How Long Until Zoloft Starts Working (Onset of Action)
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 Working
Zoloft 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.
In the PI sheetPfizer recommends: 50 mg once a day for adults with MDD and OCD. That’s where you start, that’s where you stay.
For adults with PTSD, panic & social anxiety disorders - start at 25 mg once a day and after a week increase it to 50 mg 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.
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 You about Zoloft
If 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 for
The ad campaign featuring rolling blobs. Letting people know they’re bipolar with a big, fat, dysphoric mania. In-Depth Pros & Cons
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Zoloft’s Potential Side Effects (Adverse Reactions)
Typical Side Effects
The usual for SSRIs - headache, nausea, dry mouth, sweating (more than most SSRIs) , insomnia, constipation or diarrhea, and loss of libido.
Uncommon Side Effects
Sweatiness, like headachegetting 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.
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 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 sertraline’s pharmacokinetics page.
How sertraline Works
the current best guess at any rate
Sertraline 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.
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.
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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. We 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 we write these damn things. 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. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
Last modified on Tuesday, 30 December, 2014 at 16:25:17 by JerodPoore
Zoloft, and all other drug names on this page and used throughout the site, are a trademark of someone else. Zoloft’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. 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. It may of changed hands by the time you finished reading this article.
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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. Plus we are big pottymouths and talk about S-E-X a lot. Know your sources! 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 from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. 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 medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
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.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
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 Internetis 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?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.