November 23rd, 2010
09:24 AM ET

Could emotional withdrawal be side effect of new med?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Tuesdays, it's Dr. Charles Raison, an associate professor of psychiatry and behavioral sciences at Emory University, and an expert in the mind-body connection for health.

Question asked by Lisa, Pennsylvania

My daughter started taking Zoloft for anxiety two weeks ago and since then, she has gone from talking to me every day to not speaking to me for days. We were very close, and now she gives me the cold shoulder. Her response is she doesn't want to talk and she is depressed. She has more or less cut herself off from her family. Is this a side effect?

Expert answer

Dear Lisa,

The short answer to your question is anything is possible when one starts a new medication, so it is possible that the Zoloft (sertraline) is affecting her behavior in the way you describe. It is also quite possible that her depression is worsening, leading to her increased withdrawal. Two weeks is not enough time for the medication to be anywhere near fully effective, so it is quite possible that her depression could have worsened on its own.

Let's talk a little more about potential bad effects that people sometimes experience when they first start an antidepressant such as Zoloft.

Common initial side effects are nausea, sleep disturbance, anxiety and loss of sexual desire. Nausea usually improves; the other side effects tend to persist to one degree or another. While troublesome, these side effects are not dangerous.

Every once in a while, a person will have a more concerning initial reaction to an antidepressant. Studies suggest that rarely people younger than 25 will have an increase in suicidal thinking when they start an antidepressant compared with starting a placebo. Why this happens is unknown.

Serotonin antidepressants such as Zoloft are known to agitate some people, and this has been seen as a culprit. Antidepressants appear capable of inducing mania in vulnerable individuals, and many of us think this probably also helps explain why life-saving drugs such as antidepressants can very occasionally go sour.

Many studies show that antidepressants are lifesavers. Overall, they decrease suicide in depressed individuals, so I don't want to leave you with a sense that I am down on medications for depression - far from it. But I do monitor people carefully whenever I start them on a new medication.

In the case of your daughter, let me strongly recommend you get in contact with her - don't wait for her to get in contact with you. I'd talk to her directly about the withdrawal and see whether it something specific to you or whether something else is going on.

If she is feeling more depressed or has thoughts of hurting herself or if she is agitated and not sleeping, I'd get her to her clinician immediately for additional evaluation.

soundoff (24 Responses)
  1. Scott Miller

    This is a very common side effect of anti-depressants and would get your daughter off of it. I don't know your situation so that's just my opinion. All i do know is that ssri's messed me up big time.

    November 23, 2010 at 11:52 | Report abuse | Reply
    • Bethany

      I was on about 15 diffrent AD med's over the years I am Bipolar and they all made me worse some had horrible side effects you have to be careful with medications always use your head

      November 24, 2010 at 00:47 | Report abuse |
  2. CalgarySandy

    Different antidepressants cause different reactions and different people experience them differently. These kind of drugs should always be monitored carefully. Don't accept generalizations about them. Most doctors now realize that it does not take 6 weeks to experience some improvement. If they are going to work they tend to work within a couple of weeks. I have been given many different kinds over the years.

    Zoloft stripped all my energy away without making the depression better. I was falling asleep at my desk at work. It was like putting depression on top of depression.

    Many antidepressants cause anxiety; which is worse in my opinion than the depression. If this girl is co-morbid; that is, has more than one mental health challenge; it will be difficult to find the right drug to treat all of it or to find a cornucopia of drugs.

    Make sure you have a doctor that is current on these medications. I went through horrendous withdrawal from Effexor twice and had my psychiatrist say that this was not possible. It is now widely accepted even though patients have complained about it for years. If you are put on a high dose too fast the same kind of horrible experience will occur. Again, I was told this was not happening and I ended up committing myself. Go up on them slowly and come down off them slowly.

    I do hope this young woman finds something that works. I am glad to see her Mom is not hiding her child from the world out of shame but is actively trying to find help. It is important that the young lady is not left alone even if she does not feel like talking. Do things together and enjoy them even if she is not talking. Just be there so she does not feel the whole world is against her. It is a hard road and one no one should have to walk alone.

