What you should know about sertraline (Zoloft)

What is sertraline used for and how does sertraline work?

Sertraline (Zoloft) is an antidepressant in the selective serotonin-reuptake inhibitor (SSRI) class of drugs. Serotonin is a natural chemical produced in the brain that helps regulate mood, personality, and wakefulness. Sertraline blocks the breakdown of serotonin in the brain, causing an increase in serotonin levels that can result in mood improvement. Sertraline is used to treat certain medical conditions that result from an imbalance or lack of serotonin, such as depression, anxiety, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Lexapro vs Zoloft vs Prozac: What’s the difference?

Escitalopram (Lexapro), sertraline (Zoloft), and fluoxetine (Prozac) are all antidepressant medications that work by increasing serotonin levels in the brain. Although they are all FDA-approved to treat major depressive disorder (MDD), each of these medications possesses unique qualities and is also FDA-approved for other conditions. For example, escitalopram is also approved as a treatment for generalized anxiety disorder (GAD). Sertraline and fluoxetine are also approved for panic disorder, premenstrual dysphoric disorder, and obsessive-compulsive disorder. Sertraline is approved as a treatment for social anxiety disorder, while fluoxetine is used for bipolar depression, bulimia nervosa, and treatment-resistant depression. 

Dosing and drug strength also differ between the medications, and these drugs are not equally interchangeable. Side effects also vary slightly. Escitalopram is more commonly associated with dry mouth, memory and concentration problems, and dizziness. Side effects more commonly reported with sertraline include decreased appetite and fatigue. According to several studies, fluoxetine tends to have the mildest side effect profile consisting mostly of stomach upset, gas, memory impairment, and other mild symptoms.

Sertraline warnings: what are the side effects of sertraline?

Side effects reported during sertraline use can include fatigue or “feeling sleepy” (which can usually be improved by taking the medication before bed instead of in the morning), weight loss, dry mouth, stomach upset or gas, yawning, decreased concentration, and decreased sex drive or delayed ejaculation.

Sertraline interactions: Medicines and foods to avoid when taking sertraline

Sertraline does interact with many other medications and foods. Sertraline can increase the risk of bleeding in people who take non-steroidal inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Because sertraline raises serotonin levels, it can increase the risk of a potentially life-threatening condition called serotonin syndrome, especially when taken with other drugs that affect serotonin such as amphetamines, antidepressants, certain opioid analgesics, the cough suppressant dextromethorphan, the herbal supplement St. John’s Wort, and certain foods. Grapefruit is an example of food that increases levels of sertraline in the bloodstream, which also increases the risk of serotonin syndrome. Certain medications, including carbamazepine and cyproheptadine, may decrease levels of sertraline in the blood, therefore reducing its effectiveness. Sertraline may also reduce the effectiveness of medications used to treat thyroid disease. 

Alcohol and sertraline: How to safely drink alcohol on Zoloft

Sertraline can interact with alcohol, so it is generally recommended to avoid alcohol consumption while taking this medication. Both sertraline and alcohol can cause drowsiness, which may interfere with the ability to safely operate a vehicle or perform detailed tasks. In some cases, alcohol use can worsen symptoms of depression and interfere with the beneficial effects of sertraline.

Can you take sertraline while pregnant?

Sertraline can be taken during pregnancy, but the liquid formulation of the drug contains alcohol and should not be consumed by pregnant people. Sertraline does cross the placenta and may impact fetal development, but this is often outweighed by the risks of untreated or undertreated depression during pregnancy.

Is sertraline safe: sertraline overdose and withdrawal from sertraline?

Sertraline is generally considered to be a safe and well-tolerated medication. Toxic effects of sertraline are more likely to occur when higher doses are taken. Sertraline overdose can result in nausea, vomiting, enlarged pupils, and increased body temperature. In some cases, sertraline overdose can lead to a potentially dangerous condition called serotonin syndrome.

Sertraline can also cause withdrawal when use of the drug is abruptly stopped. The risk of withdrawal syndrome is higher when sertraline is taken for more than 3 weeks and when it is discontinued suddenly. When discontinuing this medication, the dose should be gradually decreased over a period of weeks, with close monitoring by a healthcare professional. However, even gradual discontinuation can still result in withdrawal in some cases. Symptoms of sertraline withdrawal usually start within 10 days of discontinuation and can include headache, fatigue, nausea, diarrhea, insomnia, anxiety, and irritability. 

What should you do if someone takes too much sertraline?

If you develop unexplained or unexpected symptoms after taking sertraline, get guidance from Poison Control immediately. Help from Poison Control is available at www.poison.org and by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Rylie Grier, BSPS, PharmD

Kelly Johnson-Arbor, MD
Medical Toxicologist