Signs of depression. How to fight depression.

In the U.S., one in three adults suffers from depression. Depression worsens the quality of life, adversely affect relationships with friends, colleagues, reduces the effectiveness of rights at work. It should be noted that if the prior for help to a doctor, a counselor asked predominantly intellectual and economic elite of society, aware of the importance of full active life, in recent years has increased the number of people of all walks of life, preferring to use the professional psychological help.

How to understand that you or your loved ones is not just a bad mood, and depression, in which you want to seek the assistance of a physician-therapist?

Any depression is composed of three components - mood disorders, autonomic disturbances and fatigue.

The first component of depression is related to changes in mood - sad gloom lasts more than two weeks. When depression appears dim perception of the world, everything seems gray and uninteresting. There are changes in mood during the day - morning, the mood may be good, but worse in the evening. Alternatively, the mood is bad in the morning, and several razveivaetsya in the evening. Some people may not be the daily fluctuations of mood - but it is sad, sad, dismal and wet.

Gloom is in different shades. Sometimes it's gloom with a touch of longing, with a tinge of anxiety, with a tinge of desperation, as well as indifference or irritability. Sometimes people may not realize its a sad mood, but feel the so-called physical manifestations of depression. With depression, you may receive a strong feeling the heat in the chest, «heavy stone pressing on the heart». Less depression manifests itself as a chronic feeling of pain in any part of the body, while physicians of other specialties are not to organic causes of pain.

Very often the situation long-term stress man reacts with a touch of anxiety depression. Anxiety people feel in different ways. It can manifest itself in the fear of falling asleep, nightmare dreams, and in constant fear and imagination that with friends and family, something terrible will happen. Sometimes people describe anxiety as anxiety and inability to usidet in one place. Constant feeling of anxiety does not allow you to relax, for example, a person can not sit quietly on a chair for more than two or three minutes - «fidget in his chair, then jumps and starts to walk around the room».

Very severe anxiety (57 points on the scale of Shihan or more) occurs on a background of depression developed, and manifests itself in the form of panic attacks (feeling the shortage of air, heart rate, trembling in the body, feeling the heat). If you are having severe anxiety, it is said that a person has formed a huge underwater part of the iceberg of depression and anxiety disorder is the pinnacle of the iceberg of depression.

If the alarming depression people could not usidet on the ground, then when the other forms of depression, he, on the contrary, it becomes harder to move. If a person sleeps for 12 -14 hours a day, he had no sense of cheerfulness in the mornings, but everyday activities - cooking the soup, clean the apartment using a vacuum cleaner - it seems to be prohibitive, or meaningless, it may be a manifestation of apaticheskoy depression.

The processes of inhibition in the depression, covering the entire body - the person becomes more difficult to think he had a significant negative impact on memory and attention, which significantly affects the efficiency. Difficulty with concentration is that people get tired of watching TV, or short of reading a few pages of interesting books. Or, for example, a person may be a long sit in front of the computer, but unable to concentrate at work.

The second component of depression include vegetative disorders (of vegetovascular vascular dystonia). If a cardiologist and internist excluded relevant organic disease, then hurried urination, the urge false, headaches, dizziness, fluctuation of blood pressure and temperature are treated as additional vegetative signs of depression.

In the gastrointestinal tract depression affects as follows: a person has lost appetite, constipation observed in 4-5 days. Considerably less, in the form of atypical depression, a man noted an increased appetite, diarrhea or false urge.

Depression is not true, and sexual systems. As a result of developing depression in men and women caught in sexual feelings. Much less depression manifests itself in the form of obsessive masturbation, or in the form of flight in many chaotic communication. Men often appear problems with potency. Women with depression may be a delay of regular menses in 10 - 14 days to six months or more.

The third component of depression - asthenic include fatigue, sensitivity to weather changes, irritability. Irritation causes loud sounds, bright lights and sudden touching strangers (for example, when a person accidentally pushed on the subway or on the street). Sometimes, after the outbreak of internal irritations appear tears.

When there are various depression disorders of sleep: difficulty in filling up, superficial restless sleep with frequent awakening or early awakening with a simultaneous desire and inability to sleep.

Depression has its own laws of development. There are signs that indicate the severity of depression. Symptom of depression were significantly greater reflection on the senselessness of life and even suicide. Thus, the general sense of reluctance to live, thinking about the senselessness and aimlessness of life, as well as more distinct suicidal thoughts, intentions or plans appear consistent with severe depression. The appearance of these symptoms you or your loved ones is an indication for urgent treatment to a doctor, a counselor. In this state, it is important to as quickly as possible to begin drug treatment of depression in an adequate dose.

Drug treatment of depression is appointed, if the level of depression on a scale Dung equals or exceeds 48 points. The effect is due to the influence of drugs on the serotonin system (hormone of happiness and pleasure), norepinephrine, etc. Against the background of a stable mood is much easier to resolve psychological problems, to allow the conflict situation.

Many people are afraid to take antidepressants, because believe that the alleged resistance to the growing habit (drug dependence). But it does not, to antidepressants addictive (dependence on drugs) does not develop. The addiction causes strong sedatives and sleeping pills from the group of tranquilizers (benzodiazepines). Depression is treated with a drug - with antidepressants.

