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Overview

Zotral 50 MG Tablet

Zotral 50 MG Tablet

Manufacturer: Micro Labs Ltd
Medicine composition: Sertraline
Prescription vs.OTC: Prescription by Doctor required

Zotral 50 MG Tablet is used for treating obsessive compulsive disorder, major depressive disorder, post-traumatic stress disorder, panic disorder, social anxiety disorder and premenstrual dysphoric disorder (feeling of depression and irritability before menstruation). Belonging to the drug group of selective serotonin reuptake inhibitors (SSRIs), the medication helps to increase the serotonin amount (a natural substance) in the brain that maintains the mental health. This improves the symptoms of anxiety and depression.

The dosage of Zotral 50 MG Tablet will depend on your age, your health condition, the problem you are suffering from, and the way your body reacts to the first dose. It is available both in tablet and liquid form. You can take the medicine as prescribed by your doctor, with or without food. Generally, the capsule form of this medicine is taken along with food after breakfast or the evening meal.

Your doctor must be informed if you have a medical history of bleeding, liver problems, thyroid disease, seizure disorder or a family medical history of glaucoma (eye disorder). Also if you are pregnant, planning for pregnancy or a breastfeeding mother, your doctor must have prior knowledge about the same before prescribing the medication as it may affect the baby.

Zotral 50 MG Tablet can have some common side effects like drowsiness, dizziness, nausea, upset stomach, trouble sleeping, loss of appetite and excessive sweating. You can consult your doctor if these conditions persist or even get worse. However, you must inform your doctor immediately if you face any of the following serious side effects:

  • Unusual weight loss
  • Redness, swelling or pain in the eyes, widened pupils or blurred vision
  • Stiff or twitching muscles and muscle tremors
  • Black stools accompanied with blood
  • Lack of coordination, restlessness, hallucinations or seizures

As Zotral 50 MG Tablet can make you feel drowsy or dizzy, it is better to avoid activities that require your concentration like driving until you are sure how your body reacts to the initial doses. Try to avoid alcohol as it can increase your sleepiness and affect your ability to think and perform clearly.

