17 U.S. Code § 107 - Limitations on exclusive rights: Fair use
Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work, including such use by reproduction in copies or phonorecords or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright. In determining whether the use made of a work in any particular case is a fair use the factors to be considered shall include—
(1) the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes [all mirrored content falls under this clause, any ads present are mirrored from the original site, mirrored content earns me no revenue whatsoever];
(2) the nature of the copyrighted work [this is a unique resource for the mentally ill, and preservation of it can be argued to be incredibly important];
(3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and
(4) the effect of the use upon the potential market for or value of the copyrighted work. [absolutely none whatsoever, as the original work no longer exists anywhere else (outside of whatever bits and pieces archive.org managed to capture) - the original site was intermittantly completely unavailable for a extended period of time before its SSL certificate expired (and was never renewed), and eventually the site went offline for good, then finally the DNS records were removed at some point prior to May 2018, so at this point it is well beyond the 'dead and rotting' stage]
The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.

This domain is not controlled by Jerod Poore, and I will NOT continue redirecting traffic from this domain to crazymeds.us [as I formerly did] while Jerod continues with his immature temper tantrum over adblock or continues to fail to maintain his site, fucking over his entire community and countless visitors in the process. [belated clarification: with specific regards to the adblock drama I was referring to Poore at one point replacing his entire site with a single page complaining about the amount of revenue lost to users with ad blocking active, which is something that I took extreme exception to because this affected ALL visitors to the site regardless of if or if not they were actually using ad blocking]
This mirror is unfortunately incomplete (and very slightly outdated), as /CrazyTalk/ was not included when I scraped the site (it was far too large to scrape given the site's extremely poor performance, my wish to avoid worsening the poor performance further, and other factors). If you're looking for a replacement forum, I suggest visiting https://www.crazyboards.org/forums/. There are issues with many of the mirrored pages, I am working on identifying and fixing them, but I do not have the time to address every single issue at this moment (although by now the majority of these issues have been resolved). Dynamic content is obviously completely broken (this is beyond my control), and the loss of /CrazyTalk/ is quite bad given how much good user-generated info was on there, but you have Jerod to "thank" for that. Maybe I'll bring it back online at some point, but it wouldn't be the same as before. For now, I suggest visiting CrazyBoards instead.
Note (Oct 9 2018): Infrequent additional updates regarding the status of this site will be posted on https://info.crazymeds.net


Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Zoloft (sertraline) Review


The Zoloft (sertraline) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Zoloft (sertraline) provides what the educated consumer wants, highlighting its use as, and comparing it with other Antidepressants. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Zoloft (sertraline), and consumer experiences.

Classification

Primary Drug Class

Zoloft (sertraline) is in the Antidepressants class of medications.

Additional Drug Categories

SSRIs, Anxiolytics/Anti-anxiety

Indications

A review of Zoloft’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

  • Major Depressive Disorder (MDD) approved 30 December 1991
  • Obsessive-Compulsive Disorder (OCD) in both adults (approved 28 October 1996) and children (approved October 1997)
  • Panic Disorder (July 1997)
  • Post Traumatic Stress Disorder (PTSD). Zoloft was approved for short-term (acute) use on 7 December 1999 (fitting date), and for chronic (long-term) use on 16 August 2001 (just in time!).
  • Premenstrual Dysphoric Disorder (PMDD) (approved 20 May 2002)
  • Social Anxiety Disorder (approved 10 February 2003)

Drugs sometimes have different approvals in different countries.1 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

Haven’t found anything that Zoloft is approved for oversees that it isn’t approved for in the US.

Clinically Significant or Otherwise Common Off-Label Uses

Less Common/Experimental Off-Label Uses

  • Post-stroke emotional incontinence. Don’t they make adult diapers for that sort of stuff? Also known as pseudobulbar affect (PBA), pathological laughing and crying, and emotional lability - the last one is now mostly used for a medication side effect with a slightly different meaning - PBA is similar to ultradian rapid cycling in bipolar disorder. One minute everything is so fantastic that you can’t help but laugh at a bird pooping on the grass. Five minutes later you’re plunged into despair and crying because there’s a bird turd on your lawn. Keep repeating every five minutes for hours and hours, day after day.
  • Smoking cessation. It’s not all that great by itself. The data are all over the map when Zoloft is used in combination with other meds.

Failed off-label uses

Irritable Bowel Syndrome (IBS). Unlike other SSRIs, Zoloft is consistently more likely to give you the runs than constipation. Paxil is the go-to crazy med for IBS.

Potentially dangerous off-label uses

There may be some, but I haven’t found a report of any.



Efficacy & Comparisons with Other Antidepressants

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

Like all SSRIs: anywhere from a couple days to over a month, although you’ll probably feel more awake and energetic, or at least start sleeping a little better, in two to four days. If you don’t feel any positive benefit after four weeks for depression alone, or two weeks for anxiety or depression and anxiety, then you should talk to your doctor about either another SSRI or, if you already tried another SSRI or an SNRI before and it didn’t work, trying a med that hits another neurotransmitter.

