During the COVID-19 pandemic, rates of depression and anxiety surged, leading many Americans to seek relief through antidepressant medication. Even prior to the pandemic, a significant portion of the population relied on antidepressants, with 1 in 8 American adults already taking them.

Shockingly, in 2020, this number increased by 18.6%, indicating the widespread need for mental health support. Among the most commonly prescribed antidepressants was Zoloft, with over 38 million prescriptions in 2017 alone. By 2022, it had climbed to the 12th position among the most prescribed medications in the US, serving over 7 million patients.

Zoloft is a brand name for the generic drug sertraline. It belongs to the selective serotonin reuptake inhibitors (SSRIs) class of antidepressants.

In this article, we’ll explore Zoloft’s mechanism of action, its various applications, potential side effects, and other key details to offer a thorough comprehension of this commonly prescribed medication.

Key Findings

  • Zoloft is FDA-approved for depression, anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), major depressive disorder (MDD), panic disorder, premenstrual dysphoric disorder (PMDD), and social anxiety disorder.
  • Zoloft primarily works by increasing serotonin levels in the brain, affecting mood, personality, and wakefulness, with some influence on norepinephrine and dopamine.
  • Zoloft is available in oral tablets (25 mg, 50 mg, 100 mg), capsules (150 mg, 200 mg), and oral solution (20 mg/ml).
  • The dosage for PMDD can be continuous or intermittent, with dosages ranging from 50 mg to 150 mg per day.
  • Common side effects in adults include nausea, diarrhea, tremor, decreased appetite, and sexual dysfunction, while pediatric patients may experience fever, hyperkinesia, and urinary incontinence.
  • Both men and women may experience sexual side effects such as decreased libido and ejaculation failure.
  • Abrupt discontinuation of Zoloft can lead to withdrawal symptoms like nausea, dysphoric mood, irritability, tremor, and seizures.
  • Tyramine-rich foods, grapefruit, and alcohol can interact with Zoloft, leading to hypertensive crises, increased side effects, or reduced effectiveness.

Understanding Zoloft

What is Sertraline (Zoloft) Used For?

Zoloft is often a first-line medication for depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). It has also received approval from the Food and Drug Administration (FDA) for use in adults to treat:

  • Major depressive disorder (MDD)
  • Panic disorder
  • Premenstrual dysphoric disorder (PMDD)
  • Social anxiety disorder

Zoloft also holds FDA approval for treating OCD in children aged six years and older. However, it is not approved for PMDD in teens younger than age 18 years.

Although Zoloft lacks FDA approval for the conditions below, mental health providers or physicians sometimes prescribe it off-label:

  • Binge eating disorder
  • Body dysmorphic disorder
  • Bulimia nervosa (BN)
  • Generalized anxiety disorder (GAD)
  • Premature ejaculation

How Does Zoloft Work?

Sertraline works primarily by extending the duration of serotonin, a neurotransmitter in the brain that impacts mood. This heightened serotonin level helps to regulate mood, personality, and wakefulness, which are crucial in conditions like major depression.

While it mainly focuses on serotonin, sertraline also has a small effect on other brain chemicals like norepinephrine and dopamine. This broader activity profile contributes to its effectiveness in treating various psychiatric disorders beyond depression, such as anxiety disorders and obsessive-compulsive disorder (OCD).

Zoloft Doses and Administration

A man holding a handful of pills and a glass of water.

Sertraline is usually taken orally once a day, either in the morning or at night. If drowsiness happens, it’s advisable to take it in the evening. Taking sertraline with food might help it absorb better. It comes in different forms:

  • Oral tablets: in strengths of 25 mg, 50 mg, and 100 mg
  • Capsules: in strengths of 150 mg and 200 mg
  • Oral solution: with a strength of 20 mg/ml

The recommended dosage of Zoloft can differ based on the individual’s mental health condition. Typically, the starting dose falls between 25 mg and 50 mg once daily, with a maximum daily intake of 200 mg.

Presented below is a typical dosage suggestion for Zoloft:

IndicationStarting DoseMaximum Dose
Zoloft for MDD50 mg per day200 mg per day
Zoloft for OCD25 mg per day (ages 6-12)
50 mg per day (ages ? 13)
200 mg per day
Zoloft for PTSD, panic disorder, and social anxiety disorder25 mg per day200 mg per day
Zoloft for PMDD (continuous dosing)50 mg per day150 mg per day
Zoloft for PMDD (intermittent dosing)50 mg per day during the luteal phase only100 mg per day during the luteal phase only

For adults and pediatric patients with MDD, OCD, panic disorder, PTSD, and social anxiety disorder, dosage adjustments in increments of 25 to 50 mg per day on a weekly basis are possible if there is an insufficient response, depending on tolerability.

