What are the Side Effects of Sertraline?
Mental disorders affect people’s thinking, feeling, moods, or behavior. More than half of all American adults suffer from such a condition at some point in their lifetime (1), while every fifth adolescent aged sixteen to seventeen experiences at least one major depressive episode (2). Improving the condition usually requires medication treatment and other effective treatment options.
Sertraline is one of the oldest antidepressants, a selective serotonin reuptake inhibitor (SSRI), a hormone of happiness (3) . As such, sertraline has proven its efficacy in depression treatment over 30 years and in traumatic events, panic disorder, or social anxiety treatment. Yet, side effects are still a concern for some patients or their caregivers.
Suicidal thoughts, serotonin syndrome, maniac episodes, or glaucoma are some side effects that need immediate medical care. Keep reading to find out about these and other possible serious side effects. Learn about the changes that might occur and react accordingly. It may save your life but also get the best of your medication effect in your disease treatment.
What is Sertraline Used For?
Sertraline is the second oldest selective serotonin reuptake inhibitor (SSRI), available since 1991 under the brand name Zoloft. It is indicated in adults for the treatment of:
- Major depressive disorder (MDD);
- Panic disorder (PD);
- Post-traumatic stress disorder (PTSD);
- Social anxiety disorder (SAD);
- Premenstrual dysphoric disorder (PMDD) includes mood swings, irritability, bloating, and breast tenderness.
For obsessive-compulsive disorder (OCD) treatment, sertraline can be used in adults and children aged 6-17 (4).
Sertraline and other SSRIs are widely used. Doctors usually prescribe SSRIs as a first option to treat depression, thanks to their safety, efficacy, and tolerability. Sertraline inhibits serotonin reuptake and results in serotonin levels increasing and its activity (3).
Serotonin is a hormone produced in an area in the center of the brainstem. Serotonin makes people happy but also affects other processes in the body, such as memory, fear, stress response, addiction, sexuality, breathing, digestion, sleep, and body temperature. A low level of serotonin is associated with depression (3, 5).
Sertraline can increase serotonin levels and positively affect depression symptoms relief, mood and personality regulation, and wakefulness (6).
Recommended Dosage of Sertraline
Sertraline is available as an oral solution of 20mg/ml and tablets with the following strengths: 25mg, 50mg, and 100mg.
The PD, PTSD, and SAD treatment in adults begin with 25mg, while for MDD, OCD, and PMDD initial dose is 50mg. For OCD treatment in children aged 6-12 years, treatment begins with 25mg, and in children 13-17 years old, 50mg.
The doctor may increase the daily dose to 200mg in all age groups and all indications except PMDD. In PMDD, the dose can be increased to 150mg per day continuously, while if taken intermittently maximal daily dose should be 100mg.
Do not stop taking sertraline abruptly because side effects might occur. Therefore, the recommendation is to reduce the dose gradually before discontinuing (4).
Sertraline Side Effects
SSRIs became popular and widely used because these antidepressants have fewer side effects than tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). However, these medications, including sertraline, have some risks that patients should be aware of and act adequately (3).
The most common side effects in >5% of the patients, vs. placebo in clinical trials for all approved indications, were diarrhea/loose stool, nausea, tremor, dyspepsia, decreased appetite, hyperhidrosis, decreased libido, and ejaculation failure.
In the placebo-controlled studies, pediatric patients reported side effects similar to those in adults. Fever, hyperkinesia, urinary incontinence, aggression, anxiety, epistaxis, purpura, arthralgia, decreased weight, and muscle twitching is additional side effects that occur among the pediatric population with an incidence higher than 2%.
Below you may find side effects requiring an immediate call to your doctor or emergency (4). Warning: Suicidal Thoughts and Behaviors.
SSRIs may increase the risk of suicidality in young people (3). Results of clinical studies have shown a small number of children, teenagers, and young adults up to 24 years of age who used sertraline and other antidepressants had thoughts about harming or killing themselves or have been planning and trying to do so (7).
