Zoloft side effects and how to avoid them

Sertraline, most commonly known by its brand name, Zoloft, is a popular prescription medication used to treat depression, anxiety, post-traumatic stress disorder, social anxiety disorder, panic disorder, and premenstrual dysphoric disorder (PMDD). It belongs to a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs), meaning it works by increasing the amount of serotonin in the brain. As with many antidepressants, people who take sertraline may experience some adverse effects. Continue reading to learn about sertraline side effects, warnings, and possible drug interactions. 

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Common side effects of sertraline

With any medication, there is always a risk of experiencing potential adverse effects. To know when you’re experiencing side effects, it helps to understand how the drug should make you feel when it’s working correctly. In the case of sertraline, patients can expect to feel improvements in mood, appetite, sleep quality, energy level, and interest in daily life. In other words, an easing of symptoms like depression and anxiety. 

“Sertraline, just as all other SSRIs, increases circulating serotonin levels in the human body, promoting a sense of well-being and allowing persons with depression and anxiety to cope better with their current situation or condition,” says to Raul Perez-Vazquez, MD, a primary care physician of Tenet Florida Physician Services and West Boca Medical Center.

These are the most common sertraline side effects:

• Nausea
• Diarrhea
• Constipation
• Difficulty falling asleep or staying asleep
• Dry mouth
• Heartburn or indigestion
• Loss of appetite
• Weight loss or weight gain
• Dizziness
• Excessive tiredness
• Headache
• Nervousness
• Changes in sex drive
• Erectile dysfunction, including delayed ejaculation
• Excessive sweating

When do Zoloft side effects go away?

Many of the common side effects listed below can go away after a few weeks while the body adjusts. 

“Sertraline itself takes about a month to start working, and many of the mild side effects diminish after your body has adjusted to the medication,” says David Nazarian, MD, a primary care physician at My Concierge MD in Beverly Hills. 

It’s a good idea to track side effects that you experience and keep your healthcare professional updated so your physician can effectively monitor reactions and adjust medication as needed. Most importantly, tell a doctor if side effects are severe, worsening, or do not go away.

Serious side effects of sertraline

There are some less common, but severe side effects of sertraline. The following symptoms require immediate medical attention:

• Abnormal bleeding or bruising
• Agitation
• Confusion
• Fever, sweating, shivering
• Hallucinations
• Hives or rash
• Loss of coordination
• Muscle stiffness or twitching
• Nausea, vomiting, or diarrhea
• Rapid heartbeat
• Seizures
• Swelling
• Suicidal thoughts
• Trouble breathing
• Uncontrollable shaking of a part of the body

Zoloft withdrawal

Although most of the side effects are reversible, you should not stop taking sertraline abruptly. Instead, speak with a healthcare provider before discontinuing this medication to avoid withdrawal symptoms. A doctor can devise a plan to slowly taper the medication.  Withdrawal symptoms include: 

• Irritability/mood swings 
• Nausea
• Dizziness
• Vomiting
• Insomnia
• Nightmares
• Headache
• Paresthesias (prickling, tingling sensation on the skin)

Collectively, these symptoms are called antidepressant discontinuation syndrome, which requires immediate medical assistance. 

Sertraline warnings

Other FDA warnings include restrictions for:

• Patients who are allergic to sertraline or any of its inactive ingredients
• Pregnant women or those who may become pregnant, as sertraline may cause problems in newborns following delivery
• Women who are breastfeeding since sertraline may pass through breast milk
• Those with preexisting eye problems that may make them susceptible to develop angle-closure glaucoma, which can cause severe eye pain or even blindness. An eye test may be required before receiving a sertraline prescription. 
• Those with bipolar disorder. If sertraline is taken without a mood stabilizer, a patient may be at risk for shifting into a manic or hypomanic episode.

Suicidal thoughts

Perhaps the most significant warning to be aware of when taking sertraline is the potential for suicidal thoughts or actions, especially in young adults. All antidepressants, in fact, have a boxed warning (the strongest warning required by the FDA) about antidepressants and suicidal thoughts and behaviors. 

