Switch from zoloft to prozac
Which depression medication is better?
If you are living with depression, antidepressant medication can be an important part of your treatment plan. The good news is that there are many medications available to treat major depressive disorder (MDD). At the same time, the wide range of options also can seem confusing, even overwhelming.
If you, in addition to your prescribing doctor or nurse, want to search and be more informed, you can do that by narrowing the search to a certain category of antidepressant, such as the serotonin reuptake inhibitors (SSRIs). SSRIs are the most commonly prescribed type of antidepressants. Two SSRIs you might want to learn more about and consider are Zoloft and Prozac.
How might you know which one of these two is right for you? Zoloft or Prozac? There is no “one-size-fits-all” answer to that question, because the right medication will depend on many different factors, such as:
- Your age (for example, some types of antidepressants have been found to increase the risk of suicidal thoughts or actions in people under 25 years old)
- Side effects (every medication comes with its own potential side effects, yet not every person who takes that medication may experience its possible side effects)
- Interactions with other medications you may be taking (some medications should not be taken together because they may decrease the effectiveness of each other or increase the risk of serious side effects— which is why it is important to tell your doctor about all of the medications (and supplements, often called Nutraceuticals) you take when you are discussing your treatment plan)
This Minded Medication Guide will take a deeper look at Zoloft and Prozac to help you understand which antidepressant may be the better choice for you, whether this is your first time taking one of these medications, or you are considering switching from Zoloft to Prozac (or switching from Prozac to Zoloft). This information can be helpful to you when talking with your doctor, prescribing nurse, or the experts at Minded in determining the depression medication used in your treatment plan.
Read on to learn more about these two medications, including:
- An introduction to Zoloft and Prozac
- A deeper look at Zoloft vs Prozac
- Similarities and differences between Zoloft and Prozac
The information contained in this article is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription medication or following any treatment or regimen.
Zoloft and Prozac overview
There are several types of antidepressant medications. They are generally grouped by how and which neurotransmitters (small molecules in the brain that pass messages from nerve to nerve) they affect to relieve the symptoms of depression.
As mentioned above, Zoloft and Prozac are both selective serotonin reuptake inhibitors (SSRIs).
Serotonin (a neurotransmitter) helps balance your mood and plays a role in feeling satisfaction, happiness, and optimism, as well as a sense of overall well-being. When the serotonin level in your brain is too low, you may feel depressed. SSRIs increase your level of serotonin by preventing it from being reabsorbed into your neurons (the term for the nerves in your brain). Preventing reabsorption allows more serotonin to remain available in your brain.
SSRIs (like Zoloft and Prozac) are the most commonly prescribed type of antidepressants. While they are considered safe for most people, that is not to say they are entirely risk-free. For instance, SSRIs may interact with other medications and may cause symptoms of physical withdrawal and renewed mood problems, if stopped abruptly.
While Zoloft and Prozac are both SSRI antidepressant medications, they do have differences.
Taking a closer look at each of them can help you determine which medication may be a better choice for you.
{{ads-green-dots="/templates/cta"}}
A closer look at Zoloft
Zoloft is the brand name of the generic drug sertraline. It was approved by the Food and Drug Administration (FDA) in 1999 and is used to treat depression, obsessive-compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorder (PMDD), social anxiety disorder, and post-traumatic stress disorder (PTSD). One reason to know this is that depression is frequently accompanied by anxiety (which Zoloft can help).
Zoloft sometimes also is prescribed for “off-label” uses. “Off-label” use means taking a medication for a condition that it has not been approved by the FDA to treat, a common and acceptable medical practice. Zoloft may be used “off-label” to help treat binge-eating disorder, bulimia nervosa, and generalized anxiety disorder (GAD).
Zoloft (sertraline) is available in tablet and liquid forms:
Zoloft tablet
- 25 mg
- 50 mg
- 100 mg
Zoloft liquid
- 20 mg/mL
Your doctor or prescribing nurse may initially start you on a lower dose, such as 50 mg, and then increase the dosage gradually over the course of several weeks, if needed.
The highest dose of this medication usually is no more than 200 mg daily, though some people need higher doses to achieve symptom relief.
Zoloft is taken once a day. It can be taken in the morning or at night, with or without food.
If you miss a dose of Zoloft, you will want to either: Take the missed dose as soon as you remember, or if it is closer to the time when you would take your next dose, just take the next dose.
