows the clinical manifestations of potential side effects of TCAs in comparison with the spectrum of their pharmacological effects.
The indicated side effects are most likely in the presence of comorbid somatic pathology, and therefore it is not recommended to prescribe TCA to elderly and senile patients .
In young patients with moderate to moderate depression and without comorbidities, TCAs remain an important part of therapy. In this case, it is necessary to remember about such contraindications to the appointment of TCAs, such as glaucoma, heart rhythm disturbances, atrioventricular blockade, convulsive syndrome.
Amitriptyline (Tryptisol) is the most widespread in gastroenterology and is widely used in small doses. It should be borne in mind that doses of 50 mg or less do not have an antidepressant effect, but cause only a sedative, anti-anxiety and hypnotic effect. The initial dose is 12.5 mg one hour before bedtime, with a gradual increase depending on tolerance.
The antidepressant effect is achieved in a daily dose of at least 100 mg, which is poorly tolerated by somatic patients due to the above effects.In this regard, an increase in the dose is possible only with supervision in conjunction with a psychiatrist.
A useful property is the analgesic effect, expressed to a greater extent than that of drugs of the SSRI group.
Side effects are associated with its anticholinergic (dry mucous membranes, constipation, urinary retention, tachycardia, violation of accommodation) and antihistamine (drowsiness, sedation) effects.
Pipofezin (Azafen) is practically not used in psychiatry due to the weakness of the antidepressant effect.Indications for use are limited to minor depressive disorders of the neurotic level. There are almost no anticholinergic side effects and cardiotoxicity. It can be used in elderly, somatically weakened patients, including in outpatient practice. The recommended dose is 75 mg per day, divided into three doses.
The effectiveness of TCA treatment can be assessed no earlier than three to four weeks from the start of therapy.
When prescribing antidepressants to patients with chronic diseases of the digestive system, it is necessary to take into account comorbidity, first of all, with diseases of the cardiovascular system.
Based on the likelihood and severity of possible side effects, there are three groups of antidepressants, depending on the degree of their cardiotoxicity . In patients with comorbidity of gastroenterological and cardiological diseases, the use of drugs with a low degree of cardiotoxic risk is recommended. This group includes SSRIs (fluoxetine, sertraline, citalopram, fluvoxamine, paroxetine), from drugs of other groups – pirlindol, tianeptine, mirtazapine, mianserin, trazodone.
The average cardiotoxic risk includes the use of low doses of TCAs, which can cause side effects from the cardiovascular system (orthostatic hypotension, sinus tachycardia, rhythm and conduction disturbances, suppression of contractility and a decrease in heart rate variability). When using them, it is necessary to take into account the possibility of deterioration of the patient’s somatic condition. Treatment with these drugs, if indicated, should be carried out in conjunction with a psychiatrist.
Drugs with a high cardiotoxic risk (which, in particular, include TCAs in medium and high doses) should not be used to treat patients with cardiovascular disease.
There is no doubt that antidepressants have a wide range of indications for gastroenterological patients. The drugs of choice are SSRIs, which have high efficacy, better tolerance compared to TCAs, and a convenient dosage regimen in the form of a single dose of the drug per day.The effect of antidepressant treatment is significantly increased with the simultaneous conduct of individual psychotherapy.
Awareness in issues of antidepressant therapy significantly increases the level of professionalism of a gastroenterologist.
Antidepressant Pfizer Zoloft – reviews
I never wrote reviews about pills, but I will write about these, a psychiatrist prescribed it to me, since my problem was panic attacks.
At 14:00 I drank half a tablet of the drug “Zoloft”, after 1.5 hours I was in a vigorous and energetic state, although before that I really wanted to sleep, then sleep was cut off, I was in a gorgeous mood, I was laughing, I wanted something then to do, I was like on drugs.
