What to Know About Zoloft (Sertraline)

Zoloft (sertraline) is a tablet or liquid antidepressant medication that may be prescribed to treat a number of mental health disorders, including depression, premenstrual dysphoric disorder, panic disorder, obsessive-compulsive disorder, and social anxiety disorder.

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that is also sold under the generic name sertraline. SSRIs prevent the reuptake of serotonin, allowing more serotonin to stay in the brain, which may improve your overall mood, sleep, and appetite while decreasing compulsive behaviors, symptoms of anxiety, and panic attacks.

How Zoloft Works

Zoloft belongs to a class of medications called selective serotonin reuptake inhibitors (SSRIs). As an SSRI, Zoloft blocks the reabsorption, or uptake, of serotonin in the brain, leaving more of the chemical available. Serotonin is a neurotransmitter that, among other responsibilities, helps regulate your mood, learning, and memory. In particular, serotonin is associated with positive emotions; in fact, it's sometimes called the "happy" chemical.

Zoloft Uses

Zoloft has been approved by the Food and Drug Administration (FDA) to treat:

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

Before Taking Zoloft

When prescribing Zoloft, your treating mental health provider and/or doctor may evaluate your mental health symptoms and overall health using:

• The DSM-5 to give you an official diagnosis
• A physical evaluation and/or lab tests to rule out underlying health conditions that may be impacting or causing symptoms

Prior to prescribing Zoloft, your doctor will ask you questions about your symptoms, their intensity, and their frequency. They may also give you assessment questionnaires to complete. Depending on your specific needs, you may be prescribed Zoloft while also attending psychotherapy, or sometimes on its own.

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Precautions and Contraindications

Prior to taking Zoloft, let your doctor know:

• If you have an allergy to anything in Zoloft, including the inactive ingredients
• If you have a history of bleeding problems, seizures, liver problems, heart problems, low sodium blood levels, thyroid disorders, or glaucoma
• If you have a family history of bipolar disorder
• If you are taking an additional medication that increases serotonin levels
• If you are pregnant and which trimester you are in (third trimester is most at risk for complications)
• If you are nursing

Zoloft is contraindicated for use with monoamine oxidase inhibitors (MAOIs), pimozide, and disulfiram (when taken with liquid Zoloft). It is critical to disclose to your doctor all current and past medications (including allergy medications), your mental health history, as well as your family medical and mental health history to ensure that Zoloft is safe for you.

Other SSRIs

Examples of other SSRIs used to treat similar mental health disorders include Prozac (fluoxetine), Paxil (paroxetine), and Lexapro (escitalopram). These medications also work by increasing the amount of serotonin available in the brain.

Zoloft Dosage

According to Pfizer, the recommended dosage of Zoloft will vary depending on the mental health disorder.

• Major depressive disorder: The starting dosage is 50 milligrams (mg) per day with a maximum of 200 mg per day.
• Obsessive compulsive disorder: The starting dosage is 25 mg per day for those 6 to 12 years old and 50 mg per day for those 13 years old and older, with a maximum dosage of 200 mg per day.
• Panic disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
• Social anxiety disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
• Post-traumatic stress disorder: The starting dosage is 25 mg per day with a maximum dosage of 200 mg per day.
• Premenstrual dysphoric disorder: The starting dosage for intermittent dosing (during the luteal phase only) is 50 mg per day with a maximum 100 mg per day. The starting dosage for continuous dosing (during the entire month) is 50 mg per day with a maximum dosage of 150 mg per day.

Modifications

Certain populations may react to Zoloft differently and may require an adjusted dosage, as well as closer monitoring by their healthcare provider.

• Zoloft is not approved for use by children under the age of 6.
• The only FDA-approved use for children ages 6 to 17 is OCD, not any other mental health disorder.
• Children 6 to 17 years old may require closer monitoring and a subsequent dosage change if during the first few months of taking Zoloft they experience significant weight loss and/or suicidal ideation.
• Pregnant and nursing individuals will need to discuss the risks and benefits of Zoloft with their doctor, as it can pose a greater risk to their fetus and newborn during the third trimester and during breastfeeding.
• It is recommended that older patients begin with dosages on the lower end to watch for adverse reactions prior to increasing their dosage if needed.

How to Take and Store

Zoloft tablets should be stored at room temperature, out of direct light, with the bottle tightly sealed. They should also be stored out of reach of children and pets.

