Every years millions of people are prescribed Zoloft (sertraline) and similar drugs in the selective serotonin reuptake inhibitor (SSRI) class, which also includes Prozac (fluoxetine), Paxil (paroxetine), Lexapro (escitalopram), and Luvox (fluvoxamine). Every year millions more people encounter serious side effects when they try to discontinue these medications, including:
- Pins and needles sensations (paresthesias),
- Body aches, and
- Electric shock sensations.
Withdrawal symptoms are typically not as bad when coming off Prozac. This isn't because Prozac is less "toxic" than the other SSRI antidepressants. It's because Prozac has a longer half life and stays in your body longer. You have fewer withdrawal symptoms because you aren't really withdrawing from the medication, at least not as quickly with Prozac as with some of the other medications. That's why many doctors will switch their patients to Prozac to help them come off other antidepressants in the same class.
Just how difficult it will be to come off Zoloft depends in part on whether your liver activates or deactivates it. (The liver is the body's major detoxifying organ, but with regard to Zoloft and some other medications it is also an "activating" organ.) The liver uses an enzyme named CYP3A4 to transform Zoloft into its active form. If your liver starts msking a lot of CYP3A4 then activated Zoloft will stay in your system. The most often cited example of how this works is the effects of grapefruit and grapefruit juice. Grapefruit activates CYP3A4, which in turn makes Zoloft stay active. Other drugs and foods that activate CYP3A4, and which make coming off Zoloft more difficult, include:
- Earl Grey tea, due to the addition of bergamot. You probably need to avoid Earl Grey tea when you are coming off Zoloft.
- Capsaicin, the chemical that provides the heat in hot peppers. Eating lots of hot peppers will keep Zoloft in your system.
- St. John's wort. Even though St. John's wort actually is about as useful as any other treatment for depression, the combination of St. John's wort and Zoloft or other SSRIs is dangerous. The combination can cause a condition called serotonin syndrome, which in addition to giving most people explosive diarrhea and headaches, can also cause dangerously high blood pressure and manic behavior. You need to have been totally off any SSRI for six weeks before you take St. John's wort.
- Certain anticonvulsants (such as Dilantin, also known as phenytoin), antibiotics (especially Rifampicin), diabetes medications (Actos and Avandia), barbiturates (phenobarbital), reverse transcriptase inhibitors, and stimulants also increase the activity of CYP3A4 and keep Zoloft in your system.
All this means is that both you and your doctor can make the process of getting off Zoloft easier. You can avoid the foods that keep Zoloft in your body. This doesn't mean that if you eat one caper berry or a single leaf of kale you are going to have to stay on Zoloft forever, but the effects of foods are cumulative. The more problem foods you avoid, the fewer problems you will have. Your doctor and pharmacist can make the process easier by making sure you don't get medication that keep Zoloft in circulation. Tell your pharmacist you are coming off Zoloft so he or she can make sure there are no harmful drug interactions.
Many people have questions about using cannabis as an aid in withdrawal from SSRIs. It's important to understand that buying pot from a dealer off the street may or may not do you any good. Marijuana has been so heavily hybridized that it is almost as if different strains were different plants entirely. You are probably setting back your progress unless you go to a licensed dispensary. The dispensary will tell you that "stinky" strains don't help but "citrusy" stains usually do. It's the limonene that gives certain strains of pot their lemony scent and that also helps to lift depression.
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