Depression
Zotral 50 MG Tablet is used to treat the symptoms of depression like feeling sad, irritable and devoid of energy.
Obsessive Compulsive Disorder
Zotral 50 MG Tablet is used to treat the symptoms of obsessive-compulsive disorder like repetitive thoughts and behaviour.
Panic disorder
Zotral 50 MG Tablet is used to treat the symptoms of panic disorder like sweating, breathing problem, weakness and numbness in hands.
Post Traumatic Stress Disorder
Zotral 50 MG Tablet is used to treat the symptoms of post-traumatic stress disorder which develop in a patient after a shocking or scary traumatic condition or an accident.
Premenstrual Dysphoric Disorder
Zotral 50 MG Tablet is used to treat the symptoms of premenstrual dysphoric disorder like severe depression, irritability, and tension before menstruation.
Social Anxiety Disorder
Zotral 50 MG Tablet is used to treat the symptoms of social anxiety disorder like extreme fear of being watched, red face or blushing, avoiding social situations and staying quite.
Allergy
This medicine is not recommended for use if you have a known history of allergy to Sertraline.
Monoamine oxidase inhibitors
Zotral 50 MG Tablet is not recommended in the patients for at least 14 days after discontinuation of monoamine oxidase inhibitors.
In addition to its intended effect, Zotral 50 MG Tablet may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.
Decreased interest in sexual intercourse Major Common
Abnormal ejaculation Major Common
Aggression or anger Major Less Common
Diarrhea Major Less Common
Drowsiness Major Less Common
Increased sweating Major Less Common
Trouble Sleeping Minor Common
Weight Loss Minor Common
Constipation Minor Less Common
Painful urination Minor Less Common
How long is the duration of effect?
The effect of this medicine lasts for an average duration of 2 to 3 days.
What is the onset of action?
The peak effect of this medicine can be observed in 4.5 to 8.4 hours.
Are there any pregnancy warnings?
This medicine is not recommended for use during pregnancy unless absolutely necessary. Consult your doctor about the potential benefits and risks before deciding to take this medicine.
Is it habit forming?
No habit forming tendencies were reported.
Are there any breast-feeding warnings?
This medicine is known to excreted through the breast milk. It is not recommended for breastfeeding women unless absolutely necessary. Occasional side effects like sleeplessness, restlessness should be monitored.
Below is the list of medicines, which have the same composition, strength and form as Zotral 50 MG Tablet, and hence can be used as its substitute.
Strides Shasun Limited
Abbott Healthcare Pvt. Ltd
Zydus Cadila
Rpg Life Sciences Ltd
Psycormedies
Missed Dose instructions
Take the missed dose as soon as you remember. However, if it is almost time for the next scheduled dose then the missed dose should be skipped.
Overdose instructions
Contact a doctor immediately if an overdose is suspected. Symptoms of overdose may include a change in pulse rates, severe drowsiness, confusion, vomiting, hallucinations, convulsions, and fainting. Immediate medical intervention may be required if the overdose symptoms are severe.
India
United States
Japan
Whenever you take more than one medicine, or mix it with certain foods or beverages, you're at risk of a drug interaction.
Interaction with Disease
Depression Major
This medicine may increase the risk of suicidal thoughts in the patients with depression. Patients caretakers should be educated about these symptoms. Any changes in the behavior should be reported to the doctor immediately.
Glaucoma Moderate
This medicine should be used with caution in the patients with the history of glaucoma. Any symptoms of changes in the vision should be reported to the doctor immediately.
Interaction with Alcohol
Alcohol Moderate
Consumption of alcohol is not recommended in the patients receiving Zotral 50 MG Tablet. Performing works that require mental alertness like driving vehicle or operating machinery is not recommended.
Interaction with Lab Test
Lab
Information not available.
Interaction with Food
Food
Information not available.
Interaction with Medicine
Ciprofloxacin Moderate
Zotral 50 MG Tablet should be used with caution in the patients receiving medications that can cause irregular heart rhythm. Inform the doctor if you have a history of heart disease. An alternate medicine should be considered based on the clinical condition.
Clozapine Major
Report the use of either of the medicine to the doctor as the risk of adverse effects on the heart is very high if these medicines are administered together. You may require a dose adjustment and clinical safety monitoring while taking them together. In some cases, your doctor may prescribe an alternative medicine that does not interact.
Ondansetron Major
Combined use of these medications is not recommended due to the risk of seizures, confusion, fast and irregular heartbeat. You may require a dose adjustment and clinical safety monitoring while taking them together. In some cases, your doctor may prescribe an alternative medicine that does not interact.
Nonsteroidal anti-inflammatory drugs Moderate
Zotral 50 MG Tablet should be used with caution in the patients receiving medications that affect the coagulation. Monitoring of blood platelet levels should be made. Any symptoms of swelling, weakness and abnormal bleeding should be reported to the doctor.

Popular Questions & Answers

My father is 58 years old suffering from depression, for past 6-7 years & he is depressed due to my sister marriage. After treatment and medicines he become fit and fine. Later 1-2 year ago he becomes more active, aggressive and energetic than before, this behaviour remains for 1+ years. From last 5-6 months he again slowly gets into depression and becomes less active, does not talk much, keep tensed. Doctor prescribed half tablet of gatomir 15 (mirtazapine) at night and 1 tablet of zotral 50 (sertraline) at morning for 15 days. However 7+ days are past but he is not eating properly and we does not see much improvement. Can you please explain is it normal while taking anti depression medicines, and is this medicine is ok? Can we wait for some more time for improvement or we contact our doctor to change medicines?

