Zoloft: Use and Side Effects

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Zoloft is one of the most frequently used antidepressants and is one of the first drugs prescribed for treating depression and anxiety. Sertraline is the chemical name of the active ingredient in Zoloft and is the drug’s generic form.

Zoloft is in the category of antidepressants called selective serotonin reuptake inhibitors (SSRIs).¹ It works by changing the serotonin signal in the brain, which plays a role in your mood, social behavior, appetite, digestion, sleep, memory, and sexual desire and function.

What is Zoloft Prescribed For?

Zoloft is commonly prescribed to treat:

• Major depressive disorder: This is a form of depression characterized by persistent sadness, a depressed mood, diminished interest in previously enjoyable activities, and other symptoms that interfere with functioning in daily life, lasting at least two weeks. It is one of the most common mental disorders, affecting an estimated 7.1% of all adults in the U.S. each year.²
• Premenstrual dysphoric disorder (PMDD): This is a mood disorder that occurs during the menstrual cycle’s premenstrual phase. It is characterized by severe irritability, depression, and anxiety.³
• Obsessive-compulsive disorder (OCD): This is a mental health condition characterized by unwanted thoughts and fears (obsessions) and repetitive behavior (compulsions) that interfere with daily life and cause significant distress.⁴ Taking Zoloft for anxiety is a common treatment.
• Panic disorder: A panic disorder is a type of anxiety disorder characterized by intense, recurrent, and unexpected panic attacks. These occur when there is no real danger or apparent cause.⁵
• Social anxiety disorder (SAD): This is a mental health issue that involves a dread of social situations, including performing or speaking in front of others for fear of being negatively judged. Social anxiety disorder affects 7% of the U.S. population.⁶ Using Zoloft for anxiety can make a difference in its occurrence.
• Post-traumatic stress disorder (PTSD): PTSD is a mental health condition affecting an estimated 6.8% of U.S adults. People experience various symptoms following exposure to a traumatic event, such as flashbacks, nightmares, intrusive thoughts, anxiety, avoidance, and changes in mood and thinking.⁷

Taking Zoloft

Zoloft should be taken only as directed by a physician. It is crucial that you talk about anything that you do not understand and make sure the doctor knows all other medications you take and medical issues you may have. You may take this medication for several months to feel better.

The dose of the medication will be different for each individual. The amount of medicine you are prescribed depends on the:

• Strength of the medication
• Number of doses
• Time between doses
• Length of time on the medication
• Medical issue you are treating

It is essential not to take Zoloft with a monoamine oxidase (MAO) inhibitor as there may be a potentially dangerous drug interaction.⁸ Anyone with a severe allergy to Zoloft should not take it.

Zoloft Side Effects

Zoloft has a relatively low rate of side effects. Your dosage depends on the condition it is prescribed to treat, along with your age and health.

Some side effects may occur that do not need medical attention. These may dissipate during treatment as the body adjusts to the medication. A healthcare professional should be able to tell you about how to prevent or reduce some of the side effects.

Check with a healthcare professional about any side effects that are bothersome and continue over time. Having severe side effects from Zoloft may be a reason to discontinue it.

Common side effects of Zoloft include:

• Weight gain and increased appetite: If you take Zoloft, you may gain weight over time. Zoloft can affect your appetite. SSRIs may cause changes in metabolism, which can increase appetite and cause your body to be less efficient at burning off calories.⁹
• Sexual side effects of Zoloft: Approximately 40 to 65% of people who use Zoloft experience lower libido or orgasm difficulties during the initial phases of taking Zoloft. Both men and women may be affected by this. Sexual side effects tend to wear off as your body becomes accustomed to Zoloft.¹⁰
• Dizziness: In the first several weeks on Zoloft, you may experience some mild dizziness or lightheadedness. This is more common if you take Zoloft during the morning hours. Taking Zoloft in the evening may help improve the daytime dizziness.¹⁰
• Sleep problems: Like all SSRIs, Zoloft effects can disrupt the quality of your night’s sleep. It may be more challenging to fall asleep, or you may suddenly wake up during the night. This is typically a short-term effect of Zoloft that will gradually dissipate.¹¹ It is important to avoid coffee, energy drinks, and caffeinated soda within the first month of taking Zoloft, as this could make sleeping problems more pronounced. Others may have unusual dreams, restlessness while asleep, or other alterations in sleep function.
• GI effects: During the first few weeks of taking Zoloft, diarrhea and other gastrointestinal problems can be common side effects. Approximately 15% of those who use Zoloft experience mild diarrhea or bowel irritations as a side effect of Zoloft.⁹
• Headaches: Some experience headaches after starting Zoloft that typically go away after one to two weeks. If the headaches persist, your doctor could recommend a different medication.¹⁰
• Dry mouth: Others may experience a common side effect such as dry mouth. This can lead to an increase in cavities and other oral issues. Remaining properly hydrated and using good oral hygiene can be helpful in these instances.¹⁰
• Night sweats: Night sweats are also a common side effect from SSRIs like Zoloft.⁹
• Low sodium: Zoloft can also cause low sodium, which is more common in older adults.⁹
• Increased anxiety: Zoloft can also increase anxiety and create an inability to remain calm, called akathisia. This can feel like a panic attack.¹⁰
• Rash: Sometimes, you can develop a rash or increased skin sensitivity while taking Zoloft. You may have allergic reactions such as hives, itchiness, or difficulty swallowing after starting Zoloft. If any of these occur, it is important to call your doctor immediately.¹¹
• Changes in mood or behavior: Zoloft can also create changes in mood or behavior. Someone who has bipolar disorder and is taking Zoloft may begin a manic episode while on Zoloft.¹⁰

