Both triptans and sertraline increase serotonin. St. John’s wort is an herbal dietary supplement that many people take for mild to moderate symptoms of depression, as well as various other conditions. Nonsteroidal anti-inflammatory drugs are commonly used to help relieve pain, inflammation, and fever. They are not as commonly prescribed due to their side effects and drug and food interactions. Monoamine oxidase inhibitors are an older class of drugs used to treat depression.
Although antidepressants may not cure depression, they can reduce symptoms. If your healthcare provider prescribes a triptan with sertraline, you will be carefully monitored for serotonin syndrome. Additionally, at least 14 days should pass between stopping an MAOI and starting sertraline (and vice versa) to prevent serious complications like serotonin syndrome.
- Accordingly, a meta-analysis of antidepressants in older adults found that sertraline, paroxetine and duloxetine were better than placebo.
- The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior.
- Accordingly, in human trials it caused increased blood levels of CYP2D6 substrates such as metoprolol, dextromethorphan, desipramine, imipramine and nortriptyline, as well as the CYP3A4/CYP2D6 substrate haloperidol.
- Zoloft belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs).
- The combination of a triptan with sertraline can increase the risk of serotonin syndrome, especially after starting sertraline or with a dose increase.
Finding the right antidepressant
In the treatment of depression accompanied by OCD, sertraline performs significantly better than desipramine on the measures of both OCD and depression. Sertraline appears to work better in melancholic depression than fluoxetine, paroxetine, and mianserin and is similar to the tricyclic antidepressants such as amitriptyline and clomipramine. In several double-blind studies, sertraline was consistently more effective than placebo for dysthymia, a more chronic variety of depression, and comparable to imipramine in that respect. Sertraline’s effectiveness is similar to that of other antidepressants in its class, such as fluoxetine and paroxetine, which are also considered first-line treatments and are better tolerated than the older tricyclic antidepressants. It was also the eleventh most commonly prescribed medication in the United States, with more than 42 million prescriptions in 2023, and sertraline ranks among the top 10 most prescribed medications in Australia between 2017 and 2023.
- The prescribing information for sertraline includes several contraindications, or specific situations where the medication should not be used.
- Knowing what to expect and finding ways to cope can help you better manage these side effects.
- Concomitant intake of sertraline with food slightly increases sertraline peak levels and total exposure.
- This article discusses how Zoloft works and possible side effects you might experience.
- In a placebo-controlled study in which sertraline was co-administered with lithium, 35% of the subjects experienced tremors, while none of those taking placebo did.
Medical Professionals
While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents (clomipramine, imipramine, clonazepam, alprazolam, and fluvoxamine) indicates approximate equivalence of these medications. Double-blind comparative studies found sertraline to have the same effect on panic disorder as paroxetine or imipramine. Starting treatment simultaneously with sertraline and clonazepam, with subsequent gradual discontinuation of clonazepam, may accelerate the response. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with a placebo. Cognitive behavioral therapy alone is not more effective than sertraline in adolescents and children; however, a combination of these treatments is effective.
Sertraline has been the most sought-after antidepressant worldwide before, during, and after the COVID-19 pandemic, according to Google Trends data. The US patent for Zoloft expired in 2006, and sertraline is available in generic form and is marketed under many brand names worldwide. Until 2002, sertraline was only approved for use in adults ages zoloft and pepcid 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe OCD. The most potent and selective (+)-isomera was taken into further development and eventually named sertraline.
Common Zoloft Side Effects
For example, Orap and other brands of pimozide should not be taken with sertraline, as the combination can cause serious heart rhythm problems. Watch for symptoms such as agitation, confusion, rapid heartbeat, flushed skin, sweating, tremors, muscle stiffness, or restlessness. By Nancy SchimelpfeningNancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. This involves taking smaller and smaller doses over time until you eventually stop taking this medication altogether. The important thing to avoid is stopping or changing treatment without input from your physician. There may be strategies they can offer (including a dose adjustment or adjunctive therapies) to help you better adjust to the prescribed treatment.
Work functioning and physical symptoms, such as swelling, bloating, and breast tenderness, were less responsive to sertraline. The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity, and general quality of life. Significant improvement was observed in 50–60% of cases treated with sertraline vs. 20–30% of cases on placebo. The improvement is greater among the patients with later, adult onset of the disorder. Maintenance treatment, after the response is achieved, prevents the return of the symptoms.
