What is Zoloft (Sertraline)?
Zoloft is an antidepressant from a group of selective serotonin reuptake inhibitors (SSRIs). At the same, time it does not have a strong effect on reuptake of other neurotransmitters (such as norepinephrine and dopamine). The drug does not increase adrenergic activity, has no anticholinergic or sedative action and it is not a stimulant. Moreover, Zoloft does not cause either addiction or weight gain.
The product was launched on the market by Pfizer in 1991. Sertraline (Zoloft generic name and its active ingredient) is prescribed mostly to treat major depression in adults as well as obsessive-compulsive disorders, panic and social anxiety disorders in adults and children. The drug was the third of the most commonly prescribed antidepressants in the US in 2011.
There were official figures reported recently in favor of Zoloft effectiveness to treat chronic depression. A group of American scientists conducted a 7-month study where patients were studied in 12 research centers in the US. It was found that depressive symptoms returned in 26% of cases.
Another multicenter research was conducted to compare the efficiency of sertraline and imipramine in a treatment of chronic depression, complicated with anxiety. It was found after a three-month treatment that sertraline was more efficient than imipramine: 60% versus 58% of patients were able to completely get rid of the anxiety. Over mental condition of people has improved significantly after treatment.
In addition, scientists managed to prove the effectiveness of sertraline in a struggle with seasonal and atypical depression, as well as in the treatment of dysthymia.
There are no many differences of Zoloft with modern antidepressants, they are mostly limited by side effects. Medical researchers suggest that Sertraline may work better than fluoxetine (Prozac) for some cases of depression. Using Zoloft to treat panic disorders showed a significant decrease in anxiety attacks and improvement of life quality. Sertraline is not as effective as cognitive behavioral therapy to treat obsessive-compulsive disorder. Best results were achieved with a combination of these two types of treatments.
Despite the fact that the drug was approved to treat social phobia and post-traumatic stress disorder, the use of sertraline leads only to moderate improvement in these cases. Zoloft also alleviates symptoms of a premenstrual dysphoric disorder, and can be used in sub-therapeutic doses, or intermittently during treatment. Sertraline has common side effects and contraindications with other SSRIs, including nausea, diarrhea, insomnia, and sexual side effects, but the drug has relatively mild effects on cognition and attention. The drug was found in high concentrations in fetal blood when it was used by pregnant women. Use of Zoloft during pregnancy may also be associated with a higher number of different birth defects. The use of sertraline and other antidepressants for depression may be associated with an increased risk of suicide attempts (high risk for teenagers, people under 25 years old and over 65 years old).
What is Zoloft used for?
Zoloft is prescribed for treatment and prevention of relapse in cases of:
- Depressive states;
- Social phobia;
- Obsessive-compulsive disorder (OCD);
- Depression with manic states;
- Panic disorders;
- Depression with anxiety;
- Panic disorder with agoraphobia;
- Posttraumatic stress disorders.
Avoid taking Zoloft in case of:
Simultaneous intake with MAO inhibitors and pimozide;
- Simultaneous intake with MAO inhibitors and pimozide;
- Children up to 6 years old;
- Hypersensitivity to sertraline.
Take Zoloft with caution if you have organic brain disorders (including mental retardation), epilepsy, liver and/or kidney failure, substantial weight loss.
Take Zoloft pills by mouth 1 time a day in the morning or at night. You can take Zoloft pills with or without your meals.
In case of depression and OCD start taking 50 mg of Zoloft a day.
In case of panic disorder, PTSD, and social phobia start treatment with 25 mg of Zoloft a day. The dosage is increased after 1 week to 50 mg a day.
Such gradual increase in dosages is used in order to avoid possible adverse reactions.
If you do not experience any positive effects taking 50 mg of Zoloft daily, you can increase your dosage. The dosage should be increased by 50 mg of Zoloft a day each weak up to a maximum recommended dosage of 200 mg a day.
Some effect can be observed 7 days after the beginning of treatment, but the overall effect is usually achieved in 2-4 weeks (or even for a longer time in case of OCD).
During the long-term maintenance therapy, the drug taken in a minimum effective dosage, which is subsequently changed depending on a clinical effect.
Children and teenagers of 13-17 years old should start treatment with a dose of 50 mg a day in case of OCD.
OCD treatment for children of 6-12 years old is started with a dose of 25 mg of Zoloft a day for 1 week. Then the dosage is increased to 50 mg a day. Subsequently, in case of little effect, the dosage can be increased from 50 mg a day to 200 mg of Zoloft a day.
