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The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.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
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Crazymeds’ Manifesto > Meds > Antidepressants > Zoloft (sertraline): a review of the literature and consumer experience. Highlighting its use, adverse events, and pharmacology from the educated consumers’ perspective.
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.
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.
Any Black Box warning comes directly from the prescribing information. Comments are based on a review of the prescribing information and The Literature. Consumers have become either overly paranoid or jaded by the overwhelming amount of information presented in black box warnings, the number of drugs with them, and how no distinction made in many forms of direct-to-consumer advertising between minor side effects and adverse events serious enough to be listed in a black box. Hence the need to explain what a black box warning is (on the page at the link above) and comments about any warnings there may be for a drug.
Black Box warnings
Suicidality and Antidepressant Drugs
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior
(suicidality) in children, adolescents, and young adults in short-term studies of major depressive
disorder (MDD) and other psychiatric disorders. Anyone considering the use of Zoloft or any
other antidepressant in a child, adolescent, or young adult must balance this risk with the
clinical need. Short-term studies did not show an increase in the risk of suicidality with
antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk
with antidepressants compared to placebo in adults aged 65 and older. Depression and certain
other psychiatric disorders are themselves associated with increases in the risk of suicide.
Patients of all ages who are started on antidepressant therapy should be monitored
appropriately and observed closely for clinical worsening, suicidality, or unusual changes in
behavior. Families and caregivers should be advised of the need for close observation and
communication with the prescriber. Zoloft is not approved for use in pediatric patients except
for patients with obsessive compulsive disorder (OCD). (See Warnings: Clinical Worsening
and Suicide Risk, Precautions: Information for Patients, and Precautions: Pediatric Use)
Black Box comments
This warning had to be added to every antidepressant after a few teenagers, some of whom were probably misdiagnosed, were prescribed an SSRI other than Prozac or Lexapro for MDD.
Zoloft is the only SSRI, and one of a few, perhaps only modern antidepressant where it’s possible (albeit unlikely) to kill yourself with a month’s prescription (if you were prescribed the rather high, but not unheard of, dosage of 150–200mg a day) and no other drug. Zoloft is also the SSRI that is more likely to trigger an ugly dysphoric mania instead of a happy-happy joy-joy euphoric many. So a suicide warning isn’t such a bad idea.
“Noted interactions” are the really important ones and any others, especially pharmacodynamic interactions, we know of that normally don’t make it into patient information literature and online drug-drug interaction checkers.
Most consumers are interested in two rudimentary aspects of a drug’s pharmacology: plasma clearance, which is the de facto standard for systemic elimination, and the basics of its mechanisms of action. About 2% want greater details beyond plasma half-life and any detailed mechanisms of action.
sertraline has a plasma half-life of: Zoloft itself: 26 hours, give or take an hour. N-desmethylsertraline: 62–104 hours.
Estimated Plasma Clearance
sertraline has an estimated plasma clearance of: 5–6 days.
Zoloft gives new meaning to the term “extensively metabolized.” While CYP2C19 and, to a lesser extent, CYP3A4 are responsible for metabolizing Zoloft into what you piss away, you only piss away about 60% of it. Zoloft is metabolized into another metabolite for elimination via the UGT system, by primarily by UGT2B7 with some help from 1A3, 1A6, 2B4.
None really. N-desmethylsertraline is barely active as far as being a reuptake inhibitor or anything like that. It may have an indirect impact on how Zoloft works including Zoloft’s effects on people with coronary problems. The researchers really like using it when testing both Zoloft’s PK data and the PK data of other meds.
N-desmethylsertraline may inhibit CYP2D6, which isn’t a big deal if you don’t take any other drug. Otherwise, that could complicate things.
Enzymes inhibited, induced, or suppressed
The data are contradictory regarding whether or not Zoloft / desmethylsertraline are inhibitors of 2C9, 2D6, and/or 3A4; and to what extent they may inhibit those enzymes.
