What is the average dosage 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.

Description of SERTRALINE indications, dosages, contraindications of the active substance SERTRALINE

Rec.INN WHO registered

drug interaction

Included in preparations: list

Pharmacological action

Antidepressant, naphthylamine derivative. Selective blocker of neuronal reuptake of serotonin in the brain. Neuronal uptake of norepinephrine and dopamine is practically not affected. It does not have specific affinity for adreno- and m-cholinergic receptors, GABA receptors, dopamine, histamine, serotonin or benzodiazepine receptors. Does not inhibit MAO. Causes anorexia, effective in obsessive states.

Pharmacokinetics

When administered orally sertraline in doses of 50-200 mg 1 time / day for 14 days C _max in blood plasma is reached after 4. 5-8.4 hours. The average T _1/2 in young and elderly men and women is 22 -36 hours According to the half-life period, approximately two-fold cumulation of the active substance is observed until an equilibrium state is reached after 1 week of treatment. Plasma protein binding is about 98%, V _d - 20 l / kg. Intensively metabolized during the first passage through the liver. The main metabolite found in plasma, N-desmethylsertraline, has weak pharmacological activity. nine0006

T _1/2 N-desmethylsertraline varies within 62-104 hours. It is excreted mainly through the intestines and in the urine in equal amounts as metabolites, less than 0.2% is excreted in the urine unchanged.

Indications of the active substance SERTRALINE

Treatment of depressive states of various origins in patients with mono- and bipolar affective disorders. Prevention of recurrence of episodes of depression. nine0006

Open list of ICD-10 codes

F31	Bipolar affective disorder
F32	Depressive episode
F33	Recurrent depressive disorder
F41.2	Mixed anxiety and depressive disorder

Dosing regimen

Inside - 50 mg 1 time / day, if necessary, the dose can be increased to 200 mg / day for several weeks. The effect appears 7 days after the start of treatment, reaching a maximum after 2-3 weeks.

Side effects

From the side of the central nervous system: dizziness, drowsiness, headache, insomnia, fatigue, weakness, tremor; rarely - manic or hypomanic state, anxiety, restlessness, visual disturbances. nine0006

From the side of the cardiovascular system: rarely - redness of the skin with a feeling of heat or warmth, palpitations.

From the digestive system: decreased appetite, diarrhea, dry mouth, nausea, stomach or intestinal cramps, flatulence; rarely - constipation, vomiting.

From the side of metabolism: increased sweating.

On the part of the reproductive system: rarely - decreased potency.

Allergic reactions: rarely - fever, skin rash, urticaria or itching.

Contraindications for use

Simultaneous use with MAO inhibitors, hypersensitivity to sertraline.

Use in pregnancy and lactation

Adequate and well-controlled studies of the safety of sertraline during pregnancy have not been conducted, therefore, use is possible only in cases where the expected benefit to the mother outweighs the possible risk to the fetus. nine0006

It is not known whether sertraline is excreted in breast milk, so use during lactation is not recommended. Separate studies have shown that in infants whose mothers received sertraline during the feeding period, its plasma levels are negligible or not detectable, while concentrations in breast milk exceed concentrations in the mother's blood.

Women of childbearing age should use reliable methods of contraception during treatment with sertraline.

In experimental studies no teratogenic and mutagenic effects of sertraline were detected. However, at doses approximately 2.5-10 times the maximum daily clinical dose, sertraline caused a delay in fetal bone ossification, possibly as a result of maternal exposure. With the introduction of sertraline at doses approximately 5 times the maximum clinical dose, a decrease in neonatal survival was observed.

Use in hepatic dysfunction

Use with caution in hepatic dysfunction.

Use in impaired renal function

Use with caution in impaired renal function.

Pediatric use

Pediatric safety has not been established.

Special instructions

Use with caution in cases of drug abuse or dependence in history, liver dysfunction, kidney dysfunction, epileptic seizures, weight loss. nine0006

Should not be used in patients undergoing electroshock therapy. The use of sertraline is possible no earlier than 14 days after the abolition of MAO inhibitors.

Avoid drinking alcohol during treatment.

Pediatric safety has not been established.

Influence on the ability to drive vehicles and mechanisms

During the treatment period, activities requiring increased attention and high speed of psychomotor reactions should be avoided. nine0006

Drug interactions

Simultaneous use of coumarin derivatives with anticoagulants significantly increases prothrombin time.

Co-administration of sertraline may displace other drugs from plasma protein binding, resulting in an increase in plasma concentration of the corresponding active substance and an increased risk of side effects.

With simultaneous use with drugs, the metabolism of which occurs with the participation of the CYP2D6 isoenzyme, it is possible to increase the plasma concentration of these drugs due to inhibition of the CYP2D6 isoenzyme under the influence of sertraline.

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