Zoloft for Anxiety - Effective?

Published 2017-07-11 00:00:00 by Michael | SSRI adverse_effects

Anxiety medications can be life-changing for people with generalized anxiety, panic disorder and obsessive compulsive disorder. But they come with serious tradeoffs. Benzodiazepines are unquestionably effective for anxiety but have adverse neurological effects like memory impairment.

In the last two decades, SSRIs like Zoloft (sertraline) have been repurposes as treatments for anxiety. While hypnotics work immediately, one caveat of SSRIs is that they can take up to 6 weeks to work. Moreover, SSRIs don't work for every body and in some cases may exacerbate social anxiety. For example, Frick and colleagues argue that individuals with social phobia have too much serotonin, not too little.

Genetic differences may play a role in whether SSRIs are effective for anxiety. Polymorphisms affecting the serotonin transporter impact patients' ability to tolerate serotonergic agents.

What Anxiety Disorders Does Zoloft Treat?

  • Panic Disorder (Klerman GL 1993)
  • Obsessive Compulsive Disorder (Kronig, et al. 1999)
  • Social Anxiety (Van Ameringen, et al. 2001, Compton, et al. 2001)
  • Post-Traumatic Stress Disorder (Davidson, et al. 2001, Brady and Clary 2003)
  • General Anxiety Disorder (Liebowitz, et al. 2003, Allgulander, et al. 2004)

How Does Zoloft Affect Anxiety in Children?

Different Side Effects

A study found that treatment of children with various anxiety disorders may interfere with verbal memory, but not with attention. This is different from the side effects seen in adults and may need to be monitored (Günther, et al. 2005).

Social Anxiety

Sertraline partially or significantly improves anxiety symptoms in children and adolescents with social anxiety disorder after 6-weeks of treatment (Compton, et al. 2001). Treatment of children between 5 and 17 years of age with general anxiety disorder also saw improvements in psychological and physical symptoms of anxiety (Rynn, Siqueland and Rickels 2001).

What Diseases with Anxiety Symptoms Can Zoloft Be Used to Treat?

Zoloft can be used to treat the following diseases with comorbidity with anxiety

  • Major depression (Moon, et al. 1994, Carrasco, Díaz-Marsá and Sáiz-Ruiz 2000)
  • Autism (Steingard, et al. 1997)

Major depression

A 2000 study found that treatment with sertraline treats depression in three phases. In the first phase it reduces anxiety, then it reduces feelings of depression and finally it improves the ability to experience pleasure (Boyer, et al. 2000).

How Does Zoloft Compare to Other Anxiety Medications?

Sertraline is better tolerated that some antidepressants and anxiolytic drugs. For example, while sertraline is just as effective as clomipramine in treating depression and anxiety, the side effects are significantly less severe (Moon, et al. 1994).

Panic Disorders

Sertraline has shown to reduce panic attacks in patients (reduced by 77%) more than any other treatment except for one: another SSRI’s called paroxetine (Paxil) (reduced by 86%). However, other treatments such as Clomipramine (Anafranil) (76%), fluvoxamine (Faverin, Fevarin) (76%) and alprazolam (Xanax) (75%) were not far behind. When considering other factors such as comborbidy and safety, SSRIs like sertraline are well-known to be safe and effective compared to some of the other options (Hirschfeld 2000).

Obsessive Compulsive Disorder

Sertraline is not as effective as Clomipamine in reducing obsessive compulsive behaviors, which reduces them by 40% compared to 28%. However, they are more effective than Monoamine oxidase inhibitors (MAOIs) and Benzodiazepines (Hirschfeld 2000).

Social Anxiety

Although MAOI Phenelzine is the most effective in reducing anxiety (reduced anxiety in 63-70% of patients) sertraline is also a very effective treatment (reducing anxiety in 50% of patients) (Hirschfeld 2000).

Post-Traumatic Stress Disorder

While sertraline reduced post-traumatic stress disorder symptoms in a large percentage of civilians with the disease (56%), MAOIs such as phenelzine (68%) and Tricyclic antidepressant (TCA) imipamine (65%) are also strong options (Hirschfeld 2000).