The maximum dosage should not exceed 200 mg per day. Due to Zoloft’s 24-hour elimination half-life, it’s recommended to wait one week between dose changes.

For adult women with PMDD:

  • When taking Zoloft continuously, patients who do not respond to a 50 mg dose may increase the dosage by 50 mg increments per menstrual cycle up to a maximum of 150 mg per day.
  • For intermittent dosing, patients who do not respond to a 50 mg dose may increase the dosage up to a maximum of 100 mg per day during the next menstrual cycle (and subsequent cycles). This involves taking 50 mg per day for the first three days of the dosing cycle, followed by 100 mg per day for the remaining days of the cycle.

If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule should be resumed. Doubling doses should be avoided.

Sertraline (Zoloft) Side Effects

Common Side Effects in Adult Patients

The most common adverse reactions, reported in over 5% of patients and twice as often as in the placebo group, across all placebo-controlled clinical trials with Zoloft  were:

  • Nausea
  • Diarrhea/loose stool
  • Tremor
  • Dyspepsia
  • Decreased appetite
  • Hyperhidrosis
  • Ejaculation failure
  • Decreased libido
  • Somnolence
  • Insomnia
  • Agitation
  • Constipation
  • Fatigue
  • Dry mouth
  • Dizziness
  • Abdominal pain
  • Malaise

Other side effects reported by less than 5% in pooled placebo-controlled trials in adults include:

  • Vomiting
  • Palpitations
  • Visual impairment

While alterations in sexual desire, performance, and satisfaction are commonly associated with psychiatric conditions, they can also arise as a result of SSRI treatment. Here are potential sexual side effects reported by at least 2% of patients treated with Zoloft:

In men:

  • Ejaculation failure
  • Decreased libido
  • Erectile dysfunction
  • Ejaculation disorder
  • Male sexual dysfunction

In women:

  • Decreased libido

Common Side Effects in Pediatric Patients

A girl lying in bed due to fever.

The overall adverse reaction profile was generally comparable to that observed in adult studies. Other reactions reported in at least 2% of pediatric patients, and at a rate of at least double that of the placebo, include:

  • Fever
  • Hyperkinesia
  • Urinary incontinence
  • Aggression
  • Epistaxis
  • Purpura
  • Arthralgia
  • Decreased weight
  • Muscle twitching
  • Anxiety

Serious Side Effects

While most individuals tolerate the medication well, it’s important to be aware of the potential for serious reactions and to seek medical attention promptly if any concerning symptoms arise. These include:

1. Suicidal Thoughts and Behaviors in Pediatric and Young Adult Patients: It’s unclear if the risk of suicidal thoughts and behaviors in pediatric and young adult patients continues with long-term use. However, evidence from placebo-controlled trials in adults with MDD suggests that antidepressants delay depression recurrence.

2. Serotonin Syndrome:  Zoloft can trigger serotonin syndrome, a potentially life-threatening condition. The risk is higher when Zoloft is used alongside other serotonergic drugs, but it can also occur when these drugs are used alone.

Serotonin syndrome signs and symptoms may include:

    • Mental status changes (agitation, hallucinations, delirium, and coma)
    • Autonomic instability (tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia)
    • Neuromuscular symptoms (tremor, rigidity, myoclonus, hyperreflexia, incoordination)
    • Seizures
    • Gastrointestinal symptoms (nausea, vomiting, diarrhea)

3. Increased Risk of Bleeding: Bleeding events related to drugs affecting serotonin reuptake range from minor issues like ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages.

4. Activation of Mania or Hypomania: In bipolar disorder patients, using Zoloft or another antidepressant to treat depression may trigger a mixed or manic episode. Although clinical trials usually excluded bipolar patients, around 0.4% of those on Zoloft reported mania or hypomania symptoms.

5. Seizures: Zoloft has not been systematically studied in patients with seizure disorders and was excluded from clinical trials involving patients with a history of seizures.

6. Angle-Closure Glaucoma: The pupillary dilation caused by certain antidepressant drugs like Zoloft might induce an angle closure attack in patients with narrow angles who lack a patent iridectomy.

7. Hyponatremia: Hyponatremia can develop as a result of SNRI and SSRI treatments, including Zoloft. Symptoms may include:

  • Headache
  • Difficulty concentrating
  • Memory problems
  • Confusion
  • Weakness
  • Unsteadiness, potentially leading to falls

In severe cases:

  • Hallucinations
  • Fainting
  • Seizures
  • Coma
  • Respiratory failure
  • Death

In many instances, hyponatremia is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH).