Masters in Clinical Psychology
Psychologist, Lucknow
My father is 58 years old suffering from depression, for past 6-7 years & he is depressed due to my sister marriage. ...
Hi lybrate-user, He is not suffering from Depression any more its taken form of Mania. A manic episode is characterized by period of at least 1 week where an elevated, expansive or unusually irritable mood, as well as notably persistent goal-directed activity is present. The mood disturbance associated with manic symptoms should be observable by others (e. G. Friends or relatives of the individual) and must be uncharacteristic of the individual?s usual state/behavior. These feelings must be sufficiently severe to cause difficulty or impairment in occupational, social, educational or other important functioning. Symptoms also cannot be the result of substance use or abuse (e. G. Alcohol, drugs, medications) or caused by a general medical condition. Three or more of the following symptoms must be present: Inflated self-esteem or grandiosity Decreased need for sleep (e. G. One feels rested after only 3 hours of sleep) More talkative than usual or pressure to keep talking Flight of ideas or subjective experience that thoughts are racing Attention is easily drawn to unimportant or irrelevant items Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Excessive involvement in pleasurable activities that have a high potential for painful consequences (e. G. Engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). Now when the situation alters between episodes of depression and Mania it is called BIPOLAR MOOD DISORDER and it will need a fresh treatment. So I advise you to get the medication changed if it is not helping your father.

I have been taking sertraline for social anxiety about 2 mouths and 2 weeks. I started with 50 mg for the first month and the second month I upgraded to 100 mg, 3 days ago I upgraded my dosage to 150 mg. My problem is that I still have the social anxiety and I get nervous next to people. How long does it take for the medicine to work.

MD - Psychiatry
Psychiatrist, Chennai
I have been taking sertraline for social anxiety about 2 mouths and 2 weeks. I started with 50 mg for the first month...
Sertraline works for anxiety, but doubtful for social anxiety. Request you to discuss the lack of improvement with your psychiatrist and try alternative medication, and also combine with CBT from the psychiatrist or clinical psychologist. Combining CBT will lead to dramatic improvement in Social anxiety disorder.

I am 32 year old male and I am a patient of hyper-vigilance and social anxiety. Please help me I can't concentrate, eat, watch tv if people are around .my eyes always keeps scanning who is around .My eyes moves where I avoid it .I have no control on my eyes. Someone prescribed me to use Zoloft (sertraline) .should I use it or go for Paxil (paroxetine) I have tried ANULOM-VILOM but It did nothing.

BAMS
Ayurveda, Udaipur
I am 32 year old male and I am a patient of hyper-vigilance and social anxiety.
Please help me I can't concentrate, e...
Dear join proper yoga classes under the guidance of experienced person ,you need not any medicine just try yoga with dedication ,you will get definite results but the necessary conditions are :-you are to do yoga under guidance (self practice will not work) with dedication and regularity minimum for 3 months and then decide that yoga is working or not.
1 person found this helpful

Is lorazepam better or escitalopram for anxiety? And what about sertraline? Please answer any psychiatrist.

MD - Psychiatry
Psychiatrist, Chennai
Is lorazepam better or escitalopram for anxiety? And what about sertraline? Please answer any psychiatrist.
There is nothing called better or inferior. All medications are tailored to an individual depending on the symptoms, response and tolerability. Over the Counter self medication and self medication by googling is dangerous to one's body and mind. Lorazepam is a benzodiazepine and can cause severe dependence and side effects on a longer run. Escitalopram ad Sertraline are SSRI's and need to be prescribed carefully adjusting/ titrating dosage by a psychiatrist. Hope this info helps.

Popular Health Tips

Male Sexual Health

MD - General Medicine
Sexologist, Delhi
Male Sexual Health

What is ejaculation?

It is the release of semen from the penis at orgasm. Semen is made up of sperm and fluid from testes (singular testis), seminal vesicles and prostate gland.

