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Zoloft: 7 things you should know

Medically reviewed by C. Fookes, BPharm Last updated on Oct 3, 2019.

1. How it works

  • Zoloft is a brand (trade) name for sertraline. Sertraline is a medicine that may be used in the treatment of depression and other mood disorders. Experts believe sertraline's effects are due to its ability to rebalance chemicals in the brain, such as serotonin, that appear imbalanced in people with anxiety, depression, and other disorders.
  • Its activity against other neurotransmitters is much less potent than other antidepressants.
  • Zoloft belongs to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are thought to work by preventing the reuptake of serotonin by nerves, leading to an increase in serotonin concentrations within the nerve synapse (space between two nerves).

2. Upsides

  • Zoloft may be used in the treatment of moderate-to-severe depression (Major Depressive Disorder).
  • May reduce feelings of anxiety in people with obsessive-compulsive disorder (OCD), panic disorder, or social or generalized anxiety disorder.
  • Also approved to treat post-traumatic stress disorder (PTSD), relieving symptoms such as avoidance and intrusion.
  • May improve mood associated with premenstrual dysphoric disorder (PMDD).
  • Zoloft is available as a generic under the name sertraline.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • A headache, nausea, diarrhea, weight loss, insomnia, and sexual dysfunction.
  • May cause drowsiness, but not as likely as with some other antidepressants; however, caution should still be used when driving or operating machinery until full effects of the drug are known.
  • May increase the risk of suicidal thoughts or behavior in young adults (similar to other antidepressants).
  • Interaction or overdosage may cause serotonin syndrome (symptoms include agitation, hallucinations, fast heart rate, dizziness, muscle tremor, nausea, vomiting, diarrhea).
  • May cause a discontinuation syndrome if abruptly stopped or interrupted (symptoms include nausea, vomiting, diarrhea, headaches, sweating, tremors, vivid dreams, insomnia).
  • Investigate any unexplained bone pain, tenderness, swelling or bruising since bone fragility fractures have been associated with antidepressant treatment.
  • May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk (such as other antidepressants, tramadol, or St John's Wort).
  • May precipitate a manic episode in people with undiagnosed bipolar disorder.
  • May cause lowering of total body sodium (called hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
  • Rarely causes seizures.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

4. Bottom Line

Zoloft is an effective antidepressant with less potential for drowsiness than many other antidepressants.

5. Tips

  • Administer once daily either morning or evening. If Zoloft makes you drowsy, take it at bedtime. May be taken with or without food; however, this needs to be consistent.
  • Talk to your doctor if your mood worsens or you experience any suicidal thoughts particularly during the first few months of therapy.
  • Seek urgent medical advice if symptoms consistent with serotonin syndrome (such as agitation, hallucinations, fast heart rate, dizziness, flushing, nausea, diarrhea) develop.
  • Do not stop suddenly as withdrawal symptoms may occur. When the time comes to discontinue Zoloft, your doctor will advise you how to taper the dose down.
  • Report any problems with bleeding or bruising to your doctor, also report any unexplained skin changes (such as blisters or rashes), problems with urination, eye pain or swelling and vision changes to your doctor.
  • Dilute Zoloft oral concentrate immediately before use with either water, ginger ale, lemon/lime soda, lemonade, or orange juice. Take immediately after mixing.
  • For people who are allergic to latex, note that the Zoloft oral concentrate dropper dispenser contains latex.

6. Response and Effectiveness

  • Peak effects are seen within 4.5 to 8 hours. Some reduction in symptoms of depression or anxiety may be seen within the first week of taking Zoloft; however, it may take up to six weeks for the full effects of Zoloft are seen.

7. Interactions

Medicines that interact with Zoloft may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Zoloft. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Zoloft include:

  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as phenytoin, phenobarbital, or primidone
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • bupropion
  • diuretics, such as furosemide
  • lithium
  • medications that may affect the heartbeat by prolonging the QT interval, such as amiodarone, encainide, flecainide, or pimozide
  • other antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), venlafaxine, and SSRIs (eg, paroxetine, sertraline)
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • other medications that are metabolized by the same enzymes such as cimetidine, most antipsychotics, flecainide, propafenone, or vinblastine
  • others, such as HIV medications (fosamprenavir, ritonavir), or procyclidine.

Avoid drinking alcohol or taking illegal or recreational drugs while taking Zoloft.

Note that this list is not all-inclusive and includes only common medications that may interact with Zoloft. You should refer to the prescribing information for Zoloft for a complete list of interactions.

References

Zoloft (sertraline hydrochloride) [Package Insert]. Revised 09/2019. Roerig https://www.drugs.com/pro/zoloft.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Zoloft only for the indication prescribed.

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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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