Different doses of zoloft

Zoloft for anxiety; Dosages, interactions, and more

Living with anxiety can make daily life difficult. Fortunately, there are many treatment options available for anxiety that can help people find relief from their symptoms. Zoloft is one medication that may help. In this guide, we’ll explain to you what Zoloft is and how to take it for anxiety.

Taking Zoloft for anxiety

Anxiety is a prevalent condition that affects people all over the world. An estimated 31% of all adults will experience an anxiety disorder at some point in their life, and SingleCare’s anxiety survey found that 62% of respondents experienced some degree of anxiety. Zoloft is the brand name of a generic medication called sertraline. It’s a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that treats anxiety by slowing down the reabsorption of serotonin. Zoloft treats several mental health conditions:

Social anxiety disorder
Panic disorder
Depression (also known as major depressive disorder)
Post-traumatic stress disorder (PTSD)
Obsessive-compulsive disorder (OCD)
Premenstrual dysphoric disorder

Zoloft may treat anxiety if psychological treatments, like cognitive behavioral therapy, aren’t working or if your healthcare professional/psychiatrist thinks it will improve your quality of life in combination with other methods like therapy.

What’s the right Zoloft dosage for anxiety?

The right dosage of Zoloft for anxiety varies by the severity of anxiety and whether the patient has other medical conditions. In general, though, the initial therapeutic dosage of Zoloft for anxiety is 25 mg or 50 mg per day.

Zoloft tablets are available in three dosage strengths: 25 mg, 50 mg, and 100 mg. The maximum dose of Zoloft is 200 mg per day (which can be taken as two 100 mg tablets).

Most studies suggest that the most effective dose of Zoloft is 50 mg per day. This dose is proven to be the most effective and tolerable dose for most patients. People who don’t respond to 50 mg per day may be advised by their doctor to increase their dose of Zoloft by 50 mg per day at weekly intervals to a maximum of 200 mg per day. For example, a doctor might recommend taking 50 mg daily for one week, then 100 mg daily for one week, etc. Always follow your healthcare provider’s instructions for use—and only change doses under the guidance and direction of your provider. Do not initiate dosage changes on your own.

Zoloft is also available in liquid form as an oral solution. The oral solution comes as a clear, colorless solution with a menthol scent that contains 20 mg of sertraline per mL, at 12% alcohol. It comes in a 60 mL bottle with a calibrated dropper with 25 mg and 50 mg measuring marks. Zoloft oral solution must be mixed (just before taking) into 4 ounces (one-half cup) of water, orange juice, lemonade, ginger ale, or lemon or lime soda before consumption.

Always follow your healthcare provider’s instructions for use and do not change the dose of Zoloft on your own. Symptoms of a Zoloft overdose may include seizures, coma, heart problems, high blood pressure, and serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition that can occur from the buildup of excess serotonin and requires emergency medical attention. If you think you overdosed on Zoloft, you can call Poison Control at 1-800-222-1222, but if your symptoms seem severe or life-threatening, you should call 911 and go directly to the emergency room.

When does Zoloft start working for anxiety?

Zoloft doesn’t work immediately, so don’t stop taking Zoloft if your symptoms don’t improve right away. It takes two to six weeks to start reducing anxiety symptoms. Some people may feel a reduction in their anxiety symptoms within the first week of taking Zoloft, but this shouldn’t be expected for everyone.

How does Zoloft make you feel?

According to the National Alliance on Mental Illness, some of the earliest signs that Zoloft is working are improvements in sleep, energy, or appetite. These improvements could happen one to two weeks into taking the medication.

More significant changes, like feeling less depressed or regaining interest in daily life, may take six to eight weeks to occur. Over time, many people will notice a substantial difference in their anxiety symptoms, and some people may eventually have no symptoms at all.

Side effects

Here are the most common side effects of Zoloft you may experience when you start taking it:

Dizziness
Loss of appetite
Lightheadedness
Dry mouth
Nausea
Diarrhea
Increased sweating
Restlessness
Sexual side effects like sexual dysfunction
Fatigue
Trouble sleeping
Nervousness

Some side effects may be more noticeable at first, but then disappear as your body gets used to the medicine.

