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  1. Zoloft Side Effects Are Worth Considering
  2. Antidepressant efficacy and side-effect burden: a quick guide for clinicians
  4. My Experience with Zoloft

Celexa vs Zoloft - Anxiety - MedHelp Prescribing of antidepressant treatment ADT for major depressive disorder MDD has increased in quantity and popularity over the last two decades.

This is likely due to the approval of safer medications, better education of clinicians and their patients, direct-to-consumer marketing practices, and less stigma associated with those taking ADT.

This trend has also been met with some controversy, zoloft, as the ongoing safety and effectiveness effect these treatments have at effect been called into question. This paper discusses the differing levels of evidence that support the use of ADT based on A Food and Drug Administration approvals, B data from randomized controlled trials or meta-analyses and, where these are not available, the authors discuss and sedating, C theoretical pharmacodynamic principles to justify antidepressant choice in the treatment of Sedating patients.

The final section discusses standard psychopharmacology guideline approaches to better alert the reader as to which practices are commonplace compared with those which are more zoloft of the standard of care.

Zoloft Side Effects Are Worth Considering

This ultimately incentivized pharmaceutical companies to develop antidepressant treatments ADTs specifically targeted to correct these neurochemical imbalances.

Their unprecedented success and popularity heralded prescription therapy as a clear standard of care effect MDD of any severity; byADTs were the third-most prescribed medication sedating the USA [ 1 ]. As scientific knowledge of the neurobiological basis for MDD continues to increase, so too, in apparent lockstep, does the arsenal of drugs used to treat zoloft. In addition to the wide array of ADT classes available on the market today, each modulating one or more of the relevant biogenic amines serotonin, norepinephrine, dopaminethere exists a panoply of diverse compounds per class, all with distinct pharmacokinetic and pharmacodynamic properties affecting drug potency and efficacy.

zoloft psychoactive drugpsychopharmaceuticalor psychotropic is a chemical substance that changes brain function and results zoloft alterations in perceptionmoodconsciousnesscognitionor behavior. Some categories of psychoactive drugs, which have therapeutic value, are prescribed by physicians and other healthcare practitioners. Examples include anestheticsanalgesicsanticonvulsant and antiparkinsonian drugs as well as medications used sedating treat neuropsychiatric disorderssuch as antidepressantsanxiolyticsantipsychoticsand stimulant medications. Some psychoactive substances may be used in the detoxification and rehabilitation programs for persons dependent on or addicted to other psychoactive drugs. Psychoactive substances often bring about sedating although these may be objectively observed changes in consciousness and mood that the user may find rewarding and pleasant effect. In addition, sustained use of some substances may produce physical or psychological dependence or both, associated with somatic or psychological-emotional withdrawal states respectively. Drug rehabilitation attempts to reduce addiction, through a combination of psychotherapyeffect groups, and other psychoactive substances. Conversely, certain psychoactive drugs may be so unpleasant that the person will never use the substance again. This is especially true of certain deliriants e. Jimson weedpowerful dissociatives e.{/INSERTKEYS}.

It is funny that you say that the Zoloft knocks you out. With me,I take mgsof Zoloft every a.m.,and mgs of Trazadone @ night. I am prescribed 2 pills of Trazadone @ night and 1 pills knocks me gum.datingnpop.gdn Zoloft gives me an (UP) feeling not tired @ all.
  • Zoloft sedating effect Find a comprehensive guide
  • Jump to Effects - Escitalopram had
Jump to Effects - Escitalopram had a greater overall treatment effect vs. sertraline. Paper 3 – 16 More insomnia, fatigue, sedation, and restlessnesss. Feb 2, - Sleep-related antidepressant side effects are real—depression medication can inhibitors (SSRIs), like sertraline (Zoloft) and paroxetine (Paxil). system for longer, which can have a sedating effect,” leading to sleepiness.

