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Zoloft vs Elavil
Introduction
For patients suffering from major depressive disorder (MDD) or other types of depression, specific drugs can help regulate the mood by adjusting neurotransmitter concentrations in the brain. Zoloft and Elavil are two such medications often prescribed for these conditions. Both affect different neurotransmitters but share a common goal - to stabilize mood and manage depressive symptoms.
Zoloft belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), influencing serotonin levels in the brain. On the contrary, Elavil is part of a group called tricyclic antidepressants (TCAs). It impacts several neurotransmitters, including norepinephrine and serotonin simultaneously, thereby achieving its therapeutic effect.
Zoloft vs Elavil Side By Side
| Attribute | Zoloft | Elavil |
|---|---|---|
| Brand Name | Zoloft | Elavil |
| Contraindications | Should not be taken with or within 5 weeks of using monoamine oxidase (MAO) inhibitors. | Should not be taken with or within 5 weeks of using monoamine oxidase (MAO) inhibitors. |
| Cost | For generic sertraline, costs range from $0.30 to $0.90 per day for dosages of 50 mg/day, or between $0.60 and $1.80 per day for dosages of 100 to 200 mg/day. | For generic amitriptyline, costs start from as low as $0.10/day and not exceeding about $0.60/day. |
| Generic Name | Sertraline | Amitriptyline |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, Serotonin syndrome | Increased thoughts of suicide or hurting oneself, Severe allergic reactions, Cardiac issues |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | 50-200 mg/day | 25-150 mg/day |
What is Zoloft?
Sertraline (the generic name for Zoloft) is a drug of the SSRI class of antidepressants, which marked an important advancement from the first generation of antidepressant drugs known as tricyclic antidepressants (TCAs). Sertraline was approved by the FDA in 1991. Zoloft works by enhancing levels of free serotonin through inhibiting its reuptake, effectively maintaining it in the brain for extended periods. It is prescribed for various forms of depression and other mental health disorders. Zoloft selectively influences serotonin with minimal effects on dopamine and norepinephrine, resulting in fewer side effects than other antidepressants that exert stronger influence on these two neurotransmitters.
On the other hand, Amitriptyline (the generic name for Elavil) belongs to TCAs that were widely used before SSRIs like Sertraline came into being. Unlike SSRIs that target only serotonin, TCAs affect numerous neurotransmitters including norepinephrine and dopamine too leading to a broader range of side effects.
What conditions is Zoloft approved to treat?
Zoloft is approved for the treatment of several mental health conditions:
- Major depressive disorder (MDD), also known as unipolar depression
- Obsessive-compulsive disorder (OCD)
- Panic disorder
- Posttraumatic stress disorder (PTSD)
- Social anxiety disorder
- Premenstrual dysphoric disorder (PMDD)
How does Zoloft help with these illnesses?
Zoloft helps to manage depression by increasing the amount of serotonin available in the synapses of the brain. It accomplishes this by inhibiting its reuptake into neurons, thereby allowing levels to be maintained higher for longer periods of time. Serotonin is a neurotransmitter, a chemical that acts as a messenger in the brain and throughout the body, playing an integral role in mood regulation, cognition, memory formation, sleep patterns and appetite control among other things. It is hypothesized that individuals with depression may have lower levels of serotonin relative to others. Thus, by augmenting serotonin concentration, Zoloft can help mitigate depressive symptoms and assist patients in managing their condition while stabilizing their moods.
On the other hand, Elavil operates slightly differently than Zoloft does; it increases not only serotonin but also norepinephrine concentrations in your brain's synapses. Norepinephrine is another neurotransmitter involved with mood regulation along with attention and alertness so enhancing its availability alongside serotonin can bring about even further positive effects on mood stabilization beyond what increased serotonin alone might achieve.
What is Elavil?