Sexual side effects

Sometimes, individuals who take an antidepressant like Zoloft may experience sexual side effects. In men, symptoms may include delayed ejaculation, decreased sex drive, and/or problems getting or maintaining an erection—and in women, decreased sex drive and problems having an orgasm. Patients who are experiencing sexual side effects should consult their healthcare provider. Although it may feel uncomfortable to talk about these issues with your prescriber, it is very common and there are solutions available.

Serious side effects

Although it’s rare, Zoloft may cause more serious side effects like unusual weight loss, low sodium blood levels, increased risk of bleeding (especially when combined with certain drugs like blood thinners or NSAIDs), seizures, and serious allergic or skin reactions.

Serious allergic or skin reactions

While rare, having a serious allergic or skin reaction can be life-threatening and cause death. People with symptoms of an allergic reaction (hives, difficulty breathing, swelling of the face, lips, tongue, or throat) should get emergency medical help right away. Likewise, those with symptoms of a serious skin reaction (hives, blistering or peeling skin, red or purple rash, fever, burning eyes, sore throat) should seek emergency medical attention.

Increased risk of bleeding

SSRI drugs, including Zoloft, can increase the risk of bleeding (which may range from mild to life-threatening), especially when taken with certain other medications. Examples of these medicines include:

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex (celecoxib), Mobic (meloxicam), or Motrin (ibuprofen)
Anticoagulants such as Coumadin (warfarin)
Antiplatelet drugs such as Plavix (clopidogrel)

Patients should discuss all the drugs they take with their healthcare professionals before taking Zoloft. This includes prescription and OTC drugs, vitamins, and supplements.

Warnings

Zoloft also comes with a black box warning for suicidal thoughts and behaviors. A black box, or boxed, warning, is the strongest warning required by the US Food and Drug Administration (FDA). Short-term studies have shown that antidepressants increased the risk of suicidality in children, adolescents, and young adults compared to a placebo. However, people of any age who take Zoloft should be monitored, so seek medical advice right away if you’re taking Zoloft and start to have mood changes and/or suicidal thoughts or behaviors.

Contraindications

Zoloft is not safe for everyone. Zoloft should not be used in:

People who are allergic to sertraline or any SSRI medication such as Paxil (paroxetine), Prozac (fluoxetine), or Lexapro (escitalopram)
People who have taken an MAOI drug in the last 14 days
People with moderate to severe liver problems (Child-Pugh Class B-C)

Additionally, Zoloft should never be stopped abruptly (with few exceptions, such as in the event of a life-threatening reaction). When it is time to stop taking Zoloft, the healthcare professional will provide a tapering schedule so that the medication is stopped safely and slowly, over a period of time. Stopping Zoloft abruptly can cause withdrawal symptoms such as nausea, sweating, vertigo, shock sensations, confusion, sleep problems, and seizures.

There are also certain instances when Zoloft may be used with caution and close monitoring. Before taking Zoloft, tell your prescriber about all of the medications you take and all of your medical conditions, especially if you:

Consume alcohol
Are at risk of bleeding
Have liver problems
Have mental health conditions or a history of mental health conditions
Have glaucoma
Have electrolyte abnormalities
Have (or have a history of) heart or heart rhythm problems
Have a history of seizures

Interactions

Talk to your doctor about how to take Zoloft if you’re taking any of the following medications:

Other medications that increase serotonin because of the risk of serotonin syndrome (such as other antidepressants, opioid pain medications, muscle relaxants, cough suppressants, or migraine medications in the triptan drug class)
Disulfiram
Blood thinners such as warfarin
NSAIDs such as ibuprofen
St. John’s Wort
Lithium
Nardil (phenelzine)
Parnate (tranylcypromine)
Marplan (isocarboxazid)
Azilect (rasagiline)
Emsam (selegiline)
Orap (pimozide)

Zoloft taken with monoamine oxidase inhibitors (MAOIs) or other drugs that increase serotonin (such as other antidepressants, triptans, and dextromethorphan which is found in cough and cold products) could cause serotonin syndrome, a life-threatening emergency that can cause hallucinations, seizures, comas, tremors, delirium, and other serious side effects.

RELATED: Is it safe to take anti-anxiety medication with alcohol?

What is the most effective antidepressant for anxiety?