When you first start taking Zoloft, you may notice that your sleep, energy, and/or appetite begins to improve within the first two weeks. However, it can take up to 6 to 8 weeks for improvement of a depressed mood or decreased interest in activities to become noticeable.
Side effects of Zoloft
Common side effects of Zoloft include:
- Headache
- Nausea
- Diarrhea
- Dry mouth
- Sweating
- Nervousness
- Restlessness
- Fatigue
- Sleepiness or difficulty sleeping
These side effects typically decrease during the first few weeks of taking Zoloft.
Zoloft may also lead to a decreased sex drive or trouble performing sexually; these sexual side effects, however, may not decrease over time.
Talk to your doctor or the experts at Minded if you experience any of these or other side effects.
Rare or serious side effects of Zoloft include:
- Low sodium levels in your blood (symptoms of this could include: headaches, feeling weak, or having a hard time concentrating or remembering things)
- Teeth grinding
- Angle closure glaucoma (symptoms of this could include: pain in your eye, vision changes, or swelling or redness in or around your eye)
- Serotonin Syndrome (symptoms of this could include: shivering, diarrhea, confusion, severe tightness in your muscles, fever, or seizures). Serotonin Syndrome is a very serious condition and can be fatal
- Seizures
SSRI antidepressant medications, like Zoloft, may also put you at an increased risk for bleeding, especially when they are taken with medications such as aspirin, nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen), and warfarin (an anticoagulant medication), or other anticoagulants.
Zoloft with any single or combination of these medications could cause your gums, nose, stomach, or intestines to bleed more easily. Bleeding in these areas can be life-threatening.
Seek medical attention right away if you experience any of these (or other) serious side effects.
Warnings
Zoloft comes with an FDA “Black Box” warning, which means that the FDA has identified certain serious safety risks from taking it. Though these are serious safety warnings, the actual risk may be very low, even rare.
The Black Box warning for Zoloft states that antidepressants may increase the risk of suicidal thoughts or behaviors in children and young adults under 25 years old.
If you are planning on becoming pregnant, it is important to discuss your depression treatment plan with your doctor, as taking SSRIs (like Zoloft) during pregnancy or while breastfeeding may impact your baby.
Drinking alcohol is not recommended while taking Zoloft.
Alcohol can decrease the benefits of antidepressant medications and increase their side effects (such as sedation).
If you need to stop taking Zoloft, work with your doctor to discuss how to do so carefully in order to avoid withdrawal symptoms (such as agitation or anxiety, dizziness, headache, and nausea).
Let your doctor or a Minded professional know about any other medications you are taking to determine if Zoloft might have any negative interactions with them.
A closer look at Prozac
Prozac is the brand name of the generic drug fluoxetine. Like Zoloft, it was approved by the FDA in 1999. In addition to major depressive disorder (MDD), Prozac is used to treat obsessive-compulsive disorder (OCD), panic disorder, bulimia nervosa, and premenstrual dysphoric disorder (PMDD).
Prozac is sometimes used “off-label” for body dysmorphic disorder, binge eating disorder, generalized anxiety disorder (GAD), social anxiety disorder, dysthymia, and post-traumatic stress disorder (PTSD).
Prozac (fluoxetine) is available in multiple forms and doses:
Prozac capsules
- 10 mg
- 20 mg
- 40 mg
Prozac Weekly Capsules
- 90 mg
Fluoxetine liquid
- 20 mg/5ml
Fluoxetine tablets
- 10 mg
- 20 mg
- 60 mg
When you first start taking Prozac, your doctor may prescribe a lower dose, such as 20 mg, and then increase the dosage slowly over several weeks or longer, if necessary. Its highest dose is usually no more than 80 mg daily, though some patients require and can benefit from greater daily doses. Once you are on the right dose for your needs, your doctor may switch you to a weekly dose, which means you would only have to take this medication one day each week. Prozac stays in the bloodstream long enough to permit weekly dosing.
Prozac is taken once a day, typically in the morning, with or without food.
If you miss a daily dose of Prozac, you will want to either: Take the missed dose as soon as you remember, or if it is closer to the time when you would take your next dose, just take the next dose.
If you are on the once-weekly dose of Prozac and you miss the dose, take the missed dose as soon as possible and then resume your normal medication schedule.
So how long does it take for Prozac to work? As with Zoloft, you might begin to notice that your sleep, energy, and/or appetite start to improve within the first two weeks of taking Prozac. However, it may take up to 6 to 8 weeks, or longer for improvement of low mood and lack of interest (common depression symptoms) to become noticeable.