Elavil is a brand name for amitriptyline, an antidepressant that belongs to a class of drugs called tricyclic antidepressants (TCAs). This means it works by increasing the levels of certain chemicals in the brain that help improve mood. It also has an effect on other neurotransmitters like acetylcholine, inhibiting its action at muscarinic receptors. Elavil was first approved by the FDA in 1961. As Elavil is not an SSRI antidepressant, it does not inhibit serotonin reuptake in the same way Zoloft does. Its side-effect profile differs from SSRIs such as Zoloft; specifically, it may cause dizziness and sleepiness but is less likely to cause sexual dysfunction (a common side effect of SSRIs). The effects on various neurotransmitters can be beneficial for treating depression and nerve pain, especially in patients who do not respond well to “typical” SSRI antidepressant drugs such as Zoloft.
What conditions is Elavil approved to treat?
Elavil, also known as amitriptyline, is an established medication that has been approved by the FDA for treating a variety of conditions. These include:
- Major depressive disorder (MDD), where it acts to balance certain chemicals in the brain which can improve mood and feelings of well-being.
- Certain types of nerve pain, specifically neuropathic pain which can occur from various medical conditions such as shingles or diabetes.
It's worth noting that Elavil may be used off-label for other conditions like insomnia and migraines based on your healthcare provider's discretion.
How does Elavil help with these illnesses?
Elavil, also known as amitriptyline, is a tricyclic antidepressant (TCA) that functions by regulating the levels of certain chemicals in the brain to help improve mood. It works by inhibiting the reuptake of serotonin and norepinephrine, thereby increasing their availability in the brain. This makes it a potent treatment for depression and anxiety disorders. Elavil's action on other neurotransmitters such as acetylcholine may also contribute to its effects on mood regulation. While Zoloft primarily alters serotonin levels and falls under selective serotonin reuptake inhibitors (SSRIs), Elavil impacts multiple neurotransmitters making it potentially more effective for patients who do not respond well to typical SSRIs like Zoloft or might be used in combination with them.
How effective are both Zoloft and Elavil?
Both sertraline (Zoloft) and amitriptyline (Elavil) have long-standing records of efficacy in treating depression, with Zoloft being approved by the FDA in 1991 and Elavil way back in 1961. These two drugs belong to different classes; Zoloft is an SSRI while Elavil is a tricyclic antidepressant, hence they act on different neurotransmitters. The effectiveness of both medications was studied directly through a double-blind clinical trial in 2002; they demonstrated similar efficiency when it comes to managing depressive symptoms as well as comparable safety profiles.
In a review conducted in 2016, meta-analysis reports showed that sertraline effectively reduces depressive symptoms starting from the first week of treatment. Its side effect profile is more favorable than many other antidepressants including Elavil which could cause certain cardiovascular issues among other side effects due to its anticholinergic action. Sertraline has become one of the most commonly prescribed antidepressant drugs worldwide due to its tolerability even among elderly and pregnant populations.
Amitriptyline though effective for major depressive disorder, tends to be considered only after or alongside SSRIs or other first-line treatments because it carries considerable risks especially at higher doses such as cardiotoxicity and orthostatic hypotension. Most studies focus on its use along with SSRIs so data confirming its efficacy solely are not as robust compared to that for sertraline. Nonetheless, due to unique pharmacology involving norepinephrine reuptake inhibition which can help with neuropathic pain, amitriptyline might be an ideal choice for patients who didn't respond well enough to SSRIs or those suffering from co-morbid chronic pain conditions.
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At what dose is Zoloft typically prescribed?
Oral dosages of Zoloft range from 50-200 mg/day, but research suggests that a dose of 50 mg/day is generally adequate for treating major depressive disorder in most individuals. Children and adolescents may be started on lower doses, such as 25 mg/day. In either population, dosage can be increased after several weeks if there is no response or insufficient response to treatment. However, the maximum dosage should not exceed 200 mg/day under any circumstances.
Elavil (Amitriptyline) is typically prescribed at dosages between 75-150mg per day for adults suffering from depression. The initial dose often starts at around 75mg per day and can be adjusted based on patient response. It's important to note that Elavil has sedative effects so it's usually taken once a day before bedtime.