    November 23, 2010 at 13:53 | Report abuse | Reply
    • David

      SNRIs can devastate someone and getting a pharmaceutical interest to admit it is next to impossible. Effexor is one of the most destructive as it's stripping away of the mind's coping mechanism seems to be semi-permanent if the patient has been on them for more than a few months. Most of the primary health care groups and teams in Canada are virtually swamped with Pharm reps pushing cases full of samples monthly and then giving "free" seminars describing how wonderful and gentle this drug will seem to the doctors' new patients. I have even seen a Pfizer rep start to suggest that Effexor might even be indicated in rare mildly depressive patients , she was evicted and Pfizer was only allowed back in when assurances were given that this would never happen again. Money wins out most of the time but I am glad to see that you are trying to help your daughter , Lisa. This is what separates a dedicated parent from just a genetically linked pair of people.

      November 23, 2010 at 22:10 | Report abuse |
  3. Bob

    Be careful if she decides to stop taking this medications.. Withdrawel from AD's are a real problem that is not recognized as serious by Drs. Also be aware of the increase of suicidal thoughts and behaviors associated with Anti-depressants esp with teenagers..

    November 23, 2010 at 14:24 | Report abuse | Reply
  4. Scott

    Dr. Raison received $35,000 from Eli lilly in 2009. http://projects.propublica.org/docdollars/search?term=raison&state%5Bid%5D=

    November 23, 2010 at 15:33 | Report abuse | Reply
    • Veganman

      So he will tell my that it's perfectly safe to stop Cymbalta and NOT warn me about the seizures or A Fib heart spasms that have left me hospitalized.

      Most Dr.'s don't bite the hand that feeds them.

      Google "Cymbalta withdrawal" to learn more. It's becoming an epidemic.

      November 23, 2010 at 17:31 | Report abuse |
  5. Den

    I'm no doctor, but aren't ANTI-depressants supposed to prevent depression?

    On a serious note, and I'm not pointing fingers, but there is a chance her daughter may be drinking. I know someone on AD's and she really likes her wine, but when she combines, it's worse! Not accusing, but you may want to look into it.

    November 23, 2010 at 15:51 | Report abuse | Reply
  6. dtcpr

    I would be really careful here. I was prescribed a very low dose of anti-deppresants to help with constant headaches and had a terrible time with them. I ahd the typical naseua side effect, but I also became dangerously depressed and thought of suicide often. my mom could tell something was wrong and got in my face about it, a lot, until i finally heard the voice in the back of my head telling me something was wrong. You're her mom and from my experience with my mom, mothers always know, and I was 22 when this happened so I was over the age of 18 which i know is a tricky age with anti-depressants.

    November 23, 2010 at 15:56 | Report abuse | Reply
  7. Oldie

    I took Zoloft for a few years...those are years I do not remember much. And I don't drink alcohol. Most ADs are just pharmaceutical industry money-makers. If at all possible, DO NOT take any.

    November 23, 2010 at 16:07 | Report abuse | Reply
  8. pwdoodle99

    I was prescribed Zoloft a couple months ago for anxiety and depression after being on Welbutrin for a year with no results. I began experiencing the same thing this girl is, plus pretty much all of the side effects...and the anxiety/depression only got worse. I stopped taking both and noticed an INSTANT change for the better. Seriously, the change was literally overnight. Best thing I could have done was getting off the meds. Of course, it works differently for each person, and I still have bouts of depression and anxiety, but they're much less common or severe than at anytime I was on medicine.

    November 23, 2010 at 16:13 | Report abuse | Reply
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    November 23, 2010 at 16:48 | Report abuse | Reply
  10. May Voirrey

    Be vigilant and don't wait too long to make a change. I was prescribed this type of AD a few years ago. I got worse–much worse–not better and quite quickly. I was severely depressed instead of just "depressed." I thought about suicide all the time, and I couldn't sleep. My family doctor said I just wasn't trying hard enough to feel better and that it could take months to see any benefit. He prescribed Wellbutrin to boost the AD. I became manic/hypomanic, then was agitated, withdrawn, and irritable all at the same time and was tagged as having bipolar disorder, although I never had any symptoms of that condition prior to messing around with my brain's seratonin. The whole experience wasn't just awful–it was a prolonged nightmare. It took two years before a psychiatrist who re-evaluated me really listened and concluded I didn't have bipolar disorder at all–I was having a very bad reaction to the medication. He took me off everything, put me on a different class of anntidepressant, and now I am absoutely fine. In fact, I am fine and I do not take or need any medications whatsoever. Not all doctors know what they're doing with these medications, and not all of those who prescribe really know how long it should take the patient to respond. Be careful. Be aware.

