Zoloft (Sertraline)

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI). The FDA approved it in 1999¹. Zoloft is the treatment for depression, obsessive-compulsive disorder, panic attacks, social anxiety, and more. 

Zoloft, or its generic form sertraline, is a prescription medication available as a tablet in 25mg, 50mg, and 100mg, and an oral concentrate of 20mg/ml. 

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How does Zoloft work?

Zoloft is an antidepressant drug used to treat depression and anxiety disorders. It works by increasing the amount of serotonin, a natural substance produced in the body that helps regulate your mood and thoughts.

Zoloft comes from a group of medications called selective serotonin reuptake inhibitors or SSRIs. These medications help treat depression and anxiety disorders. Prozac was the first to be FDA-approved in 1987. Now, there are many more SSRIs available, including Paxil, Symbyax, Lexapro, and Celexa.  

Antidepressants work best combined with therapy

It's best to participate in psychotherapy, like cognitive behavior therapy (CBT), to get the most from antidepressants and SSRIs like Zoloft.

Research² has found that it's most effective to combine medication treatment with therapy to relieve certain disorders (like depression and anxiety).

Mental health disorders it treats

Sertraline is used to treat the symptoms of depression and anxiety disorders, including:

  • Major depressive disorder

  • Social anxiety disorder

  • Obsessive-compulsive disorder (OCD)

  • Panic disorder

  • Posttraumatic stress disorder (PTSD)

  • Generalized anxiety disorder (GAD)

  • Premenstrual dysphoric disorder (PMDD)

You shouldn't use Zoloft to manage a condition it wasn't prescribed to treat, even if it’s in the list above. For example, if your doctor prescribes you Zoloft for major depressive disorder, but you believe you also have an anxiety disorder, make sure you speak with them about the proper medication and management for both conditions.

How Zoloft treats depression

Sertraline works by increasing the levels of serotonin in the brain. It’s FDA-approved for treating major depressive disorder, posttraumatic stress disorder, premenstrual dysphoria, panic disorder, and social phobia. It is also FDA-approved for treating obsessive-compulsive disorder (OCD) in adults and children aged 6-17 years old.

Symptoms of depression include:

  • Feeling depressed: feeling sad, empty, or tearful

  • Feeling worthless, guilty for not feeling better, hopeless because nothing seems to help

  • Losing interest or pleasure in doing your normal activities

  • Eating less and sleeping more

  • Feeling low or having trouble concentrating

  • Nervousness

  • Feeling like you're moving and thinking in slow motion

  • Thoughts of suicide or suicidal behavior

How Zoloft treats other mental health disorders

PTSD

PTSD is a trauma- and stressor-related disorder that occurs after experiencing a traumatic event. It causes people to feel anxious and nervous, avoid certain situations, and sometimes even have nightmares.

PMDD

Premenstrual dysphoric disorder (PMDD) is when women experience depression, tension, and irritation for a few days before their period starts. These symptoms are more serious than those of PMS.

Panic disorder

Panic disorder occurs when someone has unexpected and repeated episodes of extreme fear. These episodes include physical symptoms, such as chest pain, shortness of breath, heart palpitations (rapid heartbeat), sweating, dizziness, nausea, and vomiting. The fear of having future episodes often accompanies panic attacks.

OCD

OCD is an anxiety disorder that causes a person to experience certain thoughts repeatedly. Symptoms include:

  • Obsessions (unwanted, recurrent, and disturbing thoughts)

  • Compulsions (repetitive, ritualized behaviors that the person feels driven to perform to lessen the anxiety produced by the obsessions)

Social anxiety disorder

Social phobia/social anxiety disorder is a fear of situations where one may feel as if others are judging them. Symptoms include:

  • Blushing

  • Difficulty talking

  • Nausea

  • Sweating

  • Shaking

Research has shown that sertraline (Zoloft) helps patients³ who suffer from binge eating disorders, bulimia, or general anxiety. However, the FDA has not approved its use for these conditions, so it would be an 'off-label' prescription. 