Depending on the hue gloom physician psychotherapist appoints different antidepressants. There are antidepressants that treat depression, with a touch of anxiety. There are medications to treat depression, with a touch of apathy, indifference, etc. If you choose the right dose of medication within three to four weeks, the depression begins to undergo reverse development - disappear suicidal thoughts, anxiety, a desire to act in stabilizing mood.

Antidepressants become effective at the end of the second - the third week. Having improved, most people already at the fourth week, dropping out of receiving antidepressant, and as a consequence, in a few weeks, the depression returned. To completely cure the depression, it is important to bear the entire course of treatment of depression, a doctor, a psychotherapist.

The duration of treatment with antidepressants doctor determines an individual psychotherapist in each particular case. But as a rule, treatment with antidepressants may take from 4 months to a year, sometimes longer. Sometimes the doctor-psychotherapist after the main course of treatment may designate a course maintenance, to secure the effect of treatment of depression. Easiest to treat depression lasting less than six months. If a person defers treatment for two or three years, or even eight - ten years, the treatment significantly increases and can reach up to half a year and a half years of maintenance therapy.

Psychotherapy of depression should be treated as a high temperature in the practice of common diseases. The high temperature is not a diagnosis, it shows corporal trouble. When a person has fever, he is drawn to the doctor and specialist deals - this flu, appendicitis or something else. Thus depression and said that, at heart a bad man, and he needed psychiatric help. The doctor-psychotherapist appoints «febrifuge» - antidepressant, and further using the methods of psychotherapy helps a person deal with the problem, which was the cause of depression.

Generic Zoloft.

Currently, one of the most common painful conditions is depression. In doing so, increasingly there is a situation where the first doctor in charge patients with symptoms of depression is not a psychiatrist, and the precinct a doctor - a physician, neurologist, cardiologist or other specialists, clinics or hospitals.

Especially in patients with depression can be found on the admission of the neurologist. In neurological patients of depression most often associated with Parkinson's disease, multiple sclerosis, intracranial tumors, especially in the temporal lobe, atherosclerosis of brain vessels.

More than two-thirds of patients with depression revealed the pain of varying intensity [Bair MJ, 2004], and severe pain associated with a higher degree of depressive symptoms [Katon W., 1994].

This has meant that the tools used not only to psychiatrists but also to neurologists, cardiologists, physicians, surgeons, dermatology and others, have also include antidepressant drugs. However, the lack of awareness about modern antidepressant leads to the predominant use of general practitioners, only long types of drugs amitriptyline, melipramina etc.

These drugs are powerful antidepressants, so far widely used in the psychiatric clinic, while deployed, a deep depression. In the same out-patient conditions, which mainly refers to the atypical, erased versions of depression occurring against the backdrop of somato-autonomic disorders, these drugs are relatively side effect, may have negative consequences.

In addition, traditional antidepressants (amitriptyline, etc.) because of poor tolerance of side effects may compromise the meaning of the treatment of depressive disorders in patients obschemeditsinskoy practice. Given what is particularly important to inform general practitioners about antidepressants, have a milder effect and without any marked side effects.


One of the modern drugs that can be recommended for use in obschemeditsinskoy practice is sertralin (INN: Sertraline), which belongs to the class of selective serotonin inhibitors reverse capture (SIOZS).

This product was originally developed by «Pfizer» and is registered in Russia under the brand name «Zoloft». Sertralin Generic Zoloft has a high efficiency, comparable to the effectiveness of the treatment of tricyclic antidepressants, but there has been much better portability and a high profile security [Casey DE, 1994].
Mechanism of Action

Sertralin inhibits reverse the seizure of serotonin (5-HT) neurons in the central nervous system, and superior in this respect amitriptyline in 100-200 times fluvoksamin 9 times, fluoxetin 5 times and 2 times clomipramine [Koe BK, 1990]. As a result of increased content of serotonin in the synapses, which link the antidepressive effect and antitrevozhny Setralin.

This sertralin has very little effect on the reverse capture norepinephrine and dofamina. Sertralin not inhibited monoaminooksidazu. Selectivity Setralin against serotonin and low affinity for adrenergic, cholinergic, GABA, DOPAMINE, gistaminovym, serotoninovym and benzodiazepinovym receptors leads to a lower frequency of cardiovascular, antiholinergicheskih and sedative side effects such as xerostomia, mist, an increase in body weight, constipation, orthostatic hypotension and sedation, often resulting in the treatment of tricyclic antidepressants.

Some positive sertralin properties associated with the peculiarities of its pharmacokinetics. The latter are also key differences from other Setralin SIOZS. When the 14-day application Setralin at a dose of 50-200 mg once daily maximum concentration of drug in plasma are achieved within 4,5-8,5 hours.

The half of the plasma is 26 hours, which is sufficient to receive a single daily dose, but eliminates the risk of cumulative drug dose and side effects (unlike fluoxetin, where the half life of 2-3 days). Regular admission at the doses of 50-200 mg once a day equilibrium state is achieved within approximately 1 week. In equilibrium condition the rate of absorption Setralin equal to the speed of its ascent, so the levels of the drug remained virtually constant.

