# why does Zoloft help some with SA?



## saosin80 (Sep 15, 2009)

As far as I know Zoloft only works on Serotonin. For SA benefits I thought a raise in dopamine is what we want. Doing some research it seems a lot of people are helped tremendously from Zoloft but others find no benefit whatsoever. How would in increase in serotonin help some people with SA?? My doc just prescribed me Zoloft for anxiety/social anxiety. Finding it hard to believe it will benefit me in any way...


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## crayzyMed (Nov 2, 2006)

By quieting the amygdala but indeed the succes rate for social anxiety is rather low...


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## Iwillovercomeanxiety1 (Aug 23, 2010)

It actually does work on dopamine. It's a dopamine reputake inhibitor... I'm taking it right now and I've noticed that it is more stimulating and does not cause some of the cognitive slowing that some other SSRI's do.

*Mechanism of action*

Sertraline is primarily a serotonin reuptake inhibitor (SRI), with a Ki=3.4 nM. Therapeutic doses of sertraline (50-200 mg/day) taken by patients for four weeks resulted in 80-90% inhibition of serotonin transporter (SERT) in striatum as measured by positron emission tomography. A daily 9 mg dose was sufficient to inhibit 50% of SERT.[151]
Sertraline is also a dopamine reuptake inhibitor, with a Ki=260 nM,[152] a σ1 receptor agonist with 5% of its SRI potency,[153] and an α1-adrenoreceptor antagonist with 1-10% of its SRI potency.[154] However, though confirming sertraline's high affinity for σ1 receptors, different studies suggest that the drug actually behaves as an antagonist at those.[155]

http://en.wikipedia.org/wiki/Sertraline#cite_note-Hashimoto-154

http://en.wikipedia.org/wiki/Sertraline#cite_note-Hashimoto-154


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## saosin80 (Sep 15, 2009)

Iwillovercomeanxiety1 said:


> It actually does work on dopamine. It's a dopamine reputake inhibitor... I'm taking it right now and I've noticed that it is more stimulating and does not cause some of the cognitive slowing that some other SSRI's do.
> 
> *Mechanism of action*
> 
> ...


has it been helping your SA then? And if so what dosage are you on? I've just started out on 25mg. Don't feel a thing after a week on it


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## areq1987 (Jul 10, 2010)

For me Zoloft worked a little for SA, Paxil (paroxetine) works the best.


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## wjc75225 (Jul 24, 2010)

I guess they work for some. I've been on most SSRI's/SNRI's (excluding Cymbalta and Celexa). All of them made me feel emotionally numb/more depressed and tired all of the time. They didn't do anything for SA for me. Now, I'm on an MAOI + Benzo, and they've at least cleared up the physical symptoms. I would get BAD muscle tension from anxiety. My parents thought I just needed to go get a massage lol. I think the Klonopin is somewhat of a muscle relaxant. Also, the MAOI doesn't make me feel emotionally numb. I can still have my happy moments =]. I still need to work on taking the initiative to talk to people, but at least it's taken away the nervousness for now. It's too bad MAOI's aren't prescribed more .. I've been on Nardil for about a month (It didn't even take much convincing), and I haven't had a bad reaction, yet. I haven't even totally been paying attention to the food list. I've just been staying from any allergy/cold medicine. Sorry, I didn't mean to hijack your post .. I was just giving my opinion/experience to it all!


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## sadeyes (Aug 22, 2010)

Zoloft calms me, however, over time I realized it didn't "cure" my social anxiety, and I couldn't just rely on a drug. I needed to change my thought patterns. (See Cognitive Behaviour Therapy). For me the drug only helped to calm my anxious mind enough to be able to think of alternative thinking. I still needed to practice my rethinking training (for a lack of a better term).


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## wjc75225 (Jul 24, 2010)

sadeyes said:


> Zoloft calms me, however, over time I realized it didn't "cure" my social anxiety, and I couldn't just rely on a drug. I needed to change my thought patterns. (See Cognitive Behaviour Therapy). For me the drug only helped to calm my anxious mind enough to be able to think of alternative thinking. I still needed to practice my rethinking training (for a lack of a better term).


Ya, medicine alone won't really help. CBT and exposure therapy need to be added, in my opinion. However, medicine does help you concentrate more on the irrational thoughts you're having, so I use both.


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## Iwillovercomeanxiety1 (Aug 23, 2010)

saosin80 said:


> has it been helping your SA then? And if so what dosage are you on? I've just started out on 25mg. Don't feel a thing after a week on it


I'm on the highest dosage 200 mg. It helps but it hasn't cured me or anything. You should do more to help yourself out other than take zoloft. Exercise, relaxation, CBT, ACT therapy, vitamins and supplements can help, and then you can always add other meds to zoloft as an augmenting strategy. There is a lot that you can do to help yourself.


