I receive a number of questions at ADD ADHD Advances. I am publishing the answer to this question because it reveals how psychiatric drugs commonly work.
“My 8 year-old son was given a prescription today for Zoloft to help combat the suppressed appetite he is experiencing since starting on Adderall XR 10 mg. I wanted to get some definitive information about this drug and pediatric use. My son has frequent low moods, but they are somewhat tolerable. Zoloft was prescribed to combat the loss of appetite. From what I’ve read, however, it is sometimes used to support another medication for ADD, or as a primary therapy. Would you, please, share some of your insight as to the good and the bad of this pharmaceutical. I need to make a decision whether or not to begin the drug, but am rather frightened by some of the things I’ve read.”
Zoloft is a selective serotonin reuptake inhibitor, one of the mood stabilizers used to treat depression, panic attacks, obsessive-compulsive disorders, post-traumatic stress disorder, bipolar disorder, and social anxiety disorder. Although this class of drug is not officially recognized as a primary treatment for ADHD, I have seen these drugs used successfully in this way.
Here is how it works. Serotonin is one of the neurotransmitters in the brain that allows for communication between brain cells.
Nerve cells communicate with each other through chemical messengers, or neurotransmitters. There is a tiny space between two communicating nerve cells called a synapse. When a nerve cell communicates with its neighboring cell, either to stimulate it or inhibit it, the cell does so by emitting a small amount of chemical, a neurotransmitter, into the synapse. The neurotransmitter comes in contact with the recipient cell and either stimulates or inhibits the cell. As long as the neurotransmitter is floating around, it can affect the recipient cell. To limit the duration of this affect, the body clears the neurotransmitter for the synaptic space as quickly as possible. It does this in one of two ways. It may release an enzyme to break down the neurotransmitter. A more efficient way is that the nerve cell that sent out the neurotransmitter reabsorbs it and stores the chemical for later use.
Thus, it comes out that the body can regulate the effects of neurotransmitters in four ways:
- It can control the amount of neurotransmitter released.
- It can control rate the absorption of the neurotransmitter.
- It can control the amount of enzymes available to breakdown the neurotransmitter.
- It can control the sensitivity of the recipient cell to the neurotransmitter.
Whatever path the body chooses to regulate neurotransmitter function, there is one basic principle; the longer the chemical sits in the synaptic junction between cells, the greater the effect that neurotransmitter has. With this we can begin to understand what Zoloft does.
Zoloft is a selective serotonin reuptake inhibitor. That means that when a cell releases serotonin to stimulate its neighboring nerve cell, Zoloft gets involved by inhibiting the first cell from reabsorbing the serotonin in the synaptic junction. The net effect is that there is more serotonin around to stimulate the nerve cells.
As far as side effects, the list is rather long as it is with all medications. It does suppress appetite in some people, but the percentage is less than 10%. The stimulants, like Adderall, are much more likely to suppress appetite.
Zoloft has been tested in children older than six and seems to be fairly safe if taken as prescribed. It should help with your son’s depression. As far as the appetite problem, this is a common problem with all the ADHD medications.
What I usually recommend people to do who are in your situation is to try it and see how it works. If it works, fine. If not or if it has unpleasant side-effects then one can always stop taking it and try something else.
ADHD treatment is very personalized. No one knows what will work for any child. However, there are enough options around now that almost everyone can find something that will help. The most important thing is to have a good working relationship with your doctor so you can find the best treatment.
P. S. One of the things I have used successfully to take care of the poor appetite is to make sure the child gets a big breakfast before he gets his morning dose of the medication. I also suggest a good multivitamin to help insure that the child is getting adequate nutrition. I recommend vitamins in all children. Studies show that children who take vitamins learn better and perform better in school.
Anthony Kane, MD is a physician, an international lecturer, and director of special education. He is the author of a book, numerous articles, and a number of online courses dealing with ADHD, ODD, parenting issues, and education. You may visit his website, ADD ADHD Advances, at http://addadhdadvances.com and sign up there for the ADD ADHD Advances online journal or send an email to firstname.lastname@example.org.