8. False-Positive Effects on Screening Tests for Benzodiazepines: False-positive test results may persist for several days after stopping Zoloft.

Zoloft Withdrawal Symptoms

Woman experiencing withdrawal symptoms

If doses are missed or medication is suddenly stopped, individuals may experience withdrawal symptoms known as antidepressant discontinuation syndrome. This condition affects approximately 20% of patients who abruptly discontinue antidepressant medication that was taken for at least six weeks.

With discontinuation syndrome, patients may experience the following symptoms:

  • Nausea
  • Diaphoresis
  • Dysphoric mood
  • Irritability
  • Agitation
  • Vertigo
  • Sensory disturbances (paresthesia, electric shock sensations)
  • Tremor
  • Anxiety
  • Confusion
  • Cephalgia
  • Lethargy
  • Emotional lability
  • Sleep disorder
  • Hypomania
  • Tinnitus
  • Seizures

Reducing the dosage gradually rather than stopping immediately whenever possible is preferable.

Precautions, Warnings, and Interactions

Contraindications of Zoloft

Zoloft is not recommended for use in certain patients due to the risk of serious adverse effects. These contraindications include:

  • Patients taking, or within 14 days of stopping, monoamine oxidase inhibitors (MAOIs), including linezolid and intravenous methylene blue.
  • Patients taking pimozide.
  • Individuals with known hypersensitivity to sertraline.
  • Patients who are taking disulfiram.

Use in Specific Populations

  • Pregnancy: Using Zoloft in the third trimester of pregnancy may heighten the risk of persistent pulmonary hypertension and neonatal withdrawal symptoms in the newborn.
  • Pediatric Use: While Zoloft is approved for pediatric patients with obsessive-compulsive disorder (OCD), its safety and effectiveness have not been established for pediatric patients with other conditions.

Drug Interactions

There are 656 drugs known to interact with Zoloft (sertraline). Among these interactions, 156 are major, 495 are moderate, and five are minor.

Generally, individuals prescribed sertraline should steer clear of nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, aspirin, and ibuprofen, as well as blood thinners and other medications that elevate serotonin levels. Excessive serotonin levels can lead to serotonin syndrome.

Other examples of medications to avoid while taking Zoloft include:

  • Adderall (amphetamine/dextroamphetamine)
  • Abilify (aripiprazole)
  • tramadol
  • trazodone
  • Wellbutrin XL (bupropion)
  • Ativan (lorazepam)
  • Fentanyl
  • clonazepam
  • gabapentin
  • Hydroxyzine
  • St. John’s Wort
  • Antibiotics, such as erythromycin, moxifloxacin, gatifloxacin, and sparfloxacin
  • Pain relievers
  • Muscle relaxants

Food Interactions

Several foods and beverages should be avoided or limited when taking sertraline. Some of the most common ones include:

Tyramine-rich foods: The interaction between sertraline and tyramine-rich foods can lead to a sudden and potentially dangerous rise in blood pressure, clinically referred to as a hypertensive crisis. Tyramine, an amino acid derivative, is present in various food categories, including dairy, meat, and certain types of beans. Examples of tyramine-rich foods are:

  • Bananas
  • Pickles and olives
  • Processed or cured meats (pepperoni and salami)
  • Dried, smoked, or fermented fish
  • Yeast extract
  • Avocado

High-fat or greasy foods: This may reduce the effectiveness of Zoloft.

Grapefruit and grapefruit juice: Consuming grapefruit juice can elevate sertraline levels in the body, leading to heightened side effects and adverse reactions. Apart from grapefruit, other fruits may also interact with Zoloft. These fruits include:

  • Apples
  • Pomegranates
  • Pomelos
  • Cranberries
  • Grapes

Alcohol: Consuming alcoholic beverages while taking Zoloft may result in increased feelings of depression or anxiety.

Caffeine: Coffee, tea, chocolate, and other items may naturally or artificially contain significant levels of caffeine. The main risk associated with increased caffeine intake is the potential for patients to experience dizziness, lightheadedness, or nausea.

Furthermore, substance use can heighten the risk of interactions. Patients should refrain from using illicit drugs, such as marijuana, cocaine, and heroin, as these substances can interact with Zoloft and result in harmful side effects.

Takeaway

Zoloft is an important medicine for treating different mental health issues like depression, anxiety, PTSD, and OCD. It works by affecting serotonin in the brain and is often chosen because it has few side effects.

Knowing the right dose and how to take Zoloft is important for getting the best results while staying safe. Patients and doctors should be aware of possible side effects and be cautious about other medicines or foods that could interact with Zoloft.

For those who don’t respond well to Zoloft or can’t tolerate it, there are other options available. With careful decision-making and working together with healthcare providers, patients can find the best treatment for them and improve their mental well-being and quality of life.