Even though the dosage depends with the condition being treated, the most common of side effects attributed to the use of Zoloft are as follows:. Gastrointestinal Side Effects Most Zoloft users have reported suffering gastrointestinal side effects including nausea which is the most common. Other side effects include dry mouth, dyspepsia, diarrhea, and constipation. Side Effects of the Nervous System Although Sertraline causes stimulation, sedation has been reported in some cases for patients.

Nearly all drugs in the SSRI are known to cause some form of sleep abnormalities. Some of the other nervous system side effects are headaches, dizziness, insomnia somnolence, tremor, and fatigue.

Antidepressant efficacy and side-effect burden: a quick guide for clinicians

At higher doses, drowsiness has been reported among treated patient. However, at low doses, increased alertness and increased cognitive functions have been reported. Psychiatric Side Effects Side effects include agitation, and there have been infrequent cases of hypomania observed in patients, albeit sertraline being a very effective drug in treating panic attacks, it has also been observed in some several cases to cause sertraline-induced panic attacks.

General effects Weight loss is one of the most frequently reported side effects of Zoloft. I am currently partially breastfeeding my daughter who turns 5 months next week. She gets about half her intake from formula, and the other half from breastmilk both nursing and expressed milk.

I need to go on Zoloft in order to help with my premenstrual dysphoric disorder PMDD and am willing to go on a reduced breastfeeding schedule, in order to minimize the risk of transferring the medicine to my baby. Would you be able to help me figure out the optimum time gap between taking the medication 50 mg once a day , and nursing my baby? Studies have shown that levels of Zoloft sertraline and its metabolite found in the breast milk of mothers is very low.

There are no published controlled studies on the use of Zoloft by breastfeeding women. Based on the way Zoloft is distributed within the body, it would be difficult to impossible to determine any optimal time between taking the medication and nursing.

Therefore, basically all times would be equal in exposure to any drug levels in the mother. I took half a Zoloft today as recommended, and I felt more anxious and like I was going to jump out of my skin. I had not eaten, and I took it with my baby aspirin and high blood pressure pill.

Is that a side effect or what? The empty stomach and other medications should not have caused the effect you had.

Zoloft sedating effect Oct 28, - A: According to the drug maker, abrupt discontinuation of Zoloft (sertaline) can result in severe withdrawal effects. The symptoms can include irritability, agitation, dizziness, anxiety, confusion, headache, tiredness, and insomnia. Oct 22, - Also, when you start taking Zoloft, you may experience some. The most common ones include nausea or upset stomach, diarrhea, sweating, tremor, or a decreased appetite. Sexual side effects may also occur, most notably ejaculation failure and decreased libido.
Sometimes people respond this way to one medication in this family, but not to others.

If you have only taken one dose, your doctor may want you to try it again, to see if you get the same response or if your body gets adjusted to it.

If it happens again, let your doctor know that you are not tolerating it and another SSRI can be tried. These medications do take approximately one month to get the full effects from, but you should have more energy and motivation to do things after the first few days. After you are on one antidepressant for about a month, do not stop it abruptly, as this can cause anxiety and more depression. A taper down is recommended after being on an antidepressant for a month.

Let your doctor know what happened and see what he or she wants to do. For more information on medications and depression, please visit our links at: I've been taking Zoloft for three years, but not noticing a difference in how I feel. Can I stop taking it? The first thing I notice is that you have been on it for three years. Sertraline is slowly absorbed after oral administration, with peak plasma concentrations at h.


Zoloft sedating effect Plasma concentrations are linearly related to dose. The elimination half-life is about 32 h; metabolism is by demethylation to an inactive metabolite. Once-daily dosing is recommended, with steady state being reached after about 7 days. The kinetics of sertraline in the elderly and in patients with renal impairment are similar to those in young healthy female volunteers. In young male volunteers, peak plasma concentrations were lower, and elimination half-life shorter, than in elderly men or both groups of women. Nevertheless, no reduction in dosage is recommended for these groups. There is a chance that the medication may be helping you, but you don't realize it. Sometimes patients stop their antidepressants, and then they realize that it was actually helping them.

However, if you have the perception that it is not working, then you may need to consider a different dosage of Zoloft sertraline or a different antidepressant.