Take into account the lower body weight of children compared to adults and increase Zoloft dosage subsequently to avoid overdose.
The drug is used for elderly people in the same dosages as for younger patients.
Take Zoloft with caution if you suffer from a liver disorder.
In case of hepatic insufficiency use lower Zoloft dosages or keep a larger interval between increasing the drug dosages.
The drug is metabolized in a body with only a small amount excreted unaltered with urine. Taking into account low renal excretion of Sertraline, you do not have to adjust the dosage depending on a severity of renal failure.
Simultaneous use of Sertraline and pimozide increases the concentration of the latter in blood. Increased pimozide levels were not associated with any changes in ECG. As the mechanism of this interaction is not yet known, concomitant use of pimozide and sertraline is contraindicated.
There have been severe complications while using sertraline and MAO inhibitors together. The development of serotonin syndrome is possible in case of such drugs combination (hyperthermia, rigidity, myoclonus, lability of autonomic nervous system (rapid fluctuations parameters of the respiratory and cardiovascular system), mental state changes, including increased irritability, agitation, confusion, delirious or even coma). Similar complications, sometimes lethal, occur if MAO inhibitors are taken together with antidepressants or immediately after their cancellation.
Drugs suppressing the central nervous system and alcohol
The combined use of sertraline and substances, which depress central nervous system, requires attention. Avoid taking alcohol and drugs containing ethanol during treatment with sertraline. There was no potentiation of ethanol effects, carbamazepine, haloperidol or phenytoin on cognitive and psychomotor performance in healthy people during clinical trials. However, it is not recommended to drink alcohol during sertraline treatment.
Indirect action anticoagulants (warfarin)
An increase of prothrombin in blood is observed if anticoagulants are used together with sertraline. It is recommended to monitor the prothrombin levels at the beginning of treatment with sertraline and after its cancellation.
Sertraline is bound to blood plasma proteins. Therefore, it is necessary to consider the possibility of interaction with other drugs that bind to the proteins.
Simultaneous intake of Cimetidine and Zoloft substantially reduces the clearance of Sertraline.
Lithium properties are not changed by concomitant use of lithium drugs with sertraline. However, tremor occurs more often when these drugs are used together. Simultaneous intake of sertraline with drugs, that affect serotonergic transmission (eg, lithium drugs) as well as taking other selective serotonin reuptake inhibitors, requires increased caution.
Substances affecting serotonergic transmission
You do not need to make a break in treatment when changing one SSRI to another. However, be cautious with drug changes during your treatment. Avoid concomitant intake of tryptophan or fenfluramine with sertraline.
Liver enzymes induction
Sertraline causes minimal induction of liver enzymes. Zoloft in a dosage of 200mg a day and more can interact with antipyrine.
Glibenclamide and digoxin
There is an interaction between these two substances, Zoloft is taken in dosage of 200mg a day.
Long-term use of sertraline at a dose of 200 mg a day has no clinically significant impact and does not inhibit the metabolism of phenytoin. In spite of this, it is recommended to monitor phenytoin levels in the blood.
There have been very rare cases of weakness, increased tendon reflexes, confusion, anxiety, and agitation in patients concurrently treated with sertraline and sumatriptan. If you need to take these two drugs together, it is recommended to have a regular medical check.
Zoloft during pregnancy and breastfeeding.
There are no medical researchers of using Zoloft by pregnant women. That is why use Zoloft during pregnancy only if an expected benefit for mother outweighs a potential risk to a fetus.
Women of reproductive age should use effective methods of contraception during treatment with Zoloft.
Sertraline penetrates into breast milk. Therefore, it is not recommended to use Zoloft during breastfeeding. There is no reliable data about using the drug during breastfeeding. You should stop breastfeeding if there is a need of taking Zoloft.
In some cases, newborns, whose mothers used selective serotonin reuptake inhibitor antidepressants during pregnancy, including Zoloft, may experience withdrawal symptoms.
Zoloft side effects
You may experience the following side effects during treatment with Zoloft:
Digestive system: dyspeptic symptoms (bloating, nausea, vomiting, diarrhea, constipation), abdominal pain, pancreatitis, dry mouth, hepatitis, jaundice, liver failure, loss of appetite (rarely - increased) up to anorexia.
There were cases of asymptomatic increase in transaminase serum activity in case of long-term use of the drug. Zoloft cancellation leads to normalization of enzyme activity.
Cardio-vascular system: palpitations, tachycardia, hypertension.
Musculoskeletal system: arthralgia, muscle cramps.
