sertraline

Pharmacologic class SSRI, or selective serotonin reuptake inhibitor.

Brand names Sertraline is sold as Zoloft in America and Lustral in Great Britain.

Indications Licensed to treat clinical depression.

Pharmacology Low serotonin levels were observed in depressed patients. Therefore, the SSRIs were developed, which prevent the body from reabsorbing serotonin, and so allow a higher level of it to build up in the brain.

Contraindications It really should not be given to patients under the age of eighteen. Few doctors seem to abide by this. It should certainly never be given to patients under the age of twelve. It should also be avoided by patients who are breastfeeding or pregnant, and those planning to have ECT. People who have had an adverse or allergic reaction to it in the past should not take it. Patients should stop taking sertraline if they have an allergic reaction or seizures.

Precautions It should only be given to elderly patients (over sixty) with close monitoring. It has been known to impair liver functions or cause liver damage. Obviously, any other physical or mental illness, or medical treatment, should be taken into account.

Interactions Monoamine oxidase inhibitors (MAOIs) are the main one. SSRIs should not be taken within five weeks of MAOIs, and MAOIs should not be taken within two weeks of SSRIs.

Adverse reactions The most common are dry mouth, nausea, sexual dysfunction, diarrhoea, dizziness and altered sleep patterns. These are often temporary, and are common to all the SSRIs. More serious side effects can include chest pain, liver damage, seizures, hallucinations and altered senses and numbness. All SSRIs have been accused of leading to an increase in violent and/or suicidal behaviour in a small minority of patients. The plural of anecdote is not data, but equally the plural of denial is not disproof.

Additional information Sertraline is neither physically nor psychologically addictive. To my knowledge, fluoxetine (Prozac) is the only SSRI licensed to treat eating disorders, obssessive compulsive disorder and anxiety, but others, including sertraline, may be prescribed for them at the doctor's discretion. There is a get-out clause which, in the UK at least, allows a doctor to prescribe any medication he or she believes will help, whether it is licensed to treat that condition or not.

Date of most recent update August 3, 2002.

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Sources: http://www.psyweb.com, those little leaflets you get with the pills, observation and experience. E2 FAQ: Prescription medications.

Sertraline is a white crystalline powder with chemical formula C₁₇H₁₇NCl₂. Besides depression, sertraline can be used in treatment of panic disorder, social phobia, and obsessive-compulsive disorder. The most common side effects include nausea, diarrhea, insomnia, drowsiness, and dry mouth.

Chemical structure:

    H      H  H H  H H  H   H
     \    /    \|  |/    \ /
      C--C  H   C--C      C--H
    //    \\ \ /    \    /
Cl--C      C--C      C--N
     \    /    \    / \  \
      C==C  H   C==C   H  H
     /    \  \ /    \
    Cl     H  C      C--H
              \\    //
                C--C
                |  |
                H  H

Sources:
http://www.rxlist.com/cgi/generic/sertral.htm
http://www.psyweb.com/Drughtm/sertra.html

Here is what living with my ex on Zoloft was like organized in HAP (Hours After taking Pill).

Morning (HAP 00) Takes pill, groggy bitch.
HAP 01 Waking up, clothes are probably on, acting normal.
HAP 02 Happy
HAP 03 THE WORLD IS WONDERFUL! LET'S DANCE! (skip to HAP 9)
HAP 09 Happy
HAP 10 Mostly happy
HAP 11 Acting weird, no screaming yet
HAP 12 Ahh, glorious paranoia
HAP 13 Mad as a dog
HAP 14 Trying to bite me and draw blood
HAP 15 The "moJoe must physically restrain girlfriend" part
HAP 16 Throwing things (police may or may not have been called yet)
HAP 17 One hour after bed time and she is generally still screaming about me being a selfish prick for not understanding why she wants to sleep with her ex boyfriend or some such nonsense.
HAP 18 She's grinning and rocking back and forth, saying nothing, but hitting me on occasion
HAP 19 On a good night, we were asleep, otherwise continue HAP 13-19 till morning.

Zoloft is the trade name for sertraline hydrochloride. It is an anti-depressant of the SSRI family - Selective^* Serotonin Re-uptake Inhibitors. It is supposed to function by blocking the reuptake of serotonin from the blood stream into cells, thus raising the serum serotonin level.^*

Yes, it has side effects. Yes, these can include nausea, headache, drymouth, sexual dysfunction, and in my case, mild lockjaw(!). Withdrawal from Zoloft is not as difficult as has been made out here, as long as it's done properly! You can't just stop taking it; you need to titrate your blood levels down slowly. Your brain becomes accustomed to a serum serotonin level when you're on it (your body and brain adjusting are what cause most of the side effects while you get acclimated) and suddenly stopping all intake of it can cause massive brain chemistry shifts which are almost always bad.

So why take it?

If you've never been depressed, then I envy you, and you have every natural reason to ask this question. You will never, however, understand the answer. If you've been depressed, then you know the answer. Although I firmly believe this to be true, I'll try to explain anyway.

Depression is a physical condition, in some cases. It can be observed in, if not traced to, blood chemistry. Depression, if you're fortunate enough to not know what it's like, is not simply feeling blue. Everyone goes through that at some point. Rather, it is a condition in which the very act of getting up off a bench on which you've spent the entire afternoon, miserable, watching people go by who seem to be reasonably happy, is a physical impossibility; your muscles won't move. It's like being so tired you can't close your eyes.. There's no reason for anything, much less for you to do anything. Have you ever looked at your calendar for the next three or four days and frowned because you realize you have nothing fun written there? Perhaps due to a deadline? Imagine feeling this way about every hour of the day, asleep or awake, for the next twenty years. This may begin to give you a slight understanding of what true depression is like. My personal favorite representation of depression in a visual form is the painting Automat by Edward Hopper.