Then it was worse, I noticed that my pupils were dilated very much, it seemed to me that my appearance was changing, I was becoming some kind of ugly, and then when I wanted to call the doctor and ask if it was normal that my pupils were dilated, and then a strange a thought in my head, my heartbeat quickens, it seems to me my body is going numb, my hands are getting cold, I felt very scared, I was never so scared, and if there were panic attacks, it was not in this form, I started calling an ambulance and running around the apartment, I wanted to run out of the house or just out the window from such a state, I wanted to call a taxi and go to the hospital myself, I didn’t know what to do, in this state I usually cry, but I couldn’t even cry, but I really wanted to …
The doctors arrived, the man told me that everything was coming out of my head, that I needed to change my thoughts, and so on, but I did not listen to him, it seemed to me that I had heart problems because of the drug, it seemed like a heart attack, a stroke….
He talked to me for a long time that I just needed to get distracted, then he told me to pour Corvalol, after Corvalol I felt better, and then I went to bed.
I started this hellish state at 12 o’clock in the morning, the doctor said that these could not be pills, since they are removed after 12 hours, I became scared again and it seemed to me that I was dying from some kind of illness ..
The next day.
I did not take these pills, I felt scared, I woke up and everything was normal, but at 15:00 my arms and legs began to go numb again, it seemed as if everything was going numb inside my body, and that I was about to fall into a coma, even now, when I write about it, my fear arises …
I also want to say that there is dry mouth, I want to drink a lot.
Sometimes my head goes numb, and it seems to me that I have problems with my head, that I have cancer.
It’s very scary.
I never wanted my previous not so strong panic attacks to return and I came to a normal life …
I understand that you can heal yourself without pills, but it is very difficult, very difficult.
Now, as I write this, I want to say that we can get out of depression on our own, we can also get away from panic attacks without pills, but there would be a desire, and change of consciousness to something else….
against the background of the treatment of cervical osteochondrosis, sleep was disturbed (falling asleep is good, but sleep is short for only 4 hours), the neurologist prescribed zoloft 1tab a day, he was ready for side effects, but not for such 16 days of taking zoloft minus 7 kg of weight (weighed 77 kg). The sleep disappeared altogether although he was covered by atarax (at the beginning 1t was enough and by the 16th day I stopped sleeping completely atarax did not help even 2t) sausage specifically. Now I am in a neurology hospital to get my sleep back. Zoloft is a very dangerous thing.
Started taking the drug as prescribed by a doctor. Depression and panic attacks, Dosage 0.25 in the first 7 days, then increase the dose to 0.50 in the next 30 days. After taking the second pill, horrible side effects appeared. Tremor of the extremities, eyelids began to twitch, chills, sweating, nausea. Panic attacks reached their climax (such terrible ones had not happened before), obsessions and thoughts appeared in the head.The head became like a fog, the pressure on the temples. It was impossible to sit in one place, I just wanted to run out of the house and run wherever they looked. In general, all the declared assistance turned out to be a continuous hell. I had to take Xanax at a dosage of 0.50 in order to somehow recover. I read that often both drugs are prescribed in combination in order to avoid the side effects of the drug. However, is it worth giving such a load on the liver and the entire body as a whole? It’s up to everyone to decide. Perhaps for some, the drug turned out to be a real solution to the problem.One thing I can safely say, the drug has a very individual tolerance. I recommend taking it under medical supervision and in strict proportions.
This drug is the latest generation antidepressant.
Antidepressant, SSRI (selective serotonin reuptake inhibitor) Active ingredient – sertraline
It is used for depression, panic attacks, phobias, obsessive-compulsive, anxiety disorders.
Based on my experience of use, I can say the following:
1. After taking the first dose (25 or 50 mg, depending on the doctor’s recommendations), a few hours later, euphoria sets in, it becomes fun, blurred consciousness. This continues for several days. Then you don’t feel anything like that when you take it steadily every day. If you stop drinking the drug, then restart it again – the same sensations will arise.
2. Copes with anxiety, it is not possible to cry at all.Aggression also disappears, but not completely. Still, something can freak out.
3. Libido is almost zero. It is very difficult to get an orgasm, and it is not pronounced.
4. Suicidal thoughts, if any, does not remove. They just become, how to put it, calm. It seems like “I don’t see the meaning of life, but I don’t want to die either.”