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## UltraShy (Nov 8, 2003)

Clinical trial data will often look something like this:

Percentage improved on each substance:

Actual drug 70% displayed improvement
Placebo 35% displayed improvement

Despite this reality, you'll never hear a drug boasting "We help twice as many folks as a sugar pill!" The placebo effect is VERY strong. In one study researchers got volunteers acting as if they were high as a kite, stoned out of their minds on what they believed to be pot. What they were actually smoking, has as much mind-altering effect as your lawn clippings. Vivid illustration of how powerful the mind is, giving you the effect you expect.

Now, trials are almost always "double-blind" to avoid bias. That means that neither patient nor doctor conducting the trial knows if one is getting the real drug or not. Blind they certainly are not. In 2001 I participated in a clinical trial testing Effexor against Paxil & placebo. After 8 days of taking a grey mystery capsule that could have been any of the above, I found that I could not orgasm. Obviously, the blindfold was totally off then, since sugar pills damn well don't prevent orgasm! Double-blind is impossible unless you're testing a drug that has basically no side effects, otherwise it's obvious if you're getting the real thing. Knowing you're getting the real drug and thinking that drug will help, clearly will significantly bias a study. Just like college kids who can get stoned on lawn clippings if they belive it's pot.


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## mike8803 (Feb 21, 2010)

I took zoloft at the max dose, i didn't even realize I was on medication. =\


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## crayzyMed (Nov 2, 2006)

Its activity on dopamine is neglible, its not any better then all the other SSRI's.


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## bazinga (Jun 9, 2010)

Because with social anxiety there can be some obsessive thinking. Negative thought patterns that are repetitive. SSRI can help to lower your concern and/or reduce these types of thought behaviors thus reducing the stress you feel about it.


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## wjc75225 (Jul 24, 2010)

bazinga said:


> Because with social anxiety there can be some obsessive thinking. Negative thought patterns that are repetitive. SSRI can help to lower your concern and/or reduce these types of thought behaviors thus reducing the stress you feel about it.


Ya, I have a feeling that my SA is compounded by my OCD. It's all of the repetitive thinking that can eat at you. However, my OCD isn't that huge of a problem anymore. When I was a kid, it used to be the whole hand washing, checking locks, etc. Now, it's mainly repetitious thoughts.


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## Rbk (Aug 5, 2010)

For me sertraline is acting in some way different than paroxetine. I think it can be related to dopamine.

And the thing which should be noticed is that sertraline is working for me on concentration and motivation but only on the beginning. When I take it for a longer period of time it is acting later like normal SSRI. I'm not sure what to think about that.


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## Rbk (Aug 5, 2010)

Say what do You want, but I'm pretty sure that sertraline IS working on dopamine even on 50mg dose. I feel it - that concrentation.

I found this. Read it guys 

http://jop.sagepub.com/content/16/3/207.abstract


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## wjc75225 (Jul 24, 2010)

Rbk said:


> Say what do You want, but I'm pretty sure that sertraline IS working on dopamine even on 50mg dose. I feel it - that concrentation.
> 
> I found this. Read it guys
> 
> http://jop.sagepub.com/content/16/3/207.abstract


It never increased my concentration, but I guess it's possible. Psychiatry isn't an exact science, and we still don't know all of the effects/modes of action of all of these medicines.


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## Edwin (Jun 19, 2008)

Sertraline only motivates in the beginning, because dopamine re-uptake is useful right away, while serotonin re-uptake has to deal with auto-receptors before it works. The usefulness of the dopamine re-uptake is then offset by the increase in serotonin-activity, which tends to lower dopamine transmission in certain areas. If you suffer from ADD (which is quite likely if you have motivation problems and SA), I wouldn't recommend more than a small dose when you're not taking stimulant medication. I myself couldn't tolerate more than 25mg.

Fluoxetine also increases DA and NE release btw, but this will also be offset by serotonin after several weeks. The highest dose I could tolerate of Fluoxetine is 20mg. I recommend not using any other SSRI when suffering from dopamine dysfunction.

If you take stimulant medication you might be able to tolerate other SSRI's or higher doses of Fluoxetine/ Sertraline.


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## jim_morrison (Aug 17, 2008)

Yeah it's interesting, SSRI's seem to work well for some people's SA, yet don't seem to work at all for others :stu.