According to the drugmaker Pfizer, a patient may become suicidal, especially at the beginning of treatment and any time that the dose is increased or decreased. Pfizer advises patients to call a healthcare provider right away if you notice new or sudden changes in mood, behavior, or thoughts. Patients and their families should be made aware of this rare but possible effect. Otherwise, all patients should regularly follow up with a doctor and call between appointments if experiencing any of the following symptoms:

• Feeling agitated, restless, angry, or irritable
• An increase in activity or talking more than usual
• New or worsening depression
• New or worsening anxiety or panic attacks
• Trouble sleeping
• Acting on dangerous impulses
• Acting aggressive or violent
• Thoughts about suicide or dying
• Attempts to commit suicide
• Other unusual changes in behavior or mood

Drowsiness

A common side effect of sertraline is sleepiness, which could affect your ability to react quickly or make clear decisions. For this reason, there is a strong warning not to drive, operate heavy machinery, or do other dangerous activities until you know how sertraline affects you. 

Serotonin syndrome

Serotonin syndrome is a life-threatening condition that can be caused by taking sertraline with other medications that increase the production of serotonin in the body. These medications include:

• Monoamine oxidase inhibitors (MAOIs—don’t use Zoloft within 14 days of these medications). 
• Other SSRIs (like Prozac, Paxil, Celexa, Lexapro)
• SNRIs (like Effexor, Cymbalta, Pristiq)
• Triptans (Imitrex, Maxalt, etc)
• Tricyclic antidepressants (such as Elavil or Pamelor)
• Fentanyl
• Lithium
• Tramadol
• Tryptophan 
• Buspirone
• St. John’s Wort
• Fanapt (iloperidone)
• Thorazine (chlorpromazine)

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Symptoms of serotonin syndrome include:

• High fever
• Rapid changes in heart rate or blood pressure
• Uncontrolled muscle spasms
• Confusion
• Headache
• Heavy sweating 
• Diarrhea
• Stiff muscles
• Loss of consciousness (passing out)

Sertraline interactions

Before taking a new prescription drug, you should disclose all medications that you’re currently taking. Over-the-counter, prescription drugs, and even natural remedies like supplements have the potential to cause harmful drug-drug interactions.

Certain antipsychotics

Mixing sertraline with antipsychotics increases your risk of heart conditions, including cardiac arrest. One example is Orap (pimozide), an antipsychotic medication often prescribed to people with Tourette syndrome. Geodon (ziprasidone) and droperidol are other antipsychotics that could interact with sertraline.

Blood thinners

Taking sertraline with blood thinners (aspirin, Plavix, heparin, warfarin) can increase your risk of bleeding, including nosebleeds as well as stomach and intestinal bleeding. 

Non-steroidal anti-inflammatory drugs (NSAIDs)

Combining sertraline with NSAIDs, like ibuprofen or naproxen, can also increase the risk of severe stomach issues, including life-threatening bleeding, and low sodium levels.

Alcohol

You should not drink alcohol while taking sertraline as both affect chemicals in the brain. Alcohol may alter the effectiveness of sertraline and lead to side effects, including sleep problems and excessive drowsiness. 

Additionally, Antabuse (disulfiram), which treats alcoholism, cannot be combined with the liquid form of sertraline because of the alcohol content in liquid sertraline.

How to avoid sertraline side effects

The best way to prevent sertraline side effects is to take the medication exactly as prescribed by a doctor and in alignment with the drug manufacturer’s instructions. 

The starting dose of sertraline is 25 to 50 mg per day, which can be slowly tapered up if necessary. Sertraline dosages can be adjusted by the physician through close monitoring of the patient and your response to the medication. “Always begin sertraline at the lowest dose, and increase slowly, reevaluating symptoms periodically, and using the lowest effective dose,” says Dr. Perez-Vazquez.

Sertraline can be taken with or without food, according to Pfizer. However, if the liquid concentrate form of sertraline is prescribed, it must be diluted with water, ginger ale, lemon or lime soda, lemonade, or orange juice.

There are a few other steps you can take to help minimize sertraline side effects while you’re waiting for your body to adjust to the new medication. “Some small lifestyle modifications can assist with sertraline side effects, like taking the medication at night to prevent lethargy or eating small frequent meals to avoid nausea,” says Dr. Nazarian. “By listening to your body, noticing the side effects, and making appropriate interventions early on, discomfort can be minimized.” 

Another sometimes overlooked step in ensuring the medication acts as it should is to follow manufacturer instructions on how to store the prescription carefully. Regarding sertraline, the bottle should be tightly closed, kept out of the reach of children, and stored at room temperature, 68°F to 77°F (20°C to 25°C).