Depression medication: ZOLOFT

[Galaril]

First some information. My wife has been having a tough time the past few months adjusting to our recent move to the US. She is originally from South Korea and even though she went to University in Canada for 4-5 years she has been feeling depressed and isolated. Anyways, she is going into see our family doctor and see about getting something to help her get over this tough stretch until she is alittle better adjusted. My question is does anyone have any experince or know anyone who has been on Zoloft and any side effects? I have heard good things about this mdeication for treating depression which I guess is very, very common in the adult population alot more than I realized.

[Klinglerware]

Perhaps it might also be helpful if your wife can find a counselor who specializes in culture shock/transition, or has a background in Asian/Asian-American cultural issues...

[albionmoonlight]

EagleFan27 is the resident psychatrist here, FYI. I can only give a layman's opinion based on things that I have learned with friends and family on anti-depressants.

First, there are several medicines out there all with different effects and side effects. Make sure that your doctor explores all of them with you. Second, make sure that you also use therapy with the medicine. The pills are supposed to be part of an intergrated approach to care--not an end unto themselves.

[oliegirl]

Galaril, you have a PM from me....

[Bee]

My wife has seasonal depression during the winter. It took a long time to be diagnosed, but after that her doctor started her on a mild anti-depressent. It took a little time to kick in, but it makes a huge difference. She hasn't had any side effects. One thing I'll say is it's very important if she ends up taking anti-depressents for you to read the list of side effects. You need to be able to recognize if things aren't going right because she may not. Hope things improve for you both.

[dixieflatline]

I have had several friends who started taking zoloft and the results ranged from helpful to lifesaver. Minimal side effects in each case. Having never actually taken this drug from what I have witnessed I think it is pretty fantastic. Also, many health plans are covering at least part of the cost. Also, a generic form is going to be available this summer in case your health plan doesn't cover it.

[Telle]

I don't know much about Zoloft, but I was on Paxil previously. Paxil is physically addictive, and causes withdrawel symptoms when you go off of it.. you should check out whether Zoloft has that kind of problem too, as I believe it's in the same family of anti-depressents.

[JonInMiddleGA]

Zoloft is one of the SSRI medications (Selective Serotonin Reuptake Inhibitors), same family of meds as Paxil, Celexa, Prozac, Desyrel, and Lexapro.

In real simple terms, they work on neurotransmitters in the brain. "Depression has been linked to a lack of stimulation of the recipient neuron at a synapse. To stimulate the recipient cell, SSRIs inhibit the reuptake of serotonin. As a result, the serotonin stays in the synaptic gap longer than it normally would, and has the chance to be recognized again (and again) by the receptors of the recipient cell, which can finally be stimulated fully."

SSRI's tend to take several weeks before really kicking in, and should be tapered off rather than stopped cold when discontinuing use.

Common side effects include:
nausea,drowsiness,headache,changes in weight and appetite,diminished libido,

[Eaglesfan27]

Zoloft is an SSRI (Selective Serotonin Reuptake Inhibitor.) It is an an effective treatment for depression that helps 60-70% of people who take it (as do all antidepressants including Paxil.) However, as others have mentioned, it is even more effective in combination with quality therapy (the efficacy rate goes up to the 90% range.)

All medications can have some side effects, and Zoloft is no exception. Some what common (as in 3-5% of people taking it) side effects include upset stomach, headaches, diahhrea, constipation, insomnia, and sexual dysfunction. The sexual dysfunction in women is primarily anorgasmia (lack of orgasms which is less common) and delayed orgasm. There are other more obscure side effects such as inducing mania (which is very rare), but these are the most common ones (but again they only occur in a small percentage of the people taking the medication.) Zoloft is one of the most prescribed medications in the USA and it has helped millions of people.

Paxil has a shorter half life and therefore does produce a "discontinuation" syndrome in which people feel ill (generally like they have the flu) as they come off it. However, if it is carefully titrated down, this generally doesn't happen with Paxil. If someone stops it abruptly, then this almost always happen. Zoloft has a longer half life and therefore people are less likely to experience a discontinuation syndrome, however, if someone was on a high dose, and abruptly stopped it, this could occur. Zoloft as well as all antidepressants should be tapered off.

Finally, you and your wife should be aware that Zoloft has to change the concentration of Serotonin Receptors in the brain for it's effects to work. This generally takes 6-8 weeks to occur. It is impossible to say if the medication is fully working or not working until 6 to 8 weeks have passed at a therapeutic dosage which is usually around 100mg (can be as low as 50mg for some or as high as 200mg for others.) Generally, some positive effects should be noted by 4 weeks at a therapeutic dosage. However, most competent psychiatrists will start a patient on 25 or 50 mg and work up over a week or two to 100mg to minimize the side effects.