There is no single antidepressant that’s best for treating anxiety. What works for one person may not work for another. Depression symptoms will completely go away for about 1 out of every 3 people who take SSRIs, but more research still needs to be done on why SSRIs work for some people and not for others. Your healthcare provider is the best person to ask which antidepressant will be most effective for you.

“Other SSRI medications can be effective for anxiety such as Prozac or Celexa or Paxil, yet each has some side effects—notably lowered libido and weight gain,” says Uma Naidoo, MD, a psychiatrist at Mass General Hospital in Boston. “Benzodiazepines are very effective in the short term while under the care of a doctor, but these are potentially addicting medications and must be used with immense caution and only as a short-term measure, e.g., grief following the death of a family member,” says Dr. Naidoo. Benzodiazepines are controlled substances, and have the potential for abuse and dependence, and include drugs such as Klonopin (clonazepam) and Xanax (alprazolam).

As mentioned earlier, your healthcare provider is the best person to ask about how to treat anxiety. Medications can be effective in treating anxiety, but Dr. Naidoo says you may have other options as well. Some additional ways to combat anxiety, in combination with your prescription medication, may include:

Talk therapy: Patients with anxiety can benefit from regular sessions with a therapist.
Physical exercise: Regular physical exercise (as approved by your doctor) can be helpful to many people, improving symptoms of anxiety and helping you sleep better, in addition to improving overall health. Talk to your doctor about an exercise plan that is appropriate for you.
Mindfulness and breathing exercises: Mindfulness can help people focus on the present and help reduce anxiety and depression.
Dietary changes: Eating regular, healthy meals will help keep your blood sugar steady, avoiding that jittery feeling from low blood sugar, which may add to anxiety. A registered dietician is often covered by insurance and can be a very helpful resource in instituting dietary changes.

Your physician can help you come up with a treatment plan that will fit well into your life.

When to see a doctor

If you are experiencing anxiety that is interfering with your quality of life, do not hesitate to seek treatment. Start with your primary care provider, who can often recommend some lifestyle changes, start you on a medication, and/or provide recommendations for a therapist. You will be on your way to feeling better soon, and you will be glad you reached out for help.

When Should You Increase Your Zoloft Dosage To Treat Anxiety?

Content

Overview
What is Zoloft?
What is the proper Zoloft dosage for anxiety?
When to increase your Zoloft dose for anxiety?
Talk to your doctor first
Factors that could impact whether you need a higher dose
Zoloft’s effects on anxiety
The lowdown

If you’ve been prescribed Zoloft to treat your anxiety, but it’s not quite doing the job, you might find it tempting to increase your dosage.

However, Zoloft is a psychiatric medicine, so it’s crucial you don’t take more or less than the dosage prescribed. However, your doctor may be able to prescribe a stronger dose if needed, if they determine that this is the right course of action.

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Zoloft, or sertraline as it is known under its generic name, is a psychiatric medicine used largely in the treatment of depression and anxiety.

Taken orally, Zoloft belongs to a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. SSRIs are a commonly prescribed antidepressant that improves mood by blocking the mechanisms that absorb serotonin, allowing it to be available to the brain for longer.

This is important because serotonin is known for its ability to induce feelings of happiness. In fact, serotonin is often referred to as the “happy hormone.”

Starting Zoloft

The appropriate dosage of Zoloft will be determined by a doctor and is likely to differ depending on the patient and their individual needs.

Typically, 50 milligrams once a day is a standard starting dosage for adults with depression, obsessive-compulsive disorder, and premenstrual dysphoric disorder. Some conditions tend to start with a lower dose of 25 milligrams once a day, like panic disorder.

Maximum dose

Your Zoloft dose must stay within a safe range, so you’re unlikely to be prescribed anything higher than 150-200 milligrams per day. In the end, your dosage will depend on the condition being treated and your individual needs.

Children

Children can also benefit from Zoloft but will follow a different dosage regimen. This dose will be at the discretion of your doctor and is based on your child’s age, size, and therapeutic need. For instance, for children aged 6 to 12 years of age with obsessive-compulsive disorder, a standard starting dose is 25 milligrams once a day.

If you have concerns or questions about your dosing, make sure to discuss it with your doctor before making any changes to your medication regimen.

If you’re taking Zoloft, but aren’t feeling any improvement in your anxiety levels, it can be tempting to simply up your dose – but it’s important not to.

