What can I expect from Zoloft?
January 28, 2010 5:25 AM   Subscribe

I've been prescribed Sertraline (Zoloft) for depression. I've never taken any SSRI or depression drug before. What can I expect? What should I do or not do?
posted by anonymous to Health & Fitness (27 answers total) 5 users marked this as a favorite
I've had much better results from therapy than from SSRIs, but if you want to give it a try then the best advice I can give is go on AND come off (when you do) much, MUCH more slowly than you think you will need to.

Adjusting very gradually is the key to avoiding side-effects.
posted by greenish at 5:29 AM on January 28, 2010

Yes, definitely increase and decrease very gradually. I found that I was extremely tired in the beginning, and also rather jittery. It made me want to quit taking it, but I kept going and found that both of those side effects decreased after about 5 weeks or so. It takes awhile for it to start working but it was well worth sticking it out.
posted by maxg94 at 5:51 AM on January 28, 2010

You may suffer from a lack of appetite. Just eat whatever you feel you can, whenever you can. For me this was apricots (dried) and a Big Mac once a day and lots of peppermint tea.

Its hard to reach sexual climax usually on SSRIs... but so worth it when you do!
posted by evil_esto at 6:05 AM on January 28, 2010 [1 favorite]

Watch out on consuming alcohol. My tolerance has gone down since I've been on Prozac, but of course YMMV.
Also, seconding the "side effects decreased after 5 weeks or so." My appetite dropped significantly, but I've recovered most of it. Definitely allow several weeks of observation before you make any permanent conclusions about how it's working for you.
posted by dorothy humbird at 6:07 AM on January 28, 2010

I've taken zoloft twice in my life. You should read the post on Crazy Meds to get some insight into some more experiences with it. I've found it has really helped me with anxiety and depression, and a slight inclination toward shutting myself in the house and refusing to interact with people. Everyone is different and SSRI's are a bit of a crapshoot in that no doctor can really say for certain which one will work for you, there is some trial and error.

Some general points I will make:

1. It really will take several weeks to evaluate. As you titrate up (meaning gradually increase your dose to a therapeutic-for-you dosage), you may see an increase in side effects. Many SSRI side effects go away after a couple of weeks. Some don't. My take on SSRI's is that the first 4 weeks sucks, because you are experiencing side effects without experiencing any of the real positive effects the medicine may be having. On the other hand, for some people, bothersome side effects don't go away and it's not worth it. If that sounds vague, it is - no one can predict really how it will go for you. The best advice is that above: go slow, and I would add that you should keep notes of the increase/decrease in side effects so that you can talk to your doctor about them.

2. Do not drink alcohol. With most SSRI's, the alcohol will make you feel much drunker than you are accustomed to, and can really cause mood problems. I'm not giving you advice about whether to abstain permanently (though your doctor may tell you to do so), because I never did. But abstain while you are adjusting to the medicine, at least.

3. You may see a change in sleep patterns. You might be more sleepy, less sleepy or have no change. Your doctor may have told you whether to take the medicine in the morning or the evening, but if not, you might consider asking. What I've done in the past, and what you should ask your doctor about, is taking the medicine at a neutral time (i.e. not before driving, and not right before bed. Say, at 2pm with lunch) for a couple days to determine if it makes me drowsy. If not, take in the morning going forward. If so, take before bed going forward. Timing of dosage can be important for these meds, so I urge you to understand that I discussed these changes with my doctor before making them and you should to.

4. If you give it the best time you can and either the side effects are intolerable or it just isn't working, you CANNOT quit cold turkey. I can tell you right now that the effects of quitting cold turkey are likely to include SSRI Discontinuation Syndrome, which, if you've never experienced is, for me, like receiving an electric shock every 2-3 minutes while feeling constantly carsick. I've had SSRIDS from reducing dosages too quickly, much less from stopping alltogether. So, just like you must increase gradually, you must decrease gradually.

5. Some people lose weight on some of these drugs and others gain it. If the loss or gain of weight will be an issue for you, you may want to start monitoring now. My experience and common wisdom with zoloft is that many people gain weight, but that is not unilaterally true across the board.

6. Finally, and I hope your doctor explained this already, SSRIs are not a magic happy pills. The changes may be subtle, so look to start or continue healthy things like eating well, getting exercise, and talk therapy if you do that. If, on the medicine, things feel a lot worse, then please tell someone right away.