Efficacy for its Approved Indications

Like all SSRIs Zoloft has about a 40–50% chance of working, factoring in having to stop taking it for intolerable side effects. Those are actually decent odds for serious brain cooties like chronic, severe depression and social anxiety bad enough to keep you from holding a job.

Zoloft is better for conditions in the anxiety spectrum than those in the depression spectrum. Which is funny given how agitated and nervous it makes a lot of people feel. It’s not just any anxiety Zoloft is good for, but social anxiety/phobia, which really is different from other forms. So they aren’t lying to you all that much with those cheesy ads featuring the sad and lonely blob.

Zoloft works well for chronic depression (i.e. every day for months on end). Like Wellbutrin, Zoloft is especially good for depression defined by sleeping too much, eating too much, and withdrawing from the world. Zoloft is more likely to work for you if you have anxiety combined with depression, although Celexa is somewhat more likely to work for anxious-depression (defined as being severely anxious and severely depressed, either simultaneously or at different times).

For Off-Label Applications

- pretty good. Going from under a minute to around 10 minutes with less risk of not being able to do anything at all as there is with Paxil and Prozac are decent results.

Zoloft versus Other Antidepressants for Approved Indications

For all Approved Applications

  • Celexa vs. Paxil vs. Zoloft - which is better for medication compliance? Getting people to stay on their meds is essential in getting them to work. That seems obvious, but all the clinical trials in the world don’t mean shit if someone won’t get a refill. This study looks at just that, which med gets the most first refills for approved treatments: depression, social anxiety, and PTSD. The winner: it’s a statistical tie between Zoloft and Celexa, with 54.70% and 54.49% of people taking them getting refills. Given the size of the study - over 14,000 people - Paxil’s first refill rate of 50.99% is significantly poorer, but isn’t overwhelmingly so.
  • Celexa vs. Paxil vs. Zoloft - which med do people stay on longer? This is an indicator of which one generally sucks the most, not which is the most successful, as this is for people who still needed treatment. 14,933 people with depression, PTSD, or social anxiety disorder all taking brand and not generics. The results: Paxil sucks the most, Celexa sucks the least.