At what dose is Elavil typically prescribed?
Elavil treatment typically begins with a dosage of 25-50 mg/day taken orally at bedtime. The dose can then be increased to 150 mg/day, divided into two doses, one in the morning and another at bedtime. If necessary, the maximum daily dosage can reach up to 300 mg, divided into several smaller doses throughout the day. This may be considered if there is no response to treatment after an initial few weeks at a lower dosage level. However, it is important that any changes in medication or dosages are made under close medical supervision.
What are the most common side effects for Zoloft?
Common side effects of Zoloft (sertraline) and Elavil (amitriptyline) include:
- Anxiety, nervousness
- Insomnia or somnolence (sleepiness/drowsiness)
- Asthenia (general weakness and fatigue)
- Tremor
- Nausea, dry mouth, constipation or diarrhea
- Change in appetite or weight
- Decreased libido (sex drive), abnormal ejaculation, impotence
- Sweating
- Blurred vision
Elavil is also known to cause dizziness and confusion in some people. Side effects such as a rash should be reported to your healthcare provider immediately. Both medications can increase the risk of suicidal thoughts, especially during initial treatment or dose changes. If you're experiencing symptoms like sinusitis or pharyngitis while taking these drugs, consult with your doctor for further instructions.
Are there any potential serious side effects for Zoloft?
While both Zoloft and Elavil are used to treat depression, the side effects can differ significantly:
- Increased thoughts about suicide or self-harm: Both medications carry a risk of increasing suicidal thoughts, especially in people under 24. It's crucial to monitor any changes in behavior when starting these medications.
- Allergic reactions: While uncommon, signs of an allergic reaction such as hives, difficulty breathing, and swelling of your face or throat require immediate medical attention.
- Vision changes: Elavil may cause blurred vision or tunnel vision more frequently than Zoloft. If you experience eye pain or swelling, seeing halos around lights with either medication contact your doctor urgently.
- Cardiovascular symptoms: Fast or pounding heartbeats could occur with either drug but are more common with Elavil. Feeling like you might pass out is also a sign that should not be ignored.
- Low sodium levels can occur particularly in older adults on Zoloft - headache, confusion, slurred speech and unsteadiness necessitate prompt medical care.
- Severe nervous system reaction is rare but serious; if you have very stiff muscles high fever sweating confusion fast uneven heartbeats tremors feeling like you might pass out seek help immediately. -Serotonin syndrome: This potentially life-threatening condition could happen with excessive serotonin levels caused by drugs like Zoloft and less commonly by Elavil. Symptoms include agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea.
If any problematic symptoms develop while taking these medicines promptly consult your healthcare provider for advice.
What are the most common side effects for Elavil?
Elavil, also known as Amitriptyline, can have a range of side effects. Some individuals may experience dry mouth, an unpleasant taste in the mouth or changes in appetite and weight. Others could suffer from blurred vision and sensitivity to light. Physical discomforts such as constipation, urinary retention or skin rashes might occur. Elavil may also cause sleep issues including nightmares and insomnia. Psychological symptoms like confusion or delirium are possible especially for older adults while some people might face increased heart rate or palpitations. Headache, dizziness along with muscle weakness and uncoordinated movements can be experienced by some users of this medication.
Are there any potential serious side effects for Elavil?
While Elavil is generally considered safe, it can sometimes cause severe side effects. These may include:
- Symptoms of an allergic reaction such as hives, difficulty breathing, swelling in your face or throat
- Severe skin reactions like a painful rash that spreads and causes blistering and peeling (potentially life-threatening)
- Increased thoughts of suicide or hurting oneself
- Unusual changes in mood or behavior such as feeling agitated, restless, hostile or more depressed
- A sudden severe headache followed by vomiting and dizziness
- Chest pain spreading to the jaw or shoulder with sweating
- Visual disturbances including blurred vision or seeing halos around lights
- Rapid heart rate; irregular heartbeat; palpitations; feeling short of breath
If you experience any of these symptoms while taking Elavil, seek immediate medical attention.