Your mental health provider must justify their thinking when recommending an off-label treatment. They should clearly explain the limitations of the research around that particular medication and if there are other options available.

Secondary uses

Sertraline also treats sexual problems, headaches, diabetic nerve pain, and fibromyalgia.⁴

What are the potential side effects of Zoloft?

Sertraline may cause side effects such as: 

  • Nausea

  • Diarrhea

  • Stomach pain

  • Loss of appetite

  • Dry mouth

  • Headache

  • Feeling tired

  • Trouble sleeping

  • Dizziness

  • Nervousness

  • Sexual problems

These often improve over the first week or so as you continue to take your medication.

You should tell your doctor about any new symptoms while taking this medicine.

These symptoms usually go away after stopping the medicine, but you should call your doctor if any side effects last more than two weeks.

Rare/serious side effects include:

  • Low sodium levels in the blood

  • Symptoms of low sodium levels, including headaches, weakness, difficulty concentrating, and poor memory

  • Teeth grinding

  • Angle-closure glaucoma

  • Serotonin syndrome

Serotonin syndrome is a serious condition caused by taking too much serotonin. Seizures, coma, and even death may occur. Aspirin, NSAIDs, warfarin, and other anticoagulants (blood thinners) may increase the risk of serotonin syndrome.

Zoloft and autism

Studies⁵ have found a link between using antidepressants during pregnancy and having children with autism. They also found boys are more likely to be autistic than girls, and older women are more likely to have an autistic child. Mothers using antidepressants while pregnant are more likely to have a boy with autism.

Are there risks associated with taking Zoloft over a long period?

Sertraline is an anti-depressant drug that is safe and effective when used as prescribed. There are no known risks associated with taking this medication long-term.

How to take Zoloft

Zoloft requires a prescription. You take it orally, with or without food, and you should take it exactly as prescribed. You should also ask your doctor about any side effects you might experience.

You should take sertraline regularly, and your doctor may need to increase or decrease the dose depending on how you feel. Don't take more than your healthcare provider recommends.

The recommended starting dose of sertraline for adults is 50mg, but your doctor may prescribe a higher (up to 200mg) or lower dose depending on your individual needs.

Don't stop taking sertraline abruptly because this might cause unpleasant side effects such as agitation, confusion, numbness, tingling, or an electrical shock feeling. Ask your doctor before stopping sertraline. 

Taking Zoloft oral solution

If you take the Zoloft oral concentrate instead of the tablet form, you need to dilute the mixture first.

Add the concentrate to 4 ounces (1/ 2 cup [120 milliliters]) of water, ginger ale, lemon or lime soda or lemonade, or orange juice⁶.

Note that the liquid form of Zoloft does contain alcohol. 

Doses

The strength of the medicine you take depends upon the amount you need. The number of doses you take, the time allowed between them, and the length of the time you take the medicine for depends on the medical condition you have.

Your doctor will likely begin by giving you a low dose, which they will gradually increase over several days or weeks until you reach an effective dose.

For oral dosage forms⁷ (solution or tablets), prescribed doses are usually:

  • For adults and teenagers: Take 50mg once a day, either in the morning or at night. It's important to talk to your doctor before adjusting your dose. However, the dose for most people is usually no more than 200mg per day.

  • Children between six and twelve years old: Initially, take 25mg once daily, either in the mornings or evenings. Your doctor may adjust the dose of your medication as necessary. For children under six years old, their physician determines use and dosage.

What happens if I miss a dose of Zoloft?

If you forget to take your medicine, do not take another dose until the next scheduled dose, and do not double the dose. 

You can use a calendar, pillbox, alarm clock, or cell phone to remind you to take your medication. You can also ask a family member or friend to remind you to take your medicine.

Talk to your healthcare provider if you need help remembering when to take your medicine.

