Zoloft Side effects, Dosage, Warnings, and Withdrawal Symptoms

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Zoloft side effects, like most other SSRIs, can be one of the reasons of its discontinuation. If taken correctly as advised by the physician and especially, when initiated in low doses, side effects of Zoloft can be easily tolerated.

Zoloft is the brand name of Sertraline, a prescription medication, that is used to treat anxiety and depression. Zoloft (sertraline), is part of a class of drugs known as Selective Serotonin Reuptake Inhibitors. SSRIs are antidepressants which increase brain levels of serotonin.

It is estimated that about 31% of adults will experience anxiety disorders at some time in their lives. Statistics show that there are 264 million people with anxiety around the world. Zoloft is commonly prescribed by doctors to manage anxiety. However, it can also be used for depression, OCD, post-traumatic stress disorder, PTSD, panic attacks and premenstrual disorder (PMDD).

Zoloft (Sertraline) Indications

Zoloft, when taken properly, can make people feel less anxious and fearful. It can also reduce the desire to repeat tasks. It can increase sleep quality, appetite, energy, and restore interest in everyday life. It can also reduce panic attacks and unwanted thoughts.

Zoloft (sertraline) Dose in various conditions:

Zoloft comes in tablets in three strengths: 25 mg, 50mg, and 100mg. For anxiety, the standard Zoloft dose is 25 mg to 50 mg daily.

These are the recommended doses for Zoloft in order to treat other disorders, according to the Food and Drug Administration (FDA).

  • Major depressive disorder (Depression): 50 mg once daily
  • OCD (obsessive Compulsive Disorder): 50 mg per day (for people older than 13 years of age)
  • Panic disorder: 25 mg per day (once a day)
  • PTSD (Post-traumatic stress disorder): 25 mg once a day
  • Social anxiety disorder: 25 mg once daily
  • PMDD (Premenstrual disorder): 50mg per day during the luteal stage only

When does Zoloft (sertraline) begin its effects:

Zoloft begins working within two to six weeks after treatment initiation. Zoloft doesn’t work immediately so it is important to wait. Zoloft can be effective in reducing sleeplessness, energy and appetite. These changes could occur as early as two weeks after the medication was started. It may take up to six to eight weeks for more significant changes, such as feeling less depressed and regaining interest in your daily life.


Side effects of Zoloft in the first week

Side effects of Zoloft (sertraline) can occur even after a single dose. It is therefore important to anticipate some side effects during the first weeks. Some physicians prefer initiating treatment on weekends or holidays. This gives time for the patient to get used to the drug. Because the body takes time to adjust to the medication, this is normal.

These are some of the most common side effect that Zoloft users experience within their first week.

  • Headache and fatigue, feeling lack of energy, and listless
  • Nausea, Constipation, and Dry mouth
  • Excessive sleepiness or trouble sleeping, and drowsiness
  • Nervousness and Restlessness
  • Erectile dysfunction and a decline in sex drive
  • Weight loss may occur initially, followed by weight gain with long term use
  • Dizziness and loss of appetite
  • Excessive sweating

Initially, you may feel strange or uncomfortable at first, however, as your body begins used to Zoloft, most of the side effects usually disappear after a few weeks.

Side effects that can occur during the course of treatment:

These side effects may occur occasionally during the course of Zoloft treatment, particularly whenever the dose is increased. 

  • Unusual weight loss can occur particularly during the early treatment period and when the symptoms of depression have not yet resolved.
  • Low sodium levels can occur that may cause drowsiness and seizures.
  • A higher risk of bleeding can occur since serotonin is one of the main mediator of platelet aggregation.
  • Angle-closure Glaucoma can occur resulting in eye pain and headache.
  • Sexual dysfunction such as delayed ejaculation and erectile dysfunction can occur especially in men.
  • People with undiagnosed bipolar disorder may experience manic episodes
  • Allergy reactions can occur resulting in hives, urticaria, shortness of breath, facial swelling, and hypotension.
  • Seizures can occur with treatment and even after sudden treatment discontinuation.

Zoloft may increase the risk of suicidal thoughts!

Zoloft comes with a warning about suicidal thoughts or behaviors. Studies have shown that antidepressants increase the likelihood of suicide in adolescents and children as compared to placebo. You should consult your doctor immediately if you experience severe mood swings and/or suicidal thoughts and behaviors while taking Zoloft. The family members must also be asked to notify the treating doctor incase they notice any change in the behaviour of the patient.

Zoloft may cause serotonin syndrome which can be life-threatening!

Zoloft shouldn’t be taken along with certain medications. It is important to know the list of all medications and other supplements that you are taking. This will reduce the chance of getting more severe side effects from Zoloft interactions especially the serotonin syndrome.

Here is a list that you should not take with Zoloft!