5. There was no insomnia from him.
6. After the abrupt change of mood is canceled, the nervous system gradually becomes the same as it was before the drug was used.
7. Price approximately 1200 for 28 tablets of 50 mg. Usually, 50 mg is prescribed per day. Sold by prescription. But it seems a couple of times I bought it without a prescription, when I was not with me. But this is an exception. Usually even nootropics are now sold by prescription.
8. There are cheaper generics, but I didn’t buy.
What conclusion can be drawn? Let everyone decide for himself. Plus, DON’T FORGET that daily pills affect the kidneys and liver!
I would also add about alcohol… one glass of wine will be nothing, but if you drink a lot, you will be sick (vomit). There was such an experience. And of course a double blow to the liver and kidneys 🙂 So I do not advise you to drink alcohol at all.
I tried it again
Tsipralex, the action is similar, but only he gave me a headache. But I don’t remember about Zoloft.
not particularly available was on sale
I don’t know how such a good doctor could prescribe these pills for me.And I had no depression whatsoever. But I trusted the doctor and started looking for this Zoloft. It was a long time ago, by the way, about five years ago, no less. Found in the pharmacy only on order, waited a long time. I drank the first pill and after I went to bed, after a while I felt strange, to put it mildly. I began to shake and pound with terrible force. There were even some kind of muscle spasms or something … I don’t know exactly spasms or not. I honestly say, I’m not lying, I thought I was going to die right that day. This state lasted for several hours and was not removed by anything, neither a corvalol, nor a shower, nor anything else I could think of.After everything was over, I felt sorry for the money spent. I read in the instructions that Zoloft is indicated for the treatment of alcoholism. I began to think about giving these pills to an alcoholic friend, but I was stopped by the thought of responsibility and what could happen to this person with these pills. I was never able to give them away. I threw it out.
While taking the drug, other organs can be damaged.
The neuropsychologist prescribed Zoloft 50 mg once a day in the morning. Immediately after taking, my legs became wadded, I wanted to lie down (This applies to everyone who drives a car – do not drink in the morning in any case!). After another half an hour, the stomach, pancreas ached, belching and nausea appeared, the intestines were swollen. The entire gastrointestinal tract could not be restored within 24 hours! Moreover, the appetite has disappeared (that’s why the instructions in the side effects – weight loss!).Restless sleep at night, headaches. The doctor answered all this – you have to get used to it, it will pass in 2 weeks. What a chemistry that takes 14 days to get used to with these symptoms! Do not drink or spoil your health!
leads to suicide
My daughter took 2 tablets of ZOLOFT, 50 mg each, and she became ill at night.They fell asleep, and in the morning she threw herself out of the window and died. I never talked about suicide. CAREFULLY!!!
Insomnia !!!!!, depression, depression or, the appearance of a feeling of fear, the state of a zombie, nausea first
It just so happened that after breaking up with my ex, I was attacked by depression, accompanied by tearfulness, irritability, unwillingness to enjoy life, etc. The doctor attributed “zoloft”, an antidepressant or tranquilizer, which was supposed to help my psyche.So the dosage is 100 mg. per day, it was necessary to start with 50 mg, the first 10 days. Then it was supposed to increase the dose to 100 mg.
1 day of taking the drug. 16.00. I drank a pill and went to work, driving, which I later regretted three times … Although the doctor assured that the “happiness” pill did not affect driving a vehicle. After 45-60 minutes I suddenly felt like sleeping, but so much, that the eyes were involuntarily closing. The first thought was, I didn’t get enough sleep … I stayed asleep as soon as I entered the house.I woke up a few hours later, wet from head to toe, I was shivering, my teeth were shaking a little, my heart was beating faster, although I never suffered from tachycardia.
Day 2. The feeling of fear, even in my usual environment, did not leave. Dizziness, an absolute lack of appetite, when thinking about food, a gag reflex. It is impossible to work, I constantly wanted to sleep.