Starting Zoloft

When people first start taking Zoloft, they usually see an improvement in mood within a week or two. However, it may take several weeks before you feel the full effect of the drug.

You may also experience side effects such as nausea or upset stomach, sweating, diarrhea, tremor, or reduced appetite.

What you can expect

Sertraline won't make you act like someone else, and your personality doesn't change. But it may help you feel more like yourself.

Sleep, energy, or appetite might improve within the first week. Depression and lack of interest in usual activities may take longer than six weeks to improve.

You should speak with your doctor if you experience new or worsening symptoms, such as aggression, anger, impulsive behavior, suicidal thoughts, or new or worse panic attacks. 

Don't stop using sertraline without speaking to your doctor first.

What is the best time to take Zoloft - morning or night?

Take Zoloft once daily, either in the morning or evening. If Zoloft causes you to feel sleepy, take it before bedtime. You may take it before or after meals; however, it must be consistent.

Establishing a routine and following it every time you take sertraline is best.

To ensure you remember to take your dose, make it part of your daily routine. For example, if every morning you eat breakfast at the same time, you could take it then.

What should my doctor know before I start Zoloft?

  • Symptoms of your mental health condition: What physical or emotional symptoms bother you the most? 

  • Suicidal thoughts: Make sure to tell your doctor if you are having or have had thoughts of suicide or self-harm.

  • Treatment history: Your doctor should know about any previous treatments you've tried and what worked and didn't work for you.

  • Medications: You should discuss any prescribed or over-the-counter medications you take with your doctor, including any used to treat migraines and psychiatric disorders. This is because your risk of serotonin syndrome increases if you take Zoloft with other drugs that also increase serotonin. 

  • Medical history: Report any other illnesses you might have to your doctor, including other psychiatric conditions. 

Withdrawal symptoms

People who stop taking antidepressants may suffer from what doctors describe as discontinuation syndrome.

Symptoms may be most intense the very first week and gradually taper off. Some people may experience a longer withdrawal period.

Doctors may mistakenly believe that withdrawal symptoms indicate a depressive relapse. The severity of symptoms depends on dose and duration.

Discontinuation syndrome symptoms include: 

  • Dizziness

  • Loss of coordination

  • Fatigue

  • Tingling or burning

  • Blurred vision

  • Vivid dreams

  • Insomnia

  • Irritability

  • Anxiety

  • Crying spells

  • Flu-like symptoms.

Overdose signs

When you take too much of this medicine, you could get sick or even die. Call your healthcare provider or 911 right away if you think you've taken too much.

Common side effects of sertraline overdose include:

  • Agitation

  • Dizziness

  • Increased heart rate

  • Nausea

  • Sleepiness

  • Tremors

  • Vomiting

Who should not take Zoloft?

Never take Zoloft if your doctor prescribes you any of the following medicines: Nardil, Parnate, Marplan, Isocarboxazid, Tranylcypromine Sulfate, or Orap. You should also avoid taking Zoloft if you're taking pimozide or disulfiram.

Sertraline should be taken with caution if you take monoamine oxidase (MAO) drugs or tricyclic antidepressants. Avoid combining sertraline with other medicines that boost serotonin, including triptans, opiates, and anti-depressants.

Sertraline increases the effect of certain other medications that raise serotonin levels. Serotonin syndrome can occur when these drugs are combined.

Pregnancy/breastfeeding

Pregnant women should avoid taking Zoloft because it could harm their unborn child. Their baby may be born with serious problems such as breathing difficulties.

Zoloft should be used with caution by pregnant women because it may cause congenital disabilities. Women taking Zoloft should avoid becoming pregnant until they stop taking the medication.

For women who take SSRIs when they're pregnant, there appears to be a less than 1% chance³ of their babies developing persistent pulmonary hypertension.

A handful of lawsuit claims blamed Zoloft for congenital disabilities. Most of these cases were withdrawn or dismissed.

Bipolar disorder

Before starting Zoloft, let your healthcare provider know if you've ever been diagnosed with or suspected of having bipolar disorder or have any family members who have been diagnosed with it.