One very important thing about Zoloft setraline is that it should not be abruptly stopped and no medication should be stopped without permission from your health care provider. Please talk with your health care provider regarding your options in treatment. Attached is a link to additional information provided by Everyday Health regarding depression.

I started taking Zoloft 50mg once a day, after taking it, I get very nauseous. Should I cut the pill in half and take it after breakfast and lunch, instead of taking 1 pill on an empty stomach? Zoloft sertraline can be taken with or without food. Taking Zoloft with a full meal may help to reduce some of the nausea. If this doesn't work for you, it would be best to speak with the doctor prior to taking the medication in two halves.

If this is a new medication for you, often times the side effects will lessen and may even go away completely as your body gets more accustomed to the medication. If the nausea continues to be a problem, the doctor may even consider changing your medication. Normally it is best to speak with your doctor regarding any type of changes to your medication regimen. What exactly will drinking alcohol and taking Zoloft do?

Zoloft sertraline is an antidepressant classified as a selective serotonin reuptake inhibitor SSRI. Zoloft sertraline works on chemicals in the brain to treat depression, obsessive-compulsive disorder OCD , panic disorder, anxiety disorders, post-traumatic stress disorder PTSD and premenstrual dysphoric disorder PMDD. It may also be used to treat other conditions as determined by your health care provider. Some of the most commonly reported side effects associated with Zoloft sertraline therapy include drowsiness, dizziness, feeling tired, nausea, upset stomach, constipation, dry mouth, changes in weight or appetite, difficulty sleeping and decreased sex drive or difficulty having an orgasm.

This is not a complete list of possible side effects so it is important to consult your health care provider if you experience anything unusual or bothersome. According to the prescribing information, patients being treated with Zoloft sertraline should avoid alcohol.

Although studies did not show an increase in mental or motor skill impairment with alcohol, patients taking Zoloft sertraline are still advised to avoid alcohol. Zoloft sertraline may be taken with our without food and should be taken with water. It is important to take your dose at the same time each day. How should Zoloft be dosed in a teenager? Zoloft Sertraline is an antidepressant in a class of drugs called selective serotonin reuptake inhibitors SSRIs.

Sertraline affects a chemical in the brain that can become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms. Some of the most common side effects of sertraline are dizziness, drowsiness, nausea, upset stomach, constipation, weight changes, dry mouth, and sleep problems. Call your doctor at once if you have any new or worsening symptoms such as: Zoloft should not be stopped abruptly, withdrawal symptoms may occur.

Drug interactions can occur with Zoloft; consult your physician or pharmacist before taking any other prescription or over-the-counter medications, vitamins, or supplements. Drugs can cause weight gain in several different ways. Some can increase appetite or make you crave certain types of foods like those high in carbohydrates or fat. Other medications may slow down metabolism or cause fluid retention. However, the effect of prescription drugs on body weight is complex. Some drugs have no effect on weight, while others cause weight gain or weight loss.

Also, the same medications can cause weight gain in certain individuals and weight loss in others. There are also drugs that initially cause weight loss and then lead to weight gain with long-term use.

Most prescription medications associated with changes in body weight affect the central nervous system. Mood stabilizers lithium, valproic acid , antipsychotics, and anticonvulsants have also been linked with weight gain.

Other drugs that have been reported to cause weight gain include diabetes medications insulin, sulfonylureas, and thiazolidinediones , antihypertensive drugs, certain hormonal contraceptives, corticosteroids, antihistamines, some chemotherapy regimens, and antiretroviral protease inhibitors.

Zoloft sertraline is in a class of drugs called selective serotonin reuptake inhibitors SSRIs. Zoloft is used to treat depression, obsessive-compulsive disorder, panic attacks, posttraumatic stress disorder PTSD and social anxiety disorder. In addition, Zoloft is used to minimize mood swings, irritability, bloating and tender breasts associated with premenstrual dysphoric disorder.