The above probably sounds scary - it's not intended to be. Zoloft has saved me from the brink within the last year, and is very very helpful for very many people.
posted by bunnycup at 6:07 AM on January 28, 2010 [4 favorites]

I did not have many side effects from it, took Zoloft for about a year. Did loose weight a little. It helped me cope with my depression, life got a bit more easy. But I missed myself when I took it, I am a woman with high peaks and great lows in emotions, Zoloft made me stuck in the middle. When I got calm enough to cope with the depression I was happy to stop with them. Took about 6 weeks before the pils worked and it took me 3 months to stop.
posted by kudzu at 6:21 AM on January 28, 2010

Weight gain and metabolic havoc. The doctors downplay this, but I don't know a single person (including myself) who hasn't gained at least 20-30 lbs while on an SSRI. If you have any tendencies toward insulin resistance or metabolic syndrome, this will be even worse - your blood sugars will probably hover in the low-diabetic range and your blood pressure will go up. Watching carbs and avoiding empty calories may help.
posted by chez shoes at 6:43 AM on January 28, 2010

You may suffer from a lack of appetite. Just eat whatever you feel you can, whenever you can. For me this was apricots (dried) and a Big Mac once a day and lots of peppermint tea.

Regarding this, YMMV. Seriously. My experience with Zoloft was that I gained 50 pounds in 6 months with no real diet or activity change, so if you start a Big Mac regimen and react like I did, you'll be in a heap of trouble. You should monitor your weight and talk to your doctor as soon as you start to see any significant swings up or down. And if they don't take you seriously, find someone that will.

I also found it useful to quit caffeine while on Zoloft to prevent the jittery feeling.

Take heart, though. Zoloft is really effective and helped me make it successfully through a time when I was struggling with depression and anxiety. I would suggest that when you get to the point where things are going well and you think you can go off the drug, then work hand-in-hand with your doctor to go off slowly and consider therapy during this time (and after) to help you adjust and continue the habits you learned while on the drug.
posted by bristolcat at 6:51 AM on January 28, 2010 [1 favorite]

I've been on Zoloft for years to combat anxiety attacks and it's been great for me. Alcohol makes me much drunker than normally, so you really have to limit yourself (and I feel some rebound depression the next day, which may or may not be attributable to the drug). I haven't gained any weight on it, so just keep an eye on the scale and adjust diet/activity levels accordingly and you'll be fine. I still drink caffeine and drink one or two drinks at a time and nothing horrible happens. This is after the 4-week adjustment period when you're starting out, though. I think it's totally worth it; it enabled me to get out of the house and socialize, which in turn helped me feel less stuck and lonely.
posted by chowflap at 7:01 AM on January 28, 2010

Datapoint: 30 year old male, been on a rather high dose of Sertraline (100 mg/day) for the last year, attempting to wean off - at psychiatrist's urging and under his supervision - sometime in the next couple of months.

Okay, now that's out of the way. The only side-effects I've noticed are some slight libido depression (which is fine as I'm not in a relationship and have never had a terribly high libido anyways) and some short-term memory loss, which I don't know if that's related or not.

There was some slight bowel discomfort the first few days, but it didn't last more than a week.

I've not experienced any weight-gain or appetite variance, but I have a pretty physically demanding life, both in work and play. No issues with jitters or lethargy, though my dreams do seem to be *way* more bizarre. Not bad, just weird. Again, can't say for sure that's related.

Alcohol tolerance has decreased, but I've also cut back on alcohol dramatically, so that's also a factor. But it's not like a beer or two or four is causing blackouts or anything.

I combined mine with about 8 months of talk therapy and it's done well for me. No major complaints overall, though as mentioned above, it's not a miracle pill that's going to cure everything instantly.

Good luck, and feel free to me-mail or e-mail me if you need.
posted by Ufez Jones at 7:15 AM on January 28, 2010 [1 favorite]

Two pieces of advice:

1. Contact your doctor with questions as often as you need to, because s/he works for you.

2. Do not listen to anyone who tries to make you feel bad/weak/whatever for taking SSRIs. At all. It's none of their business and chances are great that if they're giving you a hard time about it, they've never stood in your shoes.

