bgrar - Something to remember when reading product monographs (or any drug information distributed by a drug company) is that the give too much detail. Most mental health professionals realize this, so take info they receive from drug companies with a grain of salt.

So, I see drug monographs as "lawyer documents, written by lawyers, for lawyers".

The side effects listed for most serotonergic antidepressant (SSRIs - like Paxil [paroxetine] and Zoloft [sertraline]) are what I call "start-up" side effects. These side-effects (eg. headache, nausea, anxiety, etc.) are present when you first start taking the drug, but they usually fade and disappear within two weeks to a month after reaching your target dose.

Many times a doc will start by prescribing a lower dose of an SSRI and slowly increase the dose (weekly or twice weekly increases) in order to minimize these initial start-up side effects.

These side effects appear because many times when a person is "depressed" they often have lower than normal levels of serotonin in their brain (the amount of serotonin is "depressed". Serotonin is one of several neurotransmitters in the brain.

Electrical signals run the length of nerve cells (aka neurons), but an electrical signal cannot jump from one neuron to another or it would cause an arc of electricity which would literally fry the neurons (which I guess we could call true "burn-out"). Instead neurons release packets of neurotransmitters into the gap (aka synapse) between the two neurons. If enough of the neurotransmitters bind to receptors on the cell wall of the adjacent, this cause the second neuron to fire and the electrical signal is carried on.

There are literally 100s of different neurotransmitters in the brain, many which have not yet been discovered. When there is a lower than normal concentration of a major neurotransmitter (eg. serotonin, dopamine, GABA, norepinephrine) in the brain, other neurotransmitters will modify their amounts to try to compensate for the lack of the original neurotransmitter.

In other words, in many cases of depression there is a lack of serotonin in the brain. Other neurotransmitters (eg. esp. dopamine and norepinephrine) will increase or decrease their concentrations in certain sites in the brain, trying to compensate for the lack of serotonin. This modification of neurotransmitter concentrations do not fully compensate for the lack of serotonin and the symptoms that result from this incomplete compensation are what we call depression.

This is not the complete story as the body also modifies the number &/or sensitivity of the receptors situated on adjacent neurons, again trying to normalize the flow of electrical signals in the brain. There are other changes such as down regulation of beta-receptors which affect brain activity, but I cannot go into detail because it will just confuse you (heck, it still confuses me very much). The actual mechanism by which antidepressants resolve depressive symptoms is not yet known.

I do not believe that "abnormal" levels of neurotransmitters "cause" depression, but are only a symptom of depression themselves. We do not yet know what physiological changes actual cause depression, but when we artificially increase serotonin (or norepinephrine, or ...) concentrations in the brain, sometimes this alleviates the depressive symptoms.

Antidepressants do not "cure" depression; they only diminish or resolve depressive symptoms. To truly resolve depression one must confront their personal problems that led to the depression in the first place. Antidepressants resolve depressive symptoms, allowing the person to work out their problem. This is usually done through counseling, be it from a psychologist, clergy, or even talking it out with a friend. In a sense, antidepressants are only a bandage over a wound (ie depression); they only give you the energy and ability to function in society (rather than hide under the covers all day).

BTW, you should take Zoloft with food. This will not only decrease any stomach upset and nausea, but it also forces more or the intact drug into your blood stream.

I know that this is really long-winded, but read through it a couple times and ask me to clarify anything that you do not understand. I will not be online again until Sunday.

I hope that this is of some help. - Cam

P.S. Bear with spelling mistakes, etc. as I am using an IBM laptop with using Windows and AOL [Arrrrrggghhh!!!]. MACs are so much more user friendly; and what's with this silly flat mouse with left and right clickers placed where your thumbs rest..... [DOH!!]