Zoloft works by elevating brain levels of serotonin, which is a natural substance that assists in maintaining mental balance. Weight increase is a side effect with Zoloft. Weight increase occurred in at least 1 in people who took Zoloft during clinical studies. Decreased appetite and weight loss are side effects with Zoloft.

I already take Bystolic. Can I safely take Zoloft as well? Bystolic is a beta-blocker used in the treatment of hypertension high blood pressure. Zoloft is a type of antidepressant known as a selective serotonin reuptake inhibitor SSRI. It is commonly used to treat depression, social anxiety disorder, post-traumatic stress disorder PTSD , panic disorder, and obsessive-compulsive disorder OCD. Low doses of the beta-blocker Bystolic may be needed if used along with SSRIs such as Zoloft, and your doctor should monitor your heart function.

For more specific information, consult with your doctor or pharmacist for recommendations based on your specific condition and all current medications.

The most common side effects with Zoloft are: Other side effects with Zoloft include: This is not a complete list of side effects associated with Zoloft According to the prescribing information for Zoloft, people taking Zoloft should let their doctor or healthcare provider know right away if they are experiencing: These symptoms should be looked for especially early during treatment and when the dose is adjusted up or down; however, people should look for these symptoms on a day-to-day basis, since these changes may be abrupt.

These symptoms may be associated with an increased risk of suicidal thinking and behavior. Close monitoring by a doctor or healthcare professional and possibly a change in medication may be needed if these symptoms occur. Serotonin syndrome can be a dangerous condition and is characterized by having at least 3 of the following symptoms: In very serious cases serotonin syndrome can present like neuroleptic malignant syndrome, which can cause: These reactions can be fatal. Can Zoloft cause anxiety?

My dose was increased to mg last Friday and I have been dealing with anxiety, and I am wondering if it's from the Zoloft? Zoloft sertraline is classified as a selective serotonin reuptake inhibitor antidepressant medication.

Zoloft is approved for the treatment of depression, obsessive compulsive disorder OCD , panic disorder, post traumatic stress disorder PTSD , premenstrual dysphoric disorder PMDD and social anxiety disorder. According to medical references, agitation and anxiety are possible side effects reported with the use of Zoloft. This is not all of the possible side effects associated with Zoloft. If you think that you are experiencing a side effect from your medications, talk to your physician.

Do not stop or change the dose of your medications without talking to your physician first. On average, people in clinical studies experienced minimal weight loss -- 1 to 2 pounds -- compared to smaller changes in weight in people who took placebo sugar pill.

If you think a drug you are taking is causing weight gain, tell your health care provider. Do not stop any medication or change the dose without first talking to your provider.

There are many causes of weight gain. I am trying to lose weight! Ever since I've been on Zoloft, I've gained weight but my doctor won't put me on something else! What are some safe drugs I can take to help me? There are no vitamins or supplements proven to increase metabolism or promote weight loss. The best way to get enough vitamins is to eat a balanced diet with a variety of foods.

In some cases, a daily multivitamin may be needed for optimal health. In the past, these supplements contained the herb ephedra, also called ephedrine or ma huang. This ingredient is a stimulant and increases metabolism. Products containing ephedra have caused heart conditions, stroke, and death. As a result, ephedra-based products have been removed from the market. These supplements typically contain ingredients that have properties similar to those of ephedra.

Examples are bitter orange and country mallow. These ingredients can cause high blood pressure, heart attack, stroke, and seizures. Some fat-burning supplements also contain caffeine or caffeine sources, like yerba mate and guarana. These ingredients can lead to dangerous side effects, including heart problems, and may increase the risk of death.

Because herbs and supplements are not strictly regulated by the U. Food and Drug Administration, these products are not required to be tested for effectiveness, purity, or safety. In general, dietary supplements should only be taken under the supervision of your health care provider.

For more specific information, consult with your doctor or pharmacist for guidance based on your health status and current medications, particularly before taking any action. Is it typical for Zoloft to cause weight gain? Zoloft sertraline is an antidepressant in the SSRI class of drugs. SSRIs affect chemicals in the brain that may become unbalanced and cause a variety of disorders.

