side effects, dosage, reviews, how to take & discontinue, uses, pros & cons, and more
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Brand & Generic Names; Drug Class
|US brand name: Zoloft|
|Generic name: sertraline|
|Drug Class: Antidepressants|
|More on Generic & Worldwide Availability|
Zoloft’s Approved & Off-Label Uses (Indications)
US FDA Approved Treatment(s)
Major Depressive Disorder (MDD), Obsessive-Compulsive Disorder (OCD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Premenstrual Dysphoric Disorder (PMDD), Social Anxiety Disorder
Popular Off-Label Uses
Generalized Anxiety Disorder (GAD), Eating Disorders, Depression in people with a variety of coronary problems, Menopause symptoms
Zoloft’s Usual Onset of Action (when it starts working)Like all SSRIs anywhere from a couple days to over a month, although you should more awake and energetic in two to four days. If you don’t feel any positive benefit after four-six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter.
Likelihood of WorkingZoloft is better for conditions in the anxiety spectrum than those in the depression spectrum. Which is funny given how agitated and nervous it makes a lot of people feel. Zoloft does work well for depression defined by sleeping too much, eating too much, and withdrawing from the world.
How to Take Zoloft
In the PI sheet Pfizer recommends:
50mg a day for MDD and OCD. That’s where you start, that’s where you stay.
For PTSD, panic & social anxiety disorders - start at 25mg a day and after a week increase it to 50mg a day.
Everybody starts at 12.5–25mg and waits at least two weeks, if you can, before increasing by 12.5–25mg a day. And increase the dosage only if you need to.
How to Stop Taking Zoloft (discontinue / withdrawal)
The usual way with SSRIs. Reduce your dosage by 12.5–25mg each week. If the discontinuation syndrome is too harsh you have two options, getting a prescription for the oral solution and reducing your dosage by whatever you can tolerate, or getting a prescription for 10mg fluoxetine capsules and take 20mg a day (if you’re at 25mg of Zoloft) for two weeks and 10mg a day for another two weeks.
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Pros and Cons
The slight, but noticeable, dopamine action Zoloft has is often enough to get you out of bed and back to work within a couple of days. You might still be depressed for another two-four weeks, but at least you don’t have to lie in bed staring at the ceiling and ruminating on how much your life sucks. It also makes weight gain less likely.
The slight dopamine action Zoloft has makes it the worst Serotonin-[sorta-]Selective Reuptake Inhibitor to take if bipolar is known or suspected. Definitely the worst to have taken if bipolar was a surprise. While the dopamine action is in the right place to make you sweaty and nervous (like Wellbutrin) it’s nowhere near the right place to prevent sexual side effects.
Interesting Stuff your Doctor Probably didn’t Tell YouIf you take the tablets with food you’ll get a 25% increase in Zoloft’s peak plasma - the most you’d have in your blood - and it will happen faster, dropping from 8 hours to 5.5.
If you take the oral concentrate with food you won’t get any more out of it, but it will take longer to reach that peak amount, from 5.9 to 7 hours.
Increased and/or delayed peak plasma when taking meds with food happens all the time. But these numbers only make sense if the volunteers were professional lab rats.
Best Known forThe ad campaign featuring rolling blobs. Letting people know they’re bipolar with a big, fat, dysphoric mania.
Zoloft’s Side Effects
Typical Side Effects
The usual for SSRIs - headache, nausea, dry mouth, sweating, insomnia, diarrhea or constipation, and loss of libido. Most everything, except the loss of libido, usually goes away within a couple of weeks.
Uncommon Side Effects
Sweatiness, like really sweaty all the time. Although not uncommon for SSRIs, Zoloft is a very “nervous” drug, as it can sometimes make you sweaty, shaky and generally uncomfortable in your own skin, more so than the others in this class. Which I find hilariously ironic, as it’s approved and fairly effective for panic disorder and social anxiety disorder, and used off-label for generalized anxiety disorder.
Freaky Rare Side Effects
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What You Really Need to be Careful About
While every antidepressant was slapped with a warning about suicidal thoughts and behavior during the height of anti-psychiatry hysteria, Zoloft is actually one you need to be especially careful with. Like a large number of the instances when that sort of thing happened, it was due to the person being bipolar. It doesn’t help that Zoloft is the only SSRI where you can actually kill yourself with a month’s supply of pills (assuming an especially high dosage of 150–200mg a day, which some people actually take).
Half-Life & Clearance
Half-life: 26 hours, clearance: five to six days.
Pharmacokinetics Information Overload
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff1. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what2, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on the pharmacokinetics page.
How sertraline Works
the current best guess at any rateSertraline is the second-most potent SSRI on the US market (Paxil is the most potent)3. With its action as a dopamine reuptake inhibitor and its effect on the 5HT1A receptors, Zoloft probably affects dopamine enough, directly and indirectly, to have a meaningful impact, both good and bad, on side effects. Zoloft may also work on the sigma 1 receptors, and that would explain why it’s so effective for anxiety disorders.
More than You Probably Ever Wanted to Know about How a Drug Works
AKA mechanism/method of action, pharmacodynamics
Ratings, Reviews, Comments, PI Sheet, and More
While Zoloft is no more likely to trigger mania than any other SSRI, due to that dopaminergic kick the symptoms it triggers are a lot worse. Zoloft just gets you way more agitated and sets of these nasty dysphoric manias in the bipolar, which can be a very harsh way to discover that one is bipolar. With the other SSRIs and SNRIs it’s a coin toss as to whether they’ll trigger euphoric manias that will send you on spending sprees or marrying people you just meet, or trigger dysphoric manias that make you destroy all the furniture in a room. But with Zoloft the odds are heavily in favor of the dysphoric mania. That may be why the poor little Zoloft lozenge quit shilling Zoloft so heavily for depression, and now primarily touts its efficacy for social anxiety, panic disorder, PTSD, and PMDD. Then again it could be that Zoloft is just testing better in studies for its other approved uses. In any event, that’s you need to be extra careful with Zoloft, more than most others antidepressants, when it comes to watching out for suicidal thoughts and behavior.
As if I didn’t go on long enough already.
Get all critical about Zoloft
Rating 3.3 out of 5 from 149 criticisms.
Vote Distribution: 15 – 13 – 16 – 12 – 56 – 37
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If you’re still feeling judgmental as well as just mental4, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
Get all judgmental about the Zoloft (sertraline) Synopsis
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It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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1 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
2 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
3 In terms of sheer raw power of pure sertraline at serotonin transporter binding sites. All sorts of other factors are involved in determining a drug's potency. As I write all over the place "potency" and "efficacy" are two completely different things. See the pages on SSRI & SNRI Dosage Equivalents and Pharmacokinetics for more information.
4 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
5 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Zoloft discussion board. I welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why I write these damn things. I’m frustrated enough as it is. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds.
|Last modified on Monday, 10 March, 2014 at 10:28:39 by SomeMedCritic||Page Author: JerodPoore||Date created Wednesday, 06 April 2011, at 14:28:00|
Zoloft, and all other drug names on this page and use throughout the site, are a trademark of someone else. Look on the the PI sheet or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else.
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Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazymeds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality.
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazymeds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had a forerunner of QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]