  • SSRIs (Concomitant SSRIs, serotonin modulators, or SNRIs should not be taken while taking Zoloft)
  • Triptans (These are drugs that are used to treat migraine. Patients can develop severe hypertension and angina with concomitant intake of Zoloft)
  • Tricyclic antidepressants (These drugs are also used to treat depression, pains, migraine, and sleep disorders. The concomitant use of Zoloft with TCAs should be avoided)
  • Warfarin and other blood thinners should not be taken with Zoloft as the risk of bleeding is increased.
  • Nonsteroidal anti-inflammatory drug (NSAIDs) and St. John’s Wort should be avoided with SSRIs because of the risk of bleeding.
  • Lithium should be avoided
  • Tramadol, opiods, and other opiod-like pain medications 
  • Nardil (phenelzine), Azilect (Rasagiline, and Emsam (Selegiline), and drugs like methylene blue, orap (Pimozide), and linezolid that can aggravate the symptoms of serotonin syndrome.

Read: Which Antidepressant Does Not Cause Weight Gain

Monoamine oxidase inhibitors (MAOIs) in combination with Zoloft (Sertraline) can cause serotonin syndrome which can lead to hallucinations and seizures, coma, tremors, delirium, hypertension or hypotension, and other side effects. It’s important to inform your doctor about any medications you are taking or considering taking.


Incase, you have missed a dose of Zoloft (Sertraline):

It is very important to follow your doctor’s prescription correctly, however, there is no way to be perfect and missing a dose is not unusual. When a dose is missed, follow the guidelines given below:

  • If its a few hours left for the next scheduled dose, wait and take the next dose at the recommended time without doubling or increasing the dose. Do not take a double dose.
  • If a few hours have passed since the dose has been missed, take the dose immediately. Do not halve the dose.

If frequent doses are missed, the drug will not work as efficiently as it is supposed to. Furthermore, if a person is using the drug for a prolong duration and abruptly reduce the dose, start missing the dose frequently, or totally discontinue the dose, he or she may develop withdrawal symptoms.

American Family Physician states that 20% of patients who discontinue antidepressant treatment after having used it for at least six weeks experience antidepressant discontinuation syndrome. These symptoms may include flu-like symptoms, nausea and insomnia, as well as imbalance or hyperarousal.

It is best to take your next dose as soon and as possible incase you missed your dose. You should feel no symptoms if you have been taking Zoloft regularly again.

Read: Serotonin Modulators: Nefazodone, Trazodone, Vilazodone, Vortioxetine


What happens if a person takes high doses of Zoloft (sertraline overdose)?

Overdosing Zoloft can be more dangerous than simply missing a dose. Although there have been no cases of Zoloft overdose deaths, excessive use can lead to serious side effects and health problems. You could get:

  • Nausea and vomiting,
  • Fever, fainting, confusion, and dizziness,
  • aggression, agitation, hallucinations,
  • Tachycardia or rapid heart beat, tremors or shakiness, hypertension, and rapid changes in the blood pressure, and
  • seizures

Serotonin syndrome can be caused by too much Zoloft. This is a condition in which the brain has dangerously high levels of serotonin. This can lead to confusion, diarrhea, headaches, and other symptoms such as nausea. Seizures, hallucinations and muscle rigidity are some of the more severe symptoms.

You should immediately seek medical attention if you suspect you have taken too much Zoloft or start to feel any of these symptoms.


What time to visit a doctor about Zoloft side effects

Patients must be educated about the side effects of Zoloft to alleviate any anxiety arising from the side effects of Zoloft. Mild symptoms of Zoloft side effects do not need reducing the dose or discontinuing it. With time, most people will get used to these symptoms and once the body adjusts itself, these symptoms will go away.

More serious side effects such as confusion, hallucinations and allergic reactions, seizures, or vomiting, should be referred to a doctor immediately. Medical attention must be sought immediately if a person experiences severe anxiety or depression, suicidal thoughts or panic attacks, severe irritability, or aggressive behavior.

Occasionally, side effects of Zoloft are severe enough that necessitate changing the drug. This occurs when even low doses can not be tolerated.


What other medicines, alternative to Zoloft, are available?

Popular alternative medicines to Zoloft (Sertraline) include:

  • Celexa (citalopram) and Escitalopram (Cipralex or lexapro): These medicines are used to treat major depression and anxiety.
  • Effexor Xr (venlafaxine hcl er): Effexor is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that can treat depression, improve moods, and improve energy levels.
  • Paxil (paroxetine), a SSRI, is used to treat depression and other psychological disorders.
  • Prozac (fluoxetine), an SSRI, is used to treat OCD, major depressive disorder, bulimia nervosa and panic disorder.
  • Vortioxetine (Brintellix): It is a serotonin modulator that is different from SSRIs and is used in patients who are refractory to SSRIs.

Some patients might need benzodiazepines such as Xanax or alprazolam to rapidly reduce the symptoms of anxiety and insomnia. However, these medicines cause habituation and addiction and should be used for short durations.

In Conclusion:

Side effects of medication can be a concern, but that shouldn’t stop you from seeking the treatment you need to manage your depression or anxiety. Talking to your healthcare provider can help you to determine the best treatment plan for you. This will allow you to get relief from your symptoms.