    November 23, 2010 at 17:01 | Report abuse | Reply
  11. Craig Shearer

    My stepfather was prescribed Zoloft for his depression after becoming disabled and unable to work. After starting the meds, he stopped his crying fits, but he turned into an absolute Zombie. He had no emotion, expression or desire to do anything. He would not talk to family. He would sit on a computer all day in his bedroom and play video poker. After his surgery and recovery, my mother talked him into coming of the meds. With the help of a doctor and gradually reducing the doses as prescribed, he returned to his old self. Smiles were back, and he was socially engaging. I honestly think that these drugs are psychotropic poisons. They send you into a world of your own, and turn you into a Zombie.

    November 23, 2010 at 17:15 | Report abuse | Reply
  12. Angela W

    This is a serious issue and I do think that many doctors don't take the severe side effects very seriously. I have been prescribed bupropion (Wellbutrin) two times a couple of years apart. Both times I initially felt great, but then the depression would worsen. My psychiatrist simply told me that it was "extremely rare" for bupropion to lose its efficacy, but the depression continued to get worse and a very frightening new behavior emerged – I started cutting myself. I have never engaged in any kind of self injury when I was not on bupropion. That's a very scary side effect, and I stopped taking the drug and am not currently on any antidepressants because I'm too scared of something like that happening again.
    I think these kinds of side effects are under-reported because doctors always believe that it's a symptom of the depression and not the drug.

    November 23, 2010 at 17:23 | Report abuse | Reply
  13. ab1895

    I was on Zoloft when I was 12. It made me feel dead to everything. Instead of the constant pain of my depression, I just felt numb. I became very unresponsive. I was eventually switched to a different medication (and several after that as well) and the effect on me was different each time. Don't be afraid to tell her doctor that she is not responding well to medication. She is definitely not responding well. It sometimes takes a few tries to find what works for certain people.

    November 23, 2010 at 17:27 | Report abuse | Reply
  14. FloridaSNMom

    My autistic/manic son was 6 when they tried zoloft. It seemed to help a bit with mood swings, but he had horrible horrible nightmares about people in his family being killed every night, all night long. He was literally waking several times a night screaming, terrified that we were going to die. With his Dr. and his case manager's support we took him off the zoloft and they stopped, instantly.

    On Prozac he slept constantly, even on the playground, to the point he was hospitalized because his blood sugar dropped when we couldn't wake him to eat (he's always been hypoglycemic).

    Tenex worked for a while, then he started having seizures when they upped the dosage. That was the end of that.
    Clonodine dropped his blood pressure dangerously in three days.

    Now he's 15, on no meds, managing his condition with occupational and behavioral therapy, and homeschooling him to get him away from the stress of bullies which was causing a lot of his anxiety/manic episodes. He's been off meds for four years and we have less problems with him as a teen then we ever did when he was younger.

    Sometimes medication can help, but it should be combined with other therapy at least and side effects should be monitored *closely*. Even ADHD needs therapy as well as meds if the child is going to grow to be a productive adult, it doesn't just go away if it's a true case. Without therapy the child or adult does not learn how to manage their condition, how to recognize danger signs, and how to survive in the world. Too many people out there rely solely on medication.

    November 23, 2010 at 19:55 | Report abuse | Reply
  15. April

    I have been on Zoloft since May of this year for anxiety and depression. I have probably needed medication for the past five years, but convinced myself that since I was able to function I didn't really need it. I was so wrong! It took a major panic attack to realize that my problem was not simply "emotional" it was physical as well. The first month on Zoloft was rough – I was exhausted from the anxiety and slightly nauseous from the medication. Once that month passed, I felt progressively better every week. I don't know how long I will be on Zoloft, but my doctor is monitoring me, and I am okay with it. I realize that not every drug works for every person, but it is working very well for me.

