How does Zoloft affect bipolar disorder?

Mental Health
Zoloft is a type of medication that doctors call a selective serotonin reuptake inhibitor, or SSRI. They may recommend it for mental health conditions, including certain types of bipolar disorder.

There are some side effects to consider before using this drug, however, and some may be cause for concern.

Anyone who is uncertain about their treatment should see a doctor, as there may be alternatives to Zoloft that they may wish to try.

Does Zoloft treat bipolar?

Zoloft in pill bottle for bipolar
A doctor may recommend Zoloft if a person does not respond well to mood stabilizers.

Bipolar causes a person to have episodes of extreme mood, ranging from a low, depressed state to an overly excited, manic state.

Alone, Zoloft is usually not the first line of treatment for bipolar. Doctors typically recommend mood-stabilizing drugs initially, to help balance symptoms of manic or depressive episodes.

Mood stabilizers may include drugs such as:

  • lithium
  • valproate
  • lamotrigine
  • olanzapine
  • quetiapine

These medications are often the first line of treatment for bipolar disorder along with psychotherapy. Many times, these medications alone may be enough to keep symptoms in check.

A review in the journal Bipolar Disorders found that lithium is the most effective singular treatment for bipolar disorder. However, some people may not respond well to the drug or may experience side effects. In other cases, doctors may recommend a second medication.

Zoloft may be a helpful tool in cases where people do not respond well to mood stabilizers, or mood stabilizers are not enough to keep their symptoms in check.

In other cases, mood stabilizers may be unnecessary. For instance, a person with bipolar II may not experience the manic episodes that someone with bipolar I does. People with bipolar II often experience depressive episodes, but then they have very few symptoms of mania, known as hypomania.

In these cases, doctors may recommend a drug such as Zoloft to help alleviate depressive symptoms, which may be enough to help that person function.

A recent study in The American Journal of Psychiatry notes that Zoloft is as effective as lithium or a combination treatment in people with bipolar II. This may mean that some people need less medication to manage their symptoms.


Safety of Zoloft

Zoloft is an SSRI, which may be more common for disorders such as depression and post-traumatic stress disorder. SSRI medications help by boosting the function of specific nerve cells in the brain that use serotonin.

Some people with bipolar disorder may respond well to Zoloft. This may be more common in cases of bipolar II, which does not cause strong episodes of mania but still leads to periods of depression. In these cases, helping to balance symptoms of depression with an SSRI, such as Zoloft, may be all the person needs.

At times, there is concern that taking an SSRI when a person has bipolar disorder may trigger a manic episode. In these cases, doctors will recommend Zoloft or other SSRIs along with mood-stabilizing drugs. This may help reduce the risk of shifting to a manic state while taking the drug.


Side effects of Zoloft

A person may experience indigestion or diarrhea when taking Zoloft.
Indigestion and diarrhea are potential side effects of Zoloft.

Zoloft may cause both short- and long-term side effects. These side effects can vary slightly, and some people will experience more severe ones than others.

Side effects of Zoloft can include issues, such as:

Additionally, people with bipolar disorder who take Zoloft without a mood stabilizer may be more at risk for shifting to a manic episode from taking the drug. This does not mean that people with the disorder should not take the drug, but that they and their doctors should monitor symptoms to help manage the risk.


Rare side effects of Zoloft

Taking Zoloft may also cause more severe side effects in some people, though these side effects are rarer.

Rare side effects of using Zoloft include:

  • bleeding from the gums
  • increased bleeding from simple wounds
  • low sodium levels
  • allergic reaction, including rash, hives, and swelling
  • seizures or convulsions

Younger people who use Zoloft may be more likely to have suicidal thoughts. However, suicidal thoughts are also a symptom of bipolar disorder, so it is important to monitor younger adults, teens, and children on Zoloft and ask about their side effects and ongoing mental health.

Anyone who feels they are struggling with suicidal thoughts or is at risk of harming themselves or others should seek emergency care.

As Zoloft causes the body to continue circulating serotonin, there is also a risk that an individual may develop a life-threatening complication that doctors call serotonin syndrome.

Common side effects of serotonin syndrome include:

  • diarrhea
  • shivering and chills
  • fever
  • severe muscle tightness or spasms
  • confusion
  • seizure

Serotonin syndrome may be more likely if a person combines other medications with Zoloft. It is crucial to discuss all medications and supplements that a person is taking with a doctor before using Zoloft.

When to see a doctor

A person can work with their doctor to create a treatment plan that works for them.
A person can work with their doctor to create a treatment plan for bipolar disorder.

Finding the right treatment for bipolar disorder can take time.

Even after doctors prescribe a medication such as Zoloft, they will want to regularly check back in with the person to monitor how well the treatment or dosage is doing.

As such, anyone using Zoloft for bipolar disorder should be working closely with their doctor to monitor symptoms and gauge their treatment.

Even after doctors find the right combination of medications and therapy to help manage symptoms, regular checkups may help monitor the status of the condition and treatment.

As bipolar disorder is a lifelong illness, people with it should look to their doctor and mental health specialist as a part of their treatment plan. They should feel comfortable discussing their treatment, symptoms, or side effects openly and in detail with their doctor, as doing so may help them find new treatments or dosages to relieve symptoms.

Anyone experiencing lasting side effects that become too difficult should talk to their doctor. There may be treatment options to manage those side effects. In other cases, doctors may recommend a change to a similar medication that may cause fewer side effects.


Alternatives

If Zoloft causes unwanted side effects or does not work to manage symptoms well enough, doctors may recommend another SSRI medication.

Alternatives includes drugs such as:

  • fluoxetine, brand name Prozac
  • sertraline, brand name Zoloft
  • escitalopram, brand name Lexapro
  • citalopram, brand name Celexa
  • paroxetine, brand name Paxil

In some cases, SSRI medications may cause no more benefits than a mood-stabilizing drug on its own. Doctors may want to monitor the person as they use a mood-stabilizing drug alone, and then again as they use an SSRI along with a mood stabilizer to see if the SSRI helps manage symptoms.

Takeaway

While there is no cure for bipolar disorder, Zoloft offers a potential solution for many people to help manage the symptoms they experience during depressive episodes. However, the drug is not for everyone.

Anyone who notices their symptoms do not respond to Zoloft, or who experiences particularly strong side effects should talk to their doctor about an alternative.

Patience is important, as it takes time for antidepressant drugs to start working. It may be a few weeks before a person taking Zoloft notices their symptoms getting better.

It may also take time to find the best treatment in each case. With that said, most people can find an appropriate treatment by working directly with a doctor and mental health specialist.

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