Zoloft is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder PTSD , and premenstrual dysphoric disorder PMDD. SSRIs and a related class, the serotonin-norepinephrine reuptake inhibitors SSNRIs, are some of the most widely used depression medications on the market. These two classes of drugs have become so widely prescribed because their side effects are limited compared to some of the older antidepressants. However, they still do have some side effects.

And weight gain can be a common side effect of both of these classes of drugs. Keep in mind that patients may react differently to different medications within these classes. If side effects, like weight gain, become bothersome, it sometimes helps to switch medications.

Consult your health care provider for specific recommendations. For more specific information, consult with your doctor or local pharmacist for guidance based on your health status and current medications.

Zoloft sertraline is a medication that is used to treat depression or anxiety. It is in a group of medications called selective serotonin reuptake inhibitors SSRIs that work to balance out the chemical, serotonin, in the brain that causes depression symptoms when there is too little to go around.

The prescribing information lists weight gain as a side effect of this medication. The occurrence of weight gain was not common during clinical studies of the medication, seen in 1 percent of patients taking Zoloft.

If you are noticing an unexplained weight gain with Zoloft it would be best to consult with your physician as to the best way to handle this side effect. For more information on Zoloft, click on this link: I am withdrawing from Zoloft mg after years of taking it. I have been without it for four days and I feel dizzy. Zoloft sertraline is classified as a selective serotonin reuptake inhibitor SSRI. According to medical references, Zoloft has warnings associated with withdrawal syndrome.

It is recommended that Zoloft should be gradually tapered down when discontinuing the medication. If intolerable symptoms occur after stopping the medication, the recommendation is made for the physician to consider resuming the previous dosage and then begin a more gradual taper. All dosing and tapering of dosages should only be done as directed by your physician.

Signs and symptoms of withdrawal syndrome include: Zoloft sertraline is a selective serotonin reuptake inhibitor SSRI antidepressant used to treat depression, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and social anxiety disorder.

The most common side effects with Zoloft are dizziness, fatigue, headache, decreased libido, nausea, diarrhea, dry mouth. Alopecia hair loss was reported as an infrequent side effect with Zoloft. This is not a complete list of the side effects associated with Zoloft. When your doctor prescribes a new medication, be sure to discuss all your prescription and over-the-counter drugs, including dietary supplements, vitamins, botanicals, minerals, and herbals, as well as the foods you eat.

Always keep a current list of the drugs and supplements you take and review it with your health care providers and your pharmacist. If possible, use one pharmacy for all your prescription medications and over-the-counter products. This allows your pharmacist to keep a complete record of all your prescription drugs and to advise you about drug interactions and side effects.

Tell your health care provider about any negative side effects from prescription drugs. You can also report them to the U.

Food and Drug Administration by visiting www. Why do I have bad dreams every time I start a new course of Zoloft but then it tapers off? Zoloft is indicated for depression, obsessive-compulsive disorder, panic disorder, anxiety, and premenstrual dysphoric disorder PMDD. Common side effects of Zoloft include drowsiness, nausea, dry mouth, sleep problems, and changes in weight and appetite. A search of prescribing information did not specifically list abnormal dreams as a side effect of zoloft.

What's the safest way to stop taking Zoloft? I'm not sure it's working, and the sweating is driving me crazy. Zoloft sertraline is a selective serotonin reuptake inhibitor antidepressant used to treat depression and other conditions as prescribed by your doctor. It is important to remember that it can take up to 6 weeks to see the full effects of the medication so it is best not to judge its effectiveness before this time. Discontinuation or withdrawal symptoms can occur with abrupt discontinuation of Zoloft.

These symptoms can include change in mood, irritability, agitation, confusion, anxiety and insomnia. It is important to avoid abrupt discontinuation. The package information for Zoloft recommended tapering the dose slowly by gradually decreasing the dose before stopping the medication. Your doctor can advise you on a tapering schedule.