Bioavailability, bioequivalence and additional PK data
Doses/dosage affect on PK: NoPlasma elimination half-life (T1/2): Zoloft itself: 26 hours, give or take an hour. N-desmethylsertraline: 62–104 hours.Estimated plasma clearance (CL/F): 5–6 days.Time to reach steady state & conc. (Css) in ng/ml: 4–7 days, 38.9 ng/mlTime of maximum plasma concentration (Tmax): 5.5 hours with food, 7–8 hours fastingPeak plasma concentration (Cmax) in ng/ml: 55.1Area under the curve (AUC0–24), as ng.hr/ml: 934.0Overall bioavailability (F)%:Protein binding%: 98%
Comments and Miscellaneous PK Data:
For some reason Pfizer didn’t want to publish the usual PK data in the PI sheet. That happens now and then. Yet they did publish this:
In a relative bioavailability study comparing the pharmacokinetics of 100 mg sertraline as the oral solution to a 100 mg sertraline tablet in 16 healthy adults, the solution to tablet ratio of geometric mean AUC and Cmax values were 114.8% and 120.6%, respectively. 90% confidence intervals (CI) were within the range of 80–125% with the exception of the upper 90% CI limit for Cmax which was 126.5%.--the Zoloft PI sheet
Without more data for either the oral concentrate or tablets those may as well be a bunch of random numbers. I used this study as the source for the usual PK data. It was even smaller than the usual PK study, but not by much.
Stick to the titration schedule with buttons and magnets. 2.25″ $4 & 3.5″ $4.50 at Straitjacket T-shirts
The Essentially what is often in the current prescribing information. Although we need to go to the original prescribing information or old papers for this. This is useful because the originally theorized mechanism(s) of action is frequently how many consumers think a drug works, regardless of how long after it was disproved.
A review of the literature of new theories regarding sertraline’s mechanism(s) of action. If possible we’ll pick at least one that we think is the most likely.
Original Theoretical Mechanism of Action
The mechanism of action of sertraline is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin (5HT). Studies at clinically relevant doses in man have demonstrated that sertraline blocks the uptake of serotonin into human platelets. In vitro studies in animals also suggest that sertraline is a potent and selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. In vitro studies have shown that sertraline has no significant affinity for adrenergic (alpha1, alpha2, beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5HT1A, 5HT1B, 5HT2), or benzodiazepine receptors; antagonism of such receptors has been hypothesized to be associated with various anticholinergic, sedative, and cardiovascular effects for other psychotropic drugs. The chronic administration of sertraline was found in animals to down regulate brain norepinephrine receptors, as has been observed with other drugs effective in the treatment of major depressive disorder. Sertraline does not inhibit monoamine oxidase.--the Zoloft PI sheet
I’m coming down on the side of Zoloft has enough impact on dopamine to make a difference. It’s more than just being a dopamine reuptake inhibitor. The right kind of action on serotonin at the 5HT1A receptors can have a positive effect on dopamine, and while Zoloft may not be all about 5HT1A, Zoloft has one of, if not the greatest effect on your 5HT1A receptors.
The whole dopamine thing is an obscure aspect of 5HT1A. The current theory is those receptors help regulate sleep and whatever it is that lets us navigate through reality. Problems at the 5HT1A receptors lead to anxiety, depression, and the inability to think clearly. Too much serotonin action there can cause hallucinations.
Author’s Comments on and Experiences with Zoloft (sertraline)
While Zoloft is no more likely to trigger mania than any other SSRI, due to that dopaminergic kick the symptoms it triggers are a lot worse. Zoloft just gets you way more agitated and sets of these nasty dysphoric manias in the bipolar, which can be a very harsh way to discover that one is bipolar. With the other SSRIs and SNRIs it’s a coin toss as to whether they’ll trigger euphoric manias that will send you on spending sprees or marrying people you just meet, or trigger dysphoric manias that make you destroy all the furniture in a room. But with Zoloft the odds are heavily in favor of the dysphoric mania. That may be why the poor little Zoloft lozenge quit shilling Zoloft so heavily for depression, and now primarily touts its efficacy for social anxiety, panic disorder, PTSD, and PMDD. Then again it could be that Zoloft is just testing better in studies for its other approved uses.