For Depression Spectrum Disorders

Zoloft vs. SNRIs (mostly Effexor) and other SSRIs.
  • Celexa and Effexor are better for depression, including depression with anxiety, than Zoloft.
  • Zoloft is better than Luvox,2 as are most other SSRIs.
  • There’s not much difference in efficacy as far as Paxil, Lexapro, and Prozac are concerned, although Lexapro generally sucks less than Zoloft, while Zoloft tends to suck less than Paxil and Prozac. One study found if you’re anxious and jittery Zoloft is more likely to work than Prozac, but that was done before everything but Luvox was on the market.
  • There aren’t enough data as far as Cymbalta vs. Zoloft is concerned, but my money is on Cymbalta. Dual-action antidepressants are usually better than single-action, and whatever affect Zoloft has on dopamine and sigma opioid, it’s not enough to make much of a difference in depression spectrum disorders, other than lessening some side effects (weight gain, sexual dysfunction, triggering mania) and worsening others (sweating, nausea and other tummy troubles, having a dysphoric mania when it does trigger mania).
  • Zoloft vs. Celexa vs. placebo Over 300 patients with MDD in this double-blind study took Zoloft, Celexa or a placebo for 24 weeks. Celexa was the clear winner, especially with anxiety symptoms. Zoloft’s main problem: the GI side effects sucked too much, and lots of people in the Zoloft group dropped out by week eight.
  • Zoloft vs. Celexa for depression. 50 people taking Zoloft vs. 50 people taking Celexa for six weeks. The results: Celexa is still king of all antidepressants. It worked faster, better, and for more people.
  • Zoloft vs. Celexa vs. placebo for depression. 323 people were randomized to take Zoloft, Celexa, or a placebo for six months in this double-blind study. The results: It may have been a statistical tie as far as how well Celexa and Zoloft worked for depression and how they beat the placebo, but Celexa worked faster, worked better for anxiety, and sucked less. No numbers in the abstract, but Zoloft wasn’t statistically superior to placebo on the Hamilton anxiety scale.
  • Zoloft vs. Celexa when prescribed by primary care physicians for depression. 400 people in this double-blind, 6-month-long study were given one or the other by their PCP. The result: Celexa was somewhat, if not statistically significantly better.
  • Zoloft vs. Prozac for severe depression or anxious depression. This was one big-ass study. Actually they pooled the data from five double-blind studies. They had a total of 1,088 people, with 654 considered anxious-depressed and 212 with high severity depression. The abstract doesn’t define “high severity” depression, but it was probably based on HAM-D score. The results: Zoloft barely wins, but has a statistically significant advantage among the “severely” depressed.
  • Zoloft vs. Prozac for depression. 118 people took Zoloft, 120 took Prozac for six months. The results: Although no numbers were given, Zoloft worked better, and helped those who were taking it sleep better as well.
  • Zoloft vs. Prozac for depression, which works better and costs less? 116 people took Zoloft and 115 people took Prozac for six months. The results: No difference in how well they worked, but the people taking Prozac saw their doctors more often, and Prozac cost a lot more.
  • Zoloft vs. Paxil vs. Prozac for depression. 573 people being treated by primary care physicians (PCPs) are randomly assigned one of the three SSRIs. If it didn’t work or suck too much over the course of 9 months they got to switch to another med that isn’t one of these. The results: Zoloft wins, but is barely more effective and marginally sucks less. There is absolutely no difference between Paxil and Prozac.
  • Zoloft vs. Paxil vs. Prozac for anxious depression. 108 people with major depression with severe anxiety were randomly given one of the three meds for however long this study lasted. The results: a three-way tie. The only difference was Zoloft and Prozac started working in a week.
  • Zoloft vs. Lexapro for depression. Double blind study with 212 people over 2 months. The results: Lexapro was barely, but not statistically significantly, more effective.
  • Zoloft vs. Paxil for depression with personality disorder. 176 people took Zoloft and 177 took Paxil for six months. The results: For one thing, taking SSRIs for six months works a hell of a lot better than taking them for only two or three months. Another useful piece of information (that shows up in other studies): if nothing at all happens in two weeks, you may as well forget whichever one you’re taking. Otherwise Zoloft was somewhat better and sucked noticeably less.
  • Zoloft vs. Paxil for delusional depression. A small, short study - 46 people and six weeks - but Zoloft kicked Paxil’s ass. Zoloft worked for 75% of people taking it, Paxil worked for only 46%, and 41% of people taking Paxil dropped out because of side effects.
  • Zoloft vs. Effexor vs. Wellbutrin - which is most likely to make you manic? 174 people with bipolar 1, 2 or NOS in the depressive phase were prescribed appropriate, flexible dosages of one of the three ADs along with whatever mood stabilizer they usually take. The results: Effexor is the most likely to induce some form mania. 15% of people who took it switched to full-on bouncing off the ceiling mania vs. 7% of those who took Zoloft and 4% of those who took Wellbutrin. For any form of mania it was Effexor 31%, Zoloft 16%, Wellbutrin 14%. For people with rapid cycling the ranking is the same, but they use obtuse statistics numbers. People susceptible to rapid cycling were no more or no less likely to become manic than those who aren’t. Unfortunately no data are given regarding mania symptoms.
  • Zoloft vs. Wellbutrin SR vs. Effexor XR for depression after Celexa didn’t work. Which AD is the best second choice after Celexa? According to this decent-sized (727 people, 239 took Wellbutrin SR, 238 took Zoloft, and 250 took Effexor XR) study the winner is: Effexor by a nose, with Wellbutrin a close second. They both worked better and sucked less than Zoloft, but Zoloft wasn’t that far behind. Although when you’re looking at remission rates of 20–25% they’re not all that fantastic in any event.
  • Zoloft vs. Effexor XR for depression. Since Zoloft might affect dopamine enough to consider it a dual-action serotonin and dopamine reuptake inhibitor, someone thought comparing its efficacy with Effexor, which is a serotonin and norepinephrine reuptake inhibitor (SNRI), was only fair. So, 82 people took Zoloft, 78 took Effexor XR in this 8-week, double-blind survey. The result: Effexor won as far as how many people it worked for. The abstract doesn’t tell us how well each one worked or how many people had to quit taking them due to side effects.
  • Zoloft vs. Effexor XR for depression, and which discontinuation symptoms suck less. Really? You’re comparing Effexor with Zoloft? Not Paxil, not Cymbalta, not even Luvox with its super-short half-life? The results: Effexor XR sucked a lot more when the people in the study stopped taking it, otherwise there wasn’t much difference. How much grant money did you get for that? How much came from Pfizer? That’s what I want to know.
  • Zoloft vs. Celexa - which one costs your HMO more? Who cares about efficacy, this is what it often comes down to. Back in 1999 dollars it was $931 per patient for Zoloft vs $1,035 per patient for Celexa. That probably explains why they had 15,222 people taking Zoloft and and 3,175 taking Celexa. The conclusion sums up their thinking:
Despite potential cost savings due to a lower acquisition cost, initial treatment of depression with citalopram was associated with higher depression-related charges than was sertraline in the population studied.
Zoloft vs. TCAs.

As far as efficacy is concerned, there’s not much difference. Zoloft sucks a hell of a lot less, and is far easier to keep taking than TCAs, so taking those into account Zoloft a clear winner.