Side effects of Prozac
Common side effects of Prozac include:
- Headache
- Nausea
- Diarrhea
- Dry mouth
- Sweating
- Nervousness
- Restlessness
- Fatigue
- Sleepiness or difficulty sleeping
These side effects generally improve during the first few weeks after you begin taking Prozac.
Prozac also can decrease your sex drive and impair sexual performance. However, as with Zoloft, this side effect may not go away while you are on the medication.
Talk to your doctor if you experience any of these or other side effects.
Rare or serious side effects of Prozac include:
- Low sodium levels in your blood (symptoms of this could include: headaches, feeling weak, or having a hard time concentrating or remembering things)
- Teeth grinding
- Angle closure glaucoma (symptoms of this could include: pain in your eye, vision changes, or swelling or redness in or around your eye)
- Serotonin Syndrome (symptoms of this could include: shivering, diarrhea, confusion, severe tightness in your muscles, fever, or seizures). Serotonin Syndrome is very serious, and can be fatal
- Seizures
- Arrhythmias (irregular heartbeat—symptoms of this could include: shortness of breath, dizziness, or fainting)
And because it is an SSRI, Prozac also may increase your risk for bleeding, especially if you are also taking medications such as aspirin, nonsteroidal anti-inflammatories (NSAIDs—like ibuprofen or naproxen), and warfarin or other anticoagulant drugs.
Prozac in combination with one or more of these medications may cause your gums, nose, stomach, or intestines to bleed more easily, which can be life-threatening.
Seek medical attention right away if you experience any of these (or other) serious side effects.
Warnings
Like Zoloft, Prozac has an FDA Black Box warning about antidepressants possibly increasing the risk of suicidal thoughts or behaviors in people under 25 years of age.
Because Prozac is an SSRI, it can affect a baby during pregnancy and while breastfeeding. Be sure to discuss your depression treatment plan with your doctor if you are or plan to become pregnant, or are breastfeeding.
You should not drink alcohol while taking Prozac. Alcohol can decrease the benefits of antidepressant medications and increase their side effects (such as sedation).
Prozac can also cause withdrawal symptoms if you stop taking it suddenly, so it is important to talk with your doctor to come up with a plan to carefully go off of it, if needed.
Tell your doctor or a Minded professional about any other medications you may be taking to determine if Prozac might have any negative interactions with them.
What is the difference between Zoloft and Prozac?
Which works faster: Zoloft or Prozac?
Zoloft and Prozac both take several weeks before you may start to notice an improvement in your depression symptoms. Because neither one has an advantage over the other in this area, it is not generally a factor in decision-making when choosing between the two medications.
You may notice an improvement in your sleep, energy, and appetite within the first two weeks of starting Zoloft or Prozac. It may take up to 6 to 8 weeks for other symptoms—such as depressed mood or decreased interest in activities—to get better as well.
Zoloft vs Prozac: which is more effective?
The good news is that both Zoloft and Prozac are comparable in terms of being able to effectively treat major depressive disorder (MDD), according to a study published in International Clinical Psychopharmacology.
The study found that both people on Zoloft and people on Prozac showed measurable improvement in their symptoms—and this improvement was maintained for the duration of the study.
However, while both medications were found to be similarly effective, the study also found that around 10% of people stopped taking Zoloft because it was not working for them, compared to around 20% of people who stopped taking Prozac for the same reason. In other words, when they work, both work comparably well. But more people may find that Zoloft works for them compared to Prozac.
The study also found that the rate of adverse events (side effects) was similar for both medications, meaning around the same percentage of people taking each medication experienced side effects. The people taking sertraline (Zoloft), however, rated the side effects as less severe compared to the people taking fluoxetine (Prozac).
Side effects: Zoloft vs Prozac
While Zoloft and Prozac have many of the same potential side effects, each comes with its own list of more common side effects to watch out for and bring to your doctor’s attention.
Common side effects of Zoloft that you should notify your doctor of right away include:
- Decreased sexual desire
- Inability to perform sexually
Other common side effects of Zoloft that you may also want to mention to your doctor include:
- Upset stomach
- Belching
- Decreased appetite
- Weight loss
- Diarrhea and/or loose stools
- Heartburn
- Unusual sleepiness or drowsiness
- Difficulty sleeping
- Stomach and/or abdominal cramps, gas, or pain
Common side effects of Prozac that you should notify your doctor of right away include:
- Headaches
- Hives, rash, or itching
- Difficulty sitting still
- Restlessness
Other common side effects of Prozac that you may also want to mention to your doctor include:
- Decreased appetite
Zoloft vs Prozac: weight gain
You might have heard that antidepressant medications can cause weight gain.
