Zoloft Withdrawal: What to Expect and How to Treat It

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If you (or a loved one) are taking Zoloft or are thinking about taking it, it’s important to what to expect when you take it, Zoloft withdrawal symptoms, and how they are treated. You might also be feeling ambivalent about taking medication in general, in which case, it can be helpful to know what questions and information to discuss with a medical professional to help make your decision.

What Are Zoloft Withdrawal Symptoms?

You might think of withdrawal as something experienced only when suddenly stopping the use of illicit (illegal) drugs. However, withdrawal can be experienced even if you take Zoloft as prescribed and then abruptly stop. This is because your body becomes “dependent” on the drug in the sense that your body has been using it for some time to function better.⁵

Those at risk for Zoloft withdrawal include those who stop the medication abruptly without the direction of their medical prescriber. Zoloft withdrawal symptoms can include:

Irritability
Nausea
Dizziness
Vomiting
Nightmares
Headache
Paresthesia (tingling sensation on the skin)¹
Flu-like symptoms
Tachycardia (rapid heartbeat)
Insomnia (too little sleep) or hypersomnia (too much sleep)
Anxiety
Depression
Suicidal thoughts
Agitation
Aggression
Hallucinations (seeing or hearing things that are not there)
Decreased concentration
Ataxia (impaired coordination)
Confusion
Myoclonus (sudden, brief involuntary muscular twitching or jerking)⁵

These symptoms could peak at 36-96 hours or later after stopping Zoloft and could last up to 6 weeks.⁵

There are two withdrawal durations: acute and protracted. Acute withdrawal occurs immediately after discontinuation of Zoloft. Protracted withdrawal occurs later, lasts longer (can be weeks or months after stopping the drug), and the symptoms can sometimes be irreversible.⁵

Zoloft Rebound

“Rebound” is also a type of withdrawal. It means that the symptoms for which you started taking Zoloft return after stopping the medication abruptly, but at a greater intensity than they were before you started the medication. These symptoms can include:

Anxiety
Agitation
Insomnia
Depression
Obsessions and compulsions.

The rebound can start 36-96 hours after stopping Zoloft and could continue for about 6 weeks.⁵

Treatment for Zoloft Withdrawal

To avoid Zoloft withdrawal symptoms, your doctor will usually prescribe a tapering at the end of the medication treatment. This means that they will slowly lower the dosage over time so that your body doesn’t experience abrupt discontinuation of the drug.

If you stop taking Zoloft abruptly or experience any withdrawal symptoms, get immediate medical attention. Treatment may involve the administration of a similar drug or restarting Zoloft with a much slower taper. Treatment would also include alleviation of any dangerous or unpleasant symptoms such as hallucinations, depression, headaches, vomiting, and diarrhea.⁵

What is Zoloft?

Zoloft, also known by its generic name sertraline, is a psychotropic medication. That means it works in the brain to affect mood, behavior, thoughts, or perceptions. It is typically used to treat:¹

Major depressive disorder (MDD)
Premenstrual dysphoric disorder (PMDD)
Post-traumatic stress disorder (PTSD)
Panic disorder
Obsessive-compulsive disorder (OCD)
Social anxiety disorder

Some doctors may also prescribe Zoloft “off-label” for some conditions. This means that the Food and Drug Administration (FDA) has not approved the drug for those conditions. If your doctor has prescribed you Zoloft “off-label,” they should provide a rationale for doing this, tell you the limits of the research related to using Zoloft for these conditions, and give you any other medication options.¹

One study found that 88% of online pharmacies did not require a prescription, bringing the legitimacy of these pharmacies into question.² Only take Zoloft with the prescription of a medical provider. Your unique health history and concerns need to be considered to determine the best treatment for you.

Things to Tell Your Doctor Before Taking Zoloft

Talk with your doctor about the following before starting Zoloft or any psychotropic medication:

Your symptoms and which ones bother you the most
If you have thoughts of suicide or harming yourself in some way
If you are pregnant, trying to get pregnant, or breastfeeding
Psychotropic medications you have taken in the past and whether or not they were effective
If you have any psychiatric (e.g., bipolar disorder) or medical (e.g., high blood pressure) problems
If you have any allergies to medications
If you are receiving any non-medication treatment such as therapy or substance abuse treatment
If you use alcohol or other drugs
Any medications you are currently taking, including over-the-counter (OTC) medicines and supplements