Day 3. There is still no appetite. But realizing that I hadn’t eaten anything for 2 days, I decided to eat yogurt and processed cheese.Three times he (cheese) ended up somewhere in my throat ((((I didn’t try to eat anymore that day. Insomnia. Well, just fantastic. Until 6 in the morning, I didn’t fall asleep for a minute (((Feeling of fear and panic attacks) do not share.
4th day. I took a few days at my own expense, because “I am sick with a terrible disease.” I want to sleep, I count sheep and elephants, I drank green tea, a couple of drops of valerian. No sleep. Night falls. I scream at the moon, count the stars. Sweating appears, and with it, for some reason, chills. It is insanely hot, then terrible cold, like it’s January outside.
5 day. Allergy. Redness of the cheeks, a tooth (thank God. Not strong) milli on the cheeks and on the forehead. I endure, I bought a cream for acne. Night falls, I no longer howl at the moon, but I buy “Sonex” (about it a little later ).
6th day. People around are monsters, everything is annoying, I want to kill at least someone, preferably slowly and painfully. Night. My friend is now “Sonex”)
7 day. Minus 4 pounds on the scales. Minus 4 cm in the waist and the same amount in the hips.
Day 8. Thanks to “Sonex” and the opportunity to at least help the body with sleep, I decide to resume training in the gym after a week’s break.Weakness, slight drowsiness. I yawn constantly, every 5-7 minutes. I crawl into the gym and lo and behold! I can do anything! I could lift the weight 10-15 kilos more than a week ago before “Zoloft”. I don’t get tired! 2 hours flew by like an instant! I lost a few sweats! The first time in a year of playing sports, I regretted it. that she did not take a hairdryer with her, since she literally squeezed her hair (long) after class.
The remaining 12 days of my torment I ate “Sonex” because of the inability to sleep without it, curds (which did not make me sick), yoghurts and water.The reason for the withdrawal is the pain in the pancreas (perhaps not due to the drug, but everything went away after the withdrawal), the milliums on the face and the allergies that made my face look like … Damn, it definitely looked like something).
My life after cancellation. After 7-10 days, pimples disappeared, sleep returned without sleeping pills on the 9th day, the feeling of fear passed on the 4-5th day, appetite returned on the 2nd day, sweating and terrible heartbeat stopped by 3-5 days.
I don’t know if the following that I’ll write can be called the advantages of the drug, but !!!: the antidepressant “Zoloft”, which with a clear conscience can be called “Depressant”, is an amazing means for losing weight.It completely kills appetite, increases endurance during physical exertion. And secondly, I forgot to think about the former, “hooked” on this permitted “LSD”. No wonder they say: if you want to forget about all your problems, buy shoes 2 sizes smaller. My “shoes” kind of did the trick.
“Zoloft” I do not recommend. Although someone is delighted with it. But who?
I had enough for 3 days of admission … tatka29
Has consulted a psychotherapist about obsessive thoughts.He assigned me Zoloft. He didn’t say anything about the side effects. Dosage 50 mg once a day. I drank the first pill and after a few hours I felt pressure in the head area, well, this is still nonsense. Further the state of a complete “brake”, I was afraid even to be on the street in such a state. The next day, a terrible anxiety began, sleeplessness at night, severe fear. I called the doctor and he said to take half a pill. And half the dose was no better. A terrible state of fear and despair.In the instructions, terrible side effects are indicated.
In general, it was enough for me for 3 days and I didn’t drink this rubbish anymore. With these pills 1000 times worse than without them. Some write that you have to endure for 1-2 weeks and everything will pass, I could not endure such a nightmare, it’s even scary to remember. I didn’t go to the doctor anymore and I don’t drink any pills.
Diarrhea, increased symptoms of depression
Zoloft was prescribed to me by an immunologist)) Which, of course, is very strange.The fact is that I had a difficult life situation, and after a while I started to get sick .. For a long time and for a long time, the symptoms of a cold went away, but the low-grade fever did not go away. I went to an immunologist, she ordered a bunch of tests for hidden infections and immune status, and everything was fine everywhere. Therefore, he suggested that my temperature arose simply against the background of stress .. And in order to remove this condition, he prescribed Zoloft (and a bunch of drugs, but they were just immunomodulators).
