Zoloft is a brand or trade name of the drug Sertraline hydrochloride. It was first discovered and synthesized by a multinational company named as Pfizer. It falls in the category of antidepressant drugs. Based on the mechanism of action, it can be classified as Selective Serotonin Reuptake inhibitor. Like tricyclic antidepressants which inhibit the reuptake of norepinephrine in the synaptic terminals, Zoloft (sertraline) inhibits the reuptake of serotonin in the synaptic terminals. Decreased serotonin is believed to play a vital role in the causation of depressive disorders. So, increased serotonin in the synaptic cleft helps in the management of depression. Zoloft is more effective and safe as compared to its other counterparts in the same group as well as other antidepressants like monoamine oxidase inhibitors and tricyclic antidepressants because it has a selective effect on serotonin repute while sparing the other neurotransmitters.
What is Zoloft used for?
Zoloft is used for the following conditions:
- Depression – Zoloft has shown very promising results in the treatment of severe depression as compared to tricyclic antidepressants like Imipramine. Moreover, when compared with cognitive behavioral therapy for the management of severe depression, Zoloft alone has far better results in its management. 50 mg once daily is the initial dose which can be increased to 200 mg once daily depending on the situation.
- Dysthymia – it is a milder but chronic type of depression and Zoloft is very effective in this condition
- Depression with obsessive compulsive disorder (OCD) – Zoloft shows far better results in patients with OCD as compared to tricyclic antidepressants
- Panic disorder – in depressed patients having panic attacks Zoloft decreases the frequency of panic attacks markedly
- Depression in elderly – Zoloft is a hallmark in the management of depression in the patients more than 60 years of age. Moreover, it is well tolerated in this age group
- Other common uses of Zoloft are obsessive compulsive disorder in both children and adults, social anxiety disorders, post traumatic stress disorder, panic disorders and premenstrual dysphoric disorder
Zoloft is not only used for depressive disorders and associated conditions but it is also used for certain eating disorders like anorexia nervosa and bulimia nervosa. Moreover, studies have revealed the fact that it is equally good for the management of generalized anxiety disorders as compared to any other anxiolytic drug in the market.
Common side effects of Zoloft
Common adverse effects of Zoloft when compared with the placebo are;
- Insomnia, however in some cases there is increased somnolence
- Failure of ejaculation
- Impaired or decreased libido
- Decreased threshold of tremors
- Increased suicidal tendency
- Discontinuation syndrome – it results due to sudden withdrawal of drug. Common manifestations of this syndrome are nervousness, headache, agitated mood, increased irritability, worse dreams and unusual anger. Orthostatic hypotension is another common manifestation of this syndrome
- Akathasia – it is a rare side effect of Zoloft and is characterized by irritability, restlessness and uncoordinated movements soon after the initiation of treatment
- Microscopic enterocolitis may also occur with the use of this drug, although it is rare
- Weight loss has also been noticed in the individuals taking this medicine for long term
- Impaired liver function tests (LFTs)have been reported with the use of this drug
Zoloft side effects on children
Studies have shown that Zoloft increases the tendency of suicide in children. The increase in suicidal ideation in children and adolescents is almost two fold.
Zoloft side effects on men
In men the most prominent side effect of Zoloft is decreased libido. During the use of this drug there is decreased sensation in the genitals which results in decreases sexual arousal. Moreover, it becomes difficult to achieve orgasm while on this drug. Ejaculation failure is another adverse effect of Zoloft in men and it is closely related to decreased libido in men. Few cases of priapism have also been reported with the use of Zoloft.
Zoloft side effects on women
Similarly in women, the prime side effect is decreased sexual urge or decreased libido. Moreover, disorder of sexual arousal commonly associated with insufficient lubrication during the sexual act is also seen during the use of this drug.
Zoloft side effects on pregnant women
Zoloft (Sertraline) is metabolized into desmethylsertraline in which form it circulates in the blood. If a pregnant woman is exposed to this drug in the first trimester then almost one third of this metabolite is transported to the fetal blood where it can result in certain birth defects like;
- Omphalocele – abdominal wall defect characterized by extrusion of abdominal contents like stomach, liver and intestines
- Defects of septal formation
- Anal atresia – inability of anal canal to open or canalize
- Limb deformities
The drug is safe to be used in the breast feeding mothers because this drug is not secreted in the milk.
Zoloft side effects on elderly
In elderly, overall deterioration of the bodily systems occurs. It results in decreased clearance of the drugs from the body. Zoloft is primarily cleared by the liver metabolism in the human body and thus its clearance is decreased in the elderly. So, dose of the drug must be adjusted accordingly in order to avoid excessive adverse effects while attaining the primary effects. In elderly if the dose is not adjusted accordingly it may result in over dosage characterized by increased heart rate, vomiting, unusual fatigue and seizures. In elderly patients, Zoloft may cause decreased serum concentration of sodium (hyponatremia), which a serious metabolic disorder.
Other side effects
In addition to the above mentioned adverse effects, there are few adverse effects of Zoloft which are associated with concomitant use of other drugs. In order to avoid these effects, Zoloft use is absolutely contraindicated with monoamine oxidase inhibitors (MAOIs), disulfiram and few antipsychotic drugs. The use of Zoloft with monoamine oxidase inhibitors (MAOIs) may result in Serotonin syndrome. It can be a life threatening condition characterized by increased heart rate (tachycardia), hyperthermia, tremors, excessive sweating, shivering and metabolic disorders.