Depression, bulimia, and Zoloft

Dear Alice,

Over the past year that I spent abroad, my cyclic depressions turned into a general depression, which has more or less left me incapable of doing anything. Along with the depression, I deal with bulimia, which expresses itself in my finest moments of despair. While abroad, I recognized that the depression I was feeling was no longer normal and asked my parents to please arrange some counseling for me upon my return home. So, for the months of July and August, I went to a therapist twice a week. I have not followed up with therapy back in New York, but feel that I must do something. Actually, I did do something, I went to the university's shrink, who promptly wrote me a prescription for something called Zoloft. What can you tell me about this drug?

In the meantime, I skip 2 - 3 classes a week and couldn't keep the small job I got to help cover the cost of therapy, which I see in the future. I constantly feel paralyzed, trapped, as if there is "no way out." I can't go on like this. Suicide is not an option for me, NEVER, but THIS ain't living.

— Signed,
Extremely unhappy

Dear Extremely unhappy,

Kudos for recognizing your struggles and seeking additional support; it takes a lot of strength. Living with depression can reduce your quality of life, making it harder to navigate daily responsibilities let alone stressful events. It may be comforting to know that there are many treatment options out there, which often involve a combination of medication and therapy. A health care provider or mental health professional can recommend a treatment plan based on your needs. They’ll monitor how it’s working and make any adjustments given that treatment options impact every person differently. It’s worth noting that these treatment options take time to work, so you may not see results right away. Zoloft (generic name: sertraline) is one of several medications used to treat depression by changing the way the brain communicates (more on this in a bit). Many find that these medications help with daily activities and lift spirits enough to work through depression. You also mention that you deal with bulimia, which can occur alongside depression though the exact connection isn’t known. Some forms of treatment for depression may benefit bulimia too, so it’s best to talk with your health care provider about all that you’re experiencing when discussing treatment options, including any other underlying conditions.

So, what is the medication that you’ve been prescribed? Sertraline is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that helps increase the amount of serotonin in the brain. Serotonin is a neurotransmitter (chemical in the brain) that affects mood, feelings, levels of vitality, and sleep. It may produce a calming effect for some. In very simplified terms, SSRIs work by changing the way the body re-absorbs serotonin. This makes it more available to brain cells, which may help reduce anxiety and depression. Other SSRIs include paroxetine, citalopram, fluoxetine, escitalopram — they each work a little differently so what is best for one person may be different for others. It’s also worth noting that these medications can take weeks to build up in the body and feel its impacts. SSRIs are generally considered a low-risk treatment when taken under the direction of a health care provider. If you’re considering stopping, it’s best to avoid doing so abruptly; doing so can lead to SSRI withdrawal. While many side effects only last for the first few weeks of treatment, they most commonly include:

Nervousness or edginess
Nausea
Drowsiness
Trouble sleeping (insomnia)
Changes in appetite (weight loss or weight gain)
Sexual difficulties (such as trouble orgasming and in maintaining erections)

Adapted from Mayo Clinic.

An estimated 36 to 50 percent of people with bulimia also have depression. For some, depression and bulimia may start at the same time while for others they may experience one before the other. Common symptoms of both BN and depression include feeling unsteady or dizzy, changes in appetite, and apathy towards sex. Bulimia nervosa (BN or bulimia) is an eating disorder characterized by eating large amounts of food (binging) and then eliminating the food (purging) by vomiting, taking laxatives or diuretics, or excessive physical activity. Many people with bulimia report excessively thinking about their weight or body shape and a fear of gaining weight. As a result of BN, people may experience psychological, gastrointestinal, or oral challenges. While research is limited, there’s evidence that points to a lack of serotonin in the brain as a contributing factor to BN. For some, SSRIs may be an effective component of both BN and depression treatment.

Speaking with a health care provider may help you explore the possible relationship between bulimia and depression and see if they share any underlying causes. Openly communicating with your provider about how you’re feeling and any side effects you’re experiencing can help them to figure out if an option is effective or needs to be adjusted. Other treatment options include cognitive behavioral therapy (CBT), (a type of therapy that focuses on reframing your thoughts) or finding a support group. The Go Ask Alice! Q&A Finding low-cost counseling might provide you with options that fit your budget.

It takes a lot of courage to reach out about feeling trapped, as you’ve done here. While it may seem unbearable to feel as though there’s “no way out” right now, these thoughts may not linger forever. Reaching out to get more information is a crucial first step to finding treatment options to help you feel unstuck. Here’s hoping you find brighter days ahead.

Last updated May 07, 2021
Originally published Nov 01, 1994