In general, I drank 1 tablet at work (he did not talk about any quarters).The first 1.5 hours everything was ok .. Then I started to slow down slowly .. Then I went to lunch with a friend, and in the cafe I started to feel really bad … And I was covered with a panic attack. I never knew WHAT IT IS! In general, I am quite a stress-resistant person, but here it happened to me !!! I ran to work, I started having diarrhea (when I get nervous, it happens to me), but this time I just fiddled in the toilet)) I had this panic: my palms were sweating, my heart, I thought, would jump out! In the end, I wanted to go home, but I was wildly scared)) How will I go behind the wheel! So I got drunk on glycine and sat all day in the office alone.And then, apparently, my brain remembered this state, and I began to have terrible panic attacks .. And as the psychotherapist later said, this antidepressant is quite light and not bad, but it is not prescribed at all that way! If I had drunk half of his pill and half of the Phenazepam pill, then I would not feel any effect at all, but so, yes … I, like many, at first felt worse from him. The funny thing is, okay he would just strengthen my condition, so I never had a panic attack! And then they appeared .. After one pill, I decided to finish with antidepressants, before I could start…
In general, I will only take such drugs under the supervision of an experienced psychotherapist. If God forbid, there is a need for this. And I got rid of my panic attacks by 60% thanks to Atarax, and by 40% by the fact that I went to rest in Tai)) So, in any case, some pills are sometimes not enough …
my daughter took 2 tablets of Zoloft, 50 mg each and jumped out of the window – DIED !!! Be careful!!!
https: // www.best-antidepressanty.ru/zoloft-sertralin.php
I tried to climb the zoloft three times, but I can’t. The side effects are creepy. The first days of taking it is just hell on earth, panic intensifies, fear, nausea, fear of people. Even with my strong will, I could not wait out the side effects and left him. Together with him, I was prescribed tranquilizers to relieve the unpleasant sensations, but even with them I felt bad. But among psychotherapists, zoloft is considered a favorite drug for a prescription.probably he just didn’t suit me
After taking half a pill in the morning, the day went well, but already in the afternoon, in the evening, a strong apathy began, then by the night a feeling of fear, barely fell asleep, and in the morning an attack of tachycardia and almost panic with a feeling that I was about to lose consciousness. This is such rubbish this zoloft! Then the doctor told me that he had such a side effect and that he had to be taken for the first two weeks with a tranquilizer.People, save yourself, who can do without this chemistry !!!
Good afternoon, everyone. I think many of us have faced such a problem as depression. So this ailment did not pass me by either. And it all began after childbirth, the standard condition: the seam from the episio, unsuccessful cleaning, diastasis, hernia, it is not clear from where diabetes, problems with housing and money, etc.
The drug was prescribed to me by a psychotherapist, after examinations and tests.The fact that I was depressed I did not know, I just constantly had my eyes in a wet place and ate sooooo much, just pathological gluttony on the verge of bulimia. There were also some pretty strong panic attacks.
The drug was taken at 50 mg for the first week, then at 100 mg. Many patients are advised to take phenazepam in parallel to cover against side effects, I coped without it.
At the beginning of treatment, before the equilibrium concentrations of sertraline in the body are established, the state of health is disgusting, to put it mildly.The drug does not seem to help, but only makes the symptoms worse. Then everything returned to normal. Problems and difficulties became invisible, it became easier to go out, social phobia decreased.
Were only at the beginning of the appointment. Namely diarrhea and bloating. There was no weight loss. The appetite returned to normal.
I buy a drug for 1000-1100 in the Internet pharmacy pills ru. The price in pharmacies varies from 1200 to 1500 for 28 units in a dosage of 100mg.
I cannot recommend this drug , since I am not a doctor, and many nuances are important in the treatment of depression and panic attacks. But personally, I’m happy with the drug
increases the feeling of hunger
Hello dear guests and guests of the Otzovik website.I want to share with you my impressions of taking this drug.