Frequently Asked Questions

How long does Zoloft take to work?

Zoloft typically starts to show its peak effects within 4.5 to 8 hours after taking it. You might begin to feel some relief from depression or anxiety within the first week, but it can take up to six weeks to experience the full benefits. Early signs of improvement may include changes in appetite, sleep, and energy levels.

What happens if you stop taking Zoloft?

Stopping Zoloft suddenly can lead to withdrawal symptoms, known as SSRI discontinuation syndrome. These symptoms may include brain zaps, dizziness, and headaches. While not usually dangerous, they can be uncomfortable. It’s important never to lower your dose or stop taking Zoloft without your doctor’s approval.

If you do stop Zoloft, you may experience a return of symptoms like depression or anxiety. In such cases, your doctor may suggest restarting your medication, switching to a different antidepressant, or exploring psychotherapy options. Always consult with your doctor before making any changes to your medication regimen.

Will Zoloft make you gain weight?

Zoloft typically doesn’t cause weight gain, as reported in clinical trials. However, some rare cases noted increased appetite, potentially leading to weight gain in certain individuals. On the contrary, reduced appetite is a more common side effect of Zoloft, observed in clinical studies.

Can Zoloft make you tired?

Yes. Zoloft can cause varying degrees of drowsiness in different individuals. While some may experience mild drowsiness that resolves within a few days, others might have more severe and persistent sleepiness throughout treatment. In rare instances, Zoloft may induce severe drowsiness or sedation, potentially impacting a person’s ability to carry out daily tasks or drive safely.

Can Zoloft affect your period?

Yes. Research has confirmed that antidepressants can lead to changes in a woman’s menstrual cycle. These changes may include a missed or delayed period, irregularity in the cycle, alterations in intensity, or even the complete cessation of periods.

How much is Zoloft without insurance?

Without insurance, buying a 90-tablet bottle of 100 mg Zoloft can be as expensive as $1,500. But going for the generic version or signing up for a prescription service can cut costs by hundreds of dollars. Another option is to buy from an online Canadian pharmacy such as Pharma Giant. They offer up to 90% off top-brand medications for people in the US. You can also take advantage of additional savings with bulk orders and enjoy a 10% discount on your first purchase. Plus, you benefit from fast shipping from Canada to anywhere in the US for all your medication needs.

Will I need to take Zoloft long-term?

Yes. However, the duration of Zoloft treatment varies depending on the condition being treated:

  • For OCD, it’s typically recommended to continue Zoloft for at least 1 to 2 years after symptoms improve to prevent their return.
  • In depression cases, guidelines suggest continuing Zoloft for 4 to 9 months after symptom relief to reduce the risk of recurrence, especially for those with multiple episodes.
  • For PTSD, the duration of Zoloft treatment is determined by your doctor.
  • Social anxiety disorder patients are often advised to continue Zoloft for at least 12 months after symptoms improve to prevent relapse.
  • Panic disorder patients are recommended to continue Zoloft for 6 to 12 months after symptoms ease to reduce the risk of panic attacks recurring.
  • There are no specific guidelines for PMDD, so your doctor will advise on the duration of Zoloft treatment.

Can Zoloft be addictive?

Zoloft is not addictive and is not classified as a controlled substance. However, it can lead to dependence, where a person relies on the medication to function normally. Withdrawal symptoms may occur when stopping Zoloft, but this isn’t due to addiction. Dependency and withdrawal are separate from addiction, although they can sometimes be mistaken for each other.

Can Zoloft cause hair loss?

Yes. Zoloft can potentially lead to hair loss, particularly a type called telogen effluvium. Studies note sertraline’s role in inducing alopecia, albeit limited in number. However, it’s essential to consult a healthcare provider if experiencing hair loss while on Zoloft, as other factors could contribute to this condition. Monitoring and discussing symptoms with a healthcare professional can guide appropriate management and potential adjustments to medication.

Does Zoloft have any long-term side effects?

Long-term use of Zoloft may lead to cognitive slowing, potential worsening of memory, sexual dysfunction, weight gain, and sleep disturbances. Serotonin syndrome is a rare but serious side effect, especially with prolonged usage.

How can you get a prescription for Zoloft?

You need a licensed professional, such as a psychiatrist, to prescribe antidepressants like Zoloft. Because these medications can have side effects and require careful dosing, it’s crucial to take them under professional supervision.

If you believe you could benefit from a prescription antidepressant like Zoloft, start by scheduling an appointment with a licensed healthcare provider. During your visit, you can talk about your symptoms, get an accurate diagnosis, and create a treatment plan, which might involve medication and therapy.

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