Sertralin subjected to metabolism in the first passage through the liver. After the cessation of therapy sertralin 95% out of the body (otmyvochny period) for 1 week.
Comparative studies SIOZS and other antidepressants.

There are a large number of meta-analysis of antidepressants compared. According to these studies, SIOZS generally do not concede on the effectiveness of tricyclic antidepressants. This portability SIOZS much better than the portability of the tricyclic antidepressants . Profile of side effects also varies among SIOZS. Application SIOZS accompanied by significantly fewer antimuskarinovyh effects, with the increasingly common gastrointestinal effects and psihostimuliruyuschie.

Indications for use Generic Zoloft

The drug sertralin Generic Zoloft was developed (designed) as a drug for a psychiatric practice. Therefore, in testimony to the applicability of the depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder (PTSD) and social phobia.

There are a large number of studies have confirmed the effectiveness of Setralin Generic Zoloft when those violations. Currently, however, the use of drugs had gone beyond psychiatry.

This was largely due to the high prevalence of depression in obschemeditsinskoy practice. Thus, approximately 60-80% of patients with depression do not fall within the field of mental health treatment and medical internist, because they predominate among patients with mild forms of atypical depression.

A large proportion of these patients is found in the practice of neurologists. Milder effects Setralin Generic Zoloft and a favorable safety profile make it possible to apply it more widely by doctors of various specialties. In addition, recent studies have demonstrated high efficiency of application Setralin Generic Zoloft and with various chronic pain syndromes
.
Application Setralin Generic Zoloft with depression and anxiety
There is a lot of experience applying Setralin Generic Zoloft with a broad spectrum of depressive violations as endogenous and exogenous nature. Sertralin Generic Zoloft, can be used to treat high depressive disorder. Its effectiveness in the episode of major depression was established in 6-8-week controlled study in outpatients [Khouzam HR et al. 2003].
A separate mention should be made of the effectiveness of Setralin Generic Zoloft in the treatment of masked depression, which manifests itself in different neurological and somatic symptoms (including chronic pain syndromes).

These patients are usually reluctant to accept and carry bad tricyclic antidepressants. Monthly treatment sertralinom Generic Zoloft successfully resolves itself as a manifestation of depression, and worrying, and somato-vegetative symptoms, contributing to the normalization of sleep and the elimination of pain syndrome, regardless of the clinical picture of the prevalence of those or other somatic manifestations.

Recently, we investigate the effectiveness of sertralin Generic Zoloft in the depressions in the organic neurological disease. In neurological practice, very often, and with unfavorable prognostic point of view is the development of depression in patients suffering from Parkinson's disease.

Effectiveness sertralin Generic Zoloft in this situation is not inferior to amitriptyline. This application sertralin Generic Zoloft, but not amitriptyline significantly improves the quality of life of these patients.

Recent research has proved highly effective Setralin Generic Zoloft in the treatment of depression in Alzheimer's disease in combination with high portability, which allows to speak of sertraline Generic Zoloft as the drug of choice in this situation.

There is work that showed the high efficiency sertralin Generic Zoloft with postnatal depression and postmenopauzalnyh. Epperson et al. (1997) presented the results of 6-week placebo-controlled double-blind study the effectiveness of Setralin Generic Zoloft with this pathology. Of the 13 women received a full course of 6, 4 out of 6 completed the study were evaluated responderami, 3 of them were sertralin Generic Zoloft.

The authors come to conclusion on the effectiveness of Setralin Generic Zoloft in the treatment of postnatal depression. Stowe et al. [1997] investigated the influence of Setralin Generic Zoloft with depression in 26 patients. Was the standard dose (50-200 mg / day).. The entire 8-week course of therapy was 21 women, all marked improvement from 2 nd week of treatment. In 14 patients after the course has been recorded complete remission. Sertralin Generic Zoloft is well tolerated, side effects were minor and completely reduced by correcting the dose. Breast-feeding during treatment continued to 6 women that did not impact on children. However, it is unknown which may have influenced breast-feeding mothers taking drugs, for newborn babies in the long run. Therefore, the decision to use antidepressants for postpartum depression at kupirovaniya nursing mothers must be very balanced.

About 75% of women experiencing unpleasant feelings during the menstrual period in the form of headaches, worsening of mood according to epidemiological studies. In doing so, only in 3-8% of women, these and several other violations very seriously and expressed dezadaptiruyut women. In DSM-IV classification was introduced a special term for this condition - «perimenstrualnoe disforicheskoe disorder». Etiology of the violations are not clear. It is assumed that the physiological fluctuations in hormones rather than a violation of the ratio of the hormones are provocateurs of clinical manifestations perimenstrualnogo disforicheskogo disorder. Serotoninergicheskaya system is in close reciprocal relationship with sex hormones and is the most reasonable target for intervention. Of the drugs for this category of patients were the most effective drugs SIOZS group. In several randomized, placebo-controlled studies have shown drugs SIOZS high efficiency and minimal side effects. Recently, another study showed that even an effective periodic (only during perimenstrualnogo period) receiving the drug serotoninergicheskogo.

