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Sertraline

Zoloft

RA
UR

Written by R. Author | Reviewed by Uche Ruth

Updated on June 02, 2024

Overview

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI). It's used to treat different mental health conditions, including depression and certain types of anxiety disorder, such as panic disorder. It's typically taken by mouth once per day. This medication is available as both a tablet and liquid. Common side effects of sertraline (Zoloft) include nausea, diarrhea, and dry mouth. It's best to avoid alcohol while taking sertraline (Zoloft) because this combination can worsen side effects of sertraline (Zoloft).

What is Sertraline (Zoloft) used for?

How Sertraline (Zoloft) works

Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI). It works by raising the levels of serotonin, an important chemical in your brain that's involved with regulating your mood and anxiety.

When does Sertraline (Zoloft) start working?

Time passed since treatment started:

time
Pharmacist tips for Sertraline (Zoloft)

  • You can take sertraline (Zoloft) with or without food, but if it upsets your stomach, try taking it with food to help.
  • Sertraline (Zoloft) can cause nausea. But it should get better as you continue taking the medication. If it doesn't, let your psychiatrist know. They might need to lower your dose of sertraline (Zoloft) or have you consider lifestyle or medication options to control nausea.
  • SSRIs, like sertraline (Zoloft), can cause sexual side effects, such as low sex drive and erectile dysfunction. If this is bothersome for you, talk with your psychiatrist. They might need to lower your dose of sertraline (Zoloft) or ask you to take it at a different time of the day.
  • Sertraline (Zoloft) can make some people feel sleepy or tired. Don't drive or do anything requiring concentration until you know how this medication affects you.
  • Avoid drinking alcohol while taking sertraline (Zoloft) because it can worsen some side effects (e.g., drowsiness, dizziness) as well as worsen your depression or anxiety symptoms.
  • Don't change your dose or suddenly stop taking sertraline (Zoloft) without talking to your psychiatrist first. Doing so can cause bothersome withdrawal symptoms like nausea, headache, and sleeping problems. Follow your psychiatrist's instructions to lower your dose slowly over a period of time to stop the medication completely.
  • Antidepressant medications, like sertraline (Zoloft), can raise the risk of suicidal thoughts. Contact your psychiatrist right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.
  • Sertraline (Zoloft) can cause false-positive results for benzodiazepine in drug tests. Make sure to report that you're taking sertraline (Zoloft) if you're asked to complete a drug test for work or school.

More tips for sertraline (Zoloft) liquid:

  • You must dilute the sertraline (Zoloft) liquid solution right before taking it. You can use 4 ounces (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Don't use any other types of liquid, and don't mix it in advance to take later. It's normal if the mixture looks cloudy or hazy after mixing.
  • A dropper dispenser comes with sertraline (Zoloft) to measure out your dose. The dropper dispenser contains dry natural rubber, which can be a problem for people with a latex allergy. If you have a latex allergy and can't use the dropper, ask the pharmacy for an oral syringe or medication dosing cup to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
  • Store the liquid at room temperature in the original bottle it came in from the pharmacy.

What are the risks and warnings for Sertraline (Zoloft)?

Worsening depression, suicidal thoughts, and unusual behavior

  • Risk factors: Age under 24 years old | History of depression or other mental health conditions

Taking sertraline (Zoloft) can make your depression worse and cause you to have thoughts of suicide or harming yourself. The risk is highest if you're 24 years of age or younger, within the first few months of taking the medication, and when your dose changes. If you or anyone around you notice that you have suicidal thoughts or unusual behavior (e.g., anxiety, panic attacks, difficulty sleeping, feeling angry or irritated, restlessness) while taking sertraline (Zoloft), get medical help right away.

Serotonin syndrome

  • Risk factors: Taking other medications that raise serotonin levels in your brain

Some people taking sertraline (Zoloft) have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk for serotonin syndrome is higher if you use sertraline (Zoloft) with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications. Let your psychiatrist know about all the medications you take before starting sertraline (Zoloft). Also, don't start any new medications without talking to your psychiatrist first. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Get medical help right away if you have any of these symptoms.

Risk of bleeding

  • Risk factors: Taking blood-thinners or other medications that raise your risk of bleeding

Sertraline (Zoloft) can raise your risk of severe bleeding or bruising, especially if you're also taking antiplatelets (e.g., aspirin, clopidogrel (Plavix)) or anticoagulants (e.g., warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto)). Get medical help if you get bruising that doesn't improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums.

Not for use alone in bipolar disorder

Depression can be the first sign of bipolar disorder. If you're at risk for bipolar disorder, taking antidepressants, like sertraline (Zoloft), by themselves can trigger a bipolar manic episode. Before starting sertraline (Zoloft), your psychiatrist will check to see if you have or are at risk for bipolar disorder. Sertraline (Zoloft) isn't used to treat bipolar depression. Talk to your psychiatrist right away if you or your loved ones notice unusual changes in your behavior, such as racing thoughts, restlessness, getting easily distracted, or unusual talkativeness.