It will take a few weeks to feel the effects. Hang in there.
posted by corey flood at 7:27 AM on January 28, 2010 [2 favorites]

100% agree with corey flood. honestly, everyone reacts differently. it's best not to really expect anything specific, and not really listen to anyone because you might subconsciously look for side effects that aren't there. just take it slow, be aware, and maybe let a few trusted people know what you're undertaking and ask if they can let you know if they notice any changes that you might not yourself.
posted by assasinatdbeauty at 7:31 AM on January 28, 2010 [1 favorite]

My medical group has an emergency psychiatric hotline that you can call when you're just starting a new med and you have a reaction or a concern or a freakout. Find out if your doctor has such a thing and CALL IT the second you need to. I had a very bad reaction to Paxil and no such number existed at the time so that was a miserable time. Zoloft wasn't too bad. It just made my hands shaky.
posted by elsietheeel at 7:39 AM on January 28, 2010

It is not unheard of for SSRIs to cause suicidal thoughts/behaviors or mania. So make sure you keep talking to your doctor and monitoring your moods. These are very rare side effects. Don't be scared, just be aware.

Seconding the crazymeds recommendation.

If you have been taking it for 8-10 weeks and have not improved, talk to your doctor about switching to a different anti-depressant. Sometimes it takes a while to find one that works for you.

I hope everything works out well!
posted by gembackwards at 7:43 AM on January 28, 2010

I've been on sertraline for close to a year now and here's what I've learned:
1. Alcohol makes me drunker. I still have a drink now and then, but I am pretty careful about it.
2. I feel like my blood sugar swings around more. If I eat a very small lunch and then don't eat dinner until 8 p.m. (as happens sometimes due to busy schedule) I feel ravenous, shaky, weak, tired, and sad. Maybe that's just me. I combat this side effect by trying to eat a good amount of protein at each meal, and when I start to feel a little tired and shaky, I will have a small snack. I've gained a little weight but I'm OK with that right now.
3. Talk to your doctor as needed. My experience was I started at a low dose, went back after a few weeks and told the doctor I was feeling great, then realized after a couple months I wasn't so great. Went back to the doc, increased the dose, went through the whole cycle again. Now I'm at 150 mg/day and I feel like it's finally where it needs to be.
4. Possibly TMI, sorry - when I first started taking it I had horrible diarrhea. Like, serious omg run to the bathroom once an hour type diarrhea. I still go through a few hours of that when I forget to take a dose. YMMV, I just want to tell you about it so if it happens to you, you won't panic and stop taking the meds. It goes away pretty fast. You can talk to your doctor or pharmacist, there are probably ways to minimize this kind of reaction.

Be proud of yourself for getting the help you need! I had a lot of weird feelings about admitting I was depressed and starting medication, but I am so, so glad I did. In general, I feel a lot calmer and less anxious now. I feel like the roller coaster ride of my emotions has slowed down, smoothed out, and I have some breathing space now to learn how to take care of myself and to deal with my problems like a healthy productive adult. I feel like myself now, instead of the crazy irrational person who just wants to cry all the time. I suppose I won't stay on zoloft forever, but I'm really really glad I'm on it right now. I hope it works out for you as well.
posted by beandip at 7:43 AM on January 28, 2010

Datapoint: When I told my friend I'd tried Zoloft, he said, "Ah, Zoloft. Half the people I know who took it said it saved their life, the other half said 'it tried to kill me.'" I fell into the latter category. Most horrifying two weeks of my life, couldn't eat a thing and had major panic attacks and suicidal thoughts. And yet my mother's been taking it for years and it works wonderfully for her. Guess we're all wired differently.
posted by Melismata at 7:56 AM on January 28, 2010

Talk about SSRIs on-line always seems to focus on the negative...not that it's not important to be aware of the side effects. And these things don't work for everybody. But the overall tenor of these discussions tends to be that they're scary drugs that will give you indigestion at best and make you feel suicidal at worst.

There are risks...but there are also great benefits. For the record, I'm on Cipralex (Lexapro), though Zoloft was my other option when talking to my psych. Apparently Zoloft makes you feel more fatigued, so, well, I suppose that's something to look out for.

In terms of benefits, get a firm timeline from your doctor about when you should start feeling better. These are of course variable, but I've found that seeking the answer to the question "when will this kick in?" on-line is a bad idea. So ask your doctor, and make sure to remember what he/she tells you.

As the weeks progress, you should start getting "good days", or even good hours, meaning the drug will kick in for a short period of time. Don't be upset if you start to feel bad again after a rush of relative happiness...it happens.

Eventually you should start feeling the effects more permanently. I have to admit that there was a period when I just felt strange, for lack of a better word. The drug was changing my brain chemistry...for the better, but it felt strange.