My usual standard disclaimer applies: I'm just offering friendly advice and not any medical advice. However, if you have any friendly questions that you would prefer to PM me, feel free. Of course, you and/or your wife should ask your doctor if you have any medical questions.

[Eaglesfan27]

Zoloft is one of the SSRI medications (Selective Serotonin Reuptake Inhibitors), same family of meds as Paxil, Celexa, Prozac, Desyrel, and Lexapro.

In real simple terms, they work on neurotransmitters in the brain. "Depression has been linked to a lack of stimulation of the recipient neuron at a synapse. To stimulate the recipient cell, SSRIs inhibit the reuptake of serotonin. As a result, the serotonin stays in the synaptic gap longer than it normally would, and has the chance to be recognized again (and again) by the receptors of the recipient cell, which can finally be stimulated fully."

SSRI's tend to take several weeks before really kicking in, and should be tapered off rather than stopped cold when discontinuing use.

Common side effects include:
nausea,drowsiness,headache,changes in weight and appetite,diminished libido,

Desyrel (Trazodone) is not an SSRI. It is an unique antidepressant that is in its own class. It is not particularly effective as an antidepressant because it causes EXTREME sedation that prevents most people from being able to tolerate the doses that effectively treat depression. However, it is a very effective non-addictive sleep medication. But, it causes Priapism (the 4 hour erection) and therefore, I only use it in women generally. The rest of the info in this post is correct.

[Klinglerware]

But, it causes Priapism (the 4 hour erection) and therefore, I only use it in women generally.

Now, in what circumstances would something like that ever be prescribed to a male?

[CamEdwards]

it causes Priapism (the 4 hour erection)

I suppose that's not accompanied by a two hour orgasm, is it?

[Eaglesfan27]

I suppose that's not accompanied by a two hour orgasm, is it?

Unfortunately not, but it is generally accompanied with a long needle being stuck into the penis by a nurse who may or may not be attractive.

[Klinglerware]

Unfortunately not, but it is generally accompanied with a long needle being stuck into the penis by a nurse who may or may not be attractive.

Where do I sign up?

[Eaglesfan27]

Now, in what circumstances would something like that ever be prescribed to a male?

I *might* prescribe it to a prepubscent male. I would never prescribe it to any other male. Some psychaitrists will inform males of the risk and let them take that chance if they wish. It is only about a 1 in 1,000 chance. Personally, I wouldn't want to take that chance.

[Klinglerware]

I *might* prescribe it to a prepubscent male. I would never prescribe it to any other male. Some psychaitrists will inform males of the risk and let them take that chance if they wish. It is only about a 1 in 1,000 chance. Personally, I wouldn't want to take that chance.

Thanks for the info--I wondered why this would be any better than the other anti-depressants on the market, but then I noticed your note about it being a better sleep disorder medication...

[path12]

When I was on anti-depressants Zoloft was the first one I tried. Worked well on the depression, but totally killed my libido -- it was like pre-puberty. Really weird. Ended up with Serzone after a couple other trials and was on that for a few years. Was really glad to get off them and don't know that I'd want to go back if the depression returned, but I think that's more a factor of not trusting the pharmacutical companies and wanting to stay chemical free than any real problems from the medication.

[JonInMiddleGA]

Desyrel (Trazodone) is not an SSRI. It is an unique antidepressant that is in its own class. It is not particularly effective as an antidepressant because it causes EXTREME sedation that prevents most people to not be able to tolerate the doses that effectively treat depression. However, it is a very effective non-addictive sleep medication. But, it causes Priapism (the 4 hour erection) and therefore, I only use it in women generally. The rest of the info in this post is correct.

Dammit, I knew that, was reminded of it when I was Googling up the laundry list of SSRI's ... and then forgot to remove it from my original list.

I can, however, offer an "Amen" to the "EXTREME sedation" that goes with Desyrel. I was pretty much a zombie while taking it. I can also, happily, report that I was not the 1/1000 who suffered the other side effect ;)

Although this is a serious subject, those who are somewhat familiar with Desyrel might get a chuckle out of this page
http://www.crazymeds.org/desyrel.html

edit to add: My favorite snippet from the link above " Desyrel is the official antidepressant of Sleepy-bye Land. ... If you respond well to SSRIs and you're not sleeping, trazodone is a good addition to your cocktail to make sure you sleep. And sleep. And sleep. If you're going for the combination of antipsychotic and antidepressant, don't mix Desyrel with Seroquel if you want to wake up any time this week."