You don’t have to buy anything. Look around. Tweet what you like with to your Pinbook followers. What else are you doing right now? Working? Yeah, right.
Online consumer ratings & reviews don’t skew as negatively as once thought.1 While more people have negative experiences with medications than big pharma would otherwise have one believe, the drugs are rarely painted as badly as Internet fearmongers would like them to be. As mentioned in the Efficacy section of part 1 of this review, I also use anecdotal data gathered from non-medical social media sites with a consistent overlap of demographic sets (e.g. women with bipolar 2 and/or migraines and scrapbooking). Those sites won’t be listed because I won’t give the drug companies free information since they refuse to buy ads on this site.
Consumer Rating/Review Sites Used for Anecdotal Data
worked for me at 200 mgs. I want to reduce and get off of it after several years. gotta try right?
I Love Happy Pills’s experiences with Zoloft (sertraline)
Better than I was before
I’ve been on Zoloft a little over three years now. Recently, I had my dosage increased from 25mg to 50mg. Zoloft is the only SSRI I have ever been on, so I do not have anything else to compare it to. However, I am a lot better off now than I was before getting on it. My anxiety is significantly better and I do not get severely angry over little things like I used to. It helps me remain calm in situations that would have previously caused me to either panic or explode with rage. The side effects sucked when I first started taking it. I was more nervous for a few days and A LOT more emotional. Everything seemed so dramatic and intense and things felt like a HUGE deal, even if they weren’t. Fortunately, that faded after I got to about the fourth or fifth day.
When I first got my dosage increased, I was scared to start taking the higher dose because I remember how uncomfortable it was adjusting to it when I first started taking it, and was worried that adjusting to a higher dose would feel the same way. Fortunately, it did not. I actually did not notice any adverse side effects when moving up from 25mg to 50mg, other than being a little more spacey and getting tired and falling asleep earlier in the night and easier than before. I’ve been getting really sleep at night since I’ve been on 50mg. I am someone who has struggled with insomnia for a very long time, so it is nice that I am finally getting to sleep easier without taking any over-the-counter sleep aids like I often did before.
Posted: 2015-10-26 at 16:30:15
bob's experiences with Zoloft (sertraline)
No major side effects, seems to be working.
When I first took 50mg sertraline, had controlable but quite bad diarrhea on the first two days, but that could have been all the spicy food and cheap cider. Maybe a slight stimulant effect, nothing really noticable. I have also stopped smoking and switched to an e-cig, so the following could be due to either. It gets a bit graphic, so sensitive types might not want to read on.
Day 7, feeling a lot happier, and more confidence in social situations. Is it the drugs, or is it the fact that over the weekend I got a job that I don’t hate, and some motorbike lessons as an early christmas present?
Some slightly stronger side effects, but they have all been either slightly enjoyable or very odd but not actually bad. When listening to some old CD’s that I loved when I was young, I get the same feeling I used to get from MDMA, much weaker, but the same sensation. Both chemicals do the same sort of thing, so I guess it makes sense…
Have been sleeping a bit better, but having very odd dreams. Very vivid, often about really pervy sex stuff. Have been waking up every morning with a stronger erection than I have had in a long time. My actual desire for sex has reduced slightly. I consider that a good thing, as it means I can get on with what I need to do, instead of being distracted by girls in short skirts.
Instead of diarrhea I now do turds so big they feel like they are going to injure me on the way out. I feel a strange pride seeing those two inch diameter logs standing out of the water without support. (I was a weirdo even before I got sick)
I had these pills for about two weeks before I dared try taking them after reading all the reports of people having a bad time with them, I won’t say anybody should take them, but remember that the people who had bad effects are far more likely to post than those with good effects. Will have to see how it goes, but at the moment I am very happy with sertraline, and plan on getting another packet.
1 I feel so…Fox News skewered by The Daily Show, as the study by Hughes and Cohen uses my own website to contradict what I originally thought to be the case.
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 Monday, 14 July, 2014 at 17:12:50 by JerodPoore
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.
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.
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 Internetis 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.