![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by PaulB on November 4, 2001, at 16:49:26
Why is Zoloft No1:
I was wanting to post this message because not only is Sertraline(Zoloft) the most commonly used antidepressant- http:www.rxlist.com -literature indicates that it is a very effective "antidepressant", specific parameters because Sertaline, I have read, can help very much with all conditions that are now commonly associated with a deficit of serotonin in the brain and has also been licensed for Post Trauamatic Stess Disorder. I have my beliefs as to the reasons why this may be but would like to know other people's opinions and also if people who have taken Sertraline can compare it with other SSRIs and have had better results with Sertraline. You see I only have noticed subtle differences in the effects of Paroxetine, Fluvoxamine and Sertraline.
I think there is some speculation that people who have been intitally prescribed Fluoxetine or Paroxetine may respond better to Sertraline because there is much less likelihood of liver or CNS tolerance due to increased enzyme activity that metabolises the SSRIs; the Cytochrome P450 collection of enzymes because Sertraline is taken at higher dosages[50mg-200mg].
I have a friend who was switched from Fluoxetine to Sertraline and found the latter ot be more effective.
Furthermore Sertraline has a reputation for what is described in a medication book I have as being 'middle of the road side-effects' and therefore is usually well-tolerated, yet it is only somwhat less potent than the most potent SSRI Paroxetine I believe in the line-up of SSRI's that are currently available. Intersting?
As to its recent licence to PTSD, is that worth considering as to why Zoloft is no1.
Posted by JahL on November 4, 2001, at 18:40:06
In reply to Why Is Zoloft No1, posted by PaulB on November 4, 2001, at 16:49:26
> I have my beliefs as to the reasons why this may be but would like to know other people's opinions and also if people who have taken Sertraline can compare it with other SSRIs and have had better results with Sertraline. You see I only have noticed subtle differences in the effects of Paroxetine, Fluvoxamine and Sertraline.
Setraline was the only SSRI (including Prozac, Paroxetine & Citalopram) that didn't briefly switch me to euthymia or hypomania. Also crashed my car on it :-(
I saw the director of the Maudsley DP unit the other day & Sertraline is her favoured SSRI. She didn't give any specific reasons as to why this is (tho' I'll ask next time) other than to say that it possesses a favourable side-effect profile.
My bro' has just been prescibed Sertraline as a first AD whereas 5 yrs ago I was given Paroxetine; Sertraline was 3rd & then only when I specifically asked for it. Obviously word is spreading...
J.
Posted by LyndaK on November 5, 2001, at 2:45:19
In reply to Why Is Zoloft No1, posted by PaulB on November 4, 2001, at 16:49:26
I can tell you that Zoloft is No1 for me. Unfortunately one of the more problematic side effects is memory recall problems. I've tried almost all the other SSRI's, but Zoloft really is the most effective for me. Donepezil seemed to help some with the cognitive problems.
> Why is Zoloft No1:
>
> I was wanting to post this message because not only is Sertraline(Zoloft) the most commonly used antidepressant- http:www.rxlist.com -literature indicates that it is a very effective "antidepressant", specific parameters because Sertaline, I have read, can help very much with all conditions that are now commonly associated with a deficit of serotonin in the brain and has also been licensed for Post Trauamatic Stess Disorder. I have my beliefs as to the reasons why this may be but would like to know other people's opinions and also if people who have taken Sertraline can compare it with other SSRIs and have had better results with Sertraline. You see I only have noticed subtle differences in the effects of Paroxetine, Fluvoxamine and Sertraline.
>
> I think there is some speculation that people who have been intitally prescribed Fluoxetine or Paroxetine may respond better to Sertraline because there is much less likelihood of liver or CNS tolerance due to increased enzyme activity that metabolises the SSRIs; the Cytochrome P450 collection of enzymes because Sertraline is taken at higher dosages[50mg-200mg].
>
> I have a friend who was switched from Fluoxetine to Sertraline and found the latter ot be more effective.
>
> Furthermore Sertraline has a reputation for what is described in a medication book I have as being 'middle of the road side-effects' and therefore is usually well-tolerated, yet it is only somwhat less potent than the most potent SSRI Paroxetine I believe in the line-up of SSRI's that are currently available. Intersting?
>
> As to its recent licence to PTSD, is that worth considering as to why Zoloft is no1.