If you take Zoloft for a long period of time, you may also be at risk of a Zoloft addiction. If you think you may have an addiction, call 800-681-1058 (Who Answers?) to talk to a rehab specialist about your treatment options.

If you are on several medications, you may be especially sensitive to increased serotonin levels as a result, which is a condition called serotonin syndrome.¹² This is caused by serotonin levels becoming too high from taking a medication like Zoloft with another drug that can increase serotonin levels. Some people experience this as a bad case of the flu. The symptoms of this syndrome include:

• Hallucinations
• Delusions
• Agitation
• Coma
• Increased heart rate
• Changes in blood pressure

Less common side effects include:¹⁰

• Aggressive reaction
• Breast tenderness or enlargement
• Confusion
• Convulsions
• Diarrhea
• Drowsiness
• Dryness of mouth
• Fast-talking and excited feelings or actions

Mixing Zoloft and Alcohol

Using alcohol while taking Zoloft is not recommended. This can worsen symptoms of depression and could intensify already existing side effects of the antidepressant. Zoloft and alcohol, when combined, can produce a negative reaction, with symptoms that include:¹³

• Drowsiness
• Depressed mood
• Slowed reflexes
• Excessive sweating
• Rapid heartbeat
• Facial flushing
• Nausea
• Dizziness
• Drop in blood pressure
• Heart palpitations

Zoloft Withdrawal

If you abruptly stop taking Zoloft or any other SSRI antidepressant, you may experience severe withdrawal symptoms called discontinuation syndrome.

This happens because your body needs time to adjust to being without the medication. Therefore, it is important to decrease your dose over time gradually.

Symptoms of discontinuation syndrome can include:¹⁴

• Irritability
• Agitation
• Dizziness
• Anxiety
• Mood swings
• Elevated mood
• Confusion
• Headache
• Decreased energy
• Nausea
• Sweating
• Sleeplessness
• Electric shock sensations
• Shaking
• Ringing in the ears
• Seizures

Risks of Taking Zoloft

It is important to note that Zoloft has a boxed warning. In the United States, the FDA mandates a boxed warning to be used when approved medication to raise a significant risk of severe or even life-threatening adverse effects. It is called a boxed warning (black box warning) because the text appears in a box on the packaging stating that there may be a relationship between the use of antidepressants such as Zoloft and the risk of suicidal ideation and behavior in children, adolescents, and young adults 18 to 24.

If there is someone who is at immediate risk of self-harm, suicide, or hurting someone else, it is important to call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. Stay with a person until professional help arrives. Remove any weapons, medications, or potentially harmful objects for that individual’s protection.

You can call 800-681-1058 (Who Answers?) to speak with a treatment specialist if you or a loved one needs assistance.

References

1. Mayo Clinic. (2019, September 17). Selective serotonin reuptake inhibitors.
2. National Institute of Mental Health. (2019, February). Major depression.
3. Office on Women’s Health. (2018, March 16). Premenstrual dysphoric disorder (PMDD).
4. Mayo Clinic. (2020, March 11). Obsessive-compulsive disorder.
5. Mayo Clinic. (2018, May 4). Panic attacks and panic disorder.
6. National Institute of Mental Health. (2017, November). Social anxiety disorder: more than just shyness.
7. National Institute of Mental Health. (2017, November). Post-traumatic stress disorder.
8. Mayo Clinic. (2019, September 12). Monoamine oxidase inhibitors.
9. Wein, H. (2016, May 3). Antidepressants have varied effects on weight change. National Institutes of Health.
10. Mayo Clinic. (2021, March 1). Sertraline side effects.
11. National Library of Medicine. (2021, March 13). Sertraline.
12. Mayo Clinic. (2019, December 19). Serotonin syndrome.
13. Mayo Clinic. (2017, June 9). Antidepressants and alcohol: What’s the concern?
14. Bullock, C. and Bernstein, C.A. (2019, April 11). Discontinuation syndrome and antidepressants. Harvard Medical School.