Glaucoma

  • Risk factors: History of angle-closure glaucoma

Sertraline (Zoloft) can lead to or worsen angle-closure glaucoma. You might need to see your optometrist regularly and get eye exams to check your eyes and make sure your vision isn't worsening. Contact your psychiatrist or optometrist if you notice changes in your vision after starting sertraline (Zoloft).

Life-threatening abnormal heart rhythm (QT prolongation)

  • Risk factors: Low blood potassium or magnesium levels | Older age | Kidney problems | History of heart problems, slow heart rate, or other abnormal heart rhythms (arrhythmias) | Personal or family history of long QT syndrome | Taking other medications that cause QT prolongation

Sertraline (Zoloft) can affect your heart rhythm, which can be serious and life-threatening. One example includes lengthening the time period from when the heart pumps and then relaxes. This is known as QT prolongation. Your risk is higher if you have certain factors, including abnormal electrolyte levels, heart rhythm problems, or are taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone) and ciprofloxacin (Cipro), among others. To lower your risk, your psychiatrist or primary care provider might periodically monitor your heart and perform electrocardiograms (EKGs) to make sure your heart rhythm is normal. If you feel your chest pounding, have shortness of breath, have chest pain, or feel faint or lightheaded while taking sertraline (Zoloft), call 911 right away.

Low blood sodium levels

  • Risk factors: Older people | Taking diuretic medications

Sertraline (Zoloft) can cause low sodium levels in your blood. Your psychiatrist might closely monitor your blood sodium levels before and during treatment with sertraline (Zoloft). Get medical help right away if you experience weakness, confusion, difficulty concentrating, headache, or memory problems because these could be signs of low blood sodium levels, which is a medical emergency.

Strengths

Bottle of oral solution

60ml of 20mg/ml

Capsule

150mg
200mg

Tablet

25mg
50mg
100mg

Dosages

Adults

  • Depression, PD, OCD, PTSD, SAD: The typical starting dose ranges from 25 mg to 50 mg by mouth daily. The typical maintenance dose ranges from 50 mg to 200 mg daily, depending on your condition.
  • PMDD: The typical starting dose is 50 mg by mouth daily. Your psychiatrist might ask you to take this medication daily throughout your menstrual cycle (up to 150 mg daily), or to only take it daily starting 2 weeks before your period begins and stopping when your period ends (up to 100 mg daily).

Children (age 6 years and older)

  • OCD: The typical starting dose ranges from 25 mg to 50 mg by mouth daily, depending on your child's age. The typical maintenance dose ranges from 50 mg to 200 mg daily.

Your psychiatrist will determine your dose based on your age and medical condition. Your dose might be different if you have liver problems.

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Interactions

Sertraline (Zoloft) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Sertraline (Zoloft). Please note that only the generic name of each medication is listed below.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Side-effects

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Nausea (26%)
  • Diarrhea (20%)
  • Difficulty sleeping (20%)
  • Dry mouth (14%)
  • Sleepiness (12%)

Other Side Effects

  • Irregular heartbeat
  • Loss of appetite
  • Changes in vision
  • Tremor
  • Sexual side effects (ejaculation problems, erectile dysfunction, low sex drive)
  • Sweating

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

  • Suicidal thoughts or behaviors
  • Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, distress, seizures, distress, hallucinations, coma
  • Abnormal heart rhythm (QT prolongation): chest pounding, short of breath, chest pain, feeling faint or lightheaded
  • Severe bleeding: bruising that doesn't improve, black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums
  • Low blood sodium levels: nausea, fatigue, headache, confusion, disoriented, hallucinations (seeing things that aren't real), seizures, unconsciousness

When do Sertraline (Zoloft) possible side effects begin and end?

Time passed since treatment started:

Seek immediate medical care if you experience this side effect marked with red. If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  • Decreased sexual desire or ability
  • Failure to discharge semen (in men)

Less common or rare

  • Aggressive reaction
  • Breast tenderness or enlargement
  • Confusion
  • Convulsions
  • Diarrhea
  • Drowsiness
  • Dryness of the mouth
  • Fast talking and excited feelings or actions that are out of control
  • Fever
  • Inability to sit still
  • Increase in body movements
  • Increased sweating
  • Increased thirst
  • Lack of energy
  • Loss of bladder control
  • Mood or behavior changes
  • Muscle spasm or jerking of all extremities
  • Nosebleeds
  • Overactive reflexes
  • Racing heartbeat
  • Red or purple spots on the skin
  • Restlessness
  • Shivering
  • Skin rash, hives, or itching
  • Sudden loss of consciousness
  • Unusual or sudden body or facial movements or postures
  • Unusual secretion of milk (in females)