Some antidepressants do appear to have a higher rate of weight gain than others. Sometimes, however, weight gain while on antidepressants may not be directly caused by the antidepressant medication.
For instance, some people lose weight when depressed and before treatment has begun. As your appetite returns from the effective treatment of your depression, you may begin to gain that weight back, though not necessarily because of the medication itself, but rather from the reduction in the symptoms of depression.
That being said, one study published in 2016 in the Journal of Clinical Medicine found that Zoloft can lead to an overall greater weight gain than Prozac when taken long-term. The study found that people taking Prozac for two years gained an average of 4.6 pounds. But people taking Zoloft gained an average of 10.5 pounds over the same two-year period.
Can you take Zoloft and Prozac together?
Zoloft and Prozac should not be taken together.
Because they are both SSRIs, taking them together can cause dangerously high amounts of serotonin to collect in your body, which can lead to the potentially fatal condition noted above, serotonin syndrome.
Switching from Zoloft to Prozac (or switching from Prozac to Zoloft)
You may consider switching from Zoloft to Prozac (or vice versa) if you have been on the medication at the right dose (as determined by you and your doctor or nurse practitioner) for several weeks with no improvement in your depression symptoms, or if you are experiencing side effects that you find too difficult to tolerate.
A not uncommon problem is when someone who was deriving benefit from taking an SSRI (like Zoloft or Prozac), begins not to have the same beneficial effect they previously had. This is a time to consider switching from one to the other, or considering a different class of antidepressants (of which there are several). Speak to your doctor, prescribing nurse, or a Minded professional about what your options may be.
Depression can be effectively treated but may require changes in your medication over time.
Because both Zoloft and Prozac can cause withdrawal symptoms if stopped suddenly, switching from one to the other should be done carefully and gradually. Work with your doctor or a Minded professional to develop a plan, which may involve tapering down the dose of the medication you are currently on and then beginning the new medication.
Final thoughts on Zoloft vs Prozac
Prozac and Zoloft are both antidepressants worth considering when building your depression treatment plan. Each comes with its own pros and cons. For instance, while both are similarly effective in treating MDD, more people may find Zoloft works for them compared to Prozac, and vice versa. While Zoloft may cause more potential and common side effects, these may be more tolerable to you than the common side effects of Prozac, and vice versa as, for example in not experiencing the more common side effect of weight gain, over time, from Zoloft than Prozac.
Seeking medical advice from your health care provider or the experts at Minded can help you understand and decide which medication may be the better fit for you.
Switching from Zoloft to Prozac: What to Expect
Medically reviewed by Mary Lucas, RN
Written by Our Editorial Team
Last updated 12/09/2020
Zoloft® (sertraline) and Prozac® (fluoxetine) are two of the most common medications used to treat depression.
Both Zoloft and Prozac are selective serotonin reuptake inhibitors, or SSRIs. They work to treat depression and other mental health disorders by increasing the level of serotonin, an important neurotransmitter, in your brain.
If you’ve been diagnosed with depression, it’s common and normal to try different antidepressants before finding an effective treatment for your symptoms. If Zoloft isn’t an effective medication for you, your healthcare provider may recommend switching to Prozac.
Below, we’ve explained what you need to know if you’re switching from Zoloft to Prozac, from switching methods to potential side effects you may experience and more.
Zoloft (Sertraline) or Prozac (Fluoxetine): An Overview
Zoloft, which contains the active ingredient sertraline, and Prozac, which contains fluoxetine, are two common prescription medications for depression.
Zoloft is currently approved by the FDA as a treatment for depression, obsessive compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder (SAD) and premenstrual dysphoric disorder (PMDD). Hers mental health service offers sertraline online.
Prozac is currently approved by the FDA as a treatment for depression, obsessive compulsive disorder (OCD), panic disorder and bulimia nervosa.
Like other SSRIs, both medications are used as first-line treatments for depression due to their safety, tolerability and effectiveness.
