Q. What are the risks vs. benefits of Zoloft use in a teenager? – Catherine

 

I’m parent to a teen that has been taking 125 mg of Sertraline (Zoloft) for several years. What are the risks to her of her staying on this drug vs. the benefits of its improvements in her emotional state? What steps can we take to develop a lifestyle-based substitute for the drug? – Catherine

 

Dear Catherine,

I see broad usage of this type of medicine for everything from anxious teens to women with PMS.  It is a relatively safe drug but the long term effect is that it often depletes your natural serotonin stores. 

The drug works by blocking the re-uptake of serotonin, essentially making the serotonin work longer and harder.  Nerve A wants to signal nerve B so it sends a signal of serotonin.  The serotonin should return to nerve A to be reabsorbed in preparation for the next nerve impulse it is needed for.  But instead, Zoloft does not allow for it to be reabsorbed and it stays in the space between the two nerves causing repeated stimulation of nerve B. 

One problem . . . the longer it stays there working the greater the odds of it being broken down by enzymes and removed from the system.  Over time your serotonin pool gets smaller and smaller unless you can adequately make more serotonin.  But if you could have made more serotonin then you wouldn’t have needed the drug in the first place.

One solution would be to take a natural product called tryptophan. Tryptophan is an amino acid (protein building block) that comes from turkey and chicken and most meats in general.  If it is absorbed efficiently from the bowel then it can be taken for conversion into serotonin. 

This is where the second problem arises . . . is the bowel working efficiently?  A teenager’s diet of high fructose corn syrup, fast food, pizza and anything other than vegetables often leads to poor bowel function. 

Long term, a good diet containing quality protein, in a well functioning bowel will result in plenty of tryptophan going to form serotonin. Initially a supplement of tryptophan may be very helpful in generating a sharp rise in serotonin as the long term strategy would be to improve bowel function and diet to maintain this healthy serotonin pool.

These cases are often involved and I don’t know the particulars of your teen so the help of an integrative care physician can often be of great help.  Issues like sleep cycle, diet, MSG or aspartame ingestion, stress, exercise, vitamin D levels and even heavy metals can all play a role in explaining your child’s situation.  Zoloft may aid his/her mood temporarily but is not likely to represent a long term solution.

Sincerely,
Dr. Huber