This behavior was more likely in young patients on antidepressants than in those who did not take antidepressants (7). For this reason, in 2004 FDA issued a black box warning and asked all manufacturers to include it in the patient information (3).
Therefore, if you or your child take sertraline, you may find the warning that “Antidepressants increase the risk of suicidal thoughts and behaviors in pediatric and young adult patients (4).”
These changes in mental health may happen to older patients too. Suicidality may happen, especially when the treatment begins or the dose is increased, and any of the following symptoms can be a sign:
- attempts to commit suicide;
- acting on dangerous impulses;
- acting aggressive or violent;
- thoughts about suicide or dying;
- new or worse depression;
- new or worse anxiety or panic attacks;
- feeling agitated, restless, angry, or irritable;
- trouble sleeping;
- an increase in activity or talking more than what is typical for you;
- other unusual changes in behavior or mood.
Therefore, doctors, patients, and their parents and caregivers should closely monitor for clinical worsening and the emergence of suicidal thoughts and behaviors (4, 7).
Yet, doctors weigh this risk because depression as a disease highly increases the risk of suicide which is a reason for treatment (3).
Serotonin syndrome may happen when the serotonin level in the body is too high. It rarely occurs during sertraline treatment, yet, serotonin syndrome is a life-threatening condition and may include the following signs and symptoms:
- mental status changes – agitation, hallucinations, coma, or other changes;
- autonomic instability – racing heartbeat, high or low blood pressure, dizziness, diaphoresis, flushing, hyperthermia;
- gastrointestinal symptoms – nausea, vomiting, diarrhea;
- neuromuscular symptoms – tremor, muscle rigidity, myoclonus, hyperreflexia, incoordination;
The risk is higher if sertraline is used together with other serotonergic medications (triptans, tricyclic antidepressants, tramadol, fentanyl, amphetamine) or drugs that impair serotonin metabolism. For this reason, sertraline should not be used together with MAOI. If the patient is already on MAOI, sertraline can be introduced 14 days after discontinuing MAOI treatment. If the patient needs to take MAOI, doctors first stop sertraline (4).
Sertraline or other SSRIs may increase the coagulation time and is a risk for bleeding or bruising. If sertraline is taken together with blood thinners, it increases the risk of bleeding (4).
Blood thinners are medications that prevent abnormal blood clot formation and prevent harmful clots from causing life-threatening conditions (8). Some frequently used blood thinners are aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs, warfarin, and other anticoagulants, which may add to this risk.
If you use sertraline for your depression and use or need to use any blood thinner or NSAID, including over-the-counter, inform your doctor before doing so (4).
Other Side Effects os Sertraline That Require Medical Help
Sertraline may cause manic episodes (when switching from depression into mania) with the following symptoms:
- greatly increased energy;
- severe trouble sleeping;
- excessive happiness;
- racing thoughts;
- reckless behavior;
- talking more or faster;
- unusually grand ideas (4, 9).
Sertraline and other antidepressants may cause an eye problem called angle-closure glaucoma. If you notice one of the following symptoms, contact your healthcare provider:
- Eye pain,
- Changes in your vision, or
- Swelling or redness in or around the eye (4).
Changes in appetite and weight might happen to adults and children. Therefore, the recommendation is to monitor the weight and height during the treatment (4).
Elderly people are at a greater risk for decreased salt levels in the blood. Symptoms that occur in this condition are headache, weakness or feeling unsteady, confusion, problems concentrating or thinking, or memory (4).
Sexual Dysfunction in Men and Women
Mental disorders often change sexual desire, performance, and satisfaction. However, this change may also be due to the SSRI medication treatment. The most common side effects in men, reported in controlled clinical trials, were ejaculation failure (8%), decreased libido (7%), erectile dysfunction (4%), ejaculation disorder (3%), and sexual dysfunction (2%). Four percent of women taking sertraline reported a libido decrease (4).