When a man is sexually stimulated, the brain sends signals to the genital area through nerves in spinal cord that causes contraction of pelvic muscles. Waves of pelvic muscle contractions transport the semen from the testes to tip of penis through vas deferens. This is called ejaculation or orgasm (colloquially to cum, shoot, blast or bust).

What is premature ejaculation (PE)?

PE means 'cumming too soon', that is, a man ejaculates before he is ready for it and he has no control over it.

Studies have shown that most men ejaculate between 2-5 minutes after penetration. This time frame is again arbitrary since it can differ from men to men, couple to couple, between cultures and other factors. So, for practical reason, if ejaculation occurs within 1 minute of penis entering into a vagina, it is called premature ejaculation. It is the commonest sexual problem in men and affects all ages.

What are the causes?

  • Premature ejaculation can be primary or secondary.
  • Primary or lifelong PE is when a man has not had control of ejaculation from the time of his first sexual experience. It can be caused by a chemical imbalance in brain centres that lowers the threshold for ejaculation.
  • Secondary or acquired PE is usually when there has been a period of normal functioning before premature ejaculation began. Secondary premature PE is often linked to psychological factors like stress, performance anxiety, relationship issues and impotence.

How is it diagnosed?

There are no tests or scans to diagnose PE. If you have premature ejaculation, you need to see your local doctor and a diagnosis is made based on your history.

What treatments are there for premature ejaculation?

Treatment for PE may involve sex therapy, behavioural techniques, medications, local gels and creams, and treatment of other conditions like erectile dysfunction.

Sex therapy is administered by a person called sex therapist. This is particularly important if the cause of premature ejaculation is psychological like relationship issues and anxiety. Sex therapist provides counselling to address these issues.

There are mainly two behavioural techniques that can be used for treating premature ejaculation:

Seman's 'stop start' technique and Masters and Johnson's 'squeeze' technique.

How to perform Seman's 'stop start' technique

  • Arouse yourself sexually by playing with your penis or ask your partner to stimulate it for you
  • Once you are fully aroused and feel you are close to ejaculation, stop playing
  • Wait for some time until the feeling of ejaculation passes away
  • Once the feeling has passed, you can restart stimulating your penis
  • Repeat this cycle 5-6 times until you finally ejaculate
  • Once you feel more confident with this technique, you can actually practice this after entering your partner. Start thrusting your partner until you feel you are close to ejaculation, stop thrusting and divert your attention to something else. Once the ejaculation feeling passes away, resume thrusting and stopping until you finally ejaculate.
  • How to perform Masters and Johnson's 'squeeze' technique

Once you are fully aroused and feel you are close to ejaculation, squeeze the tip of the penis between your thumb and index finger (or your partner can squeeze it for you) for several seconds until the feeling of ejaculation passes away. Repeat this squeeze and release technique for as long as you can until you finally ejaculate.

What medications are used to treat PE?

  • You need to see your local doctor to get medications prescribed for PE.
  • Dapoxetine (Priligy) is the only medication that is specific to the treatment of premature ejaculation. It is taken 'on-demand' only, one to three hours before sexual intercourse.
  • Some antidepressants have the side effect of delayed ejaculation and used for premature ejaculation. They include SSRIs like fluoxetine, paroxetine and sertraline and tricyclic antidepressant called clomipramine.
  • If PE is associated with erectile dysfunction, Viagra, Cialis or Levitra may be prescribed by your doctor.
  • Local anaesthetic creams and gels can reduce penile sensation and help premature ejaculation. They should be applied up to 30 minutes before sexual intercourse.
  • Using two condoms can reduce penile sensation and help a man take longer to ejaculate.

Just remember

Premature ejaculation is a very common sexual problem in men and affects all ages. It can cause embarrassment and anxiety and affects a man's self-esteem. It can affect both partners emotionally and sexually. There are many treatments available including sex therapy, behavioural techniques and medications but you need to seek help early. It is very important for partners to discuss this openly and get help from a doctor or other health care professionals.

6 people found this helpful

Priapism - How Can It Be Treated?

Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine, Certified course in Herbal(Ayurvedic) medicine
Sexologist, Ludhiana
Priapism - How Can It Be Treated?

Priapism is a condition of the penis where the erection persists long after the sexual stimulation. It is a painful condition and is extremely common among patients suffering from sickle cell anaemia. Medical treatment is necessary at the earliest in order to prevent any damage to the tissue. This condition is mostly observed in people in the age segment of 30-40.

Symptoms of priapism:
The symptoms of priapism vary according to the type of priapism a person is affected with. Two of the most common types of priapism are non-ischemic and ischemic priapism. While the latter is more common to those with a family history of the same disease, the former can occur to any person. Some of the common symptoms of both the condition include the following:

  1. An erection that lasts for more than an hour or more
  2. Pain in the penis during erection
  3. Rigid shaft of the penile with a soft tip

What are the causes of priapism?

  1. Blood-related disorders such as leukaemia, thalassemia, and sickle cell anaemia
  2. It can also arise from side effects of other medications such as fluoxetine, sertraline, papaverine, warfarin, atomoxetine, chlorpromazine, phentolamine etc
  3. Abuse of alcohol, marijuana, drugs etc.
  4. An injury or trauma to the penis, perineum and pelvis restricting the blood flow.
  5. Penis cancer
  6. Metabolic disorders such as amyloidosis and gout
  7. Neurological disorders such as syphilis or an injury to the spinal cord
  8. A toxic infection or a bite from a spider

What are the possible complications?
Priapism can lead to serious consequences, especially the ischemic type. The trapped blood inside the penis that is devoid of oxygen can start damaging the tissue of the penis. If this disease is not treated on time, it can lead to erectile dysfunction.

How is priapism diagnosed?
A doctor starts from a physical exam and goes through the medical history in order to get first-hand knowledge of the condition. This is followed by the prescription of tests such as blood gas measurement, ultrasound, count of red blood cells and platelets and other toxicology tests.

What are the treatment options?
There could be various approaches that are taken by a doctor. Excess blood can be drained out with the help of a syringe and the penis can be flushed with saline in order to get rid of the oxygen-devoid blood out of the penis. Certain medications can be injected into the pen that helps the blood to flow normally without accumulating inside the penis. If all else fails, a surgeon can perform a procedure in order to drain the blood from a different route.

6 Symptoms Of Depression And Its Treatment!

MBBS, MD - Psychiatry, Senior Resident Psychiatrist
Psychiatrist, Ahmedabad
6 Symptoms Of Depression And Its Treatment!

Feeling tired all the time? Do you feel that you can’t focus on things anymore? Have you lost interest in things and people you once loved spending time with? Does your temper fly off the hook at the drop of a hat? If it is a ‘yes’ to the questions above, then you might be slowly but steadily succumbing to depression. Depression is a psychological disorder that is characterized by symptoms of extreme sadness, worthlessness and hopelessness over a prolonged period of time.

Symptoms

  1. Lack of Interest: This is probably the starkest of all the symptoms. Hobbies or activities that you used to enjoy once no longer catch your fancy. You do not find little or no pleasure in social activities or any other hobby of yours anymore.
  2. A constant Feeling of Hopelessness: You tend to develop a negative outlook towards life in general, as you feel that the current situation will never get better and will only worsen.
  3. Loss of Appetite: Loss of appetite is a common feature of depression; it can also lead to rapid weight loss. If engulfed by depression, one generally tends to ignore food completely, remain hungry, both of which contribute to the vicious cycle that depression is.
  4. Changes in Sleep Patterns: Insomnia is a condition that is marked by a sheer inability to sleep, no matter how physically exhausted one is. Depression tends to exhibit this particular symptom in maximum cases. However, oversleeping, or sleeping more than the sufficient hours is also common.
  5. Reckless Behavior: Depression makes one more prone to reckless behavior; one generally develops an angry and irritated persona; this in turn, may make one to exhibit reckless and rash behavior.
  6. Lack of Energy and Focus: Depression causes one to feel fatigued and sluggish the entire day. Factors such as a total loss of appetite contribute to this particular symptom. Stemming from these symptoms are two other major occurrences; an inability to focus on anything and an inability to decide on anything.