I'll stop here, because I'm sure, even though I haven't looked, that there are multiple nodes out there doing a better job of explaining this; depression, you see, is not an uncommon malady.

Now imagine that there is a drug which can make you functional. You can think about the future without it appearing to be an empty pit with nothing to look forward to. The very thought of getting up is followed almost immediately by the action, with no disconnect between the two. You have to stop and think for a moment to recall what it felt like, sitting on that bench. Given this, the price in side effects may seem rather small. The effort and inconvenience of always having the stuff available may not be such an onerous burden after all.

This drug is not for everyone. It's not even for everyone who's depressed; its use is indicated in very specific circumstances. However, if you do suffer from this condition, and are fortunate enough to respond properly to Zoloft, then you may consider yourself extremely lucky to have it.

I know I do.

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Spuunbenda: I would be very careful with the writings of Andrew Weil. He's (IMNSHO) a fairly dangerous quack, preferring alternative medicine without scientific inquiry over tested medical science.

Ahab: Don't get me wrong! I'm all in favor of the stuff; it's saved most of my life.

ryouga: Hmm. Well, I suggest you tell the next person you meet with bipolar disorder (a chemical-based mood-related problem) to just suck it up and see where that gets you.

^*: I'm grateful to j3z for two corrections, one made here and one not; I had originally thought it was Serum Serotonin Reuptake..when in fact it's Selective Serotonin...etc. This is a critical difference, and I've made the change. Also, apparently (according to j3z) my assertion that it blocks serotonin reuptake into cells, thus raising blood serotonin levels, is not supported by medical evidence. I'm inclined to trust the correction; I leave my original version here as another possible explanation since the actual mechanism has apparently not been proven.

Other nodes of mine concerning this stuff:

• July 26, 2002

So many bad comments about Zoloft... when it has had such a good effect on a lot of peoples lives.

I used to be very depressed, now I'm just a bit down sometimes. And who isn't? Isn't that "normal", after all?

I had slight OCD, panic attacks and depression, and good ol' Zoloft dragged me back from my pit of despair and confusion. I started on 50mgs, and have now stabilised my intake at 100mgs a day.

A side effect you may not expect: weight loss. After losing my appetite for 4 months, I lost about 10kgs with absolutely no change to my exercise habits.

If you're trying to decide whether to start on it or not, I say just give it a go for a while- it could save your life in the end.

And that's not so bad, is it? (Cue sappy music now... awww).

Another interesting side effect of taking Zoloft is that it "may cause some irritability in some patients."

This is something I and my housemates found out. At about eight hours after taking my daily dose, I was prone to attacks of rage that I could barely keep from aiming straight at the people I cared about. (Breaking cheap glassware was the best method I had for dealing with the anger.)

I thought it was just an aspect of the depression, though and declined to deal with it (by switching medications) until about a year later. It was my first antidepressant.

Why did I put up with all the nasty side effects? Well, it's because taking Zoloft had two main benefits: it made me feel better emotionally and it killed my normally overactive appetite. I was told the antidepressant would kick in after about two weeks, and the effect hit me two days after I began the regimen. I just didn't want to risk switching to something that might not work for me as well as this proven one had.

At the risk of writing GTKY blather, when someone tells you that zoloft or any of the other SSRI antidepressants cause sexual dysfunction what they mean quite often, for guys anyway, is the inability to ejaculate. Ejaculation is either seriously delayed or never comes at all, pun intended. I, um, had a friend who had this unfortunate experience with both prozac and zoloft.

He found the delay to occur both in intercourse and, um, alone, regardless of the circumstances. In the case of intercourse, while this problem allows plenty of time for the female to get her jollies, sometimes the male just has to give up. Masturbation sometimes works, sometimes doesn't. YMMV. The ironic thing is that this does not improve one's depression at all. He has talked with his doctor about this and done a little research on his own, but he has not found any remedies other than patience, hard work, or quitting the drug.

Needless to say this dysfunction poses big problems if you are trying to have children. Guys, consider this when you and your doctor are discussing treatment options.

I took this stuff in high school, for only four weeks. It might have taken longer to work, but my father was an impatient person. Here's how I kept afloat, grade wise.

take it at night. The drowsiness is useful if one feature of your depression is insomnia.

Plan not to eat. I didn't eat much at all. I mostly subsisted on Carnation instant breakfast and vitamin pills, with the occasional coffee thrown in.

You won't care about anything. I was prescribed this for my extra short no time to burn fused temper. I'd blow up at the slightest thing, often breaking things and once or twice nearly somebody's face got rearranged. After about a week of this my father told the doc, who prescribed this. I didn't scream, cry, or carry on anymore. I just sat passively and smiled at nothing in particular.

Drinking with this med is a bad idea. My father gave me a small glass of sparkling white wine after dinner once because I was slightly hiper. I took it with my Zoloft and within ten minutes was literally unconscious on the couch. I woke up there the next morning, so I guess they simply covered me and left me there.

Don't bundle up, even if it's cold inside a room. Warmth makes you sleepy and that doesn't help when taking this. I literally slept through every class, even through lunch. There was no differentiating for me when what class was or where it was. I just sleepwalked to the next room and usually collapsed just inside the door.

Ladies, pay attention. You will have a hell of a time orgasming. I promise. Don't worry about it much.

Thanks for the space and time.