Zoloft is not an instant relief medication. SSRIs do not exert instant effects like, pain relief does. Zoloft (and other SSRIs) is a little more complicated and it takes longer for its full effects to be felt.

These medications take time for their effectiveness to peak. Zoloft works by blocking the reuptake of serotonin and it takes repetitive dosing and time for the medication to be able to exert its effects on your system. It can take around two to six weeks before you start to experience a reduction in your anxiety symptoms.

If after this period you still haven’t seen any benefits then you may want to talk to your doctor about altering your Zoloft dose.

While Zoloft can have a positive impact on anxiety, it can also come with some minor side effects. Zoloft can also increase your risk of serious side effects if you have an existing medical condition or are taking other medication.

Therefore, increasing your Zoloft dose without approval from your doctor should not be done under any circumstances. This can have serious detrimental effects on your health and wellbeing and can result in coma and seizures.

Zoloft side effects and drug interactions

The following side effects¹ and potential drug interactions² highlight why it’s important to follow your Zoloft prescription and avoid increasing your dosage without your doctor's approval.

Potential side effects of Zoloft include:

Nausea
Loss of appetite or indigestion
Diarrhea
Excessive sweating
Tiredness or fatigue
Sexual performance issues, e.g. reduced sex drive, failure to ejaculate
Sleep disturbances, e.g. sleepiness or insomnia
Shaking hands
Increased agitation and irritability
Suicidal ideations
Impulsive and dangerous behavior
Worsening of depression and/or anxiety symptoms
Violent behavior
Seizures
Manic behavior, e. g. fast-paced and racing thoughts, extreme high and low emotions, excessive energy, and talking grandiose thinking.
An allergic reaction (typical symptoms include trouble breathing, a rash or hives, and swelling).
Eye problems, e.g. blurred vision, red eyes, pain in the eyes.
Serotonin syndrome includes symptoms such as hallucinations, agitated behavior, loss of consciousness/coma, increased heart rate, vomiting, and rigid muscles

There are also specific side effects that can affect children taking Zoloft:

Nose bleeds
Urine problems, e.g. frequently needing to urinate or leaking urine
Changes to menstruation, specifically heavier periods
Agitation or fidgeting
Aggressive or irritable behavior that is out of the norm
Changes to physical development. You may see your child’s growth rate start to slow down and/or weight gain.

Conditions that can increase your risk of Zoloft side effects:

Glaucoma: People with glaucoma can experience an increase in glaucoma attacks if they take Zoloft and should therefore talk to their doctor to determine if the SSRI is appropriate.
Seizure conditions: Since seizures are already a potential side effect of Zoloft, the medication should be considered carefully in people with a seizure condition lest it increases their frequency or severity³.
Liver issues: Patients with liver problems should take care when starting Zoloft as they can experience stronger effects than normal, due to their liver’s inability to break down the medication.
Bipolar disorder: Bipolar disorder is a possible contraindication for Zoloft as you may experience a higher risk of manic symptoms.
Kidney issues: Much like the liver, if your kidneys aren’t functioning well then you may not be able to filter medications properly, resulting in higher levels of Zoloft in your system.

Side effects that can occur when Zoloft is taken alongside certain medications:

Increased risk of serotonin syndrome can occur when Zoloft is taken with monoamine oxidase inhibitors, linezolid, intravenous methylene blue, triptans, lithium, fentanyl, tramadol, and St John’s wort.
Heart problems can occur when Zoloft is taken with pimozide.
Bruising and bleeding can occur when taken with nonsteroidal anti-inflammatory medications, e.g. aspirin.
A build-up of medications (including Zoloft) can occur in your system when taken with cimetidine, tricyclic antidepressants.

While it’s important to stick to the dose recommended by your doctor, there are legitimate and safe reasons why your doctor may increase your Zoloft dose.

For instance, your doctor may increase your Zoloft dose if you aren’t seeing a significant reduction in your anxiety symptoms, so long as it is safe.

The risks of altering your Zoloft dosage without medical approval are substantial. However, with a prescribed dosage and professional advice, Zoloft can have a positive impact on your anxiety and improve your quality of life.

