Sertraline (Zoloft)

Sertraline brand names

• Zoloft

What is sertraline prescribed for?

Sertraline is prescribed for major depressive disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, and premenstrual dysphoric disorder. 

Generally, it is not prescribed to treat depression in people under 18, as the risk of developing suicidal thoughts while on this medication is higher in younger age groups.^[1][2] However, it may be prescribed to this age group if it is deemed necessary for the treatment of depression.

Sertraline may also be prescribed off-label for various eating disorders or generalized anxiety disorder (GAD).^[3]

How does sertraline work?

Sertraline works by affecting the neurotransmitter called serotonin. It increases serotonin concentration in the brain, helping to improve mood.

Sertraline also has some effect on neurotransmitters called dopamine and norepinephrine, which also contribute to the improvement of several symptoms, allowing it to be a useful treatment for a variety of psychiatric disorders.^[2]

How is sertraline usually taken?

Sertraline is available as an oral tablet, in 25mg, 50mg, and 100mg strengths, and as an oral concentrate , containing 20mg of sertraline per 1ml.

Typically, you will be prescribed one dose of sertraline per day, which can be taken either in the morning or at night, depending on the drowsiness you experience. 

The tablet form of this medication must be swallowed whole without crushing.

The liquid form of this medication needs to be diluted with half a cup of water (120ml). Ensure you use the proper measuring device to receive your correct dose and follow your doctor’s instructions for administration.

For the treatment of major depressive disorder or obsessive-compulsive disorder, you will likely be prescribed a 50mg dose initially, which can be slowly increased, if required, over the following weeks. Your daily dose will likely not exceed 200mg.

To treat panic disorder, PTSD, and social anxiety disorder, you may be prescribed 25mg per day, which can be increased slowly over the following weeks, to find your required dose. However, your maximum dose will likely not exceed 200mg.

To treat of premenstrual dysphoric disorder, you may either be prescribed a continuous treatment, taken every day, or an intermittent treatment, taken only on specific days of the month. You may be prescribed between 50-150mg per day for this treatment.

This medication should be taken as prescribed without missing a dose. If a dose is missed, take the medication as soon as possible, or skip the missed dose if it is close to the next dosage time. Never take double your prescribed dose in one go, as this can have adverse effects and may increase the risk of side effects. 

How long does sertraline stay in your system?

After taking this medication, you may notice some improvements in your symptoms within the first week or two, but it will likely take several weeks, or up to three months, for sertraline to take full effect. ^[3][4]

After you stop taking sertraline, the medication may take several weeks to entirely leave your system.

Do not suddenly stop taking sertraline without medical advice, even if you feel better, as this can seriously impact your physical and mental health and cause an increase in symptoms of depression. However, if your doctor advises that it is safe to come off this medication, they will likely reduce your prescription slowly, to prevent adverse effects.

Sertraline side effects

When you begin a new medication, you may experience some common side effects. They will likely reduce within the first week or two, but if they continue or become problematic, consult your doctor immediately, as you may need a reduced dose or a medication change.

Common side effects of sertraline include:

• Stomach upset, including nausea, vomiting, constipation, or diarrhea
• Changes in appetite or weight
• Dizziness
• Tiredness
• Sweating
• Shaking
• Changes in sex drive

Serious side effects and allergic reactions to sertraline are less common but may still occur. If you experience any of the following, seek medical attention immediately:

• Rapid or irregular heart rate
• Muscle pain, stiffness, or twitching
• Seizures
• Unexplained bleeding or bruises
• Confusion
• Loss of coordination
• Weakness or unsteadiness
• Rash or blisters
• Swelling of the face or mouth
• Breathing difficulties
• Fever
• Redness or pain in or around the eyes
• Changes in mental state, including an increase in depression or anxiety, suicidal thoughts, thoughts of harming yourself, agitation, or hallucinations

Sertraline precautions

Sertraline can cause an increase in suicidal ideation, particularly at the beginning of your treatment. This risk has been found to be higher in people under 24 years old.^[1] Contact your doctor or mental health professional immediately if you experience any thoughts of harming yourself or notice any other changes in your mental state.

It is important that your doctor is aware of any past or present mental health conditions you have experienced to enable safe monitoring of your condition while on this medication or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Because of the potential side effects, you may not be able to take this medication safely if you have experienced liver problems.^[1] Therefore, your doctor may wish to prescribe a lower dose and closely monitor your physical health during your treatment.

Tell your doctor about all medications you are currently taking or plan to take (including vitamins and dietary supplements), as they may cause adverse reactions.

Discuss with your doctor if you are pregnant or planning to get pregnant. You must be aware of any risks to your fetus and can make an informed decision about your treatment. Your doctor may deem it necessary to start, or continue, your sertraline prescription while pregnant.

Breastfeeding has been found to generally be safe while taking sertraline. However, it may be excreted in breast milk in small amounts ^[2][4], so it may be advisable to monitor your baby for any changes in their mental or physical condition.

Depending on your prescription and the time you have been on this treatment, you may experience withdrawal symptoms when coming off this medication. Your doctor will likely reduce your prescription slowly to prevent this. Taking sertraline exactly as prescribed by your doctor can also help to prevent withdrawal symptoms.^[2][5]

This medication can cause drowsiness and sedation, so it is important to avoid driving until you know how sertraline affects you and it is safe to do so.

Sertraline interactions

Certain antidepressant medications, called monoamine oxide inhibitors (MAOIs), should not be taken with sertraline due to the increased risk of serotonin syndrome.^[1] There should be 14 days between your last MAOI and your first sertraline dose.

The liquid form of sertraline contains alcohol, so it should not be taken with disulfiram, as this can cause an aggressive reaction.

Some other medications may also interact with sertraline, impacting the effectiveness of your medications or increasing the risk of side effects. This includes blood thinners, anti-inflammatory medications, seizure, migraine, or heart medications, sedatives, tranquilizers, opiate medications, and mental health medications, including other antidepressant drugs, antipsychotics, or anti-anxiety medications.

St. John’s wort and tryptophan can also interact with sertraline, causing adverse effects.

Always discuss your medications with your doctor before starting a new treatment.

Sertraline storage

Always keep all medications out of reach of children.

Store sertraline in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of medication that is out of date or no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the bin, as this can create unnecessary risks.

What to do if you overdose on sertraline

If you overdose on sertraline, call a medical professional or Poison Control at 1-800-222-1222, or in case of an emergency, call 911. Symptoms of a sertraline overdose may include fast or irregular heartbeat, hallucinations, fever, seizure, vomiting, confusion, or coma.

FAQs

How long does sertraline take to work?

You may notice an improvement in your symptoms within the first week or two, although it will likely take 2-3 months for the medication to take full effect.^[3]

Ensure you continue to take your medication as prescribed, as missing doses can cause an increase in symptoms or decrease the effectiveness of the medication.

Can you take sertraline while pregnant?

You can take sertraline while pregnant, but your doctor will advise you of any risks associated with fetal development.^[1][2] 

It may be safe to come off sertraline while you are pregnant, but this could cause an increase in mental and physical symptoms, so your doctor may advise you to keep taking it and closely monitor any changes in your mental and physical health.

Is sertraline addictive?

Sertraline is not considered an addictive substance, but it is possible to develop a physical dependency on the medication with prolonged or extensive use ^[5]. This can create withdrawal symptoms upon stopping the medication suddenly. Therefore, always take your medication exactly as prescribed by your doctor to prevent adverse effects.