Although Zoloft and Prozac are both effective medications, it’s common and normal to have to change from one antidepressant to another. Research has found that only about 37 percent of people with depression experience remission after the first stage of treatment..jpg)
online mental health assessment
your mental health journey starts here
How to Switch From Zoloft (Sertraline) to Prozac (Fluoxetine)
Several methods are used to switch SSRIs. For some antidepressants, it’s safe to switch from one medication to another immediately. For others, you may need to taper your dosage slowly and switch after several days or weeks.
When switching from Zoloft to Prozac, the recommended approach is to taper your dosage of Zoloft (sertraline) until you stop using your medication. After completely stopping Zoloft, you’ll typically start using fluoxetine at a dosage of 10mg per day. You can buy fluoxetine online using Hers mental health service.
The tapering process involves gradually lowering your dosage very few days, typically over the course of approximately four weeks. Your healthcare provider will provide specific instructions to help you reduce your dosage of Zoloft in a safe, controlled manner.
Based on your medical needs, your previous usage of antidepressants and other factors, your healthcare provider may suggest a faster or slower tapering process or prescribe Prozac at a higher or lower dosage.
It’s important to follow your healthcare provider’s instructions carefully. Do not suddenly switch from one medication to another or stop taking your medication without tapering. Doing this can increase your risk of antidepressant discontinuation syndrome or drug interactions.
To learn about switching from Prozac to another common antidepressant, read our article: switching from Prozac to Lexapro or switching from Celexa to Lexapro.
online therapy
online therapy sessions, now made affordable
Side Effects of Zoloft and Prozac
As SSRIs, Zoloft (sertraline) and Prozac (fluoxetine) usually cause similar side effects. However, as these medications aren’t exactly the same, you may experience slightly different side effects after switching from Zoloft to Prozac.
According to data from clinical trials, the most common side effects of Zoloft are:
Diarrhea
Difficulty ejaculating
Dyspepsia (indigestion)
Hyperhidrosis (excessive sweating)
Nausea
Reduced appetite
Reduced libido
Tremor
The most common side effects of Prozac are
Abnormal dreams
Abnormal ejaculation
Anorexia
Anxiety
Asthenia (physical weakness)
Diarrhea
Dry mouth
Dyspepsia (indigestion)
Flu syndrome
Impotence (erectile dysfunction)
Insomnia
Decreased libido
Nausea
Nervousness
Pharyngitis (sore throat)
Rash
Sinusitis
Somnolence (sleepiness)
Sweating
Tremor
Vasodilation (widening of blood vessels which can cause a drop in your blood pressure)
Yawning
If you experience any unpleasant or persistent side effects after switching from Zoloft to Prozac, it’s important to talk to your healthcare provider.
psych meds online
psychiatrist-backed care, all from your couch
In Conclusion - What to Expect Switching from Zoloft to Prozac
Switching from sertraline online to Prozac usually isn’t difficult. Typically, your healthcare provider will tell you to gradually taper your dosage of Zoloft over the course of a few weeks, then start your usage of Prozac once Zoloft is out of your system.
In certain cases, you may need to taper on a shorter or longer schedule. Follow your healthcare provider’s instructions and keep them informed if you experience any side effects or changes in your symptoms during the process of switching medications.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.
Changing first-line antidepressants | Attending Doctor is a professional medical publication for physicians. Science articles.
| To achieve the desired clinical effect of antidepressants, it is recommended to switch from tricyclic antidepressants to drugs with a similar mechanism of action, in particular venlafaxine, a modern serotonin and norepinephrine reuptake inhibitor | |
partners Keywords / keywords: Antidepressants, Velaxin, Venlafaxine, Depression, Noradrenergic system, Neuropsychiatry, Serotonergic system, Thymoanaleptic therapy
VEL 25.
09.2020/7
Thymoanaleptic therapy is a dynamic process, the scenario of which depends on the characteristics of the disease and the response to treatment. According to the current recommendations, the clinical effect of an antidepressant (BP) of more than 50% within 3-4 weeks is considered sufficient [1]. According to statistics, such effectiveness is not achieved in 30-50% of patients with initial therapy with the first-line drug [1]. In such cases, it is recommended to increase the dose of blood pressure to the maximum, and in some cases, especially with the use of SSRIs, improvement still develops: a full effect can be achieved at 4-6 or even 8 weeks of treatment [1]. If this does not happen, and also in cases where increasing the dose is impractical (for example, in case of poor tolerance), it is recommended to change the blood pressure to a drug within the same pharmacological class or with a different mechanism of action [1]. In this case, a special algorithm should be followed.