[Desnudo]

I don't know how mobile you are, but she might find it much easier living on the West Coast. Even a short vacation to San Francisco or Vancouver might help.

[bbor]

I use Zoloft for Panic/Anxiety attacks.....I have been taking them for about 7 years or so....i have suffered no side effect and it has totally stopped my attacks.Before i started taking Zoloft i was basically housebound for 3-6 months.It really turned my life around.I take a relativly low dosage(25mg) so i don't know how a higher dosage would effect me.I do understand though that if you were to ever stop taking the medication and then decide you need it again a few months down the road that the effect of the drug would not be as effective as the first time you took them.

[Galaril]

Perhaps it might also be helpful if your wife can find a counselor who specializes in culture shock/transition, or has a background in Asian/Asian-American cultural issues...


I had thought about this but unfortunately where we live 40 miles outside of (Boston) there aren't anyone with thi specialization. In LA there are tons of them but not here.

[Galaril]

I don't know how mobile you are, but she might find it much easier living on the West Coast. Even a short vacation to San Francisco or Vancouver might help.

First off I would like to thank everyone for there help and advice.
Yeah we are here for the duration. That being said she we have a trip back to visit her family and friends back home next month.

[bbor]

BTW Zofloft is available in generic form but only if it is prescribed for depression(at least in Canada anyways) If it is prescribed for Anxiety/Panic the pharmasist must give you the brand name.

[Daimyo]

First some information. My wife has been having a tough time the past few months adjusting to our recent move to the US. She is originally from South Korea and even though she went to University in Canada for 4-5 years she has been feeling depressed and isolated.
My wife moved here from China five years back and went through a similar phase... She came on a fiancee visa so she couldn't work for a while which didn't help much because it just made her more lonely while I was at work. The thing that helped her a lot was that she started taking a lot of classes at a local community college and made some friends. She's still homesick pretty often and flies back probably once a year or so to visit her family (her parents came to visit us for 6 weeks last year too).

[oliegirl]

it causes Priapism (the 4 hour erection)

I have GOT to get radii on that medication!!!! :p

[Eaglesfan27]

Thanks for the info--I wondered why this would be any better than the other anti-depressants on the market, but then I noticed your note about it being a better sleep disorder medication...

I worded that post poorly (due to rushing as I had a patient waiting.) All of the antidepressants have about the same efficacy for treating depression, except for MAOI Inhibitors which seem to work slightly better. However, MAOI Inhibitors have some potentially nasty side effects and require a rather restrictive diet which severely limits their use. The real difference between antidepressants is their side effect profile.

[Eaglesfan27]

I have GOT to get radii on that medication!!!! :p


Radii, don't fall for it! Remember, that needle isn't small ;)

[Galaril]

Eaglesfan or anyone who knows an answer to this. If my wife was advised to see a therapist or such as a pyschiatrist will medical insurance pick it up? We have Harvard Pilgrim PPO FOR health coverage provider. I belive I saw that it was covered if our primary referred her.

[oliegirl]

Eaglesfan or anyone who knows an answer to this. If my wife was advised to see a therapist or such as a pyschiatrist will medical insurance pick it up? We have Harvard Pilgrim PPO FOR health coverage provider. I belive I saw that it was covered if our primary referred her.

When I was on Zoloft, my ins. covered it without question, and I was not in therapy or seeing a psych. for it...that goes for any of the anti depressants I've tried, always been managed by my PCP and my ins. has never questioned it.

[Pumpy Tudors]

So I'm sitting here at work with this priapism and --

Never mind.

[Eaglesfan27]

Eaglesfan or anyone who knows an answer to this. If my wife was advised to see a therapist or such as a pyschiatrist will medical insurance pick it up? We have Harvard Pilgrim PPO FOR health coverage provider. I belive I saw that it was covered if our primary referred her.

Most "good" insurance companies will cover a therapist or a psychiatrist as well the medication. However, even "good" insurance companies generally place a rather low limit on the number of visits in a year one of their customers can go to a therapist or psychiatrist. That is usually counterproductive to optimal treatment. That is why Fonzie and myself occasionally mention the need for Mental Health Parity Laws to be enacted by our government...