It is essential to tell your doctor all the medications you take, whether OTC (e.g., cough and cold medications) or psychotropic medication. This is because combining them with Zoloft could cause serotonin toxicity. Serotonin is one of the brain chemicals that Zoloft works to balance. Taking certain medications with it, particularly other antidepressants that also impact serotonin levels, could lead to too much serotonin in the body.³

Some symptoms for the different levels of serotonin toxicity include:³

Mild toxicity: Nervousness, insomnia, nausea, diarrhea, tremor, dilated pupils
Moderate toxicity: Increased reflexes, sweating, agitation, restlessness, muscle spasms, side-to-side eye movements
Severe toxicity: Body temperature greater than 101.3^oF, confusion, constant movement or rigidity, rhabdomyolysis (dark, reddish urine, decreased amount of urine, weakness, and muscle aches)

If you experience any symptoms of toxicity, get to a hospital right away.

What Can I Expect with Zoloft?

As with many psychotropic medications, doctors initially prescribe Zoloft at a lower dose and then gradually increase the dose depending on how it affects you. There may be a few adjustments to the dose before reaching one that is optimal for you. Talk with your doctor about any side effects you experience and how it affects you in general. Some common side effects include:

Headache
Nausea
Diarrhea
Dry mouth
Increased sweating
Feelings of nervousness or restlessness
Fatigue, sleepiness or insomnia (trouble sleeping)¹

Side effects usually improve over the first week or two as you continue to take the medication.

Zoloft is usually taken once per day and can be taken with or without food; be sure to follow your doctor’s instructions on how to take the medication.

In addition, talk with your doctor about:

What to do if you miss a dose.
What other medications or substances you should avoid when taking Zoloft.

You will probably notice an improvement in some symptoms within the first 1-2 weeks of taking Zoloft. It could take up to 6-8 weeks to have the full benefits of the medication, depending on the reasons you take it.

Do not stop taking Zoloft without consulting your prescriber, even when you start to feel better. Your doctor will determine how long you need to take the medication, depending on your situation. At this time, there are no known problems associated with the long-term use of Zoloft; it is safe and effective when used as directed.¹ Additionally, one review of the literature found no cases of Zoloft misuse.⁴

Should I Take Zoloft?

You might be wondering if taking Zoloft is a good idea. Perhaps your therapist recommended you meet with a doctor about the possibility. At the same time, you may have heard some common sentiments such as “antidepressant medications are a crutch” and that the “right” way to overcome mental or behavioral problems is to utilize therapy and coping strategies.

You might also be worried that Zoloft will change your personality or that the side effects are not worth it. These are normal and understandable concerns.

The reality is, mental health disorders vary in type and severity between individuals; therefore, different types of treatments are best for different people. Moreover, certain types of mental health disorders may have a strong organic (biological) component to them for which medication is most effective. If you have, for instance, severe major depressive disorder, anti-depressant medication is likely to have significant positive effects.⁶

If you have experienced crying uncontrollably for no real reason or getting easily irritated by little things that most people can ignore, medication may be more effective than therapy alone for such symptoms. The brain is, after all, an organ like any other organ in the body. Taking psychotropic medication should be as destigmatized as is, for example, taking insulin to manage diabetes.

You might find that Zoloft significantly improves your quality of life and that with it, your personality doesn’t change so much as you feel better and more positive overall. That could in turn allow you to use healthy coping strategies in response to life stressors more easily.

Only a mental health professional can help you determine appropriate treatments for you, and only a medical professional can help you determine if the benefits of Zoloft will outweigh the costs for your unique circumstances.

If you are concerned that you or a loved one might be experiencing Zoloft withdrawal or toxicity, call 911. You can also contact us at 800-681-1058 (Who Answers?) to get help today.

References

College of Psychiatric and Neurologic Pharmacists (2020). About mental illness. National Alliance on Mental Illness.
Monteith, S. & Glenn, T. (2017). Searching online to buy commonly prescribed psychiatric drugs. Psychiatry Research, 260, 248-254.
Foong, A., Grindrod, K.A., Patel, T., & Kellar, J. (2018). Demystifying serotonin syndrome (or serotonin toxicity). Canadian Family Physician, 64, 720-727.
Evans, E.A. & Sullivan, M.A. (2014). Abuse and misuse of antidepressants. Substance Abuse and Rehabilitation, 5,107-120.
Lerner, A. & Klein, M. (2019). Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Brain Communications, 1-23. Advance access publication.
Fava, G.A. (2014). Rational use of antidepressant drugs. Psychotherapy and Psychosomatics, 83, 197-204.