General Anxiety Disorder

Compared to another SSRI, paroxetine, sertraline was just as effective at treating general anxiety disorder. Side effects were also similar (Ball, et al. 2005).

What dosage is typically taken?

Dosage depends largely on the patients age and comorbidity. A study of children with autism and anxiety found that relatively low doses were effective to temporarily treat anxiety (Steingard, et al. 1997).

References

Allgulander, C, AA Dahl, C Austin, PL Morris, JA Sogaard, R Fayyad, SP Kutcher, and CM Clary. 2004. "Efficacy of sertraline in a 12-week trial for generalized anxiety disorder." Am J Psychiatry 1642-9.

Ball, SG, A Kuhn, D Wall, A Shekhar, and AW Goddard. 2005. "Selective serotonin reuptake inhibitor treatment for generalized anxiety disorder: a double-blind, prospective comparison between paroxetine and sertraline." J Clin Psychiatry 94-9.

Boyer, P, JP Tassin, B Falissart, and S Troy. 2000. "Sequential improvement of anxiety, depression and anhedonia with sertraline treatment in patients with major depression." J Clin Pharm Ther 363-71.

Brady, K, and CM Clary. 2003. "Affective and anxiety comorbidity in post-traumatic stress disorder treatment trials of sertraline." Compr Psychiatry 360-9.

Carrasco, JL, M Díaz-Marsá, and J Sáiz-Ruiz. 2000. "Sertraline in the treatment of mixed anxiety and depression disorder." J Affect Disord 67-9.

Compton, SN, PJ Grant, AK Chrisman, PJ Gammon, VL Brown, and JS March. 2001. "Sertraline in children and adolescents with social anxiety disorder: an open trial." J Am Acad Child Adolesc Psychiatry 564-71.

Davidson, JR, BO Rothbaum, BA van der Kolk, CR Sikes, and GM Farfel. 2001. "Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder." Arch Gen Psychiatry 485-92.

Günther, T, K Holtkamp, J Jolles, B Herpertz-Dahlmann, and K Konrad. 2005. "The influence of sertraline on attention and verbal memory in children and adolescents with anxiety disorders." J Child Adolesc Psychopharmacol 608-18.

Hirschfeld, RM. 2000. "Sertraline in the treatment of anxiety disorders." Depress Anxiety 139-57.

Klerman GL, Hirschfeld RNA, Weissman MM, Pelicier Y, Ballenger JC, Costa e Silva JA, Judd LL Keller MB. 1993. Panic anxiety and its treatment. Report of the World Psychiatric Association Presidential Education Program Task Force. Washington, D.C: American Psychiatric Press, Inc.

Kronig, MH, J Apter, G Asnis, A Bystritsky, G Curtis, J Ferguson, R Landbloom, et al. 1999. "Placebo-controlled, multicenter study of sertraline treatment for obsessive-compulsive disorder." J Clin Psychopharmacol 172-6.

Liebowitz, MR, NA DeMartinis, K Weihs, PD Londborg, WT Smith, H Chung, R Fayyad, and CM Clary. 2003. "Efficacy of sertraline in severe generalized social anxiety disorder: results of a double-blind, placebo-controlled study." J Clin Psychiatry 785-92.

Moon, CA, W Jago, K Wood, and DP Doogan. 1994. "A double-blind comparison of sertraline and clomipramine in the treatment of major depressive disorder and associated anxiety in general practice." J Psychopharmacol 171-6.

Rynn, MA, L Siqueland, and K Rickels. 2001. "Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder." Am J Psychiatry 2008-14.

Steingard, RJ, B Zimnitzky, DR DeMaso, ML Bauman, and JP Bucci. 1997. "Sertraline treatment of transition-associated anxiety and agitation in children with autistic disorder." J Child Adolesc Psychopharmacol 9-15.

Van Ameringen, MA, RM Lane, JR Walker, RC Bowen, PR Chokka, EM Goldner, DG Johnston, et al. 2001. "Sertraline treatment of generalized social phobia: a 20-week, double-blind, placebo-controlled study." Van Ameringen MA1, Lane RM, Walker JR, Bowen RC, Chokka PR, Goldner EM, Johnston DG, Lavallee YJ, Nandy S, Pecknold JC, Hadrava V, Swinson RP Am J Psychiatry.

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