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Zoloft works by restoring the correct balance of naturally occurring chemicals in the brain and is the most prescribed antidepressant in the United States, with some 29,652,000 prescriptions being written each year.

Zoloft® (sertraline HC) is an antidepressant medication, known as a selective serotonin reuptake inhibitor (SSRI).  It is used to treat depression, social anxiety disorder, severe premenstrual dysphoric disorder, panic disorder, post traumatic stress disorder, obsessive compulsive disorder and has also been used to treat decreased sexual ability (premature ejaculation) in males.[1]

What is Depression?

The term “depression,” refers to a medical condition that has specific symptoms, however, individual symptoms of depression will vary.  Depression refers to a long lasting sense of melancholy and a sadness that does not seem to abate, combined with a loss of interest and pleasure in normal activities.  Of course different people experience different symptoms, some experience all and some have additional symptoms, such as [2]:

  • Changing appetite or weight loss
  • Sleep pattern disruption or changes
  • Noticeable restlessness or decrease in activities
  • Energy levels decreasing or feelings of being tired all the time
  • Loss of focus, difficulty concentrating or making decisions
  • Thoughts of death or suicide

To be diagnosed by a physician, a person must have five or more of the symptoms listed, and at least one of the symptoms must be one of the first two major symptoms of depression.  The symptoms must also be present for a period of two weeks or longer.  The severity of the symptoms would also affect all aspects of a persons life including work, social and everyday life. A person may have difficulty concentrating, remembering, or making decisions, or difficulty sleeping, early-morning awakening, or oversleeping. 

Depression can also manifest itself into other areas of a persons life and health and may cause digestive problems, dry mouth, nausea, constipation or diarrhea, there may be changes in appetite and weight changes, as already mentioned, there may be symptoms of aches or pains, headaches, cramps, or digestive problems without a clear physical cause. Feelings of worry, anxiety or irritability can also be hidden signs of depression and should be checked by a physician, as well as feelings of guilt, worthlessness, or helplessness and pessimism.[2] 

When you're constantly irritable, persistently sad, anxious, or “empty” mood, when you lose interest in your hobbies and activities, when you have decreased energy and you're constantly fatigued, which includes even moving or talking more slowly or you're feeling restless or having trouble sitting still.[2]

When to Consider Treatment with Zoloft®

Prior to treatment with Zoloft®, it is necessary to visit a physician for a consultation to determine if a regimen of Zoloft® is necessary.  The physician will ask questions about the symptoms being experienced, take a complete medical history including a family history of depression, perform a psychiatric evaluation and other considerations when deciding which course of treatment would be medically appropriate.

Once it has been determined that Zoloft® is the desired course of treatment, the physician will then decide which program of therapies to use in addition to medication. Oftentimes, it is necessary for the patient to use the medication in conjunction with psychotherapy and behavior modification, because the medication alone may only mask the symptoms of depression and not address the actual cause.

The Benefits of Zoloft®

Benefits from treatment with Zoloft® include successful treatment of obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder.  Long-term studies of the medication also found that individuals treated with Zoloft® were less likely to suffer from a relapse of depressive episodes.[3]

Another benefit of treatment with Zoloft® is that it is non-habit forming, however if you suddenly stop taking sertraline, you may experience withdrawal symptoms such as nausea, sweating, depression, mood changes, frenzied or abnormally excited mood, irritability, anxiety, confusion, dizziness, headache, tiredness, seizures, ringing in the ears, numbness or tingling in the arms, legs, hands, or feet, difficulty falling asleep or staying asleep.[4]

Another benefit of treatment with Zoloft® is that it does not cause weight gain or the changes in weight gain are minimal [5].  Zoloft® is believed to be a more effective treatment option than older tricyclic antidepressants such as amitriptyline or nortriptyline. However, some people do report weight gain and claim it is caused by Zoloft. The reason could be in fluid retention, lack of exercise, increased appetite, or other factors. 

Zoloft® should be taken exactly as prescribed by the physician and it is necessary to allow the recommended time frame to achieve the maximum benefits of the medication.  If a dosage of Zoloft® is missed, try to resume the normal schedule as soon as possible and never double up on the medication to try and catch up.

Side Effects of Zoloft®

A very important notice that every parent or caregiver should take into consideration is that a small number of children, teenagers, and young adults who took antidepressants such as sertraline (Zoloft) during clinical studies became suicidal: they had thoughts of harming or killing themselves or planning or trying to do so. Therefore, caregivers should know that those who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. Zoloft may not be responsible for suicidal thoughts, depression itself is. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant.[4]

For people taking Zoloft®, it is important to know all the possible side effects of the medication, which are as follows [1]:

  • Ejaculation failure
  • Dry Mouth
  • Increased sweating
  • Somnolence (drowsy feeling)
  • Dizziness
  • Headache
  • Paresthesia (tingling, prickly sensation on the skin)
  • Tremors
  • Rash
  • Anorexia (severe limitation of food intake)
  • Constipation (hard stool)
  • Diarrhea (loose stool)
  • Dyspepsia (indigestion)
  • Nausea
  • Vomiting
  • Fatigue
  • Anxiety
  • Agitation
  • Insomnia
  • Decreased Libido
  • Nervousness
  • Abnormal Vision

Before taking a regimen of Zoloft®, the physician will also address any other medications the patient is taking to guard against any further side effects or adverse reactions that may be caused as a result.  It is important to note, that any combination of side effects should be promptly reported and addressed by the prescribing physician to protect the health of the patient.