Application Setralin Generic Zoloft with obsessive-compulsive
disorder (ROC)

Sertralin Generic Zoloft is used to treat obsessy and kompulsy patients with ROC. ROC is characterized by intrusive ideas, thoughts, beliefs or the way (obsessiyami), which are distonicheskimi and / or repetitive, purposeful and intentional action (kompulsiyami) that a person sees as excessive or unreasonable. Effectiveness Setralin Generic Zoloft was set at 12-week and 52-week studies in outpatients diagnosed with ROC [Koran LM, 2002], and currently use Zolofta with ROC recommended American Psychiatric Association (2007).
Application Setralin Generic Zoloft in children and adolescents

Application Setralin Generic Zoloft are allowed to have children (6-12 years) and adolescents (13-17 years) only if ROC. Alderman J. et al. (2006) demonstrated the efficacy and safety of long-term therapy, even sertralinom Generic Zoloft in children with the ROC.

However, children treated with antidepressants should be undertaken with caution, given the increased risk of suicidal attempts in children and adolescents taking antidepressants [Cheung A., 2007]. Therefore, in the appointment of any antidepressant to children or adolescents should carefully weigh the risk ratio and the clinical feasibility of (harm and benefit), as well as closely monitor the mood and behavior of patients who have decided to appoint a drug.
Treatment sertralinom Generic Zoloft, panic disorder Panic disorder (PR) is a chronic condition, which is characterized by sudden re-emergence of panic attacks.

Panic attacks is a dramatic episode of fear or discomfort, which suddenly appear palpitations or increased heart rate, sweating, tremors or chills, feeling the shortage of air, asthma, pain or discomfort in the chest, nausea or indigestion, dizziness, fainting, or volatility, derealizatsiya (feeling not practical) and Depersonalization (loss of my own), a sense of loss of control, fear of death, paresthesia, chills or hot flushes.

Panic disorder is usually accompanied by distress and dizadaptatsiey due to disturbing the expectation of new attacks, concern about their effects and / or significant changes in behavior associated with panic attacks. These patients have high consumption of health services and pronounced decline in the quality of life. They are often found in the doctor in the clinic. They make numerous somatic complaints, such as chest pain, nausea, dizziness.

PR is often combined with depression, alcohol or other substances, as well as other disturbing irregularities, including the social fobiyu, generalized anxiety disorder, PTSD and the ROC. There are different medicinal and nelekarstvennye methods to successfully cope with the treatment of panic disorder. This SIOZS are drugs of choice (first line), with pharmacotherapy OL. Among SIOZS sertralin Generic Zoloft is different in that it is effective not only for improving the symptoms of panic.

Sertralin Generic Zoloft reduces the expectation of an alarming new attacks, and significantly improves (various aspects), the quality of life for the patient. In the study, Pollack MH, Marzol PC (2000) showed that sertralin Generic Zoloft was effective even in patients with poor prognosis of disease outcome (agoraphobia, komorbidnaya depression, personality disorder, high duration of disease, female sex).

Panic disorder is a chronic disease, so that the patient responsible for medical treatment, appropriate to continue therapy. This should match the minimum effective dose, and periodically evaluate the appropriateness of the continuation of maintenance therapy.
Treatment sertralinom Generic Zoloft posttraumatic stress disorder

In connection with emergencies in the modern world, a growing number of violations, known as «post-traumatic stress disorder» (PTSD). PTSD (according to the criteria DSM-III-R/IV) develops in response to travmatiziruyuschee event that involves threat of death or serious injury, threat of physical damage to the person or other people and the response of intense fear, helplessness or horror.

Symptoms resulting from travmatiziruyuschego events include re-experience the events in the form of intrusive thoughts, dreams, or flashes, intense physiological distress, and physiological reactions to memories of the event, avoidance of situations reminiscent of travmatiziruyuschem event, inability to recall the details and / or reduction general reactivity in the form of reduced interest in the important cases, alienation from others, restricted affect, or feeling a lack of future, the initiation of vegetative symptoms, including insomnia, increased skittishness, the violation of concentration, irritability, or an outbreak of anger. The diagnosis of PTSD requires persistence of symptoms for at least a month and the presence of significant distress or violation of social, occupational or other activity.

Sertralin Generic Zoloft is used for the treatment of PTSD. The effectiveness of the drug with PTSD has been established in several placebo-controlled studies [Brady K et all, 2000]. When maintenance therapy should periodically assess the appropriateness of its continuation.

Application Setralin Generic Zoloft elderly and patients with somatic Pharmacotherapy in the elderly is a great difficulty in mind the high risk of developing complications from the treatment. The use of antidepressants in this category of patients requires special caution.

The high profile security Setralin Generic Zoloft makes it attractive for use in gerontology. Comparative studies Setralin Generic Zoloft with amitriptyline, nortriptilinom fluoxetin and demonstrated its high efficacy and relative safety of this category of patients [Thompson C., 1992].

In recent years certralin Generic Zoloft have been applied in obschesomaticheskih disorders, in particular, in patients post-myocardial infarction.