Central and peripheral nervous system: extrapyramidal disorder (dyskinesia, akathisia, gnashing of teeth, gait disorders), involuntary muscle contractions, paresthesia, syncope, somnolence, headache, migraine, dizziness, tremor, insomnia, anxiety, agitation, hypomania, mania , hallucinations, euphoria, nightmares, psychosis, decreased libido, suicide attempts, coma.
Respiratory system: bronchospasm, yawning.
Urinary system: bedwetting, urinary incontinence or retention.
Reproductive system: sexual dysfunction (delayed ejaculation, decreased potency), galactorrhoea, gynecomastia, menstrual disorders, priapism.
Senses: blurred vision, mydriasis, tinnitus.
Endocrine system: hyperprolactinemia, hypothyroidism, inappropriate ADH secretion syndrome.
Dermatological reactions: skin redness, blood rush, alopecia, photosensitivity reaction, purpura, sweating.
Allergy: urticaria, pruritus, anaphylactoid reactions, angioedema, periorbital edema, swelling of the face.
Other: weight loss or weight gain, peripheral edema, increased cholesterol levels, weakness, bleeding (including nasal, gastrointestinal or hematuria).
There were rare cases of withdrawal symptoms after the end of treatment with Zoloft. Common withdrawal symptoms include paresthesia, hypoesthesia, depressive symptoms, hallucinations, aggressive reaction, agitation, anxiety or psychotic symptoms.
Can you overdose on Zoloft?
Acute Zoloft overdose is often followed by vomiting, lethargy, ataxia, tachycardia, and seizures. Seek an immediate medical help or call your doctor in case of overdose with Zoloft.
Can I take Zoloft during pregnancy?
Studies have compared the levels of Sertraline in mother's blood and their concentrations in the umbilical cord blood during breastfeeding. The data showed that the effect of sertraline and its metabolites on a fetus is approximately one-third of its effects on a mother. Taking Zoloft during the first trimester of pregnancy is associated with an increased risk of the following birth defects: omphalocele, anal atresia, reduced limb defects, septal defects. However, these specific defects are rare and, therefore, the absolute risk is quite small. The concentration of sertraline in breast milk varies greatly and is equal to its average concentration in mother's blood. As a result, more than a half of breastfed infants received less than 2 mg of sertraline a day. But in most cases, Sertraline was not found in their blood.
Sexual side effects of Zoloft
Like with taking other SSRIs, the use of Zoloft is associated with sexual side effects, including sexual dysfunction and difficulty in achieving orgasm. The observed frequency of sexual side effects depends largely on whether they were spontaneously reported by patients during the manufacturer tests or actively noted by physicians. There were several double-blind studies of Zoloft sexual side effects of versus placebo or other antidepressants were conducted. While Nefazodone (Serzone) and Bupropion (Wellbutrin) does not have a negative effect on sexual function, 67% of men taking sertraline, reported difficulties with ejaculation, compared with 18% before treatment.
Furthermore, 41% of women from a group of women, who did not originally have difficulty in achieving an orgasm, started to experience such difficulties after taking Zoloft. The other mixed group study showed 40% level of orgasmic dysfunction during treatment with Zoloft.
Improved mood while Zoloft intake sometimes compensates these side effects. Sexual desire and overall satisfaction with sex are the same as they were before getting the drug. However, placebo intake slightly increased the performance of sexual desire and satisfaction with sex.
While these effects are generally reversible, they can be rather long-term even after the treatment. This phenomenon is called post-SSRI sexual dysfunction.
A sudden cancellation of Zoloft (sertraline) intake may lead to withdrawal syndrome. Over the half of people with depression experienced withdrawal symptoms while taking sertraline compared to 14% of patients treated with fluoxetine and 66% of patients treated with paroxetine during a blind study.
During the 5-8 day period, when Zoloft was temporarily replaced by placebo, the most common symptoms (reported by more than a quarter of patients) were: irritability, agitation, dizziness, headache, nervousness, tears, emotional lability, nightmares, and anger. About a third of patients reported worsening of mood at a level usually associated with a major depressive disorder.
During another clinical study of people with the impaired panic disorder, sudden discontinuation of Zoloft-induced insomnia and dizziness, while symptoms of a headache, malaise and depression did not increase very much.
The next research of recovered patients with panic disorder showed that Zoloft withdrawal symptoms have been completely eliminated with a gradual decrease of dosages for three weeks. In comparison, people who were taking paroxetine, suffering from withdrawal syndrome.