  • In fact, the bitching about side effects and difficulty of medication compliance (combing side effects with having to take TCAs 2–3 times a day vs. once a day for Zoloft) is bad enough that one hospital found brand-name Zoloft to be slightly cheaper to use than generic TCAs.
  • Although one study found that Zoloft works better and sucks less for women, while TCAs work better and suck less for men. While nothing actually confirms that, in fact , when I looked at studies with full text or demographic data in the abstracts, combined with some of the reports, I think they might be onto something. At least as far as Zoloft is concerned.
  • Zoloft vs. Tofranil (imipramine) for depression and panic disorder. 138 people took Zoloft, 69 took imipramine. For some reason women outnumbered men 3–1 in this study. The results: a tie. Zoloft sucked a lot less, otherwise the numbers were almost identical.
  • Zoloft vs. Tofranil (imipramine) vs. various personality disorders for chronic major depression. No, I wrote that correctly. Read the self-defeating abstract for yourself and you’ll understand what I mean.
  • Zoloft vs. imipramine for non-melancholic depression. “Non-melancholic” is another term for “exogenous” - depression caused by something in your life and not because your brain is messed up. Although exogenous tends to be out of proportion, but that’s splitting DSM hairs. The results: Zoloft clearly won this one. It was more effective for more people, kept more of them depression-free after they stopped taking it, and sucked a lot less.
  • Zoloft vs. Tofranil (imipramine) for people 60 and older with severe depression. This small study - only 55 people - tracked the geezers for all of 6 weeks. The results: Imipramine was slightly more effective. As to which sucked less, that’s hard to figure out. More people taking imipramine dropped out due to intolerable side effects, but of those who completed the study, imipramine’s side effects sucked less than Zoloft’s.
  • Zoloft vs. imipramine for chronic major depression with anxiety. Two hundred nine people took imipramine and 426 took Zoloft. 36% liked the Mel Brooks movie met criteria for high anxiety. The winner: people with anxiety, as more of them (66% vs. 54%) responded to either med. Otherwise the results were the usual: the two meds work the same, but Zoloft sucks less.
  • Zoloft vs. imipramine to prevent relapse in chronic depression. 635 people were randomized to Zoloft or imipramine in a 2:1 ratio, given 12 weeks to get better and followed up after 16 weeks. Anyone who didn’t get better was given the other med. The results: a tie, except Zoloft sucked less. Gee, couldn’t see that one coming. I found this to be especially funny:
LIMITATIONS:The absence of a placebo group constrains interpretation of our results, but chronic depressions have low placebo response rates.
Zoloft vs. other meds. This is way too random to pin down.
  • Zoloft vs. reboxetine for depression. This was a small study of 41 people, 20 on reboxetine 21 on Zoloft. The results: Hard to say. Reboxetine is more effective and works faster, but sucks more - the one person who dropped out was in the reboxetine group. By the time the study was done both meds worked for about 80% of the people in each group. Turkish language version of the study is here.
  • Zoloft vs. moclobemide for atypical depression. In this double-blind study 197 people took either Zoloft or the MAOI moclobemide for three months. The results: Zoloft was significantly better. That is surprising, as MAOIs are usually the best meds around for atypical depression. Zoloft worked better (HAM-D score decreased from 35.9 to 14.5 in the Zoloft group vs 36.3 to 16.1 in the moclobemide group) for more people (77.5% vs. 67.5%). Zoloft also worked better for anxiety, sleep, and a few quality of life categories.
  • Zoloft vs. psychotherapy vs. Zoloft and psychotherapy for chronic moderate depression (dysthymia). Although not approved for dysthymia, SSRIs are used for it all the time and it’s close enough. The results: Zoloft alone worked best, followed by Zoloft + therapy. Zoloft alone kicked interpersonal psychotherapy’s ass, but maybe they just like drugs up in Canadia.
  • Zoloft vs. Solian (amisulpride) - which works faster for depression? Solian (amisulpride) is an atypical antipsychotic (AAP) available in Australia, the EU and other European countries, but not the US. In Italy it’s also approved to treat depression. The results: Solian works a lot better a lot faster. It takes Zoloft three months to catch up.
  • Zoloft vs. Valdoxan (agomelatine): which one helps you sleep better in depression with anxiety. Since Zoloft is pretty good at helping people with anxious depression sleep, why not compare it with a melatonin agonist? 154 people took Zoloft, 159 took Valdoxan for six weeks. The results: Valdoxan (not available in the US, or many other places) makes you sleep a hell of a lot better, and that seems to help with depression and anxiety caused or exacerbated by insufficient and/or crappy sleep.
  • Zolft vs. St. John’s Wort for depression. A randomized, double-blind study run by real doctors involving people with real depression. The results: Both were equally effective, but St. John’s Wort sucked less. What? Some herb you can get at Ye Olde Suplement Shoppe works as well as real medicine? Not quite. They didn’t use ground up St. John’s Wort or even random St. John’s Wort extract. They used pharmaceutical-grade Hypericum extract imported from Germany, which is sold in, you know, pharmacies. And while the Hypericum generally sucked less, 4 people were withdrawn from the study by their doctors due to drug-induced side effects, including suicidal ideation and drug-induced mania, compared with one person taking Zoloft. And while the Hypericum sucked less, it didn’t suck that much less, and has side effects comparable to any antidepressant on the market.
  • Here’s another one pitting Zoloft against Hypericum extract. The objective of the study totally gives away the desired outcome, “to demonstrate the non-inferiority of hypericum extract versus sertraline in the treatment of moderate depression.” Right. Give Zoloft to people who aren’t depressed enough to need real medication, and see if Hypericum doesn’t fail when comparing the results. The results being a complete tie, with Hypericum sucking somewhat less.
  • Zoloft vs. extended-release Desyrel (trazodone) for depression. This is a weird one. I didn’t think anyone still used trazodone as a primary antidepressant. Oh, wait, this study was done in Italy. In Europe Desyrel is still used as an actual antidepressant and not just an add-on for sleep, or a sleep aid by itself. 62 people took Zoloft, 60 people took Desyrel (trazodone) XR in this double-blind, double-dummy3, 6-week study. The results: a tie. Although people in the trazodone group slept a lot better. Big surprise there.
  • Zoloft vs. Mirapex for depression in people with Parkinson’s. Did these people have a grudge against Zoloft or something? Sure, the people with Parkinson’s didn’t have any movement problems, but still. The results: Mirapex (pramipexole) kicked Zoloft’s ass from Napoli to Pfizer HQ and back.
    • Zoloft vs. Remeron ODT for depression. 345 people in this 8-week long, double-blind study took either Zoloft or the then-new Remeron orally disintegrating tablets (ODT - about the only way you can get Remeron most places these days). The results: Remeron worked faster, but eventually they were equality effective. Zoloft sucked less in what people usually consider the most important AD side effects: weight gain and sexual dysfunction.