Taking Zoloft can cause a hypomanic or manic episode in bipolar disorder.⁸

Black box warning for suicide

The FDA requires Zoloft and all other anti-depressants to include a black box warning about the risk of suicide and suicidal thoughts in people younger than 25. Studies show that a small number of people in this age group who take this medication may experience thoughts of suicide or death. 

If you experience thoughts of wanting to harm yourself while taking Zoloft, call 911 or visit your nearest emergency department.

Clinical trials history

These studies established the effectiveness of Zoloft⁴:

MDD: two trials in adults and one trial in children.

OCD: three trials in adults and one in children.

PD: three trials in adults.

PTSD: two trials in adults.

SAD: two trials in adults and one trial in women.

PMDD: two trials in adults

Observed results

Multiple controlled clinical trials showed that sertraline was effective at treating depression. Continued treatment with sertraline prevents both a relapse of current depressive episodes and future depressive episodes.

Sertraline decreases the frequency of panic attacks and improves the quality of life¹⁰. Zoloft significantly improved symptoms in 50–60% of people compared to 20–30% who received a placebo.

Observed side effects

Clinical studies have found a risk of developing depression when taking Zoloft. People who have this side effect should try other antidepressants.

Clinical trials are under different conditions than real life. Adverse reactions seen in clinical trials are not always the same as those in real life.

Nausea was the most common side effect reported in all studies. Other side effects included diarrhea, loose stools, sweating, vomiting, loss of appetite, and sexual problems⁹.

Researchers noticed other, more serious side effects during Zoloft clinical trials⁵. These side effects were rarer but are worth mentioning. They include gynecomastia (male breast enlargement), urinary problems, flu-like symptoms, menstrual disorders, amnesia, hallucinations, delusions, thirst, anemia, aggression, ear and eye pain, muscle cramps, weight gain, back pain, weight loss, and seizures.

Allergic reactions

Allergic reactions to Zoloft are uncommon. However, if you take Zoloft and develop signs or symptoms of an allergy, you should contact your doctor immediately. Signs to look out for include a rash, hives, swelling, and breathing difficulties. 

Drug interactions

If you take any medicines that interact with Zoloft, they may decrease its effect, make you feel worse, affect how long it works for you, or increase side effects (like nausea, diarrhea, etc.).

Sometimes an interaction between two medications means that you need to stop taking one of them. Ask your doctor if there are any interactions between your drugs and how to manage them.

  • Taking Zoloft with non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners may increase the risk of stomach bleeding⁵.

  • You should never take Zoloft with alcohol because it will make you feel more intoxicated than you normally would.

  • Don't take St. John's wort with Zoloft because it will lower your serotonin levels.

  • Combining lithium with SSRIs like Zoloft can cause serotonin syndrome, which happens when too much serotonin is released into the brain. This can lead to agitation, confusion, hallucinations, seizures, coma, heart problems, liver damage, changes in blood pressure, rashes, and even death.

  • Tryptamines like St. John's wort can also cause serotonin syndrome.

  • Any medications that may cause drows­iness, such as benzodiazepines (e.g., diazepam, lorazepam), first-gen­eration antihistamines (such as doxylamine or prozemetha­mine), metoclo­pramide, or opioids.

  • Don't drink alcohol or use illegal drugs when taking antidepressants.

  1. Drug approval package | U.S. Food & Drug Administration

  2. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis (2014)

  3. Sertraline (Zoloft) | National Alliance on Mental Illness

  4. Zoloft (Sertraline) | Everyday Health

  5. Zoloft | Drugwatch

  6. Sertraline | Medline Plus

  7. Sertraline (oral route) | Mayo Clinic

  8. Precautions you should take before taking Zoloft | Very Well Mind

  9. Zoloft | Rx List

  10. Sertraline | Wikipedia

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Disclaimer

Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.

However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.

It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.

Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.

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