I don't know the specifics of Harvard Pilgrim PPO as that is not an insurance company that I deal with down here in New Orleans.

[Klinglerware]

Eaglesfan or anyone who knows an answer to this. If my wife was advised to see a therapist or such as a pyschiatrist will medical insurance pick it up? We have Harvard Pilgrim PPO FOR health coverage provider. I belive I saw that it was covered if our primary referred her.

I would call your insurance provider to confirm the mental health benefits you are entitled to and the process for getting them. Yeah, it's a pain to navigate the phone tree but it's good to be sure what will be covered before you start treatment...

[bbor]

So I'm sitting here at work with this priapism and --

Never mind.

Pumpy Pix are NOT needed here.

K.Thx.

[Pumpy Tudors]

Only three hours to go...

[Greyroofoo]

I find alcohol to be a good cure for the blues. And I've recently found out that exercising while depressed is helpful too.

[amdaily]

I find alcohol to be a good cure for the blues. And I've recently found out that exercising while depressed is helpful too.

Seconded, on both counts ;)

[Izulde]

Zoloft put me in an apathetic zombie state when I was on it, but then, I also have bipolar disorder, which is a different kettle of fish from what your wife has.

One of my housemates is on Zoloft currently and it's helped him out immensely, so the general rule of thumb with anti-depressants applies: YMMV.

[Sporkimata]

Im on Zoloft too and find it acceptable. Like the last poster I too am bi-polar with anxiety-panic disorders. So I take a whole cocktail of drugs. I was on paxil before but found that it worsened a lot of my symptoms. The problem with pschotheraputic drugs is that in all honesty there an inexact science. They have to put you one, see how it goes, doesnt work go to drug number 2.

[Godzilla Blitz]

My wife moved here from China five years back and went through a similar phase...The thing that helped her a lot was that she started taking a lot of classes at a local community college and made some friends.

I'd agree with this. I've lived in a few foreign countries, and I do think one of the keys to getting over the hump quickly is to get active as quickly as possible. Do lots of new things. Of course, that's easy to do when you feel fine; tougher to do when you're depressed. The way I've thought of it is to "hit the ground with my feet running", and it's made a lot of transitions to new places easier for me.

It might help if she can get in touch with the Korean community in the area. The area up by Porter square has a strong Asian influence, although I'm not sure to what degree it's Korean.

The other thing to note is that a lot of cultural adjustment simply takes time. Outside of college--where like ages and abilities are all clumped together to facilitate making friends quickly--it can take a year or more of quality effort to build up a network of solid friends and good activities.

Lastly, from personal experience, I would think that this type of depression is incredibly common. I interact with some Asian exchange students to the US on occasion, and the stories of how lonely and difficult the first six months are incredibly common.

[Galaril]

Well, just to give a update. My wife and I went to see outr family doctor and she diagnosed my wife with clinically depression. She prescribed 50mg of Zoloft and my wife will also go to see a mental health counselor help her with the adjusting to our new move. And as far as logistics go my wallet is happy since our HMO has coverage for 26 visits to a therapist/counselor per calendar year minus a $20 copay:) My already wife feels alittle better now knowing hwat is going on. And though I know there will be ups and downs we are confident of getting through this. I also, agree with those of you who recommend my wife keep busy. She is a black belt in a korean form of karate martial art which she studied in Korea and she was continuing her training here in America until an hamstring injury a month ago sidelined her. That in fact seems along with the move to a new country alot of the reason for the depression rearing it's head. One intersting thing our doctor told us which I didn't know is that clinically depression is something we are basically born with and have the condition our whole life but our bodies have certain resources (chemicals?) that keep it under control. The depression only surfaces in a time of great stress such as a death in the family, new baby or big move and those resources are overtaxed bring about brain chemistry changes. That through what gthe doctor said and I have pieced together is the layman's version of clinically depression. Eaglefan feel free clarify it further. Anyways I want to give sincere thank to all my FOFC brothers and sisters here who have taken the time to give advice to us it is most appreciated.

-Dan

[Eaglesfan27]

There are several theories about depression, and it sounds like your family doctor was giving a simplified version of the endogenous theory. In any case, I'm glad your wife is getting treatment, and you are fortunate to have very good insurance (covering 26 visits/year equates with high quality insurance generally.) Also, 50 mg is generally the dosage I start someone on to minimize side effects, although many adults need to go up to 100 mg over the course of a month unless they are very petite. If you have any questions, feel free to ask. I hope your wife starts to feel better soon.

[Galaril]

Thanks Eagle.