Research tells us that Zoloft can effectively reduce anxiety scores. One study⁴ found that Zoloft managed to significantly improve anxiety, worry, and depressive symptoms in patients (60 years and older), with an anxiety diagnosis (generalized anxiety disorder, panic disorder, agoraphobia, or social phobia).

Zoloft is also an effective treatment option for children suffering from anxiety. A 2018 study found that SSRIs significantly reduced anxiety symptoms⁵ in children. The study also found that a combination of Zoloft and cognitive behavioral therapy was a particularly effective treatment option.

What To Expect When You Take Anxiety Medication

Zoloft is an effective treatment for managing anxiety. Your doctor will prescribe Zoloft if they believe it is a good fit, and may gradually increase your dose until you start to see results or reach a maximum dose.

However, since Zoloft can have some serious side effects and can interact negatively with other drugs, do not increase your dosage until you have consulted a medical professional.

What you should know about antidepressants

Ekaterina Kushnir

treats anxiety disorder

I have generalized anxiety disorder.

For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.

The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my illness.

The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.

At the same time, it must be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.

See a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

Fact No. 1

Antidepressants may make symptoms worse at first

Antidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - this is the name for causeless motor arousal, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.

Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry

There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.

Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.

The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.

Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.

/list/antidepressant-myths/

8 myths about antidepressants

I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.

After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs. And they ended faster, and then they completely disappeared.

My letter to a psychiatrist. I was scared: I expected an increase in background anxiety, but not panic attacks. I even thought about giving up the medicine

Fact No. 2

The effect of antidepressant treatment will not be immediate

Increase the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.

SSRI dosage - NHS

What doses of antidepressants will be optimal - an article in The Lancet

The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped. However, this is not the case for everyone, sometimes the process goes faster.

The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.

It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.

Fact No. 3

Antidepressants are usually taken in combination with other drugs

Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers. Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.

Antidepressants together with benzodiazepines work better for depression - BMJ magazine

My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.

As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.

My prescriptions for drugs. I never used one, because there was no such medicine in pharmacies

Fact No. 4

Side effects are not always, but they are

Modern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed.

Side effects of antidepressants - the National Health Service of the UK

Side effects of various antidepressants - Uptodate

Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE

STRICTIC STRICTION OF REDICAL

. effects of antidepressants - advice from the Mayo Clinic staff

Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary.

The first couple of weeks of taking there is a risk that the state of health will be so-so - it's worth thinking about. It may be worth scheduling the start of therapy on vacation.

I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.

It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.

There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:

nausea - about 25% feel it;
diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
sweating and a feeling of heat occur in about 20% of people;
sexual dysfunction, decreased libido may occur in 80% of cases;
insomnia - in 11% of cases;
headache and dizziness - in about 10-11% of cases;
weight gain - not all drugs give this effect. Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.

It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.

Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.

I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1. 5, and it became -3.5.

I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.

Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.

If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects.

I wrote to the doctor again when my visual acuity decreased

Fact No. 5

Antidepressants need to be taken long term

Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.

Anxiety Therapy - UpToDate

For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine.

The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.

Psychotherapy review - UpToDate

Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru

The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R. At first, you will need to visit him about once every 1-1.5 months, then less often.

You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.

Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.

/psychotherapy/

How much does psychotherapy cost

Fact No. 6

Antidepressants should not be stopped abruptly

Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as discharges of electric current while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.

Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry

How difficult it is to stop taking antidepressants - American Psychological Association

Stopping antidepressants in adults - UpToDate

treatment, they should be canceled only under the supervision of a doctor.

Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects. As a rule, this is the same medicine that was at the beginning of the intake.

Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.

Fact No. 7

If you need to change the drug, everything will start over

It is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one.

Changing antidepressants in adults - UpToDate

Serotonin syndrome - MSD

Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.

You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good. Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.

For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.

If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.

/psychotherapy-search/

How to choose a psychotherapist

Fact No. 8

Among antidepressants there are original drugs and generics

Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.

Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.

Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.

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As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened.

In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine. Moreover, the cost of originals and generics is not always very different.