More recently, patients with cardiovascular disorders excluded from any study antidepressants because of their cardiotoxicity and the potential risk of undesirable interactions of antidepressants and kardiotropnyh drugs.

Sertralin Generic Zoloft has proved safe in this regard and are well tolerated by these patients. Most revealing in this regard is the study SADHART [Glassman A., 2002], which studied patients with severe depression and myocardial infarction in the acute period (30 days) or post-attack of coronary disease.

The study was multicentered placebo-controlled, double-blind and lasted 24 weeks. The average age of patients was 57 years old, dose - 50-200 mg / day. Sertralin Generic Zoloft had 186 patients a placebo - 183. Almost all patients received the usual set of kardiotropnyh drugs. The study showed that sertralin Generic Zoloft was significantly more effective than placebo. At the same side effects in both groups hardly differed in frequency and severity of manifestations. In patients receiving sertralin Generic Zoloft, from the side effects are diarrhea was presented. The authors conclude on the efficacy and safety Setralin Generic Zoloft for cardiac patients with depression.

Another study examined the effectiveness of Setralin Generic Zoloft in 38 depressed patients post myocardial infarction. Patients received 50 mg Zolofta day. 27 patients completed the study, and none of them have not seen any side effects. The authors confirmed the assumption that sertralin Generic Zoloft contributed to the restoration of cardiac function in depressed patients after a heart attack [Parissis, 2007].


Effectiveness and safety Setralin Generic Zoloft was demonstrated in the study of Rasmussen et al [2003], which applied sertralin Generic Zoloft for the purpose of preventing the development of depression in patients with stroke. 138 patients were studied for 12 months. Sertralin Generic Zoloft has demonstrated a significant advantage over placebo in this component of the study, as well as positively influence the improvement of cognitive functions of patients.

In the group of patients who received sertralin Generic Zoloft, there were lower numbers of blood pressure, decreased tachycardia.

Application Setralin Generic Zoloft in chronic pain Antidepressants are effective means kupirovaniya chronic pain of different origin and have not only analgetics action, but also significantly reduce the accompanying emotional (affective) reaction, ie facilitate the experience of pain and suffering to the patient.

Indeed, following the reduction in pain usually appears clear and psychotropic effect: improved mood, enhanced performance, recover interest disappears fobicheskaya symptoms (worrying anticipation of pain). Changing the very perception of pain and attitudes towards it - it becomes more efficient, eliminates its affective saturation. There is a gradual distancing from the identity of pain, which allows to increase its protective mechanisms and adaptive capacity.

Antinotseptivnye properties of the antidepressants were discovered almost immediately after its introduction into psychiatric practice. During the 40-year history of their use was to do a large number of open and controlled studies proving their effectiveness, with chronic, organic pain syndromes of different etiologies, including those resistant to conventional analgetics funds.

Theoretically antinotseptivny antidepressants may have an effect on the three main mechanisms: redutsiruya depression, potentsiruya Effects of exogenous or endogenous analgetics substances because of their own analgetics properties. The latter fact is confirmed by data obtained in the experimental study in animals and in humans, indicating that antidepressants increase the threshold of pain sensitivity and have antinotseptivny effect of direct exposure to the opiate receptors.

However, it remains unclear whether the stimulation of opiate receptors primarily or indirectly, through activation noradrenergicheskih and serotoninergicheskih neurons. Modern theories of endogenous pain control require involvement of the two systems NEUROMEDIATOR (noradrenergicheskoy and serotoninergicheskoy).

Therefore, for treatment of chronic pain used primarily tricyclic antidepressants or SIOZSN. However, in some cases, a good effect can be achieved with the use of drugs that affect mainly to serotoninergicheskuyu system. Operations were performed, which showed high efficiency Setralin Generic Zoloft in the treatment of tension headache, pain dysfunction syndrome temporomandibular mandibular joint with the muscular-fascial pain syndrome, with pain in women in the pelvic area and even in the diabetic polineyropatii [Gustaw K. , 2000; Engel CC Jr, 1998; Goodnick P.J., 1997].
Application certralina Generic Zoloft can be seen especially in cases where the patient is not receiving transfers, or the effect of amitriptyline previous therapy (including amitriptyline) was insufficient.
However, recommendations for the use of Zolofta with pain syndromes in the general medical practice requires additional, more extensive studies that have confirmed the effectiveness of certralina found in chronic pain.
Other uses
certralina Generic Zoloft
Violation of ejaculation is one of the most common sexual disorders among men. Missing data (controlled clinical research) that would prove the effectiveness of psychotherapy in the normalization of sexual function in these patients. Now there is increasing interest, both by doctors and pharmaceutical companies to the possible pharmacological treatment of this violation.