Before I started taking this drug, I suffered for a long time from panic attacks, fear, insomnia and, accordingly, other related sensations. Naturally, I turned to doctors specializing in this field for help, each of them prescribed all kinds of treatment, but I felt terribly bad from many drugs, or there was no reaction at all to the drug, but this drug Zoloft became my savior.Initially, I did not have a period of getting used to it, as usually happens in the first two weeks. And now, a month after taking it, when the drug accumulated in the right amount, I began to hover like a bird, all the terrible symptoms disappeared, I felt like a full-fledged person, and now it’s been the third year since I have been taking it, and honestly I don’t want to quit. It hurts me to be calm and comfortable with him.
The only negative, as for me, is weight gain, for me it reached 20 kg in 2 years.But the drug just enhances the appetite, and what we ram about ourselves is already our problem.
In my opinion, the drug is effective. But I don’t know yet or is there an addiction to it. The doctor says no, but it should be canceled according to the scheme.
I wish you all good health and longevity.
thank you for your attention
“Good antidepressant.The only thing to pay attention to is the duration of the reception. If you do not go through the course to the end, and then try to repeat the treatment, the drug may not work. Gold basically eliminates obsessive states and panics, makes the brain work in the right direction, which will allow you to take your thoughts in order. ”
Benefits: Handles problem
Disadvantages: high price, side effects
In general, since childhood I am afraid to ride in an elevator, I have a fear of a closed space.But I never went to doctors with this problem until this terrible incident happened. I myself am a physician and have attended advanced training courses. And so a group of nurses and I got into the hospital elevator, although I didn’t want to go because of my phobia, and it fell. What was going on there is beyond words, since we all remained alive, and even in the hospital, there is no need to go far for help. That’s when I told the doctor everything, he prescribed Zoloft tablets for me, ordered me to drink for a long time for three months. First, for the first two weeks, I drank half a tablet, then a whole one.The first days, a week, I did not feel anything, I just soothed myself that I was drinking an antidepressant. And then my condition began to stabilize, anxiety disappeared, delusional thoughts disappeared from my head. Has become an adequate person.
I have a story like this. Intracranial pressure, vasoconstriction and some other clever words in the conclusion of the EEG. After a couple of traumatic brain injuries, after a long state of stress and depression, I suddenly felt bad. Swelling of the throat, terrible shortness of breath, panic attacks, fear of death from suffocation.Saturday evening, the whole city traveled around and found barely a neuropathologist. Without any papers, he did not make a diagnosis, wrote off stress and panic attacks for depression, prescribed zoloft. I read it on the Internet, it has a cumulative effect, honestly I am a little confused how pills with a cumulative effect can act so quickly, unless of course there are side effects. At first I did not take it, but after another stress there was such a state that many here describe, hands, head, tongue, throat went numb, shortness of breath was strong, I thought everything was a stroke! Spasm of the left hand, stabbing at the heart.Staggering, stuffiness in the ears and a sound, a squeak as if it were. Everything floated around. I drank valimidine and asked me to massage my neck so that the blood would flow more actively to the brain. I do not give in to panic, I go from corner to corner, I go out for a walk, I try to distract myself, I understand that if I succumb to panic, it will be worse. After that I immediately bought Zoloft. After the reception there was a feeling of joy, there was energy, I began to do things around the house, and more often to play with my children. Two weeks later, even earlier, a feeling of calmness, I do not worry about trifles, there is drowsiness, but I became calmer.They prescribed one pill for 60 days to drink, now the neurologist said that the nervous system is so exhausted that it is necessary to take strong medications that for 10 days I will lie like a vegetable with apathy to everything. Until I do the treatment, the children are small, the youngest is 6 months old, on the guards. Leave no one with, and without a breast will torment and torment others. I decided to drink Zoloft for now and slowly wean it off. And so, some side effects are not felt, maybe it is too strong for such diseases as VSD, etc.
https: // lekotzyvy.com / preparat / z / zoloft /
Gives hope for a happy future
Advantages: effective !!!