Another meta-analysis relegated sertraline to the second line, proposing trauma focused psychotherapy as a first-line intervention. Other guidelines also suggest sertraline as a first-line option for pharmacological therapy. Sertraline is equally effective for men and women, and for patients with or without agoraphobia. The treatment recommendation is to start treatment with half of the maximal recommended dose for at least two months. It was better tolerated and, based on intention-to-treat analysis, performed better than the gold standard of OCD treatment clomipramine. However, in a 2003 trial the effect size was modest, and there was no improvement in quality of life as compared to placebo.
Side effects
Welch generated several potent norepinephrine and triple reuptake inhibitors, but to the surprise of the scientists, one representative of the generally inactive cis-analogs was a serotonin reuptake inhibitor. Development of tametraline was soon stopped because of undesired stimulant effects observed in animals. The history of sertraline dates back to the early 1970s when Pfizer chemist Reinhard Sarges invented a novel series of psychoactive compounds, including lometraline, based on the structures of the neuroleptics thiothixene and pinoxepin. Several notable analogues sertraline are known, including desmethylsertraline, dasotraline, tametraline, and lometraline.
Depression
Reduction, hydroxylation, and glucuronide conjugation of both sertraline and desmethylsertraline also occur. The principal metabolic pathway for sertraline is N-demethylation into desmethylsertraline (N-desmethylsertraline) mainly by CYP2B6. Sertraline is subject to extensive first-pass metabolism, as indicated by a small study of radiolabeled sertraline in which less than 5% of plasma radioactivity was unchanged sertraline in two males. Similarly, the clinical relevance of sertraline’s blockade of the dopamine transporter is uncertain. Although there could be a role for the σ1 receptor in the pharmacology of sertraline, the significance of this receptor in its actions is unclear.
Other anxiety disorders
Because Zoloft affects serotonin levels in the brain, it also has the potential to cause serotonin syndrome. The pandemic has led to an increase in searches for antidepressants, with sertraline, fluoxetine, duloxetine, and venlafaxine showing the highest search volumes, whereas searches of citalopram decreased during the pandemic. In a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.
You may or may not quickly begin to feel the effects. Both liquid and tablet forms of the medication are available. After six to eight weeks, you may see a more noticeable impact on the symptoms of your condition. Sleep improvements and a better appetite are changes you may see during your first month or so of taking your medication. Zoloft takes time to work, so you may wonder how to tell if your medication is helping. Your doctor may recommend changing when you take your medication depending on the effect you experience.
Continuing sertraline treatment helps prevent relapses of OCD with long-term data supporting its use for up to 24 months. Sertraline has much lower rates of adverse effects than these TCAs, with the exception of nausea, which occurs more frequently with sertraline. Compared with amitriptyline, sertraline offered a greater overall improvement in quality of life of depressed patients.
Plasma, serum or blood concentrations of sertraline and norsertraline, its major active metabolite, may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain statistically significant results. The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for fluoxetine. The unique effect of sertraline on dopaminergic neurotransmission may be related to these effects on cognition and vigilance.
Side Effects of Zoloft (Sertraline)
However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ1 receptor and DAT. By binding to the serotonin transporter (SERT) it inhibits neuronal reuptake of serotonin and potentiates serotonergic activity in the central nervous system. As expected from in vitro data, sertraline did not alter the human metabolism of the CYP3A4 substrates erythromycin, alprazolam, carbamazepine, clonazepam, and terfenadine; neither did it affect metabolism of the CYP1A2 substrate clozapine. Bupropion is metabolized by CYP2B6, which is inhibited by sertraline, and this may result in an interaction between sertraline and bupropion. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance of 37% or 50% depending on the statistical technique used.
Weight Gain
In addition, sertraline appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. Limited pediatric data also demonstrates a reduction in depressive symptoms in the pediatric population though remains a second-line therapy after fluoxetine. It is on the World Health Organization’s List of Essential Medicines and available as a generic medication. If you stop taking Zoloft, it is also possible that you may experience a return of symptoms.
Fatigue, insomnia, and nausea are common, but usually go away on their own Its anti-Cp effect is indeed due to its serotonergic activity and not its other effects. Specifically, Palit & Ali 2008 find that sertraline kills almost all promastigotes of Leishmania donovani.