Self-help, Coping tips and Treatment-

  1. Connect with different people: Being isolated from the rest can and usually aggravates symptoms of depression. So, reach out to other people and your loved ones; talk to your loved ones and try to empty your mind when you are having a one-to-one with them. Interacting and talking to others will make you feel better and should go a long way in taking that huge rock off your chest.
  2. Try to ditch that sedentary lifestyle; go out in the open: An early morning jog can feel daunting at first but the benefits are immense. Exercising regularly has been proven to be as effective as anti-depressants in combatting depression. Even a 20 minutes jog early in the morning releases ‘endorphins’ in the body, also known as the ‘feel good hormones’. These hormones induce a feeling of happiness and relaxation, thus taking your mind off any particular event or circumstance that has been ruining your sanctity of late.
  3. Avoid Alcohol and Drugs: Avoid alcohol and drugs to come out of your sadness; they have never helped and will never help. Taking these substances provides a temporary solution to depression, as it will again show up once the effects of the intoxicants wear off. It will also interfere with other medications that you may be taking to combat depression, thus reducing their potency.
  4. It’s high time you bought the meditating mat: Sleep has a beneficial effect on your mental health as it has been proven to improve memory and other cognitive and brain functions. Another way to improve brain function and be more relaxed is to meditate regularly. Meditation induces a state of relaxation, and if done on a regular basis, can be an effective treatment for depression. Meditation also helps with an improved focus and reduced anxiety.
  5. Medications can always help: Medications such as anti-depressants are administered to treat depression. Selective Serotonin Reuptake Inhibitors (SSRIs), including citalopram, fluoxetine and sertraline are the most commonly administered medications to cure this condition. However, it is advised to try the abovementioned methods first so that you do not have to depend on medications alone; the reason being that these medications do have their fair share of side effects.
5 people found this helpful

Symptoms And Treatment of Post Traumatic Stress Disorder!

MBBS, MD Psychiatry
Psychiatrist, Kottayam
Symptoms And Treatment of Post Traumatic Stress Disorder!

A particularly stressful situation or event that has created terror or been overly dramatic or dangerous can lead to stress and anxiety long after the individual has physically come out of the situation. This kind of a traumatic condition is usually what characterises Post Traumatic Stress Disorder (PTSD).

In simple words, PTSD is a neurological disorder which affects individuals after experiencing severe traumatic situations.

Symptoms of PTSD:

  1. Mood symptoms: Mood swings are the most common outcome of these symptoms. The patient may experience a complete lack of enthusiasm and drive to indulge in activities like hobbies and socialising. Also, the patient may end up harbouring feelings of negativity towards family, friends and strangers, besides going through phases of guilt and self blame for the occurrence of the traumatic event.
  2. Re-experiencing symptoms: These symptoms include flashbacks and life like re-imagination in the form of dreams and nightmares. In many cases, the patient may remember and re-experience the entire scene or series of events that have led to the trauma in the first place. This can be triggered by a memory or association with words, events and other such things that have to do with the memory of the traumatic episode.
  3. Arousal symptoms: Arousal or reactivity symptoms may trigger the same reactions that the person showed during the traumatic experience. These may include being on edge constantly in anticipation of a reoccurrence, or even getting startled by the slightest thing since the mind is already occupied with thoughts of the event, constantly. Anger and emotional outbursts may also be caused due to these symptoms.
  4. Avoidance or rumination: Those suffering from PTSD avoid being reminded of the trauma, such as people, situations or circumstances associated with the event. They try to suppress memories associated with the event.- Many others ruminate excessively and prevent themselves from coming to terms with it.