Patients and physicians hesitate to discuss such side effects regularly, which is one of the difficulties in obtaining reliable estimates of the incidence and severity. Yet, if you use sertraline or another SSRI and experience any of the described side effects, talk to your doctor (4).
The whole list of side effects is available in the Medication Guide (4). Read it carefully before you start your treatment, and ask your doctor any additional questions you might have. Then, if you experience any of the described side effects or experience an adverse event that bothers you, call your doctor or report it to FDA.
Additional Tips for Sertraline Safe Use
Sertraline is a medication for once-daily use. Follow recommendations and take sertraline every day at the same time. Daily alarms, pillboxes, or cell phone alerts can help to take the medication regularly.
If you miss the dose, take it asap unless the time is close to the next dose. If so, wait until the time comes. If, for some reason, you overdose, call your doctor or emergency for urgent medical care.
Do not use sertraline if you are allergic to the active substance of any other component in the medication. Some signs of allergic reactions are rash, itching, red or swollen skin; wheezing; tight chest or throat; unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat (9-10).
It takes weeks to feel the full benefit of sertraline therapy. Do not change the dose, stop taking the medication, or start before you talk to your doctor. It can cause side effects.
Talk to your doctor if you are pregnant, plan to be, or are breastfeeding. The baby is at increased risk of:
- A serious lung problem at birth, though in less than 1% of infants,
- Being born before or
- May have withdrawal symptoms after birth.
A small amount of sertraline passes into breast milk.
Drinking alcohol should be avoided (9).
Depression and other mental disorders, in many cases, require medical treatment. Sertraline is a medication that can improve your mood and how you look at life. However, in some patients, sertraline may cause side effects.
Today, side effects are well known after more than 30 years of practice. However, patients should know them and communicate with the healthcare provider. Parents and caregivers should pay special attention to behavior changes and recognizing suicidal thoughts and symptoms. A prompt reaction and asking for medical help can save a life.
Talk to your doctor and report adverse events. It can be beneficial for you and other patients. Then, follow the advice that your doctor gives you and make necessary changes to make overall improvement.
You are not alone with your mental condition. Be aware of your condition and seek medical advice and assistance if needed. It can do a lot in getting the maximum of your treatment efficacy.
- MedlinePlus. Mental Disorders. 2010. Disponible en: https://medlineplus.gov/mentaldisorders.html
- Major depression. National Institute of Mental Health (NIMH). Disponible en: https://www.nimh.nih.gov/health/statistics/major-depression
- Andrew Chu and Roopma Wadhwa. Selective Serotonin Reuptake Inhibitors. National Library of Medicine. May 8, 2022. https://www.ncbi.nlm.nih.gov/books/NBK554406/
- Food and drug administration. ZOLOFT (sertraline hydrochloride) tablets, for oral use and oral solution, prescribing information. December 2016. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839S74S86S87_20990S35S44S45lbl.pdf
- Harvard Medical School. Serotonin: The natural mood booster. July 20, 2021. https://www.health.harvard.edu/mind-and-mood/serotonin-the-natural-mood-booster
- Hardeep K. Singh and Abdolreza Saadabadi. Sertraline. National Library of Medicine. May 2, 2022. https://www.ncbi.nlm.nih.gov/books/NBK547689/
- MedlinePlus. Sertraline. January 15, 2022. https://medlineplus.gov/druginfo/meds/a697048.html
- MedlinePlus. Blood thinners. January 31, 2022. https://medlineplus.gov/bloodthinners.html
- National Alliance on Mental Health. Sertraline (Zoloft). December 2020. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Sertraline-(Zoloft)
- Memorial Sloan Kettering Cancer Center. Sertraline Pediatric Medication. October 25, 2021. https://www.mskcc.org/cancer-care/patient-education/medications/sertraline-01