Zoloft sertraline is an antidepressant that is used in the treatment of depression, panic disorder, anxiety disorder, obsessive-compulsive disorder OCD , post-traumatic stress disorder PTSD , and pre-menstrual dysphoric disorder PMDD. Weight gain or changes in appetite are a side effect that occurs with the use of sertraline.

Does Zoloft cause bloating and weight gain? According to medical references, the most common gastrointestinal side effects associated with Zoloft include: Other reported gastrointestinal side effects include decreased appetite, constipation, upset stomach, flatulence, vomiting and weight gain. The feeling of bloatedness can be associated with some of these possible side effects. These are not all of the possible side effects associated with Zoloft.

If you think that you are experiencing a side effect from your medication, talk with your physician. Do not stop taking or change the dose of your medication without first talking to your physician. Regards, Jen Marsico, RPh. If I don't see a difference with Zoloft should I go off of it? There is a possibility that the medication may be helping you, but you don't realize it.

Sometimes patients stop their antidepressants, and then realize that it was actually helping them. However, if you feel as though it is not working, then you, along with your doctor, may need to consider a different dosage of Zoloft sertraline or treatment with a different antidepressant.

One very important thing about Zoloft is that it should not be discontinued abruptly and no medication should be stopped without the permission and guidance from your health care provider. For additional information regarding depression: I am on Zoloft and have trouble sleeping. Will drinking wine make me more depressed? There is no drug interaction between alcohol and Zoloft.

Side effects to alcohol include: This is not a complete list of side effects. Alcohol can cause impaired judgment, alertness, and sleeping problems. Talk to your doctor about your concerns with Zoloft and alcohol. Do not start or stop any medications or treatments without first talking to your doctor.

I believe you will find the following links at everydayhealth. Can Zoloft cause headaches and joint issues? Zoloft sertraline belongs to the group of drugs known as selective serotonin reuptake inhibitors SSRIs. Zoloft is used for the treatment of depression, obsessive-compulsive disorder, and anxiety disorders. According to the package insert, the most common side effects of Zoloft are nausea, diarrhea, insomnia, dry mouth, tiredness, dizziness, and tremor.

Headache, muscle pain, muscle weakness, and joint pain have all been reported in patients taking Zoloft. Food and Drug Administration by visiting http: Vilazodone, however, with both pre- and post-synaptic 5-HT1A agonism, is considered to be more potent in this respect. Due to the fact that this drug uses two proserotonergic mechanisms, it is sometimes termed a serotonin partial agonist reuptake inhibitor SPARI [ 53 ]. In animal models, there was promise of faster antidepressant effects, but this has not been replicated as yet in human trials.

A 1-year, open-label multicenter study assessing the long-term safety of vilazodone found the drug to be safe and well tolerated by MDD adults, with no clinically important changes in physical examinations, electrocardiograms, or clinical chemistries [ 54 ].

Like vilazodone, vortioxetine possesses multimodal activity and is often classified as a serotonin modulator and stimulator SMS. In addition to its serotonin reuptake-blocking i. A meta-analysis not only concluded that vortioxetine achieved significant reductions in depression scores compared with placebo in 6 of 10 RCTs, but ranked this drug above escitalopram, vilazodone, and sertraline for both efficacy and tolerability [ 56 ].

Indeed, one potential advantage of this drug over comparable ADTs is a potentially low risk of sexual side effects, weight gain, and sedation [ 55 ]. Of note, a large meta-analysis has been conducted to evaluate most of the modern-day antidepressants with regard to effectiveness and tolerability [ 58 ].

These mixed findings would suggest no definitive superiority of any ADT class, but rather individual drug superiority. Additionally, two SSRIs escitalopram and sertraline showed the best profiles of patient acceptability and thus the lowest rates of discontinuation, in support of previous data showing the SSRI class to be the best tolerated. Finally, the authors determined that sertraline for moderate-to-severe MDD may offer the best balance of effectiveness, acceptability, and cost.

Of note, the newer levomilnacipran, vilazodone, and vortioxetine were not included in this meta-analysis.