Originals and generics of some SSRIs

Active ingredient	Original	Original cost	Generics	Cost of generics
Sertraline	Zoloft	About 700 R, 100 mg tablets	Serenata, Sirlift	500-600 R 100mg tablets
Escitalopram	Cipralex	3000 R, tablets 10 mg	"Selektra", "Elycea"	500-1300 R 10 mg tablets
Fluoxetine	Prozac	About 350 R, 20 mg tablets	Profluzak, Fluoxetine	100-200 R, tablets 20 mg

CERTRALIN

Original

"Zoloft"

Original cost of the original

about 700 r, tablets 100 mg

Generies

"Serenata", "Cerelift"

The cost of Jeeneriki

9000 500-600 r.

, tablets 100 mg

Escitalopram

Original

Cipralex

Original cost

3000 r, tablets 10 mg

generics

“Chektra”, “Elice”

The cost of generics

500-1300 r, tablets 10 mg

Fluoxetine

“Przak”

cost

cost cost

Cost cost cost original

About 350 R, tablets 20 mg

Generics

Profluzak, Fluoxetine

Cost of generics

100—200 R, tablets 20 mg

one remained unclaimed

Fact No. 9

Do not take alcohol along with antidepressants

Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.

Why you shouldn't mix antidepressants and alcohol - Mayo Clinic

Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.

With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.

The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.

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Fact No. 10

Antidepressants are incompatible with certain drugs and have contraindications

It is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.

Antidepressant Warnings - NHS

Drug Compatibility Test - Drugs.com

It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.

If it is not possible to consult a doctor before taking any medication, carefully read the instructions for it and your antidepressant. It is also worth informing all doctors who prescribe something to you during the therapy period about taking antidepressants.

whether they help, treat or relieve symptoms, cause addiction, make them gain weight

Daniil Davydov

medical journalist

Author profile

million people.

At the same time, the cures for this disease are surrounded by many myths. Antidepressants are accused of ineffectiveness and severe side effects, but often the problem is not with the drugs themselves, but with their misuse.

We collected 8 myths about antidepressants and found out how close they are to the truth.

Go see a doctor

Myth 1

Antidepressants almost never help

Most likely, this myth arose due to the fact that antidepressants do not work in all patients - so even some doctors and scientists doubt their effectiveness. However, antidepressants cannot be called ineffective, there are just important nuances in the use of these drugs.

Antidepressants are a class of drugs that normalize the level of neurotransmitters, that is, chemicals that help nerve cells in the brain exchange information.

What are Antidepressants - International Drug Database RxLis

What Medications Help Clinical Depression in Adults - International Primer for Physicians UpToDate

How Antidepressants Help Pain - Mayo Clinic Bulletin

All Antidepressants Used to Treat Depression in Adults , work - The Lancet

Who Antidepressants Help and Who Don't - Clinical Guidelines for British PhysiciansPDF, 141 KB

These medicines help people whose problems are due to a deficiency or excess of neurotransmitters. Antidepressants reduce symptoms of depression, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, and bipolar affective disorder.

There is evidence that antidepressants are effective for chronic pain. Antidepressants increase the amount of neurotransmitters in the spinal cord, which reduces pain signals.

Most specialists have no doubts that antidepressants work. For example, according to the British Royal College of Psychiatry, 50-65% of people with depression who take antidepressants feel better - compared with 25-30% of those who take a placebo.

However, there are situations where the benefit of antidepressants is questionable. For example, antidepressants are good for treating moderate to severe depression, but do not work well for people with mild depression - psychotherapy is more suitable for them.

And there are situations when these medicines were prescribed by mistake. Then antidepressants really won't help.

When antidepressants don't help

Sergey Divisenko

psychotherapist

There are three cases when antidepressants most often cause problems.

The antidepressant didn't work because the doctor prescribed the wrong dose. Minimum doses of these drugs do not help in half of the cases. Then competent doctors increase the doses to those recommended in clinical guidelines, while illiterate ones refuse them.

Sometimes, in order for antidepressants to work, they need to be augmented—i.e., enhanced—with other classes of drugs. For example, second-generation antipsychotics, or normothymics, that is, drugs that stabilize mood. If this is not done, the person taking antidepressants will not feel relief.

The antidepressant didn't help because the doctor misdiagnosed and was trying to treat a condition that these drugs don't work for. To help a person, one had to either use other drugs or use non-drug methods of treatment: for example, psychotherapy, transcranial stimulation, or electroconvulsive therapy.