    November 23, 2010 at 20:57 | Report abuse | Reply
  16. mtngrrll

    My son was on Zoloft for his fibromyalgia for 3 years, from the time he was 10 until he was 13. It worked like a dream, allowing him to sleep through the night, think clearly and decreased his headaches as well as muscle aches and pains. All of that stopped when he hit puberty. He became radically suicidal, was terrified to leave the house, or for anyone else to leave the house as he was positive we would all die in a car crash if we did. He had terrifying nightmares and constantly was in tears because he couldn't understand what was wrong with him. It took me about 4 weeks to figure out it was the meds, and his doctor threw him on Prozac since there was no time to wean him off of the Zoloft. It has been 2 years on the Prozac, and he is now weaned off and ready to go on to a more appropriate fibro meds. One specifically for sleep, and the other specifically for the pain and headaches. Since we live at 6,000 ft., the cold pressure fronts and rapid changes in weather can be very painful, and riding up and down the mountain for school can also cause pain. He is now 15 and if they can control his fibro now, he won't end up like me. I have had fibro since I was 5 yrs old, didn't get diagnosed until I was about 28, and in major pain constantly. Most of the pain is irreversible, and I monitor my boys carefully to look for symptoms so they would not have to live as I did. So far, my 10 year old seems to be doing okay. I do not know how old your daughter is, but if she is approaching puberty, or has already hit it, that could be one of the reasons that the Zoloft is not working. All I know is that when it is happening to you (or your child) they truly do not know why they are feeling the way they do. It is going to be up to you and their doctor to figure it out through trying small adjustments at a time in her medication. Just keep reassuring her that it is the medication and not her fault, and that you love her and will do whatever you can to help her through this. Best of luck!

    November 24, 2010 at 02:35 | Report abuse | Reply
  17. Andrea

    In General these Medications are safe. BUT...each person is different and reacts different. In some ppl their own Bodies Physiology and Metabolism work faster and in some slower. With the difference in that lies sometimes a difference in processing Medications. Sometimes an underlying undiagnosed Medical condition that affects such things are present and can and do make a difference in the efficiency of a Medication. If this Girl has an underlying possibly other Mental Condition in Addition to the Depression then this may, and it seems isnt, work well for her. If as an example she is Bipolar and is simply put on an AD it can and mostly will get worse. Ad's are not designed to treat Bipolar by themselves. There almost always has to be a Mood Stabilizing med added to control the different phases of depression and Mania. Another instance that will affect the way these medications work are other Medications. As an example if one takes a Medication such as Tramadol, an synthetic opioid analgesic, and an AD extreme Caution is needed. The other medication may not specifically be designed to work on Serotonin Receptors, but it does. Such Medications when taken together can cause Serotonin Syndrome that can be fatal (via technically an accidental OD). Alot of Pain medications work that way...you take them they make you feel good (Seratonin) and thats partially why they are abused. Bottom line this needs to be monitored! Is she taking any other Medications (prescribed and otherwise procurred)? Has she got any underlying medical Conditions, mental and physical? I hope Mom takes her back to her Doctor and gets some help...she should be feeling better if prescribed the proper Regiment of Medications for ALL Conditions! And please...always try to inform yourself...to many ppl take things coming from their Doctors or other Health Care Prof's blindly...I am not saying question...but stay informed!!!

    November 24, 2010 at 07:17 | Report abuse | Reply
  18. Suzanne Drake

    Antidepressant discontinuation syndrome is real and should be taken seriously! I do not understand why the doctors who are so willing put you on these meds, are not as willing to tell you the truth about coming off of these meds! I personally know that it is real. A word of warning about the longer acting half lives like Prozac, compared to the shorter acting, say Cymbalta. With the Prozac, you may feel fine for a while before the symptoms occur. It can take a month before it starts and then you may not even connect it to the Prozac. The Prozac withdraw is like the worst flu you have, but it is nothing compared to the Cymbalta hell. The worst symptoms ever. Made my brain feel fried. I could go on and on about how bad it can make you feel and it lasts for months, not 2 weeks!
    Remember, it is easy to go on a medicine, but it is not so easy to come off!

    November 24, 2010 at 09:13 | Report abuse | Reply
  19. froggyalley

    There's a reason why they don't tell you about withdrawal...it's because there is no intention of having the patient EVER come off the medication. "You have a chemical imbalance"...really? and how did you measure this?

    Swallow this stuff at your own risk... and thank you all for speaking up!

    November 24, 2010 at 14:22 | Report abuse | Reply
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