Treatment for PTSD:

Mindfulness meditation (not a treatment option) helps in recognizing cognitive dissonances and affected thought patterns and aids in recognizing and overcoming their influence. Other therapies, including Cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are also done depending on the patient's condition.

How do medications help regulate these responses?

The medications prescribed for treating PTSD symptoms act upon neurotransmitters related to the fear and anxiety circuitry of the brain including serotonin, norepinephrine, gamma-aminobutyric acid (GABA), excitatory amino acids. There is great interest in developing agents with novel and more specific mechanisms of action than are currently available to target the PTSD symptoms described earlier while also minimizing potential side effects.

Studies show that a number of medications are helpful in minimizing PTSD symptoms. Most of the time, medications do not entirely eliminate symptoms but provide symptom reduction and could be more effective when used in conjunction with an ongoing program of trauma specific psychotherapy for patients.

Medications

Several types of medications can help improve symptoms of PTSD:

  1. Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
  2. Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
  3. Prazosin. If symptoms include insomnia with recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.

You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks. If you wish to discuss about any specific problem, you can consult a psychiatrist.

2489 people found this helpful

Addiction

MBBS, DPM (Psychiatry)
Psychiatrist, Thrissur
Addiction

ADDICTION


Decades ago addiction was a pharmacologic term that clearly referred to the use of a tolerance-inducing drug in sufficient quantity as to cause tolerance (the requirement that greater dosages of a given drug be used to produce an identical effect as time passes). With that definition, humans (and indeed all mammals) can become addicted to various drugs quickly. Almost at the same time, a lay definition of addiction developed. This definition referred to individuals who continued to use a given drug despite their own best interest. This latter definition is now thought of as a disease state by the medical community.
Physical dependence, abuse of, and withdrawal from drugs and other miscellaneous substances is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). Unfortunately, terminology has become quite complicated in the field. To wit, pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence); psychiatrists refer to the disease state as dependence; most other physicians refer to the disease as addiction. The field of psychiatry is now considering, as they move from DSM-IV to DSM-V, transitioning from "dependence" to "addiction" as terminology for the disease state.
The medical community now makes a careful theoretical distinction between physical dependence (characterized by symptoms of withdrawal) and psychological dependence (or simply addiction). Addiction is now narrowly defined as "uncontrolled, compulsive use"; if there is no harm being suffered by, or damage done to, the patient or another party, then clinically it may be considered compulsive, but to the definition of some it is not categorized as "addiction". In practice, the two kinds of addiction are not always easy to distinguish. Addictions often have both physical and psychological components.
There is also a lesser known situation called pseudo-addiction.{(Weissman and Haddox, 1989}} A patient will exhibit drug-seeking behavior reminiscent of psychological addiction, but they tend to have genuine pain or other symptoms that have been undertreated. Unlike true psychological addiction, these behaviors tend to stop when the pain is adequately treated.
The obsolete term physical addiction is deprecated, because of its connotations. In modern pain management with opioids physical dependence is nearly universal. While opiates are essential in the treatment of acute pain, the benefit of this class of medication in chronic pain is not well proven. Clearly, there are those who would not function well without opiate treatment; on the other hand, many states are noting significant increases in non-intentional deaths related to opiate use. High-quality, long-term studies are needed to better delineate the risks and benefits of chronic opiate use.
Not all doctors agree on what addiction or dependency is, because traditionally, addiction has been defined as being possible only to a psychoactive substance (for example alcohol, tobacco and other drugs) which ingested cross the blood-brain barrier, altering the natural chemical behavior of the brain temporarily. Many people, both psychology professionals and laypersons, now feel that there should be accommodation made to include psychological dependency on such things as gambling, food, sex, pornography, computers, work, exercise, cutting, and shopping / spending. However, these are things or tasks which, when used or performed, cannot cross the blood-brain barrier and hence, do not fit into the traditional view of addiction. Symptoms mimicking withdrawal may occur with abatement of such behaviors; however, it is said by those who adhere to a traditionalist view that these withdrawal-like symptoms are not strictly reflective of an addiction, but rather of a behavioral disorder. In spite of traditionalist protests and warnings that overextension of definitions may cause the wrong treatment to be used (thus failing the person with the behavioral problem), popular media, and some members of the field, do represent the aforementioned behavioral examples as addictions.