For example, in bipolar disorder, symptoms can be very similar to depression or anxiety. But with bipolar disorder, antidepressants help only if they are used together with other drugs - mood stabilizers. By themselves, they will either work for a short time, or they will not work, or they can cause a phase inversion - that is, a person will switch from a depressive phase to a manic one.

The patient was not helped by a particular antidepressant, but another might. Antidepressants differ in the principle of action - on this basis they are divided into classes. It happens that one antidepressant does not work, but another from the same or another class helps. If the treatment does not work, you should not stop drug therapy, but continue to look for a drug that will help this particular patient.

Myth 2

Antidepressants only relieve symptoms, but do not eliminate the cause of the disorder

In most cases, this is not a myth. However, in some situations, antidepressants act on the cause of the disorder.

Depression is a heterogeneous disease. Experts identify a different number of subtypes of depression - from 4 to 12. But for our purposes, depression can be divided into two large subtypes.

American Criteria for Depressive Disorders - A Handbook for Psychiatrists DSM-5PDF, 32 MB

What Depression Is - An International Primer for Physicians UpToDate

associated with depression. Disorders that can be attributed to this group are more common.

If these causes affect a person long enough and he does not understand how to deal with them, depression may develop. In this situation, antidepressants act as drugs that alleviate the symptoms of the disease. To influence the cause of the problem, psychotherapy is needed.

Depression provoked by internal causes. Approximately 7% of people with depression have the correct way of thinking, there are no internal conflicts and injuries, and there are no serious illnesses. In this situation, the cause of depression is the lack of neurotransmitters: serotonin, norepinephrine and dopamine in the synapses of brain nerve cells. In such people, the antidepressant acts precisely on the cause of the disease, that is, it corrects the production of serotonin in neuronal synapses.

Myth 3

As soon as it gets better, you can stop taking the antidepressant

This is also not entirely a myth - it would be more correct to call it a belief that is true only for some, but not for all patients with depression.

It is generally advised to continue taking antidepressants for at least six months after remission. If the duration of the disease is short, that is, the person was ill for about two weeks, then for the onset of remission, one or two months usually need to take medication. If the duration of the disease is long, from several months or years, then more time is required for the onset of remission. It’s impossible to say exactly how much: different people with depression have different recovery times.

Some people have recurrent depression. In this case, the period during which you need to take the medicine depends on how many bouts of depression have already been during your life. If more than three, it is recommended to take antidepressants for several years or for life.

Myth 4

Antidepressants cause addiction

Perhaps the roots of this myth are that some people need to take depression medication for life. And at the beginning of treatment, some patients have to increase the dose. But in fact, antidepressants do not cause either true physical or drug dependence.

True physical dependence on a drug is a situation where a person becomes so addicted to a drug that when it is withdrawn, the symptoms of the disease sharply increase. People who are dependent on the drug have to increase the dosage, otherwise the drug stops helping.

What is True Drug Addiction—Bulletin of the National Institute for the Study of Drug AbusePDF, 7 MB

What is Drug Addiction—Bulletin of the American Psychiatric Association

Drug dependence may include physical dependence on a drug. But this addiction has a unique feature. Dependence can also develop in a healthy person who used the drug not to recover, but to enjoy it. But when he tries to quit the drug, he still experiences physical suffering, which is called the withdrawal syndrome. As a result, a person is forced to look for a new dose of a drug.

Although a person who takes antidepressants to treat depression gets better, the drugs themselves are neither pleasurable nor addictive. Taking them as drugs is useless.

Of all the drugs that are used in psychiatry, true physical dependence can only be caused by psychostimulants that activate mental activity and anti-anxiety, that is, benzodiazepine tranquilizers. Antidepressants are not included in this list, because there is no need to increase the dosage of correctly selected drugs from this group.

However, some people who stop taking antidepressants early sometimes experience withdrawal symptoms such as nausea, hand tremors, and some feel “shocks” in the head, similar to the sensations of an electric shock. Depressive symptoms return to patients who need to take the medicine for a very long time.

Antidepressants are sometimes abused, but they cannot cause addiction - Journal of Modern Psychiatry

To avoid unpleasant consequences, stop taking antidepressants only if the attending physician says that they are no longer needed. But even in this situation, it is necessary to cancel antidepressants slowly, that is, gradually reducing the dose. This will help avoid unpleasant side effects.