Drug Interactions with Zoloft®

Patients taking Zoloft® should discuss any other medications being taken with a physician to avoid contraindications and harmful side effects.  Zoloft® should only be taken under the guidance and direction of a physician and exactly as prescribed.

Serious side effects have been noted in patients who take Zoloft® in combination with Monoamine oxidase inhibitor (MAOI) medication , symptoms of a drug interaction include:

  • Hyperthermia (high fever)
  • Rigidity (stiffening)
  • Myoclonus (irregular involuntary muscle contraction)
  • Autonomic Instability with possibility of rapid vital sign fluctuations
  • Mental Status Changes (confusion, irritability, agitation, delirium, coma)

Zoloft® should never be taken in conjunction with an MAOI or within a period of 14 days discontinuation of taking MAOI medications.  A period of 14 days should be allowed after cessation of taking Zoloft® before starting a regimen of MAOI medication as well.[6] MAOI medications to avoid when taking Zoloft® include:

  • Linezolid
  • Furazolidone
  • Isocarboxazid
  • Moclobemide
  • Phenelzine
  • Procarbazine
  • Selegiline
  • Tranylcypromine

Zoloft® should also not be used when taking the following medications because of the serious interactions that may occur:

  • Pimozide
  • Weight loss medications (sibutramine, phentermine)
  • Tryptophan
  • Terfenadine
  • Astemizole
  • Dihydroergotamine

Prescription and nonprescription medications that the physician or pharmacist should also be made aware of are, as follows:

  • Ayahuasca
  • Buspirone
  • Carbamazepine
  • Clozapine
  • Dextromethorpan
  • Flecainide
  • Lithium
  • Melatonin
  • Meperidine
  • Nefazodone
  • Propafenone
  • Thrombolytic drugs
  • Anticoagulants
  • Antiplatlet drugs
  • Other SSRI antidepressants (citalopram, fluvoxamine)
  • St. John's Wort
  • Thioridazine
  • Tramadol
  • Trazadone
  • Tri-Cyclic antidepressants
  • “Triptan” migraine drugs (sumatriptan)
  • Venlafaxine
  • Low dosage Aspirin
  • Anti-anxiety drugs
  • Antihistamines
  • Anti-seizure drugs
  • Sleep medications
  • Muscle relaxers
  • Narcotic pain relievers
  • Psychiatric medications
  • Tranquillizers
  • Check the labels on all medications as they may contain drowsiness-causing ingredients

Zoloft® should also not be taken by those with hypersensitivity to sertraline or any other ingredient found in Zoloft®.   For those taking liquid Zoloft®, the medication contains alcohol and should not be taken with Antabuse (disulfiram).  Liquid Zoloft® should only be mixed with 4 ounces water, ginger ale, lemon/lime soda, lemonade or orange juice and no other type of liquid. 

Prior to taking Zoloft®, it is necessary to let the physician or pharmacist know of any allergies, liver disease, seizures, heart disease, thyroid disease, other medications, if pregnant or planning to become pregnant or if nursing a infant.

Zoloft® Interactions with Alcohol

The concomitant use of Zoloft® and alcohol has not been studied in depth, however, is not recommended.  Combing alcohol and Zoloft® may result in an increase in the side effects of alcohol such as drowsiness, slowed reflexes, central nervous system depression, headaches and lowered heart rate and blood pressure changes are also possible.[7]

Some patients taking Zoloft® have reported an increased craving to drink large amounts of alcohol.  The results of one scientific study has shown that increasing levels of serotonin by any means, produces an increased craving for alcohol, as well as anger and anxiety levels being elevated.  For more information about combing alcohol with Zoloft®, consultation with a physician is necessary.

Withdrawal from Zoloft®

Zoloft® has a half-life span of about one day.  This means that for every one day that passes without taking another dose of Zoloft®, the blood level of the medication decreases by 50%.  After one day of cessation, the medication blood level is 50% less then it was the previous day, after two days it falls to 25%, after three days it falls to 12.5%, and so on.

If someone stops taking Zoloft® abruptly, withdrawal syndrome can develop.[4] Some of the symptoms that may be experienced are nausea, tremors, muscle pain, feelings of being lightheaded, insomnia and anxiety.  The withdrawal symptoms may last for a period of up to two weeks and in some cases can last for up to one month. 

It is highly recommended that when stopping Zoloft®, a patient should do so over time and in gradual steps, under the guidance of a physician. Never quit taking Zoloft® cold turkey, doing so can result in serious side effects and a relapse into depression or other conditions the medication was prescribed for.

Prognosis for Treatment with Zoloft®

Treatment with Zoloft® has shown great promise in the treatment of clinical depression and a wide variety of other mental health disorders.  When taken as prescribed by a physician and used in conjunction with psychotherapy and behavior modification, Zoloft®has shown to dramatically improve the symptoms of depression and other forms of anxiety and stress related disorders.