In the contemporary view, the trend is to acknowledge the possibility that the hypothalmus creates peptides in the brain that equal and/or exceed the effect of externally applied chemicals (alcohol, nicotine etc.) when addictive activities take place [citation needed]. For example, when an addicted gambler or shopper is satisfying their craving, chemicals called endorphins are produced and released within the brain, reinforcing the individual's positive associations with their behavior.
Despite the popularity of defining addiction in medical terms, recently many have proposed defining addiction in terms of Economics, such as calculating the elasticity of addictive goods and determining, to what extent, present income and consumption (economics) has on future consumption.
Varied forms of addiction
Physical dependency
Physical dependence on a substance is defined by the appearance of characteristic withdrawal symptoms when the substance or behavior is suddenly discontinued. While opioids, benzodiazepines, barbiturates, alcohol and nicotine are all well known for their ability to induce physical dependence, other categories of substances share this property and are not considered addictive: cortisone, beta-blockers and most antidepressants are examples. So, while physical dependency can be a major factor in the psychology of addiction and most often becomes a primary motivator in the continuation of an addiction, the initial primary attribute of an addictive substance is usually its ability to induce pleasure, although with continued use the goal is not so much to induce pleasure as it is to relieve the anxiety caused by the absence of a given addictive substance, causing it to become used compulsively. A notable exception to this is nicotine. Users report that a cigarette can be pleasurable, but there is a medical consensus [citation needed] that the user is likely fulfilling his/her physical addiction and, therefore, is achieving pleasurable feelings relative to his/her previous state of physical withdrawal. Further, the physical dependency of the nicotine addict on the substance itself becomes an overwhelming factor in the continuation of most users' addictions. Although 35 million smokers make an attempt to quit every year, fewer than 7% achieve even one year of abstinence (from the NIDA research report on nicotine addiction).[citation needed]
Some substances induce physical dependence or physiological tolerance - but not addiction - for example many laxatives, which are not psychoactive; nasal decongestants, which can cause rebound congestion if used for more than a few days in a row; and some antidepressants, most notably venlafaxine, paroxetine and sertraline, as they have quite short half-lives, so stopping them abruptly causes a more rapid change in the neurotransmitter balance in the brain than many other antidepressants. Many non-addictive prescription drugs should not be suddenly stopped, so a doctor should be consulted before abruptly discontinuing them.
The speed with which a given individual becomes addicted to various substances varies with the substance, the frequency of use, the means of ingestion, the intensity of pleasure or euphoria, and the individual's genetic and psychological susceptibility. Some alcoholics report they exhibited alcoholic tendencies from the moment of first intoxication, while most people can drink socially without ever becoming addicted. Studies have demonstrated that opioid dependent individuals have different responses to even low doses of opioids than the majority of people, although this may be due to a variety of other factors, as opioid use heavily stimulates pleasure-inducing neurotransmitters in the brain. The vast majority of medical professionals and scientists agree that if one uses strong opioids on a regular basis for even just a short period of time, one will most likely become physically dependent [citation needed]. Nonetheless, because of these variations, in addition to the adoption and twin studies that have been well replicated, much of the medical community is satisfied that addiction is in part genetically moderated. That is, one's genetic makeup may regulate how susceptible one is to a substance and how easily one may become psychologically attached to a pleasurable routine.
Eating disorders are complicated pathological mental illnesses and thus are not the same as addictions described in this article. Eating disorders, which some argue are not addictions at all, are driven by a multitude of factors, most of which are highly different than the factors behind addictions described in this article.