Finally, after the prescribed number of weeks, go back to your doctor and describe exactly how you feel. Also, feel free to ask for an increase in dosage if need be (I did this about four weeks into my treatment). And if you don't feel better, and you didn't feel any serious side effects, feel free to try another SSRI...they do react in different ways, and you might find one that works.

Previewing this post I sound like I'm a shill for big pharma...really, I just wanted to highlight some of the benefits these drugs have. People do take them for a reason, and it's not because big brother pharma and its gov't friends wants to turn us all into mindless, TV-consuming robots.
posted by hiteleven at 8:11 AM on January 28, 2010

Data point: I've been on Zoloft, both brand name and generic (sertraline) for nigh unto 13 years. It suppresses my libido mildly. I successfully lost 30 pounds while on it, although it took a great deal of effort, as losing 30 pounds will tend to do. I take it for depression and generalized anxiety disorder with OCD features, and it helps the disease get out of my way so I can do my stuff.

I'd try therapy first, if you haven't, but for severe issues, it can be a godsend.
posted by chesty_a_arthur at 8:40 AM on January 28, 2010

Seconding Bunnycup's advice. The Crazymeds site, while it can worry you with its list of potential effects, is chock full of information and also boards filled with people asking similar questions. A lot of them have taken many many different meds, and have experience with them. Note however, that just because a drug did X for Y people, doesn't mean it will do exactly the same for you.

I do know that it has helped many many people, and, it has been around for a while so there's lots of opinions out there. You won't really know how it affects you personally until you try.

From my personal experience I would say, while it was mostly great for me, I do not believe the stuff will truly 'hurt' you unless it turned out you were plainly allergic to the medicine. Now, can it make you also potentially feel weird, crappy, strange, good, bad, disaffected, more moody, less moody, have digestive disturbances, fix! digestive disturbances, or any/all of those things at some point or in combination to varying degrees? Yes. And that can suck, but it's not like your spleen will spontaneously combust from taking a trial of this particular medication. Obviously if you take it for a few days and just feel absolutely hideous, tell your doc and they'll probably have you not take that particular medication any more.

As other mefi threads/posters have stated before, there may be lots of other stuff you can try if you don't want to start using anti-depressants at this point, although you did not ask about alternatives. You may or may not have already tried all those other things (variety of exercise types, yoga, biofeedback, alpha-stim, therapy, a combination of those, etc).

The only real warning I have is - assuming that even if you take your medication and it works wonderfully, and you have zero side effects, be aware that it can potentially stop working at any time. Nobody's really sure why that is, there are theories. But going completely cold turkey off of SSRI's for some people, like it was for me, can be really nasty. This doesn't mean you may have to take em forever, just that you should be aware that if you feel like that starts happening, inform your doctor asap so they can help you with that.
posted by bitterkitten at 8:46 AM on January 28, 2010

I'm taking 40mg/day of Fluoxetine (Prozac) to combat Obsessive-Compulsive Disorder, and there's a few things I've found:-

1. At first, it made me feel worse. OCD is an anxiety disorder so it kind of amplified the effects of it, but by the end of the second week things had calmed down a bit.

2. Again, for the first few weeks it made me sweat ridiculous amounts. I'm not exactly thin, so I can get a bit sweaty from time-to-time, but it did take the piss a little bit.

3. The ballpark figure of around 6 weeks for them to properly kick in is about right. You probably won't notice it at first, but in my case I noticed that I wasn't worrying about things as much as I was before - it can be quite subtle.

4. Remember that the drugs are to level you out. Rather than going up and down *does wavy sine-wave thingy with hands* they're intended to level you out somewhere and stop you from sinking mentally into a pit. The flipside of this is that I often find it difficult to get excited about pretty much anything.

5. Some people call anti-depressants 'happy pills', which is a bit of an exaggeration, at least in my experience. Rather than turn me from an anxiety-wracked hermit into a raving maniacal loon, I've found that it's more of a not-giving-a-shit than oh-my-god-isn't-everything-wonderful. Which is kind of related to...

6. Concentration. I've never really had a problem with concentrating on the job at hand, but it's now 6 months since I started on the tablets and it's almost like I've had to learn to concentrate all over again. Some days my 5-year old son has a longer attention span than me, which at times is rather amusing. In turn, this leads to...

7. Motivation, or lack of. It could be related to the underlying depression, or it could be a side effect of the drugs, but that not-giving-a-shit attitude and finding it difficult to concentrate comes together to make it really difficult to do something that I don't really have any interest in (some things at work, tidying the garden, running errands, etc.).