Myth 5

A person on antidepressants becomes lethargic and loses interest in life

This popular myth is based on real but outdated data.

These mental changes are seen in patients taking first-generation tricyclic antidepressants such as amitriptyline. It has a sedative, that is, a sedative effect. A person who takes high doses of amitriptyline can indeed become sleepy and indifferent to the outside world.

Amitriptyline - Sedative - Drugs.com International Drug Database

SSRIs do not sedate - Drugs.com International Drug Database

Current second-generation antidepressants that are recommended to start treatment with, such as selective serotonin reuptake inhibitors, or SSRIs almost never cause drowsiness and apathy.

On the contrary, in most people with depression they return interest in life.

Sometimes SSRIs do cause drowsiness, but this has not yet been proven

Sergey Divisenko

psychotherapist

It is believed that in rare cases, modern antidepressants can provoke SSRI-induced apathy. But this condition is extremely rare.

And even then psychiatrists still doubt that the cause is precisely in the drugs, and not in the patient's condition. After all, some people during the time of taking antidepressants may develop other adverse mental states in which apathy occurs: for example, schizotypal disorder, which was not noticed before.

Myth 6

Antidepressants have many side effects

This is partly true: both SSRIs and antidepressants from other groups have side effects. But it is quite possible to deal with them.

At the beginning of treatment, when people first start taking antidepressants, many complain of increased anxiety, dry mouth, nausea, and trouble sleeping. But after a few days or weeks after the start of the course of treatment, these symptoms usually disappear. If the side effects do not stop, it makes sense to consult a doctor - he will replace the antidepressant.

Dealing with antidepressant side effects - tips from the Mayo Clinic staff

Here's what to do before the side effects go away:

Take antidepressants with meals, unless the instructions say otherwise, so the antidepressant will be less annoying stomach;
put a bottle of clean water on the desktop - if your mouth is dry, you can take a sip. Unsweetened lollipops and chewing gum also help with dry mouth;
take a walk for at least half an hour before going to bed - this will make it easier to fall asleep. If you can’t sleep at all, you can ask your doctor to pick up sleeping pills.

The second most common side effect is an increase in anxiety at the beginning of antidepressant use. To avoid this problem, psychiatrists resort to two effective methods:

titrate the dose - that is, start with the minimum dose of the antidepressant and then gradually increase it;
at the beginning of the reception, sedatives - tranquilizers are prescribed together with the antidepressant.

The third common side effect of SSRIs, especially sertraline, known as Zoloft, and escitalopram, better known as Cipralex, is decreased libido. Approximately 20-30% of people taking antidepressants from this group experience a decrease in sexual desire to one degree or another. At the same time, it is difficult to say how much the drugs are to blame, because approximately 35-50% of people with depression have already experienced sexual dysfunction.

Many people with depression experience sexual dysfunction before starting antidepressants - Harvard Medical School Bulletin

Switching to another antidepressant usually helps, but many people prefer to wait until the medication can be stopped. In some cases, psychiatrists prescribe antidepressants from other groups in addition to the libido-lowering antidepressant. Sometimes it helps to regain interest in sex.

Myth 7

Weight gain due to antidepressants

This is not a myth, but a half-truth. There are both antidepressants that contribute to weight gain, and those that do not have a similar effect.

The most common complaint about weight gain during treatment is people taking the tetracyclic antidepressant mirtazapine, which actually increases appetite. Another weight gaining antidepressant is paroxetine, better known by the trade name Paxil. But "Zoloft" and "Cipralex" do not contribute to weight gain.

If a patient feels that an antidepressant is causing them to overeat, it is wise to consult a doctor and discuss a change of drug.

Myth 8

Antidepressants are expensive

True, but not for all patients. Most people can cure depression and not go broke.

Antidepressants from different groups vary greatly in price. There are both very expensive drugs and relatively low-cost drugs among them. At the same time, both of them work equally well. However, there are situations when a cheap antidepressant cannot be dispensed with.

On the left - inexpensive "Zoloft" for 327 R, a drug based on sertraline, on the right - the most expensive antidepressant "Ixel" based on milnacipran for 2453 R

For example, there is a good antidepressant venlafaxine.

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