For Anxiety Spectrum Disorders

Although Zoloft tends to work better for anxiety, especially social anxiety, than depression, there aren’t nearly as many comparisons with other meds for anxiety disorders. Probably because Zoloft is better for social anxiety disorder/phobia (SAnD), while all the other meds with approvals to treat anxiety disorders are better than Zoloft.

For Off-Label Uses

These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Zoloft (sertraline) Should Be Recommended

  • You have depression that involves lots of sleeping, lots of eating, and lots of never leaving your room.
  • Another SSRI almost worked for depression with the above features.

Why/When Zoloft (sertraline) Should Not Be Recommended

  • You or your doctor suspect you might be bipolar. Unless you really, really want to find out for sure.
  • You’re frequently agitated.
  • Your depression features insomnia and not eating.


Stick to the titration schedule with buttons and magnets. 2.25″ $4 & 3.5″ $4.50 at Straitjacket T-shirts
Pile of Pills buttons at Straitjacket T-shirts
Pile of Pills
Vaccines Cause Immunity buttons at Straitjacket T-shirts
Vaccines Cause Immunity
Brain Cooties Aren't Contagious buttons at Straitjacket T-shirts
Brain Cooties Aren’t Contagious
Team PTSD buttons at Straitjacket T-shirts
Team PTSD


Dosage, Titration, and Discontinuation

A review of Zoloft’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

  • Typically it’s one 25, 50, or 100mg tablet once a day, usually in the morning. Larger tablets are often split in half to save money.
  • The Crazymeds’ suggestion: However many whole and half tablets of any size it takes to get the dosage that works for you, anywhere a range of 12.5 to 100mg a day, in increments of 12.5mg. So that’s 12.5, 25, 37.5 and so forth.
  • Zoloft is rated safe up to 200mg a day, and many people take dosages above 100mg a day. The are probably ultra-rapid metabolizers.

Dosing Schedule

  • Unless you find it makes you sleepy, take Zoloft in the morning. Zoloft tends to wake people up.
  • Taking it with food would probably help with any gastro-intestinal problems you might have.
    • However, taking Zoloft with food slightly alters its pharmacokinetics. Not enough to affect how much you need to take, but possibly enough to affect how it makes you feel a few hours after you take it, so taking it before or with breakfast might make a difference.
  • Just don’t mess around too much with when you take it. Like almost all SSRIs Zoloft has a half-life in the neighborhood of 24 hours, so taking it at the same time each day, give or take an hour, will make your life a lot easier.
  • If you’re Chinese you can probably get away with taking no more than 25mg a day. At least that’s what they found in this single, small study. And while that is a frequent occurrence with crazy meds, don’t base your insurance plan selection on your ethnicity.
  • The oral concentrate has some interesting instructions:

ZOLOFT Oral Concentrate contains 20 mg/mL of sertraline (as the hydrochloride) as the active ingredient and 12% alcohol. ZOLOFT Oral Concentrate must be diluted before use. Just before taking, use the dropper provided to remove the required amount of ZOLOFT Oral Concentrate and mix with 4 oz (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade or orange juice ONLY. Do not mix ZOLOFT Oral Concentrate with anything other than the liquids listed. The dose should be taken immediately after mixing. Do not mix in advance. At times, a slight haze may appear after mixing; this is normal.--the Zoloft PI sheet

  • Why only ginger ale, lemonade, OJ, and what I guess is 7-Up or Sprite (or generic equivalents)?4 Did the R&D guys grow up drinking Gin Bucks or something? Furthermore…

Note that caution should be exercised for patients with latex sensitivity, as the dropper dispenser contains dry natural rubber.--ibid

  • OK, that’s easy enough to deal with. At least they warn you. Back to making mixed drinks with Zoloft…

ZOLOFT Oral Concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate.--ibid

  • There’s nothing in the literature about it, but I’ve read a few reports and seen it myself, Zoloft makes some people drunker faster. So it seems extra weird to even supply Zoloft in a liquid form if it needs a solution with 12% alcohol to keep the sertraline stable.

Titration Schedule

Pfizer recommends:

Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD)–ZOLOFT treatment should be administered at a dose of 50 mg once daily.

Panic Disorder, Posttraumatic Stress Disorder and Social Anxiety Disorder (PTSD)–ZOLOFT treatment should be initiated with a dose of 25 mg once daily. After one week, the dose should be increased to 50 mg once daily.

While a relationship between dose and effect has not been established for MDD, OCD, panic disorder, PTSD or social anxiety disorder, patients were dosed in a range of 50–200 mg/day in the clinical trials demonstrating the effectiveness of ZOLOFT for the treatment of these indications. Consequently, a dose of 50 mg, administered once daily, is recommended as the initial therapeutic dose. Patients not responding to a 50 mg dose may benefit from dose increases up to a maximum of 200 mg/day. Given the 24 hour elimination half-life of ZOLOFT, dose changes should not occur at intervals of less than 1 week.--the Zoloft PI sheet

We suggest:
Everybody starts at 12.5–25mg and waits at least two weeks, if you can, before increasing by 12.5–25mg a day. And increase the dosage only if you need to.

Premenstrual Dysphoric Disorder (PMDD)–ZOLOFT treatment should be initiated with a dose of 50 mg/day, either daily throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle, depending on physician assessment.
While a relationship between dose and effect has not been established for PMDD, patients were dosed in the range of 50–150 mg/day with dose increases at the onset of each new menstrual cycle. Patients not responding to a 50 mg/day dose may benefit from dose increases (at 50 mg increments/menstrual cycle) up to 150 mg/day when dosing daily throughout the menstrual cycle, or 100 mg/day when dosing during the luteal phase of the menstrual cycle. If a 100 mg/day dose has been established with luteal phase dosing, a 50 mg/day titration step for three days should be utilized at the beginning of each luteal phase dosing period.--ibid

Sure, why not. I have no freaking idea. Girls’ plumbing is complicated. Maybe starting at 25mg like everyone else will work. Try to find an OB/GYN who knows about psych meds or a head doctor who treats PMDD on a regular basis.

One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

The usual way with SSRIs. Reduce your dosage by 12.5–25mg each week. If the discontinuation syndrome is too harsh you have two options, getting a prescription for the oral concentrate and reducing your dosage by whatever you can tolerate, or getting a prescription for 10mg fluoxetine capsules and take 20–30mg a day (if you’re at 25mg of Zoloft) for two weeks and lowering your dosage by 10mg a day each week.

Discontinuation Symptoms

The same as with any other SSRI.

Notes, Tips, etc. About Discontinuing Zoloft

As with every other SSRI/SNRI, if a really slow taper isn’t working for you, beg your doctor for liquid Prozac. It tastes like mint-flavored mouthwash / cheap schnapps and lets you control the dosage to the milliliter.



Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Zoloft (sertraline) for its approved indications and clinically-significant or otherwise common off-label uses.

Pros

  • The slight, but noticeable, dopamine action Zoloft has is often enough to get you out of bed and back to work within a couple of days. You might still be depressed for another two-four weeks, but at least you don’t have to lie in bed staring at the ceiling and ruminating on how much your life sucks.
  • That also makes weight gain less likely.
  • Zoloft has the lowest rate of cardiovascular side effects of any SSRI.

Cons

  • The slight dopamine action Zoloft has makes it the worst Serotonin-[sorta-]Selective Reuptake Inhibitor to take if bipolar is known or suspected.
  • Definitely the worst to have taken if your bipolar diagnosis was a surprise.
    • By “the worst” I don’t mean it’s more likely than any other SSRI to trigger mania, that’s the same as all the others. No, by “the worst” I mean you’re more likely to have a dysphoric, smash everything in site, scare the shit out of the kids, have the neighbors call the cops mania instead of a euphoric, max out your credit cards, drive to Vegas and marry a complete stranger mania.
    • Then again, it’s difficult to truly gauge “worst.”
  • While the dopamine action is in the right place to make you sweaty and nervous (like Wellbutrin), and to exacerbate insomnia, it’s nowhere near the right place to prevent sexual side effects.