Disadvantages: did not notice
Zoloft began to take after consultation with a neurologist. Before that, they were diagnosed with agarophobia and panic attacks. He took antidepressants and tranquilizers. Passed the drug route valerian-corvalol-phenazepam-afobazol-grandaxin-paxil. I know what the cancellation effect is. In general, I was skeptical about Zoloft, but I had phenazepam as a safety net and 10 days to get used to the new drug.Of course, I did not leave the house during this period. He started with an octopus of pills, increasing the dose every 5 days by 18 parts. The fears did not go away, but there was no panic. Zoloft is better tolerated than the previous drug. And Zoloft has a cumulative effect. It took me about 40 days to start smiling again and be like everyone else. The course of treatment was 6 months. Then, gradually, the dose of the drug was reduced and the moment came when he stopped drinking … and the panic did not return. The headaches remain, but I can bear them easier.The drug gave me back the joy of life and hope that everything can be very
I had my first depression at the age of 13, then at 17 with insomnia, and two more happened while I was living alone abroad. It should be noted that the latter was the strongest. Violent sweating with social phobia and terrible apathy. A constant feeling of the unreal. Nothing brought joy. But now everything is different.Lifestyle change and Zoloft helped me. I must say right away that now the depression is completely gone. And I don’t drink Zoloft anymore. In this case, the recommendation is a bit silly. If your doctor a psychotherapist has appointed it, then you need to drink it. Of the dangers: be sure to gently lower the dose after the course of treatment, the withdrawal syndrome will nullify everything
+ Quality, minimum side effects, efficiency and availability
– Decreased libido and unpleasant withdrawal syndrome
Drink it and do not be afraid of anything
https: // irecommend.ru / content / moi-realnyi-opyt
Hello. I read not very positive reviews about Zoloft and was a little surprised.
Zoloft was prescribed to me by a psychotherapist for my complaints about the fear of spending the night alone in the apartment, fear of the dark and similar fears. At first I drank half a pill, then the dose was increased to 1 pill a day (half in the morning, half in the evening). The first thing I noticed was that fears really go away. It was a pleasant surprise, and in general, there is a feeling that the psyche has become healthy and normal.A very pleasant side effect for me was a decrease in appetite. I almost didn’t feel like eating, so I lost weight without any effort. The psychotherapist said that when Zoloft is canceled, my appetite will return to me and the weight will return, but not roll over to the original one. And so it turned out. With the withdrawal, the appetite increased and the weight returned. I didn’t have any negative side effects, and I’ll tell you a secret: my friends who drank Zoloft also had a decrease in appetite! Good remedy!
https: // otzovik.com / review_3586170.html
is effective, does not cause drowsiness, does not inhibit, the consciousness remains clear. I did not experience any side effects. No addiction.
for me they are not
For the first time I got acquainted with ZOLOFT back in 1997. The drug is used mainly for the treatment of depression and panic attacks.
Packages are 50 mg and 100 mg.I always take 50 mg.
It had just appeared on the Russian market at that time. Well, our doctors love to prescribe the latest drugs. So I became, one might say, a guinea pig on which this drug was tested).
True, I am not even mad at the doctor, I am even grateful to him, since ZOLOFT has become my faithful friend for many years. Helped me in different periods of time and for different diseases. I drank it with significant interruptions, but to this day, if I need medication, I resort to ZOLOFT.I am now singing an ode to this drug, however, I DO NOT RECOMMEND, BEGINNING MY words of praise to ZOLOFT’S ADDRESS, run to the pharmacy and self-medicate. All the drugs I tried were prescribed by the doctor! And watched my reaction!
The tablet is tiny – no problem with swallowing. Signed. Unfortunately, it is not visible in the photo, but there is an inscription. If it falls out of the package, you will always know what the pill is.
ZOLOFT helped me significantly (70-90 percent). I think this is a wonderful result, since NO OTHER medicine has worked for me (and I have tried a lot).KIDNEYS ABSOLUTELY NOT caused.
I will list the PROS of this drug:
+ EFFICIENCY (as I said, 70-90% of the problem goes away). Suppresses phobias, improves mood. There is a desire to live.