Statistically speaking though Zoloft's remission rate for SA doesn't seem to be that different from any other SSRI, so I don't think it's weak DRI effects are of much relevance.


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## Canadian4Life (Sep 27, 2010)

Edwin said:


> Sertraline only motivates in the beginning, because dopamine re-uptake is useful right away, while serotonin re-uptake has to deal with auto-receptors before it works. The usefulness of the dopamine re-uptake is then offset by the increase in serotonin-activity, which tends to lower dopamine transmission in certain areas. If you suffer from ADD (which is quite likely if you have motivation problems and SA), I wouldn't recommend more than a small dose when you're not taking stimulant medication. I myself couldn't tolerate more than 25mg.
> 
> Fluoxetine also increases DA and NE release btw, but this will also be offset by serotonin after several weeks. The highest dose I could tolerate of Fluoxetine is 20mg. I recommend not using any other SSRI when suffering from dopamine dysfunction.
> 
> If you take stimulant medication you might be able to tolerate other SSRI's or higher doses of Fluoxetine/ Sertraline.


This was exactly what my case was. I took a few ssri's and they did nothing but give me side effects. I was diagnosed adhd and put on ritalin a few years back and just started on zoloft again (2nd time) but I can feel some amazing effects after just 2 weeks. If you have underlying adhd then antidepressants can make it worse if not treated.


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## Canadian4Life (Sep 27, 2010)

crayzyMed said:


> Its activity on dopamine is neglible, its not any better then all the other SSRI's.


Have to disagree with you most definetly on that one. I was on paxil,celexa,effexor,paxil,remeron, and they all made me feel worse, dull with no ambition or feelings of self worth. I take ritalin too a dopamine reuptake inhibitor and it's effect were almost totally overpowered by moderate doses of any ssri and the loss of self confidence, drive and major cognitive dysfunction made ssri's untolerable for me and most ramped up my anxiety oddly. I was off of antidepressants for a year and a half and the negative effects they had on me made me worse. I decided to try zoloft as a last attempt (also reading that it has cognitive boosting effects unlike ANY of the other ssri's because of it's dopamine reuptake inhibition properties) about 14 weeks ago. Was on 50mg up until 4 days ago and now on 62.5 mg a day. It is the ONLY ssri that I can take that will not kill the control ritalin gives me over my hyperness and any focus problems. It actually augments the cognitive boost pretty significant. On days off my ritalin I find that focusing and keeping on task is a whole lot easier than it ever was. The feelings of self confidence and self worth help me have alot more drive in my life. I am focused and zoloft does for me what I would think a med should. It's effects on dopamine seem very significant to me.


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## leon21 (Nov 8, 2009)

crayzyMed said:


> Its activity on dopamine is neglible, its not any better then all the other SSRI's.


That`s not true, Wes

http://www.ncbi.nlm.nih.gov/pubmed/20816814

http://www.preskorn.com/books/ssri_s3.html

http://www.psychotropical.com/SSRIs_Sertraline.shtml

(less means more):
------------------------------------------
Compound: SERT; NET; DAT;
------------------------------------------
Citalopram (Celexa): 1.8; 6100; *40000*;
Fluoxetine (Prozac): 6.8; 370; *5000*;
Sertraline (Zoloft) : 3.4; 220; *260*;
------------------------------------------
Desvenlafaxine (Pristiq): 40.2; 558.4; ?
Duloxetine (Cymbalta): 0.8; 7.5; 240
Venlafaxine (Effexor): 82; 2480; ?
------------------------------------------
SERT = Serotonin Transporter
NET = Norepinephrine Transporter
DAT = Dopamine Transporter
------------------------------------------


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## Rbk (Aug 5, 2010)

Like I said before - I feel dopaminergic effects of sertraline mainly in first days of taking the drug. Later, it is just matter of not impairing concentration etc. I can only compare it to paroxetine(from SSRIs) as I haven't taked any other SSRI and differences are strong - paroxetine is generating some kind of strong tension which leads me to smoking cigarettes and drinking alcohol. But on the other hand paroxetine is working much better for me on generalised anxiety, stupid thoughts and mood.

Of course - these are only my experiences.


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## crayzyMed (Nov 2, 2006)

leon21 said:


> That`s not true, Wes
> 
> http://www.ncbi.nlm.nih.gov/pubmed/20816814
> 
> ...


Interesting, the first study does show significant effects on dopamine, however ritalin seems pretty useless for SA, which has more potent effects on dopamine wich would explain why its not superior for SA, however it can be better for folks that have ADHD.


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## Rbk (Aug 5, 2010)

I'm wondering... What drug can act in this way like sertraline in first days? Probably some dopaminergic. Ehh.