When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

  • Zoloft has some interesting pharmacokinetics
    • If you take the tablets with food you’ll get a 25% increase in Zoloft’s peak plasma - the most you’d have in your blood - and it will happen faster, dropping from 8 hours to 5.5.
    • If you take the oral concentrate with food you won’t get any more out of it, but it will take longer to reach that peak amount, from 5.9 to 7 hours.
    • Increased and/or delayed peak plasma when taking meds with food happens all the time. But these numbers only make sense if the volunteers were professional lab rats.
  • Zoloft is one of the few modern antidepressants (not a TCA or MAOI) where taking a month’s worth all at once could possibly kill you.
    • You’d need a prescription for 150–200mg a day, and the odds are still 99-to-1 against you dying
      • unless you take other stuff with it - then who knows what the odds are - but it’s still a greater than zero chance.

What Zoloft (sertraline) is Best Known for

  • The ad campaign featuring rolling blobs.
  • Letting people know they bipolar with a nasty dysphoric mania instead of the stereotypical happy-happy joy-joy euphoric mania.
    • Always remember: Your mileage may vary (YMMV).
    • You can get that surprise diagnosis in the form of a dysphoric mania with other antidepressants, and
    • Zoloft can trigger euphoric mania,
    • but the odds are zoloft + bipolar - mood stabilizer = dysphoric mania.

Noted Traits & Effects



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Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

While Zoloft (sertraline) has the usual side effects for SSRIs, they aren’t as typical as most SSRIs:

  • headache
  • dry mouth
  • sweating
    • more so than any other SSRI
  • assorted sex problems
    • Typical, because it is an SSRI, but less likely and less bad than all the others.
  • insomnia
  • diarrhea
  • nausea
    • The various gastro-intestinal problems are often worse than with other SSRIs.
    • You’re also way more likely to have diarrhea than constipation, so Zoloft and IBS aren’t a good match.
  • Zoloft is the SSRI least likely to cause weight gain.

Most everything usually goes away within a couple of weeks.

I originally wrote that you were less likely to have GI problems with Zoloft than with other SSRIs. That’s what I get for getting too much evidence from the bipolar with our paradoxical reactions. Sorry.

Uncommon Adverse Events

  • Sweatiness, like really sweaty all the time.
  • Although getting a little sweaty isn’t all that odd for an SSRI, Zoloft is a very “nervous” drug, much more so than the others in this class. Zoloft (sertraline) is almost Wellbutrin-like in how it can sometimes make you sweaty, shaky and generally uncomfortable in your own skin.
    • Which I find hilariously ironic, as Zoloft is approved and fairly effective for panic disorder and social anxiety disorder, and used off-label for generalized anxiety disorder.
  • Making the symptoms worse
    • While making symptoms worse is a potential side effect of all drugs, from non-prescription meds you get at a grocery store to the most expensive chemotherapy on the planet, Zoloft (sertraline) has a fairly high rate (i.e. around 1–2%) of screwing you over with this one5. If any medication makes your symptoms worse, call your doctor immediately.

Potentially Dangerous Adverse Events

  • Hyponatremia (electrolyte imbalance, mainly not enough salt) - usually a problem with older people.
  • Various liver problems.

Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

Hmmm, I wonder if Michael Jackson used to take Zoloft…

Ways to counter / minimize / mitigate / deal with some side effects

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Zoloft in these countries

Argentina, Brazil, Bulgaria, Canada, China, Czech Republic, Denmark, Finland, France, Germany, Hong Kong, Hungary, Indonesia, Italy, Korea, Malaysia, Netherlands, Peru, Philippines, Poland, Sweden, Switzerland, Taiwan, Thailand, Uruguay, Venezuela

Other trade name(s) for Zoloft used in these countries

  • Altruline: Mexico
  • Aremis: Spain
  • Atruline: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
  • Besitran: Spain
  • Deprax: Chile
  • Dominum: Colombia, Peru
  • Doxime: Paraguay
  • Gladem: Austria, Germany
  • Lesefer: Colombia
  • Lustral: England, Ireland, Israel
  • Sosser: Colombia
  • Zolof: Colombia
  • Zosert: India

Generic Name and Availability

US Generic name/INN:sertraline
US Generic available?Yes

sertraline is available in these countries6

Belgium, Colombia, Brazil, Indonesia, Korea, Malaysia, Thailand

Branded Generic Names7 & Transcribed or Transliterated INN/Generic Name8

  • Fatral: Indonesia
  • Fridep: Indonesia
  • Nudep: Indonesia
  • Seltra: Korea
  • Sercerin: Brazil
  • Serlain: Belgium
  • Serlift: Malaysia
  • Sertranex: Colombia
  • Sertranquil: Colombia
  • Traline: Korea


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Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

Generics with independently-tested bioequivalence

How Supplied

Available/Supplied As

25, 50 and 100 mg tablets.