We know that one of the side effects certralina Generic Zoloft is delayed ejaculation. In the study, McMahon CG, Samali R. (1999) have shown that the use of certralina Generic Zoloft in men with premature ejaculation had a normalizing effect on sexual function. There is also a description of the successful application of certralina Generic Zoloft in a patient with frontal-temporal dysfunction, which manifests itself in an extremely sexual desire with the serious, aggressive sexual harassment to the wife. Receive certralina Generic Zoloft Normalized behavior and sexual function in this patient [Anneser JM, 2007].
Metering mode
Zoloft is available in tablets of 50 and 100 mg. Standard dose - 50 mg per day. Zoloft designate once a day - morning or evening. Depending on individual sensitivity to the drug and the other reading a range of doses in adults and adolescents can vary from 50 to 200 mg / day., In children from 6 to 12 years - from 25 to 200 mg / day.

In patients with dysfunction of the liver should reduce the dose or a multiplicity of use of the drug. Older people recommend the same dose as adults. However, given the frequent greater sensitivity of older people to drugs in general, it is advisable to initiate treatment with lower doses than in younger people.
Security.
Undesirable effects
As indicated above, the selectivity of action Zolofta to reverse the seizure of serotonin and the lack of affinity for adrenergic, cholinergic, and serotoninovym benzodiazepinovym postsinapticheskim receptors define a low frequency of development of certain undesirable events that may mediate these neuromediators. Nevertheless, it is necessary to know the possible complications that may arise when applying Zolofta to warn of the possibility of the emergence of the patient and take action to overcome them.
Unwanted effects in the application Zolofta may include:
• Violations of the autonomic nervous system (disorder ejaculation, dry mouth, sweating);
• Violations of the central and peripheral nervous system (somnolence, tremor);
• general (fatigue);
• gastrointestinal disorders (anorexia, constipation, diarrhea, or erratic stools, dyspepsia, nausea);
• psychiatric disorders (agitation, anxiety, insomnia, decrease in libido).

The children, moreover, when applying Zolofta may arise giperkineziya, tick fever, malaise, purpura, reducing body weight, a violation of concentration, manicheskie reaction, emotional lability, a breach of thinking, and bleeding from the nose.
What should the doctor tell
patients taking Zoloft?
Do not expect a rapid onset of effect of taking the medication. Symptoms of depression and a reduced interest in life is usually held within 4-6 weeks after the start of taking the medication. Reducing some of the somatic symptoms and normalization of sleep may occur earlier, within 1-2 weeks after the start of taking the medication before a measurable improvement in mood or interest in any activity. This may be an indication that the therapy will be effective.

Nevertheless, following a tangible improvement of therapy should be continued. Before you judge the effectiveness of the drug against depression, Zoloft should be taken at least 2 months. You can not stop the self, or alter the dose of medication. A sudden withdrawal of taking the medication could lead to one and / or more of the following symptoms lifting: irritability, nausea, dizziness, vomiting, nightmares, headaches, and paresthesia. Zoloft normally be taken 1 time a day. Tablets can be taken during meals. At the beginning of taking the medication may cause some side effects.

The most frequently increased sweating, drowsiness, nausea, diarrhea, tremor, dry mouth, loss of strength, headache, decrease, or a set of weight, dizziness and anxiety. These side effects are generally slight or moderate and usually go through 1-2 weeks while continuing taking the medication. It may be a worsening of sexual function when receiving Zolofta.
Thus, the emergence of a new class of antidepressants - SIOZS - the possibility of more widespread use of antidepressants, not only in mental health, but also obschemeditsinskoy practice. One of the members of this group is the drug sertralin Generic Zoloft, which has high efficiency with a broad spectrum of depressive violations, which are typical for a large number of patients seeking treatment to the doctor about somatic complaints. The high profile of security and ease of use of sertralin Generic Zoloft is an effective drug.

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Generic Zoloft Information

Generic Zoloft Pharmacological Effects

Antidepressants, a specific inhibitor capture serotonin in neurons. Has very little effect on the reverse capture norepinephrine and dopamine.
In therapeutic doses it blocks the seizure of serotonin in human platelets. Generic Zoloft does not have a stimulating, sedative or antiholinergicheskogo act.
Through selective oppression capture, Generic Zoloft no increases adrenergic activity. Generic Zoloft has no affinity to muskarinovym holinoretseptoram, serotoninovym, dopaminovym, gistaminovym, and adrenergic receptors.
Generic Zoloft does not cause drug addiction, does not cause an increase in body weight during long-term admission.

Generic Zoloft Indications

- Depression of varying etiology;
- Obsessive-compulsive disorder;
- Panic disorder;
- Post-traumatic stress disorder;
- Social phobia.
Generic Zoloft Metering mode

Generic Zoloft appoint 1 time / day morning or evening. Tablets of Generic Zoloft can be taken irrespective of food intake.
When depression and begin treatment with the dose of 50 mg / day - 150 mg/day.
Treatment of panic disorder, The use of Generic Zoloft under the scheme will reduce the frequency of unwanted effects of early treatment, which are typical for panic disorder.
With little effect Generic Zoloft application in patients in a dose of 50 mg / day daily dose can be increased.
Dose should be strengthened at intervals of not more than 1 time per week to a maximum recommended dose is 200 mg / day.
The initial effect may occur within 7 days after the start of treatment, but the full effect is usually achieved within 2-4 weeks.
In a long-term maintenance therapy medication designate the minimum effective dose, which subsequently changed depending on the clinical effect.
In children and adolescents aged 13-17 years, Generic Zoloftom treatment should begin with a dose of 50 mg / day.
In children aged 6-12 years old begin therapy with doses of 25 mg / day, after 1 week it increased to 50 mg / day.
Later, with little effect of the dose can be increased step by 50 mg / day to 200 mg / day as needed.
However, to avoid overdosing, with increasing doses over 50 mg should be taken Generic Zoloft into account the smaller body weight in children than adults.
You may change the dose should be at intervals of not less than 1 week.
In old age, drug use in the same doses as in younger patients.
In patients with liver disorders should use lower doses or increase the interval between taking the medication.
In patients with disorders of kidney function with the correct dose of light manifestation of renal failure is not required.