Contraindications for Zoloft and Elavil?
Both Zoloft and Elavil, along with many other antidepressant medications, have the potential to intensify symptoms of depression in certain individuals. If you observe an escalation in your depressive symptoms, or a rise in suicidal thoughts or behaviors, it is imperative that you seek immediate medical assistance.
Neither Zoloft nor Elavil should be taken if you are currently using, or have recently stopped using monoamine oxidase (MAO) inhibitors. Remember to always inform your doctor about all medications that you are taking; MAOIs will need approximately 5 weeks to be fully eliminated from your system to avoid hazardous interactions with both Zoloft and Elavil.
How much do Zoloft and Elavil cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Zoloft (50 mg) averages around $320, which works out to about $10.5–$21/day, depending on your dose.
- The price of 30 tablets of Elavil (50 mg) averages around $70, working out to approximately $2.3/day.
Therefore, if you are in the higher dosage range for Zoloft (i.e., 200 mg/day or higher), then brand-name Elavil is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
For the generic versions of Zoloft (sertraline) and Elavil (amitriptyline), costs are significantly lower:
- Sertraline (50 mg tablets) is available in packs of 30 capsules and above, with approximate costs of $0.30 to $0.90 per day for dosages of 50 mg/day, or between $0.60 and $1.80 per day if you are taking more typical dosages of 100 to 200 mg/day.
- Amitriptyline is available in packs of 30 up to 1000 tablets (50 mg), with the cost to you starting from as low as $0.10/day (if you buy the largest pack upfront), and not exceeding about $0.60/day.
Popularity of Zoloft and Elavil
Sertraline, also known by its brand name Zoloft, was estimated to have been prescribed to about 38.9 million people in the US in 2020. Sertraline accounted for almost 30% of SSRI antidepressant prescriptions in the US. It is considered a selective serotonin reuptake inhibitor (SSRI), which are typically first-line treatment options for depression and anxiety disorders due to their more tolerable side effect profile compared to older classes of antidepressants.
Amitriptyline, often recognized under the brand name Elavil, was prescribed to approximately 12 million Americans in 2020. As a tricyclic antidepressant (TCA), amitriptyline accounts for just over half of TCA prescriptions in the United States, and around 5% of overall antidepressant prescriptions. Despite being older than newer classes like SSRIs or SNRIs, TCAs like amitriptyline continue to be prescribed due their efficacy particularly with certain types of pain such as neuropathic pain.
Conclusion
Both Zoloft (sertraline) and Elavil (amitriptyline) have a proven track record in the treatment of depression, backed by numerous clinical studies suggesting they are more effective than placebo. These medications can sometimes be used concurrently, although this should only be done under careful supervision by a physician due to potential drug interactions. They work differently; Zoloft is a selective serotonin reuptake inhibitor (SSRI), primarily increasing levels of serotonin in the brain, while Elavil is an older tricyclic antidepressant that affects both norepinephrine and serotonin.
Zoloft is typically considered as first-line therapy for depression due to its improved side effect profile over older drugs like Elavil which might serve as an adjunctive or second-line option especially when SSRIs fail or aren't well-tolerated.
Both Zoloft and Elavil are available generically, providing significant cost savings for those paying out-of-pocket. Both may require some time before their full effects are noticed.
Side effects vary between these two drugs: While both are generally well-tolerated, Zoloft tends to cause fewer anticholinergic side effects such as dry mouth and constipation than does Elavil but may lead to gastrointestinal upset or sexual dysfunction. Patients on either medication should closely monitor changes in mood, particularly when beginning treatment, seeking immediate medical attention if depressive symptoms worsen or thoughts of suicide arise.
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Refrences
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- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Preskorn, S. H., & Lane, R. M. (1995, September). Sertraline 50 mg daily: the optimal dose in the treatment of depression. International Clinical Psychopharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/00004850-199510030-00001
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