Incidence not known

  • Abdominal or stomach pain
  • Bleeding gums
  • Blindness
  • Blistering, peeling, or loosening of the skin
  • Bloating
  • Blood in the urine
  • Bloody, black, or tarry stools
  • Blue-yellow color blindness
  • Blurred vision
  • Chest pain or discomfort
  • Chills
  • Clay-colored stools
  • Cough or hoarseness
  • Darkened urine
  • Decreased urine output
  • Decreased vision
  • Depressed mood
  • Difficulty with breathing
  • Difficulty with speaking
  • Difficulty with swallowing
  • Drooling
  • Dry skin and hair
  • Eye pain
  • Fainting
  • Feeling cold
  • Feeling of discomfort
  • Feeling, seeing, or hearing things that are not there
  • General feeling of discomfort, illness, tiredness, or weakness
  • Hair loss
  • High fever
  • High or low blood pressure
  • Hoarseness or husky voice
  • Hostility
  • Increased clotting times
  • Indigestion
  • Inflamed joints
  • Irritability
  • Joint or muscle pain
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • Lethargy
  • Lightheadedness
  • Loss of appetite
  • Loss of balance control
  • Loss of bladder control
  • Lower back or side pain
  • Muscle aches
  • Muscle cramps and stiffness
  • Muscle trembling, jerking, or stiffness
  • Muscle twitching
  • Painful or difficult urination
  • Pains in the stomach, side, or abdomen, possibly radiating to the back
  • Pale skin
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Rapid weight gain
  • Rash
  • Red, irritated eyes
  • Red, sore, or itching skin
  • Right upper stomach pain and fullness
  • Severe mood or mental changes
  • Severe muscle stiffness
  • Shuffling walk
  • Sore throat
  • Sores, ulcers, or white spots in the mouth or on the lips
  • Sores, welting, or blisters
  • Stiffness of the limbs
  • Sweating
  • Swelling of the face, ankles, or hands
  • Swollen or painful glands
  • Talking or acting with excitement you cannot control
  • Tightness in the chest
  • Troubled breathing
  • Twisting movements of the body
  • Twitching
  • Uncontrolled movements, especially of the face, neck, and back
  • Unexplained bleeding or bruising
  • Unpleasant breath odor
  • Unusual behavior
  • Unusual tiredness or weakness
  • Vomiting of blood
  • Weight gain
  • Yellow eyes and skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Acid or sour stomach
  • Belching
  • Decreased appetite or weight loss
  • Diarrhea or loose stools
  • Heartburn
  • Sleepiness or unusual drowsiness
  • Stomach or abdominal cramps, gas, or pain
  • Trouble sleeping

Less common

  • Agitation, anxiety, or nervousness
  • Bladder pain
  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • Changes in vision
  • Cloudy urine
  • Constipation
  • Difficult, burning, or painful urination
  • Flushing or redness of the skin, with feeling of warmth or heat
  • Frequent urge to urinate
  • Increased appetite
  • Pain or tenderness around the eyes and cheekbones
  • Stuffy or runny nose

Incidence not known

  • Flushed, dry skin
  • Fruit-like breath odor
  • Increased hunger
  • Increased urination
  • Redness or other discoloration of the skin
  • Severe sunburn
  • Swelling of the breasts (in women)
  • Unexplained weight loss
  • Unusual secretion of milk (in women)

Common Concerns

Yes, sertraline (Zoloft) is an selective serotonin reuptake inhibitor (SSRI).
How long it takes for sertraline (Zoloft) to work might differ depending on your medical condition. For example, if you're being treated for depression, you might notice improvements to your mood 2 weeks after you start taking sertraline (Zoloft). But, it can take about 1 to 2 months before you feel its full effects. You might feel certain side effects of sertraline (Zoloft), such as nausea and diarrhea, before noticing improvement in your mental health. Talk with your healthcare team if you're not sure if sertraline (Zoloft) is working.
Sertraline (Zoloft) isn't FDA-approved for generalized anxiety disorder (GAD). But, it's one of the first-choice options for GAD (off-label use). It's also approved to help with certain anxiety disorders, such as social anxiety disorder (SAD) and panic disorder. Talk with your psychiatrist if you've more questions about sertraline (Zoloft) and anxiety.
Yes, it's possible to gain weight from taking sertraline (Zoloft). But sertraline (Zoloft) is less likely to cause weight gain compared to some other SSRIs, such as paroxetine (Paxil). During clinical studies, some people reported weight loss instead after starting sertraline (Zoloft). Talk with your provider if you're experienced unexpected weight changes after starting this medication.
Yes, sertraline (Zoloft) can cause tiredness as a side effect. This medication can also make it hard for people to sleep at night, which might also lead to feeling drowsy during the day. When you first start sertraline (Zoloft), pay attention to how this medication is affecting your sleep. If it's making you too sleepy or interrupting your sleep, contact your psychiatrist. They can try to ease this side effect by making changes to your dose or the timing of when you take this medication.
Many side effects from sertraline (Zoloft), such as nausea or sleeping problems, can get better over time. You're more likely to get side effects when first starting the medication and with dose changes. If any side effects become too bothersome for you, let your psychiatrist know. They might adjust your sertraline (Zoloft) dose or recommend certain tips to manage side effects.
It takes about 5 days for most of sertraline (Zoloft) to leave your body after a single dose. This time frame is estimated based on the half-life of sertraline (Zoloft).
No, sertraline (Zoloft) isn't a controlled substance and it doesn't have a risk of addiction, misuse, or dependence.

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