Generic Zoloft Side Effects

On the part of the central nervous system and peripheral nervous system: headache, dizziness, tremor, insomnia (rare - drowsiness), anxiety, agitation, gipomaniya, delusion, disturbance of gait, visual impairment,
ekstrapiramidnye disorders (diskinezii, akatiziya), paresthesia, convulsions.
Motor violations occurred more frequently in patients with indications for their existence in history or in the concomitant use of antipsychotic funds.
Upon the termination of treatment Generic Zoloftom describe rare cases of development of the syndrome cancel.
May appear paresthesia, gipostezii, symptoms of depression, hallucinations, aggressive reaction, psychomotor agitation, anxiety or psychotic symptoms that are indistinguishable from the core symptoms of the disease.
On the part of the body as a whole: increased sweating, decrease or increase in body mass, weakness.
On the part of the digestive system: decreased appetite (rare - increasing), until anorexia, dry mouth, dispepsicheskie disorders (flatulence, nausea, vomiting, diarrhea), abdominal pain.
On the sexual system: a violation of sexual function (ejaculation delay, reduction of libido, decrease in potency, anorgazmiya).
On the part of the cardiovascular system: reddening of the skin or the tides of blood to the face, bleeding (including nose), palpitation.
Allergic reactions: urticaria, pruritus.
Dermatological reaction: skin rash, rarely - Stevens-Johnson syndrome and epidermal nekroliz.
On the part of the endocrine system: a violation of the menstrual cycle, galaktoreya, giperprolaktinemiya.
From the laboratory performance: transient hyponatremia (typically develops in elderly patients, as well as when receiving diuretics or certain other medications. This side effect associated with the syndrome of inappropriate secretion of hormones antidiureticheskogo), rarely (if long-term use) - the symptomatic improvement of activity of transaminases in serum (lifting of the drug resulted in normalization of enzyme activity).

Generic Zoloft Contraindications

- Pregnancy;
- The period of lactation;
- Children up to age 6 years;
- Hypersensitivity to Generic Zoloft.

Be wary - with organic brain diseases or renal insufficiency, expressed by reduction of body weight.

Generic Zoloft Pregnancy and lactation

Controlled by the application of Generic Zoloft in pregnant women is not, therefore, to appoint Generic Zoloft during pregnancy only if the expected benefits to the mother outweighs the potential risk to the fetus.
Women of reproductive age during treatment Generic Zoloft should use effective methods of contraception.
Generic Zoloft found in breast milk, hence the use of Generic Zoloft in the period of lactation is not recommended.
No reliable data on the safety of its use in this case, no. If the designation of the drug needed, then breastfeeding should be discontinued.

Generic Zoloft Cautions

Generic Zoloft can be used no earlier than 14 days after the lifting. Inhibitors also can be used no earlier than 14 days after lifting Generic Zoloft.
You must be careful while appointing Generic Zoloft with other drugs. Such a joint appointment with the possibility should be excluded, given the likelihood of pharmacodynamic interactions.
With caution should be used Generic Zoloft to the drug, depressing the central nervous system. Use of alcoholic beverages and preparations containing ethanol during treatment Generic Zoloftom prohibited.
The experience of clinical research whose purpose was to determine the optimal time required to transfer patients from receiving other antidepressive and antiobsessivnyh funds for Generic Zoloft is limited.
You must be careful with such a transition, especially with long-acting drugs, such as fluoxetin. The required interval between the cancellation of a selective inhibitor of serotonin and a capture
start receiving a similar drug is not installed.
It should be noted that in patients exposed to Electro-therapy, an adequate and therefore sexperience of Generic Zoloft absent. . ThThe possible success or risk of such combination therapy is not understood.
No experience with the application Generic Zoloft in patients with convulsive syndromehould avoid its use in patients with unstable epilepsy and patients with controlled epilepsy should be carefully observed during treatment.
When a drug seizures should be abolished.
Patients suffering from depression are risk group in relation to suicide attempts. This risk persists until the development of remissionerefore, from the beginning of treatment and to achieve an optimal clinical effect in patients should be constant medical observation.
During clinical studies gipomaniya and mania occurred in about 0.4% of patients receiving Generic Zoloft. Cases activate mania / gipomanii described as a small portion of patients with manic-depressive recipients or other antidepressive antiobsessivnye funds.
Apply Generic Zoloft in patients with liver disease should be with caution, it is necessary to carry out correction of dosing regime.
Use in pediatrics
Safety and effectiveness Generic Zoloft installed with the ROC in children (aged 6 to 17 years).
Impact on ability to driving of vehicles and management mechanisms
Appointment Generic Zoloft are generally not accompanied by a breach of psychomotor functions. However, its use in conjunction with other drugs may lead to a breach of attention and coordination of movements. Therefore, during treatment Generic Zoloftom operate motor vehicles, special equipment or engage in activities associated with increased risk, not recommended.