>
>
Posted by Mitch on November 5, 2001, at 13:04:51
In reply to Why Is Zoloft No1, posted by PaulB on November 4, 2001, at 16:49:26
> Why is Zoloft No1:
>
> I was wanting to post this message because not only is Sertraline(Zoloft) the most commonly used antidepressant- http:www.rxlist.com -literature indicates that it is a very effective "antidepressant", specific parameters because Sertaline, I have read, can help very much with all conditions that are now commonly associated with a deficit of serotonin in the brain and has also been licensed for Post Trauamatic Stess Disorder. I have my beliefs as to the reasons why this may be but would like to know other people's opinions and also if people who have taken Sertraline can compare it with other SSRIs and have had better results with Sertraline. You see I only have noticed subtle differences in the effects of Paroxetine, Fluvoxamine and Sertraline.
>
> I think there is some speculation that people who have been intitally prescribed Fluoxetine or Paroxetine may respond better to Sertraline because there is much less likelihood of liver or CNS tolerance due to increased enzyme activity that metabolises the SSRIs; the Cytochrome P450 collection of enzymes because Sertraline is taken at higher dosages[50mg-200mg].
>
> I have a friend who was switched from Fluoxetine to Sertraline and found the latter ot be more effective.
>
> Furthermore Sertraline has a reputation for what is described in a medication book I have as being 'middle of the road side-effects' and therefore is usually well-tolerated, yet it is only somwhat less potent than the most potent SSRI Paroxetine I believe in the line-up of SSRI's that are currently available. Intersting?
>
> As to its recent licence to PTSD, is that worth considering as to why Zoloft is no1.
>
>It and Prozac were the only two SSri's to get me up and moving. The others made me an apathetic couch potato. I am taking sertraline now. Now, if I could stop getting up so early in the morning and if it wasn't so harsh on my stomach...
Posted by Cressida on November 5, 2001, at 17:43:10
In reply to Why Is Zoloft No1, posted by PaulB on November 4, 2001, at 16:49:26
I was on 100-200mg of Zoloft for roughly three years for ADD and OCD. Although it helped, it took a while for it to work, and I experienced unusual side-effects a lot in the beginning of treatment. The two most disturbing were frequent episodes of depersonalization and derealization, both of which are reported adverse reactions in the Physician's Desk Reference for prescription drugs.
Posted by SLS on November 6, 2001, at 12:54:51
In reply to Re: Why Is Zoloft No1, posted by JahL on November 4, 2001, at 18:40:06
> > I have my beliefs as to the reasons why this may be but would like to know other people's opinions and also if people who have taken Sertraline can compare it with other SSRIs and have had better results with Sertraline. You see I only have noticed subtle differences in the effects of Paroxetine, Fluvoxamine and Sertraline.
>
> Setraline was the only SSRI (including Prozac, Paroxetine & Citalopram) that didn't briefly switch me to euthymia or hypomania. Also crashed my car on it :-(
>
> I saw the director of the Maudsley DP unit the other day & Sertraline is her favoured SSRI. She didn't give any specific reasons as to why this is (tho' I'll ask next time) other than to say that it possesses a favourable side-effect profile.
>
> My bro' has just been prescibed Sertraline as a first AD whereas 5 yrs ago I was given Paroxetine; Sertraline was 3rd & then only when I specifically asked for it. Obviously word is spreading...
>
> J.
Hi.Sertraline (Zoloft) became the treatment of choice for most psychiatrists at least 5 years ago. I think many are now turning to citalopram (Celexa).
I know one person who is doing considerably better now on Celexa than he did on Zoloft for many years prior.
Zoloft is the least "potent" (affinity to bind to the reuptake transporter) of the SSRIs currently available. I'm not sure how important this distinction is. It just determines the dosage needed to have the desired effect.
Zoloft: 100mg - 200mg
Prozac: 20mg - 60mg
Paxil: 20mg - 50mg
Celexa: 20mg - 40mg
Luvox: 100mg - 300mgOther things are brought into consideration when trying to explain the actions of a drug at a particular dosage or concentration. Selectivity might be more important than potency. Even here, selectivity is usually nothing more than a relative term, since it depends upon which other actions it is being compared to.