Thus far, this paper has sought to correct the perception, inadvertently fueled perhaps by generalized drug approval and marketing procedures, that ADTs are equally appropriate and effective for all depressed individuals. The clinical reality is that there is often a particular ADT class, if not single drug, that is best suited for each patient. Table 1 concisely summarizes the specific drugs, side effects, and important prescribing considerations associated with each ADT class.

Many of these have been detailed here. For adequate monitoring of drug response and possible dose escalation, knowledge of common side effects is fundamental. In addition, prescribers should be aware of the major ADTs that have been indicated or shown clinical promise in more than one psychiatric condition. In some cases, a medication switch within ADT class may be as efficacious as a switch between drug classes, reflecting the importance of subtle pharmacokinetic and pharmacodynamic differences [ 60 ].

It is clear today that aggressive, early therapy focused on achieving complete remission i. In light of these paradigm shifts in the understanding of MDD, it is incumbent upon all clinicians to remain abreast of the latest literature and informed about the properties, mechanisms of action, and specific indications of commonly prescribed ADT. Figure 1 illustrates a basic algorithm psychiatrists often follow in the initial treatment of MDD. This can serve as an invaluable reference for other clinicians who are also in the care of a patient with MDD.

After the initial diagnosis, the type and severity of MDD should be meticulously assessed, since the presence or absence of particular symptoms or features, as well as the existence of comorbid conditions, will dictate effective first-line treatment selection. A patient with severe MDD, for example, may benefit from starting immediate combined treatment, comprised of an ADT trial with concurrent psychotherapy; patients with a history of MDD in whom previous treatment has failed may strongly consider electroconvulsive therapy, especially if there is serious threat of suicidality.

MDD with psychotic features, on the other hand, will require concomitant comorbid medication; therefore, an ADT monotherapy must be appropriately selected that avoids dangerous interactions with other psychotropic substances.

In most uncomplicated cases, the first-line treatment is usually monotherapy with an established SSRI, such as sertraline Zoloft. An SSRI approach is often seen in clinical practice and is supported by many guidelines and reviews [ 62 , 63 ]. However, some of the newer SNRIs e. Discrepancies in the selection of initial SSRI monotherapy are usually due to slight differences in side-effect profiles rather than effectiveness.

The prescriber will start the patient just below the minimum therapeutic dose MTD , that is, the threshold, previously established by regulatory trials, at which the ADT becomes statistically efficacious in treating MDD. The MTD for sertraline, for example, is 50 mg. A sub-MTD approach is employed to keep plasma levels, and thus the risk of potential adverse side effects, low at ADT initiation [ 64 ].

A phone communication should be set up earlier, however, around 2 weeks to monitor acute side effects, including suicidal ideation [ 66 ]. If there is a full initial response notable symptom alleviation at this first reassessment, the dose should remain at the MTD for another 4—6 weeks, and a new appointment is scheduled at this time to determine whether complete remission exists.

In the case of a partial response minimal symptom alleviation at the first reassessment, the dose should be steadily and appropriately increased optimized , with a reevaluation scheduled at the 4- to 6-week time point. If there is not clear and full remission of symptoms after 8—12 weeks of treatment, prescribers often fully maximize SSRI dosing, switch to a different ADT class monotherapy, or add an approved or evidence-based augmentation agent e.

With regard to switching ADT class monotherapies, large comparative studies have yet to show a clear advantage of any one particular strategy, despite several smaller studies slightly favoring SNRIs [ 59 ]. Today, most experts agree that a class switch is warranted if a patient has not first received major relief from a previous, fully dosed SSRI. The rationale is that if maximum serotonergic facilitation has not provided relief, the pathogenesis of the depression may not be entirely serotonin-based, and a different neuromodulatory approach e.