Overdosage

Severe symptoms of overdose with Generic Zoloft not detected even when using the drug at high doses. However, while the introduction of other drugs or alcohol can be severe poisoning.
Symptoms: serotoninovogo manifestations of the syndrome: nausea, vomiting, drowsiness, tachycardia, agitation, dizziness, psychomotor agitation, diarrhea, increased perspiration, and mioklonus giperrefleksiya.
Treatment: No specific antidotes. Requires intensive maintenance therapy, and constant monitoring of vital functions of the organism. Induce vomiting is not recommended. Introduction of activated charcoal may be more effective than gastric lavage. It is necessary to maintain adequate airway. Do Generic Zoloft large volume of distribution, thus enhancing diuresis, a dialysis gemoperfuzii or blood transfusions may be inconclusive.

Drug interactions

In a joint application Generic Zoloft and pimozida been an increase in levels of pimozida when his single assignment to a low dose (2 mg). Increased levels of pimozida did not involve any changes in the ECG. Since the mechanism of this interaction is not known, but pimozid is a narrow therapeutic index, simultaneous reception pimozida and Generic Zoloft contraindicated.
There are severe complications, while the application Generic Zoloft and MAO inhibitors including selective effect (selegiline) and reversible type of action (moklobemid). Perhaps the development serotoninovogo syndrome: hyperthermia, rigidity, mioklonus, autonomic nervous system lability (rapid fluctuations in the parameters of respiratory and cardiovascular system), changes in mental status, including increased irritability, expressed excitement, confusion, which in some cases may go to state delirioznoe or to whom.
In a joint appointment with warfarin Generic Zoloftom noted a slight but statistically significant increase in prothrombin time - in these cases it is recommended to monitor the prothrombin time at the beginning of treatment Generic Zoloftom and after its repeal.
Pharmacokinetic interaction
Generic Zoloft binds to proteins of blood plasma. It is therefore necessary to take into account the possibility of its interaction with other drugs, have been linked to proteins (eg, diazepam and tolbutamidom).
The simultaneous use of tsimetidinom significantly reduces the clearance Generic Zoloft.
Prolonged treatment Generic Zoloftom dose of 50 mg / day increases the plasma concentration of both drugs in the metabolism which is involved isoenzyme CYP2D6 (tricyclic antidepressants, drugs antiaritmicheskie Class IC - propafenon, flekainid).
Experiments to study the interaction in vitro showed that the ongoing isoenzyme CYP3A3 / 4 betagidroksilirovanie endogenous cortisol, as well as the metabolism of carbamazepine and terfenadina with long-term appointment Generic Zoloft at a dose of 200 mg / day did not change.
The concentration in blood plasma tolbutamida, phenytoin and warfarin in the long-term appointment Generic Zoloft in the same dose also does not change. Thus, one can conclude that Generic Zoloft not inhibits isoenzyme CYP2S9.
However, while receiving Generic Zoloft reduces clearance tolbutamida - requires monitoring of blood glucose.
Generic Zoloft does not affect the concentration of diazepam in serum, suggesting a lack of inhibition of isoenzyme CYP2C19. According to the studies in vitro Generic Zoloft practically did not affect or minimally inhibits isoenzyme CYP1A2.
Pharmacokinetics of lithium does not change with the concomitant introduction Generic Zoloft. However, tremor occurs more often in their joint application. The joint application Generic Zoloft with drugs that affect the serotoninergicheskuyu transfer (eg, lithium), requires increased caution.
When replacing a single inhibitor of neuronal serotonin capture on the other there is no need for a "period of Money." But be careful if you want to change the course of treatment. Avoid joint appointment with tryptophan or fenfluramina Generic Zoloftom.
Generic Zoloft causes minimal induction of liver enzymes. Simultaneous Generic Zoloft appointment at a dose of 200 mg antipyrine and leads to a small (5%), but also significantly reduce antipyrine half.
When coupled with the introduction Generic Zoloft does not alter beta-adrenoblokiruyuschee action atenolol.
When you enter Generic Zoloft in a daily dose of 200 mg drug interactions with glibenklamidom and digoxin have been identified.
Prolonged use of Generic Zoloft at a dose of 200 mg / day does not have a clinically significant effect and did not suppress the metabolism of phenytoin. Despite this, it is recommended to closely monitor the level of phenytoin in the blood plasma of the designation Generic Zoloft and adjusted doses of phenytoin.
There are very few cases of weakness, enhanced tendon reflexes, confusion, anxiety and initiation in patients concurrently taking Generic Zoloft and sumatriptan. Recommended surveillance for patients who have appropriate clinical reason for the simultaneous reception and Generic Zoloft sumatriptana.

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