For what it's worth, Zoloft produces the most dopamine reuptake inhibition of the SSRIs, although its magnitude is considered by most as being irrelevant at therapeutic dosages. However, this always begs me to ask the question: "How does one determine the amount of anything that can be neglected?"
http://www.preskorn.com/columns/9909.html
- Scott
Posted by PaulB on November 6, 2001, at 13:00:35
In reply to Why Is Zoloft No1, posted by PaulB on November 4, 2001, at 16:49:26
As always it is nice to see people respond to your messages. I think I willl scroll on down and see what else has been posted since I was last here. I wouldnt add anything to what has been posted other than that I would probably lump Sertraline with Fluoxetine as being much less likely than Fluvoxamine or Paroxetine to cause sedation. Still, as Mitch mentioned those early mornings and bad stomach days sure make Sertraline less bearable.
If you like check out
http://www.zoloft.com.
Its good.
Posted by Mitch on November 6, 2001, at 13:48:41
In reply to Re: Why Is Zoloft No1, posted by SLS on November 6, 2001, at 12:54:51
> For what it's worth, Zoloft produces the most dopamine reuptake inhibition of the SSRIs, although its magnitude is considered by most as being irrelevant at therapeutic dosages. However, this always begs me to ask the question: "How does one determine the amount of anything that can be neglected?"
> - ScottHi Scott,
That is interesting about the dopamine reuptake inhibition. When I saw that on my pdoc's "receptor affinity profiles for SSRi's" it found that somewhat peculiar. It is interesting that I get the least amount of dystonia from Zoloft than any of the other SSRI's. There's another thing, too. The primary drug sertraline has a half-life of about 26 hrs. Well, it's primary metabolite desmethyl-sertraline has a half-life of 2-3 *days*. It's not supposed to be *active* but that makes me a little puzzled. It seems when I take a dose I get a little drowsy the first few hours (kind of like Celexa, i.e.), but then later in the day I seem to become very alert. When I am up the next day just before my dose I feel very attentive and alert. I wonder if desmethyl-sertraline has more of a dopaminergic or noradrenergic effect they aren't telling us about?
Mitch
Posted by Jane D on November 6, 2001, at 15:29:20
In reply to Re: Why Is Zoloft No1, posted by PaulB on November 6, 2001, at 13:00:35
Posted by Katey on November 7, 2001, at 20:05:23
In reply to Re: Why Is Zoloft No1 » SLS, posted by Mitch on November 6, 2001, at 13:48:41
in my book anyways. four years ago, when i got my first prescription, it was for zoloft. i bounced on and off it for a year, and it had little affect beyond making me detatched and numb. it made me eat though. then they put me on effexor XR which is satan incarnate of the pill form, and now Fluexatine (sp?)which doesnt seem to be doing much either. im beginning to wonder if the diagnosis isnt correct, although the symptoms reek of depression, it could be a combination? have an appt with the pdoc tomorrow, might bring it up.
Posted by Mitch on November 7, 2001, at 23:24:18
In reply to Re: Why Zoloft is NOT No1..., posted by Katey on November 7, 2001, at 20:05:23
> in my book anyways. four years ago, when i got my first prescription, it was for zoloft. i bounced on and off it for a year, and it had little affect beyond making me detatched and numb. it made me eat though. then they put me on effexor XR which is satan incarnate of the pill form, and now Fluexatine (sp?)which doesnt seem to be doing much either. im beginning to wonder if the diagnosis isnt correct, although the symptoms reek of depression, it could be a combination? have an appt with the pdoc tomorrow, might bring it up.
Hi Katey,
You sound like someone who doesn't respond too well to "serotonergic" meds. I really don't respond well to SSRi meds for *depression* either. I chiefly seem to depend on them for anxiety relief (at very low doses). But I do have seasonal major depressions (twice yearly) that only respond well to meds like Wellbutrin or Adderall. Ask your doc about a trial of Wellbutrin.
Mitch
Posted by Mair on November 8, 2001, at 21:21:43
In reply to Re: Why Zoloft is NOT No1... » Katey, posted by Mitch on November 7, 2001, at 23:24:18
Katey - I'd endorse what Mitch suggested. I've never reacted very positively to the ssri's including prozac, zoloft and luvox. I also found effexor to be intolerable. I've been on Wellbutrin now for some years. It has not proved to be a miracle drug either, but it has made a difference in the way none of the others did, and for me anyway, it's proved to be a very easy drug to tolerate.
Mair
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.