It is very important to sleep well after you stop taking Zoloft because a rare but very unpleasant side effect is frequent awakening and interrupt dreams.
If you have any mood swings during treatment with Zoloft, immediately contact your doctor, as it may be a symptom of bipolar disorder.
Some people did not suffer from SSRIs withdrawal at all. Your doctor will help you to adjust your Zoloft dosage, gradually reducing it until you stop taking the drug completely.
Can Zoloft cause weight gain?
Seeking for a medical help in case of depression and treatment with antidepressants is a bold and important first step on the road to recovery. However, those who follow this path are often faced with another problem – excessive weight gain.
According to medical experts, up to 25% of people taking a majority of antidepressants, including popular SSRIs (selective serotonin reuptake inhibitor), such as Prozac, Lexapro, Paxil, and Zoloft, are at risk to increase their body weight by 4.5 kg or more.
Most people swear they do not eat more than before, but still gaining weight. That is why we can assume that some metabolic changes still occur. Other people report they are hungry and eat now more than ever. However, since these drugs have no effect on carbohydrate metabolism and cannot be responsible for the uncontrollable craving for sweets, we assume that the increase in appetite is also playing its role in terms of weight gain.
Antidepressants only help us to rediscover the pleasure of life - including food.
While experts are not sure exactly why antidepressants cause weight gain, but they know that simple change in medications can help.
Some antidepressants influence less on weight fluctuations. For example, Effexor and Serzone usually do not cause weight gain, while Wellbutrin can even lead to weight loss.
Sometimes switching within the same class of drugs can be a very wise step to stop weight gain.
Paxil, a drug from the SSRI group, is considered to be the worst antidepressant in terms of weight gain. While another drug from the same group, Zoloft, is least likely to cause this side effect. That is why a simple drug replacement would be quite enough for most of the people.
If you have already started to gain extra weight, switching to a healthy diet, reducing calories intake and increasing physical exercise is still worth trying in order to stop weight gain.
In addition, the growing amount of scientific evidence shows that an increase in the proportion of daily physical activity can not only promote weight loss but also help you to get rid of depression. One large study involving more than 3,400 Finnish men and women published in Preventive Medicine Journal, found that those, who exercise at least two to three times a week, are much less often faced with depression, anger, and stress, than those who exercise less often or not at all involved in sports.
However, experts warn that you should not be hard limiting your calories intake while using antidepressants. This is not only adversely affects the brain chemistry - any strong constraint can contribute to your depression.
Zoloft and alcohol
You should be cautious using Zoloft together with substances, which depress the central nervous system. Actually, it is recommended to avoid taking alcohol and drugs containing alcohol during treatment with Sertraline. There was no increase of alcohol, carbamazepine, haloperidol or phenytoin effect on cognitive and psychomotor performance in healthy people during clinical trials. No matter what, avoid taking Zoloft and alcohol together.
Is Zoloft Addictive?
Possible Zoloft addiction is a very serious issue for many people planning to take the drug. There is a definite answer to this question - drugs, which are used to treat depressions, are not addictive regardless of the duration of treatment. They only help your body to restore brain functions, which have been violated by depression. That is why Zoloft is not considered to be an addictive medication.
What is the best time of day to take Zoloft
Zoloft is prescribed individually considering your diagnosis and health condition. That is why only your doctor can instruct you about what is the best time of a day to take Zoloft.
Generally, it is considered to better take Zoloft in the morning. However, there are no strict time limits in terms of taking the drug.
Is Zoloft a narcotic?
Zoloft belongs to selective serotonin reuptake inhibitors and is used to treat depression, anxiety and other mental disorders. That is why it is not a narcotic and is not in a list of controlled substances.
Can you get high off Zoloft?
Zoloft is just an antidepressant, it is not an opiate or other narcotic substance. That is why it is unlikely you can get high on Zoloft. You can feel some Zoloft side effect, like dizziness, if you take a large dosage of the drug. But it will not be a euphoria state you desire to achieve. Moreover, taking too much of the drug can cause an overdose.
How much does Zoloft cost?
Zoloft prices vary depending on places, where are you going to purchase it. You can buy Zoloft in a physical drugstore, but you need to have a prescription from your doctor. However, buying Zoloft online without prescription is not always safe, but can help you save some money. You just have to choose reputable and trusted online pharmacy.
What is a generic name for Zoloft?
Generic Zoloft is usually called Sertraline, like its active ingredient. It is easy to buy generic Zoloft online. Zoloft generic price is usually much cheaper in online pharmacies than in physical drugstores.