• Zoloft can be taken with or without food.
• Zoloft should never be taken with alcohol or illegal drugs.
• When taking Zoloft, avoid grapefruit juice and eating grapefruits as it can prevent the medication from being properly metabolized.
• Zoloft should not be taken within two weeks of taking an MAOI.
• When travelling, Zoloft can be stored in your carry-on or in checked baggage, although carry-on may be the safer bet in case your luggage gets lost.

If you miss a dose of Zoloft, take it as soon as you remember, unless you are due to take your next dose soon. In other words, don't double your dosage. Keep in mind that you may experience some side effects within a few hours of your missed dosage, which may include dizziness, nausea, and feeling weak. If you have questions, be sure to reach out to your doctor.

Side Effects of Zoloft

Since Zoloft alters brain chemistry, you may be worried about how taking this medication will affect you. There's no way to predict how Zoloft will make you feel since everyone may respond differently to it. But these are the side effects to be aware of:

Common Physical Side Effects

You may experience physical side effects from taking Zoloft. These may include: 

• Diarrhea
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Insomnia
• Nausea
  
• Shaking
• Sweating

Common Emotional Side Effects

• Nervousness
• Agitation
• Restlessness

Sexual Side Effects

Some of the most potentially bothersome side effects of Zoloft and other SSRIs are sexual issues. These can include reduced sexual desire or difficulty reaching orgasm, difficulty ejaculating, or less frequently the inability to maintain an erection (erectile dysfunction). These can be so distressing for some people that they may choose not to take the medication.

If taking Zoloft interferes with your sex life, speak with your prescribing physician.

• Your doctor may suggest adding a second antidepressant. Wellbutrin (bupropion) has been found to sometimes counter the sexual side effects of SSRIs. 
• Your doctor may prescribe a different medication to see if another one works better for you.
• Your doctor may adjust your dosage.
• Your doctor may want you to take the same dosage for a bit longer, as sometimes sexual side effects get better on their own. 
• Your doctor may suggest taking another medication to improve sexual function. Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) are all approved by the FDA to treat sexual problems in men. Some research suggests sildenafil may also improve sexual issues in some women. 

Severe Physical Side Effects

Contact your doctor immediately if you experience any of the following:

• Allergic reaction symptoms like hives, rash, difficulty swallowing or breathing, and swelling of the face, mouth, throat, or tongue
• Difficulty sleeping
• Symptoms associated with serotonin syndrome
• Increase in bruising and/or bleeding
• Headaches
  
• Rapid heart rate
• Seizures
• Vomiting

Severe Emotional Side Effects

• Increase in suicidal thoughts or attempts
• Aggression or emotional outbursts
• Increase in depressive symptoms
• Increase in panic attacks
• Confusion
• Extreme nervousness, irritability, or anxiety

Zoloft Warnings and Interactions

Warnings and interactions when taking Zoloft:

• If you decide you want to stop taking Zoloft, do not quit cold turkey. Talk to your doctor first so they can help you gradually wean off of Zoloft. Quitting abruptly can cause you to potentially experience some serious sertraline withdrawal symptoms.
• Be mindful of any changes to your behavior, thoughts, and emotions, especially six to eight weeks after beginning the medication. If symptoms worsen, contact your doctor right away.
• Zoloft can increase the risk of bleeding when taken with aspirin, anticoagulants, and nonsteroidal anti-inflammatory drugs.
• Zoloft should not be taken with St. John's Wort , 5-HTP, or SAMe as these supplements can lead to serotonin syndrome.
• Illegal drugs and alcohol should not be taken while on Zoloft.
• Zoloft has a "black box warning" that, in some cases, children, teenagers, and young adults (under 25) may have increased suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the drug or after the dose is changed.

Serotonin Syndrome

In rare cases, an antidepressant such as Zoloft can cause high levels of serotonin to build up in the body. This is most likely to happen to someone who's taking another medication that can elevate serotonin such as other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort.

Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination, and a rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

Cost of Zoloft

The price you might pay for Zoloft varies with many factors such as insurance coverage, region, market, strength, and more. Consult your doctor, insurance company representative, and pharmacist to get an idea of the drug's cost to you.

Alternatives to Zoloft

Healthcare providers often must try several antidepressants before finding the most effective drugs with the least side effects for their patients. As an SSRI, Zoloft has many alternatives. These include:

• Prozac (fluoxetine)
• Cymbalta (duloxetine)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Effexor (venlafaxine)
  

How Long Is Zoloft Effective?

As with many other antidepressants, you can build up a tolerance to Zoloft over time, which means the same dosage becomes less effective. If you feel Zoloft isn't working as well for you anymore, consult your healthcare provider. They might change your dosage or try a different antidepressant altogether.