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## Canadian4Life (Sep 27, 2010)

Sertraline augmented with low dose ritalin is a potent combo for SA, depression, motivation and drive. Even 5mg of ritalin three times a day with your sertraline will make a HUGE difference. The effects on dopamine sertraline has is majorly enhanced by ritalin even in very low doses. This combo (to me) would make a very potent antidepressant and effective social anxiety medication. The anti-social effects of ritalin are caused by it's adrenic properties and taken WITH sertraline they are gone and you get a dopamine boost. Two very synergystic meds


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## TheFinest12 (Jan 26, 2012)

*Sad*

I don't know what the hell you guys are talking about. Why is this even a topic? It has been proven by the FDA that zoloft is a cure for SAD. I also know this from experience my SA is completely cured from zoloft. I don't know why you all think your doctors on here, granted some of you may be but most of you just copy and paste info on this drug from another website. And for the reviews don't write a negative review about zoloft for SAD if you were not prescribed to it for that reason, if you were prescribed for depression you are not gonna see the same results for SA as someone who gets prescribed for that reason alone.


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## InterestinglyInteresting (May 7, 2010)

While dopamine is important in mood, it may be more about motivation. It isn't quite clear ye t but dopamine may be more about motivation and opioids more about pleasure. serotonin is more like that chilled out satisfied feeling at least when it activates the right receptors and downregulates the wrong ones. But anyway ssris may indeed sensitize the dopamine receptors in the mesolimbic tract over time, perhaps that works too well in some ppl and why they get manic


and amphetamines work for sa prolly because they boost dopamine in the pleasure/motivation regions which is an even shorter bandaid solution than ssris, also if you accidentally boost dopamine too much in your frontal lobes (like chronic ritalin) you may feel like **** and start obsessing about things. so be careful. 

on a side note ask your doc about an ssri + stim combo


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## Edwin (Jun 19, 2008)

Because of Zolofts dopamine reuptake properties, I've always considered it my favourite. I have just gotten back on after trying Prozac for more than 7 months (largely useless for SA). I couldn't tolerate Zoloft the first time I took it (higher than 25 mg made me lethargic), but I've had no trouble getting to 100mg this time around.

I combine it with Rhodiola Rosea for some synergistic effects.


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## barry1685 (May 25, 2011)

Ritalin works best for my SA, makes me want to talk because talking gives me pleasure in it. Ssris stop my obsessive thinking and makes me not worry and give a ****. It makes things acceptable. What helps even more than ssris is opiums. They make me numb to people and numb to everything. I can go out in the freezing cold and clean my car with not a care in the world.


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## baranok (Nov 17, 2011)

I think dopamine isn't THAT much important as some think in my opinion.

I think what creates our problems is called Amygdala hijack
this may create irrational fears as it literally skips your logical thinking.

medicine that would be inhibitor of this hijacking could be more useful than SSRI and other AD's, but dunno if our science is so far in selectivity in brain (and perhaps mainly negative hijacking)

what do you think??


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## Inshallah (May 11, 2011)

I agree dopamine is not important at all, rather the contrary. A lot of adhd'ers manage to get social anxiety or psychosis from being on stimulants non-stop whereas they didn't have it before. It will give you an extra push to actually talk, might be a good choice for depression, ... but that is not a (direct) effect on someone's social anxiety.


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## Edwin (Jun 19, 2008)

Inshallah said:


> I agree dopamine is not important at all, rather the contrary. A lot of adhd'ers manage to get social anxiety or psychosis from being on stimulants non-stop whereas they didn't have it before. It will give you an extra push to actually talk, might be a good choice for depression, ... but that is not a (direct) effect on someone's social anxiety.


Yes but it's very hard to find pure dopamine-acting stimulants. All regularly used stimulants for ADD/ADHD also act (almost equally) on norepinephrine, which has always been anxiety provoking for me.

Sertraline has more dopamine activity than norepinephrine activity, and is mostly an SSRI - this makes it so useful.


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## Inshallah (May 11, 2011)

Edwin said:


> Yes but it's very hard to find pure dopamine-acting stimulants. All regularly used stimulants for ADD/ADHD also act (almost equally) on norepinephrine, which has always been anxiety provoking for me.
> 
> Sertraline has more dopamine activity than norepinephrine activity, and is mostly an SSRI - this makes it so useful.


How would more dopamine, which is clearly linked to compulsive thinking, help extreme compulsive thinkers such as... us? :teeth It may help you go out there and interact with other people, which will help your social anxiety. But that would have also helped your SA if you did exactly that without taking a dopamine booster.


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