The classical scheme suggests the gradual withdrawal of the initially prescribed drug, and after a washout period, the appointment of a new one with the selection of its therapeutic dose [2]. This method is used if there is a likely risk of an unwanted interaction that occurs when switching from drugs with a long half-life (such as fluoxetine), if the activity of the liver enzyme systems is reduced in the patient, or if the drugs differ radically in the mechanism of action (for example, when switching from mirtazapine or mianserin to milnacipran).
Both the patient and the doctor are much more comfortable with the one-time method of “switching” between drugs with a similar mechanism of action, when one day the first drug is canceled, and the second is prescribed immediately in a therapeutic dose. In this context, it seems convenient to switch patients from tricyclic antidepressants, fluvoxamine, sertraline, paroxetine, and milnacipran to a modern serotonin and norepinephrine reuptake inhibitor (SSRI) venlafaxine ( Velaxin ® [3]).
The need for such a transition arises in clinical practice, because. the effectiveness of venlafaxine is somewhat higher than that of SSRIs due to a wider spectrum of neurochemical action [1]. The drug acts immediately on three types of neurotransmitters: serotonin (improves mood), norepinephrine (promotes activation) and dopamine (improves motivation for action) [3]. In addition, the advantage of Velaksin ® is a special form of release in capsules. It provides a prolonged action of the active molecule of the drug [3], a more harmonious distribution in the corresponding synaptic sections of the CNS, which, in turn, reduces the risk of adverse events in the process of simultaneous administration or gradual achievement of a therapeutic dose [4].
It should be taken into account that the transition from fluoxetine to Velaxin ® should be gradual due to the aforementioned long half-life of fluoxetine, in order to avoid unwanted interactions.
When switching to Velaxin ® from mirtazapine, you will also have to observe the transition interval of 1-2 weeks, but in this case, due to the fundamentally different mechanisms of action of these drugs [2].
- Russian Society of Psychiatrists. Depressive episode, Recurrent depressive disorder. Clinical guidelines. 2019.
- D.V. Hawks. Changing antidepressant therapy: causes and tactics. Medical business. 2007; 3:53-59.
- Instructions for medical use of the drug Velaksin® capsules LSR 000030 dated 05/24/2017.
- R.A. Becker, Yu.V. Bykov. Velaxin® capsules: presentation of a new long-acting form and review of the latest data on efficacy and safety. Psychiatry and psychopharmacotherapy. T.20. No. 1. 2018.
The material is intended for medical professionals.
What you need to 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 should 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 firstAntidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, 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 was already expecting these panic attacks, I immediately tried to relax, calm down, remember that this was just a temporary effect of 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 medicineFact No. 2
The effect of antidepressant treatment will not be immediateIncrease 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 get ready 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
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. 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 pharmaciesFact No. 4
Side effects are not always, but they areModern 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.
For the first couple of weeks of taking it, there is a risk that you will not feel well - 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 to 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 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 consolidate the effect 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 psychotherapy works
Fact No. 6
Antidepressants do not develop dependence. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges 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 overIt 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 effect of generic drugs should not differ from the effect 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.
/list/covid-depression/
Psychoneurological complications after covid: memory problems and depression
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 price | Generics | Cost of generics |
|---|---|---|---|---|
| Sertraline | Zoloft | About 700 R, 100 mg tablets | "Serenata", "Sirlift" | 500-600 R, tablets 100 mg |
| Escitalopram | "Cipralex" | 3000 R, tablets 10 mg | "Selektra", "Elicea" | 500-1300 R, tablets 10 mg |
| Fluoxetine | Prozac | About 350 R, 20 mg tablets | Profluzak, Fluoxetine | 100-200 R, tablets 20 mg |
CERTRALIN
Original
"Zoloft"
The cost of the original
about 700 r, tablets 100 mg
Generiki
"SERELIFT"
Cost of Jennarics
Cost of Jennarics Cost of Jen , tablets 100 mg
Escitalopram
Original
Cipralex
Original cost
3000 r, tablets 10 mg
generics
"Selectra", "Elicea"
The cost of generics
500-1300 r, tablets 10 mg
22222222222212 "Origin 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
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 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.
/trevoga/
How I Treated Generalized Anxiety Disorder under CHI
Fact No. 10
Antidepressants are incompatible with certain drugs and have contraindicationsIt 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 medication. 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.
