Sertraline Positives and Negatives

I was on Sertraline for over ten years and it helped me a great deal in coping with everyday anxiety, but I also noticed that it made me okay with things that were not okay. For example, I made some rather dubious life choices while on sertraline and just did not give them the proper gravity because my emotions were dulled. I also put up with some truly awful behavior from toxic people around me and was very complacent in dealing with things like planning for the future. I really noticed the difference because I had to go off it/adjust doses a couple of times.

I got off it completely about a year and half ago and I am truly appalled at a lot of the things I did/didn't do. I've done some pretty serious damage to my life because I was too comfortable in situations that should have made me uncomfortable. I was too happy to go with the flow when I should have been being proactive.

I'm not saying that I didn't need it at times because it certainly helped in some cases and probably saved me from suicide at one point, but I wonder if long term use is always the best idea. I feel like a more tempered approach would have benefited me so much more. Sometimes we need to be uncomfortable with a situation so we can act to change it.

I'd love to hear if anyone else has experienced anything similar.

First time I had a 4 month or so stint on sertraline (Zoloft) when I was having a bit of a crisis, I was okay on it, very chilled like you described. I was only ever meant to be on it short term though, my GP specifically told me she didn’t want me on it longer than 6 months. So I tapered off, that felt a bit weird as I remember, I got some odd symptoms.

A few years later, stressed out at the start of the pandemic working in food retail and dealing with all sorts I asked for sertraline again but this time I wasn’t well on it at all, it really disagreed with me for some reason, I took it a week at most then came off. No idea why.

I see what you mean about sertraline making you okay with situations you shouldn’t have been okay with. I felt like I had emotional blunting on it, I wasn’t sad but I wasn’t happy either. There’s a lot being said about the so called efficacy of antidepressants, and the side effects too.

They have their place, but definitely need to be monitored and used less liberally . My first doctor required a therapist to okay their use and monitor me. My second doctor just kept renewing my script and would just ask a couple of basic mood questions once a year. Coming off of it wasn't easy. Lots of dizziness/lightheadedness and some panic attacks. It took about three months of slow decrease to get off of them and another three for my mood to level off. Then came a lot of anger at some of the choices/situations I had been tolerating realizing I had just been glossing over parts of my life.

There's such a balance sometimes. You can't function if you're overwhelmed, but a little discomfort pushes you to deal with actual problems.

SSRIs and SNRIs in general tend to blunt your emotions. It's a result of increased serotonin levels and downregulated 5-HT2A/5-HT2C receptors, I believe. Serotonin and dopamine have an inverse relationship to each other's levels--when one goes up, the other goes down. Decreased dopamine and increased serotonin is what causes this blunted affect.

Of the SSRIs, both sertraline and fluoxetine are supposed to be least likely to cause this, but it still happens. Just not as badly as with citalopram or escitalopram. The SNRIs also tend not to cause this effect as badly, because norepinephrine reuptake inhibition increases dopamine in the prefrontal cortex. However, most SNRIs are more potent for serotonin reuptake inhibition over norepinephrine reuptake inhibition except for Fetzima (levomilnacipran).

Sometimes bupropion is added to SSRIs/SNRIs to combat this as well as other side effects (such as weight gain, sexual dysfunction, etc.), but bupropion can increase anxiety in some susceptible individuals, so it's not for everyone. Stimulants are an option to add on, but most doctors as wary of doing this.

The serotonin modulators and reuptake inhibitors, Viibryd and Trintellix, also supposedly have less of an impact on emotional "vibrancy." This is because they're both 5-HT1A partial agonists, which causes downstream dopamine release. Trintellix has additional mechanisms of action, such as 5-HT1B partial agonism, 5-HT1D antagonism, 5-HT3 antagonism, and 5-HT7 antagonism, which enhances the release of various neurotransmitters, including acetylcholine and histamine, which have a vigilance-promoting effect and pro-cognitive effect. But Trintellix and Viibryd are also not without their side effects, especially gastrointestinal side effects.

I wish you all the best in finding something that works for you!