+ LACK OF SIDES (here everything is individual. In general, the drug is well tolerated. Usually. But there are exceptions to any rule. Organisms are different for everyone. Some have side effects. Honestly, I don’t know a single such person in real life, but judging by the reviews in Internet, sometimes)
+ NO SLEEPY AND INHIBITION.A very important factor. Absolutely does not inhibit the reaction. I don’t want to sleep. With Zoloft, you can drive a car absolutely calmly!
+ DO NOT RECOVER FROM THE PREPARATION !!! This is a very important advantage. It’s no secret that many antidepressants make you swell by leaps and bounds! So with Zoloft, I even dropped a couple of kilograms, because I stopped seizing my sorrows)
+ DOES NOT CAUSE ADDICTIONS Years without the drug are quite easy to live. Hands do not reach, shaking, to the package in order to get the coveted pill from there and drink.
+ DRINK ONLY 1 TABLET PER DAY, in the morning and is forgotten until the next morning. Comfortable.
I don’t see the MINUSES in the medicine. You could name the price. But if you consider that the package is enough for almost a month (there are 28 tablets), then it is not particularly expensive. I’ll make a reservation that I buy only the PFIZER manufacturer! Previously, only they produced ZOLOFT. Now Haupt Pharma Latina is also being produced. I do not know anything about this Zoloft. And it is half the price, although it is also Italy.
Well, and one more thing, HALF MINUS: Zoloft does not start to act immediately, it should accumulate in the body.The first effect appears about a week after 2. It starts to work at maximum strength after 2-3 months of admission. Well, you need to drink it for a long time.
And one more thing scares me: Zoloft IS NOT COMPATIBLE WITH ETHANOL, that is, with alcohol. But it’s not the fact that I don’t drink in the company (I don’t drink at all), but the fact that no alcohol-containing medications can be taken!
My EXPERIENCE: I have used it in different years. First, from a depressive state. Later from panic attacks.
From DEPRESSION: I drank a whole tablet at once from the very first use. In general, I am a terrible pessimist and crybaby. My face was dry already on the second day of admission. And every day it became easier and easier.
Gradually, you begin to think like an absolutely adequate person: you do not grind your own and other people’s actions in your head, you stop being offended, taking everything at your own expense. Thoughts are more and more bright. Strengths appear, I want to do something, to do something (the state leaves I do not want anything).You breathe deeply and feel like a living person, not a weak-willed creature. In general, as if some kind of switch in the head is triggered, something flips in the brain. From a depressive state, perhaps 90-95% helps.
FROM PANIC ATTACKS: I start drinking half a tablet of 50 mg, that is, 25 mg (so that the already strong manifestations of this terrible thing do not intensify). 1/2 tablet is drunk for a week. Then whole.
If you suddenly start to pound, then you have gone too far with the primary dose (I read once that a person became ill from the very first pill).And the pounding is not from the pill, but from the fact that it has not yet begun its action! Even the instructions say that in case of panic disorder, you need to start with half the dose.
Zoloft helps me from panic by 70-80 percent. Attacks become much more rare and less intense. And if they do, I can handle them.
Summing up, I can say: the creators of ZOLOFT need to erect a monument during their lifetime!
For myself, I have not found any other drug that would be so effective and at the same time did not cause side effects! Definitely, I RECOMMEND ZOLOFT for the treatment of depression and panic attacks.Yes, there are
newer and more advanced PAXIL preparations, for example, but from him completely different sensations, which I will write about a little later!
If someone is interested in this drug, and you want to discuss it with your doctor, here are detailed instructions for using the drug ZOLOFT in order to have an idea of this remedy:
to enlarge the text, just click on the photo and it will enlarge.
The drug helps to restrain aggression, excessive emotionality, soothes.But the result is not as fast as you want. I noticed changes around 1.5 weeks. But thanks for that too. Saw zoloft, as prescribed by a doctor, together with atarax, there is an effect and this is the main thing. But from the pills, I decided to still jump to chamomile tea and soothing herbs.