20mg/mL oral concentrate.
OK, Pfizer keeps telling us that there’s not much evidence that Zoloft works any better at dosages above 50mg a day, so the 100mg tablets must be so you can split them in half and save money, right? And if the recommended dosage for everything is 50mg a day, why is the oral concentrate the equivalent of a non-existent 20mg tablet?

Shelf Life

Tablets: 5 years.

Rate this article

If you feel like it, you may rate this article on a scale of 0 (worst) to 5 (best). The more value-judgments the better, even if you can criticize each only once.

Please rate Zoloft (sertraline): a review of the literature and consumer experience.

4.5 stars Rates 4.2 out of 5 from 5 value judgments.
Vote Distribution: 0 – 0 – 0 – 0 – 4 – 1


Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Zoloft’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014
  8. Stahl, Stephen M. “Placebo-controlled comparison of the selective serotonin reuptake inhibitors citalopram and sertraline.” Biological psychiatry 48.9 (2000): 894-901.
  9. Gaynes, Bradley, et al. “What did STAR* D teach us? Results from a large-scale, practical, clinical trial for patients with depression.” Psychiatric Services 60.11 (2009): 1439-1445.
  10. Kroenke, Kurt, et al. “Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: a randomized trial.” JAMA 286.23 (2001): 2947-2955.
  11. Rush, A. John, et al. “Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression.” New England Journal of Medicine 354.12 (2006): 1231-1242.
  12. Forlenza, Orestes Vicente, Alberto Stoppe Júnior, Edson Shiguemi Hirata, and Rita Cecília Reis Ferreira. “Antidepressant efficacy of sertraline and imipramine for the treatment of major depression in elderly outpatients.” Sao Paulo Medical Journal 118, no. 4 (2000): 99-104.
  13. Akgül, Turgay, Tolga Karakan, Ali Ayyildiz, and Cankon Germiyanoğlu. “Comparison of sertraline and citalopram for treatment of premature ejaculation.” Urology journal 5, no. 1 (2009): 41-45.
  14. McHugh, Josh “Drug Test Cowboys: The Secret World of Pharmaceutical Trial Subjects” Wired Magazine 15.05 (24 April 2007) Revised 10 May 2007
  15. Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
  16. Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
  17. Stahl, Stephen M. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition Cambridge University Press 2009. ISBN:978–0521743990
  18. Virani, Adil S., K. Bezchlibnyk-Butler, and J. Jeffries Clinical Handbook of Psychotropic Drugs 18th edition Hogrefe & Huber Publishers 2009. ISBN:978–0889373693
  19. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587 An imprint of Elsevier
  20. Instant Psychopharmacology 2nd Edition Ronald J. Diamond MD © 2002. ISBN:978-0393703917 Published by W.W. Norton.
  21. The Complete Guide to Psychiatric Drugs Edward Drummond, MD © 2000. ISBN:0471353701 Published by John Wiley & Sons, Inc.
  22. PDR: Physicians’ Desk Reference 2010 64th edition
  23. Healing Anxiety & Depression Daniel G. Amen, M.D., and Lisa C. Routh, M.D. © 2003. Published by G.P. Putnam’s Sons.
  24. Sheldon Preskorn’s Applied Clinical Psychopharmacology www.preskorn.com Sheldon Preskorn, M.D. Chief Executive Officer of the Clincal Research Institute and a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine - Wichita Last Accessed 08 July 2014

1 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

2 This is a prime example of really contradictory data. If Lexapro consistently tests as good as, if not better than Celexa, how can Zoloft be better than Lexapro if Celexa is better than Zoloft?

3 If you're looking for an Italian joke, there isn't one. In a "double-dummy" study participants get a mixture of active and inactive product so all the pills are the same size, and everyone gets the same number of pills, and takes the same doses at the same time. That's probably a given, but this is the first time I've seen the term, thus it was explicitly spelled out they actually bothered to do it that way.

4 Because there aren't many exclusively lemon sodas or exclusively lime sodas on the US market.

5 Making the symptoms worse seems to be something meds that affect the sigma-1 receptors, like Luvox and Zoloft, are more likely to do than other meds.

6 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

7 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

8 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.


If you have any questions not answered here, please see the Crazymeds Zoloft discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)


Last modified on Wednesday, 24 September, 2014 at 13:24:10 by JerodPoorePage Author Date created Sunday July 13, 2014, at 15:16:17
“Zoloft (sertraline): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2014 Jerod Poore Published online 2011/04/06
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Zoloft, and all other drug names on this page and used throughout the site, are a trademark of someone else. Zoloft’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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