8. It's made me have bizarre dreams. Not scary nightmares, but just... well, odd. I've always had somewhat odd dreams, and it seems to have had an effect on that.

You're probably reading these replies and getting disheartened at the plethora of side effects, but don't. Keep an eye on things - especially your mood, as obvious as it may seem. If you feel markedly worse (or even suicidal), make sure you get straight to your doc's. I think I've been lucky in that Fluoxetine is the first SSRI I've been given, and it's worked (so far) for me, but for a lot of people it can be a case of trying different ones until you find one that works for you.

Good luck!
posted by robzster1977 at 8:54 AM on January 28, 2010

No grapefruit. There's *something* about grapefruit that reverse the effect of zoloft and generics. My prescriber at the time either didn't know or didn't mention this to me and I only found out from a sticker that the pharmacy stuck on my third refill. Had I known in advance, I might have altered my gallon-a-week grapefruit juice habit.

Other citrus is fine. Pharmacology is weird.
posted by stet at 9:06 AM on January 28, 2010 [1 favorite]

If you're a man, nthing sexual climax and libido issues. Also, try not to drink too much. Excessive drinking (beyond a drink or two) won't cause anything catastrophic to happen, but you'll lose the effect of the drug for the next day or two. Of course, your milage may vary on these issues.

If it doesn't work, your doctor will want to switch you to another SSRI. Don't lose hope. Your doctor is not a quack. For some odd reason, one SSRI will probably work where others haven't. Expect to play around with dosages and different brands for a while. Or, if SSRIs don't work, you might try Welbutrin.

Also, if you have a good plan for prescriptions, consider Abilify if Zoloft or another SSRI helps, but not quite enough. I know I sound like Pepsi Blue, since it's got a huge ad campaign right now, but it really has worked out well for me.

For the record, Zoloft was bad for me, but Effexor XR has been good for me as of late. But everyone's different.
posted by mccarty.tim at 9:27 AM on January 28, 2010

I'm on Zoloft for anxiety, and have been for... 3 years or so? It took a while to get the dosage right for me, but once that was worked out, I've been fine. No side effects anymore at all, at least that I've noticed. The only negative experiences I had were that, whenever my doctor would increase my dosage, I would have horrible, gory, terrifying nightmares for a night or two. Thankfully, that stopped.
posted by sarcasticah at 9:41 AM on January 28, 2010

Everyone else has great advice.

I just wanted to add: Don't be worried that you're untreatable if this medication doesn't work for you after you've given it a fair trial, which should actually last 12 weeks at a therapeutic dose according to STAR*D. ("While some people may experience benefits in the first six weeks of a treatment strategy, full benefits may not be realized until 10 or 12 weeks have passed. During this time, doctors should work with their patients to adjust dosages so as to find an optimal level, and avoid stopping a treatment prematurely.")

SSRIs don't work for everybody (they didn't work for me) but there are many other medication options out there if they don't work for you.

Good luck, may your side effects be few and the positive experience large.
posted by saveyoursanity at 11:39 AM on January 28, 2010

I was on Zoloft a few years ago and I'm on a different SSRI now. I didn't have any weight gain or negative side effects on either. I did have some side effects when first starting the SSRIs - I had terrible dry mouth for two weeks, and trouble sleeping - but all side effects wore off within a couple weeks, once I had adjusted.

I fall into the "SSRIs are a lifesaver" camp. However, although SSRIs alone help my mood, they don't help enough, so I'm on some other prescriptions to augment my SSRI. It took a whole lot of experimentation, but my mood is the most stable/best it's been in years.
posted by insectosaurus at 12:35 PM on January 28, 2010

I've been on Zoloft, at varying dosages, a lot. Minimal side effects. Mild sexual side effects. A lot less depression.
posted by theora55 at 4:59 PM on January 28, 2010

Zoloft worked great on my depression. My sleep patterns evened out and my daily functioning improved. I kept going off it though, because shortly after I stabilized and the worst of the depression symptoms went away, I'd notice I felt off. Between that and the dead libido and gastric distress, I'd start "forgetting" the stuff. I made myself incredibly sick a few times by mixing withdrawal side effects with onset side effects. Seriously, you'll probably want to both start and stop gradually to control that.

I eventually wound up on Wellbutrin, which doesn't work as well, but also doesn't annoy me into "forgetting" to take it.
posted by Karmakaze at 11:52 AM on January 29, 2010

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