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The question was submitted 14/11/2005

Subject: Afraid of weaning off Zoloft

I have had about 4 severe bouts of depression in my life, the first depression being 16yrs old. Two of those episodes have been untreated and I suspect that the depression had not really gone away completely between the episodes of more severe depression. I am now 38 and have been on Zoloft 150mg daily for about 2 yrs now. It was discovered recently with my psychologist, that I have PTSD which was triggered by some extremely distressing events occuring between 15 - 18yrs old. Late last year I dropped down to 100mg of Zoloft daily due to the expense and within a couple of months of dropping down, became very depressed again. Since I've been on Zoloft, I have become calmer, the mood swings have disappeared, feel more confident and much happier than I have ever been in my whole life. My husband has noticed an enormous change for the good and it has helped me to look after my children in a calmer and positive way. I do find that my stress threshold is very low which I am aware of and it doesn't take much to tip me over the edge. My 7yr old son has ADHD and generalised anxiety and I find that some of his problems cause me quite some stress. I am wanting to know if it is safe to continue on Zoloft and also I am so terrified of coming off it due to the *enormous* positive changes the medication has provided over the last 2yrs. I don't want to ever go back to the way I had been for so many years, I couldn't bear it. Could there have been some permanent chemical changes in my brain from the PTSD or from the ongoing depression since my teens untreated (unrecognised)?

Answer from DepNet

Thanks for your question. It certainly sounds like you have walked a long road with your illness and have done very well on treatment.

I am not sure why or if you are considering stopping your treatment but this is certainly not something that should be done without the full support and advice of your doctor.

The length of time one is kept on an antidepressant is dependant on many things including your diagnosis, co-existing diagnoses, how many episodes of depression you have had, response to treatment, ongoing stressors etc. In your case, for example, having a child with an anxiety disorder and ADHD is obviously an ongoing stressor for you and this may affect your response to treatment. In addition, a previous attempt to lower the dose of your antidepressant resulted in a relapse of your symptoms. These are some aspects your doctor will consider when he/she thinks of stopping or altering your medication.

The safety of antidepressants in the long term is a question many patients are concerned about. There are many people who are kept on their medications indefinitely, especially those people who have had multiple depressive episodes. Unfortunately society has not really embraced the concept of depression as a chronic illness, however, for some people it is just as chronic and has just as much associated morbidity as does any chronic physical illness e.g. diabetes or hypertension. Certainly untreated and severe depression can even be fatal in some instances.

The long term safety of your particular medication is an issue you should discuss with your doctor. In addition, the manufacturer of your medication may be able to provide you or your doctor with details of any studies they have done measuring safety and efficacy in the long term.

There seems to be no doubt that mood disorders and anxiety disorders run in families and hence a genetic vulnerability exists. The question of undiagnosed depression causing ‘permanent chemical changes or damage’ to the brain is an ongoing debate. Some authors believe that some areas of the brain are in fact altered by failure to treat depression; however this has not been unequivocally proven and more studies are needed in this area.

Genetics and physiology aside, the most valuable thing for you to consider is how you are clinically and how you have responded to your treatment. For some people, even the thought of stopping their medication causes increased anxiety and stress.

Please do talk about this further with your doctor.

We wish you everything of the best.

The answer was published on DepNet 17/11/2005