Brief Answer:
recommended treatments and dose adjustments

Detailed Answer:
Hello,
Thank you for asking at healthcaremagic.

I carefully read your question and understand your concern.

Zoloft is an SSRI drug that helps with anxiety and depression, its medical name is sertaline. There are other SSRI drugs that are metabolized by the CYP2D19 and other ones that induce it but it seems sertraline (zoloft) is not one of them.
Clonazepam (the medical name for klonipin) is also does not seem to be in the list of the CYP2D19 inducers and amphetamine is not effected by CYP2D19 either.

Depression is a very common symptom with schizophrenia and i understand you feel unwell. Amphetamines do make you feel much better but they do have the risk of dependence and weighing risks and benefits is very important. Amphetamine is not a drug we give regularly for depression and anxiety in patients with schizophrenia. Actually the withdrawal effect of the stimulating drugs like amphetamine is that they might make you feel very down and even worsen depression when you are not taking them and increase the suicidal thoughts so even though at first you may feel well with them, in a long run they are dangerous.

On the other hand i would like to say that sertraline is a very good drug for depression but the dose you are having is very low and you might consider with your doctor to increase the dose of it at least 100-150 and than you can benefit from its therapeutic effect. The effect might take 10 days to be obvious after the dose change.
There are many other drugs that effect mood and help a lot in schizophrenia and your doctor might need to go through the options with you.

Basic principle is that optimizing the anti-depressive treatment with the medications for schizophrenia is very important and among the best ones for mood disorders in schizophrenia are the atypical anti-psychotics like Olanzapine. Any anti-psychotic (drug for schizophrenia) have side effects and it is your doctor that should describe them and monitor you closely every time a drug is started.
If you have optimized the use of anti-psychotics than adding and antidepressant like Zoloft would help but the optimal dose for it is 100-150 mg a day.

So to conclude:
1. you need to make sure you use an atypical anti-psychotic like olanzapine which is the most helpful in patients with schizophrenia that have depression
2. optimize the dose of the anti-psychotic- make sure you use a good dose of it
3. optimize the dose of zoloft
4. be closely working with your GP on any dose changes or medications to be added
5. sports, activities, counseling therapy might be nice addition to the treatment and might be very helpful
6. anytime you have suicide thoughts you need to talk with your doctor and ask help immediately


I hope this is helpful to you and answers to your question but please feel free to reply if any clarification is needed on this.

Kind regards,

Antoneta Zotaj, MD

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