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Ask Your Guide: Zoloft Withdrawal, MAOIs vs. SSRIs


Updated July 14, 2014

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From time to time, readers write in to ask questions which I feel are of interest to many of you. I will use this space to answer these questions. If you have a question you'd like answered in "Ask Your Guide", write to me at depression@aboutguide.com. I will answer all emails, even if your question is not selected to appear in a future issue.

Q. I read your biography and saw the initials M.S. after your name. Does that stand for medical specialist?

A. M.S. stands for Master of Science. My post-graduate work is in Community Health Education. I am not a mental health professional, but rather a health educator. Our Mental Health Guide has done a feature called What do those initials mean after the names? which can give you further information about mental health degrees and licenses.

Q. How long does it take for Zoloft to wear off?

A. Zoloft has a half-life of about one day. That means that for every day that passes without taking the medication the level in the blood falls by 50%. After one day the level is reduced to 50% of the original level, after two days to 25%, after three days to 12.5%, and so on.

When one stops Zoloft too rapidly a withdrawal syndrome may develop. Among the symptoms that may be experienced are nausea, tremors, lightheadedness, muscle pains, weakness, insomnia, and anxiety. The withdrawal symptoms usually last 1-2 weeks but in some instances they may gradually decrease over a period as long as a month. It is generally recommended that one taper off this medication gradually under a doctor's supervision. Check with your own personal physician for specific instructions.

Q. How do the SSRI's compare to the MAOIs? Are the MAOIs stronger but with added risks?

A. MAOIs are perhaps the most effective antidepressant agents in the psychiatrist's medical arsenal, but because of dietary restrictions and concerns over hypertensive reactions, they are often used only after other agents have failed. MAOIs are useful for atypical depression. Criteria for atypical depression include reactive mood disturbance, prominent anxiety, histrionic features, phobic features, marked fatigue, reversed neurovegetative features, insomnia combined with sleeping abnormally long periods of time, adequate premorbid personality, psychosomatic complaints and/or hypochondriasis. SSRIs are generally the first choice for treatment of depression because they are effective and they have fewer problems with side effects. With MAOIs, adverse effects and potentially severe drug-drug and drug-food interactions are possible. Fatal hypertensive crisis has occurred with concomitant use of tryptophan or tyramine. Serotonin Poisoning or Serotonin Syndrome has also occurred with combination tryptophan or tyramine and MAOI use, and is characterized by mental status changes, hyperreflexia, tachycardia, fever, sweating, shivering, diarrhea, and/or incoordination. Primary care providers should not prescribe MAOIs unless they have experience with these medications.

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