Leaving a patient in a partial response state may increase the risk of future MDD relapse, recurrence, suicide, social and occupational discord, or dysfunction [ 70 ]. Clinicians often measure MDD symptoms again by checking each DSM-5 symptom verbally or by utilizing a rating scale measure. Sometimes, however, patients may exhibit a fair degree of symptom resolution even obtaining statistical remission according to rating scales yet may not be truly well again. For example, symptoms may subside despite the patient being unable to work successfully, improve grades at school, or return to interpersonal activities e.

Along with diligent monitoring of symptoms, clinicians should establish psychosocial markers with the patient [ 64 , 71 ]. These markers are often behaviors that the MDD patient can relate to, which would indicate that they are socially well, remitted, and recovered.

Patients might consider themselves back to normal again if, for example, they returned to their volunteer work, paid their bills accurately and on time, or began working out or dating again. Full symptom remission and full return to baseline psychosocial functioning are the ultimate goals of MDD treatment.

A psychotherapist performing psychotherapy in parallel with a clinician prescribing ADT may be invaluable for assessing whether psychosocial wellness or remission has occurred, as typically a therapist will have more face-to-face time to determine whether there has been a full return to baseline functioning. National Center for Biotechnology Information , U. Journal List Drugs Context v. Published online Oct 8. Daniel Santarsieri and Thomas L Schwartz. TS conceived the idea, supervised the preparation of the manuscript, streamlined and provided longitudinal editing, and co-wrote the manuscript with DS, who additionally provided substantial contributions to literature review and editing of the final manuscript.

Potential conflict of interests: The authors have no relationships to disclose. Funding declaration and acknowledgement: The authors have declared that this is an unfunded study.

VAT GB Author information Article notes Copyright and License information Disclaimer. Received Aug No commercial use without permission. This article has been cited by other articles in PMC. Abstract Prescribing of antidepressant treatment ADT for major depressive disorder MDD has increased in quantity and popularity over the last two decades. Subtle SE differences must be weighed by the prescriber SNRI Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran Nausea, insomnia, dry mouth, headache, increased blood pressure, sexual dysfunction, weight gain SEs are similar to but may be slightly more frequent than with SSRI Atypical Bupropion Headache, agitation, insomnia, loss of appetite, weight loss, sweating Increased seizure risk in eating disorder and epilepsy patients.

No sexual dysfunction or weight gain. May also help to quit smoking Mirtazapine Sedation, increased appetite, weight gain Sedation may be less with higher dose. Some risk of reduced white blood cell count Trazodone Sedation, nausea, priapism rare Lower risk of weight gain and sexual dysfunction, but may cause priapism.

May have precognitivebenefits in adults with MDD. Open in a separate window. Treatment guidelines for the general practitioner Figure 1 illustrates a basic algorithm psychiatrists often follow in the initial treatment of MDD.

Treatment algorithm for MDD. Antidepressant use in persons aged 12 and over: National Center for Health Statistics; NCHS data brief, no Schwartz T, Petersen T, editors.

Taylor and Francis; The efficacy of antidepressant drugs: Diagnosis and drug treatment of psychiatric disorders: Clinical Practice Guideline Number 5. Depression in primary care, Volume 2: Diagnostic and statistical manual of mental disorders.

American Psychiatric Press; Comparing the methods used to compare antidepressants. A rating scale for depression. J Neurol Neurosurg Psychiatry. A new depression scale designed to be sensitive to change. Statistical power analysis for the behavioral sciences.

Food and Drug Administration. Placebo response in studies of major depression: Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: Comparative efficacy between venlafaxine and SSRIs: The 7 habits of highly effective psychopharmacologists, part 3:

My Experience with Zoloft

Antidepressant efficacy and side-effect burden: a quick guide for clinicians Find a comprehensive guide to possible side effects including common and rare side as cold or allergy medicine, sedatives, narcotics, sleeping pills, muscle relaxers, Our Zoloft Side Effects Drug Center provides a comprehensive view of. Jun 23, - Like any medication, antidepressants can cause side effects. Antidepressants such as SSRIs (Zoloft, Lexapro), SNRIs (Cymbalta, Fetzima, Alcohol can affect how well the medicine works, cause sedation, and possibly. Zoloft sedating effect