Sertraline (Zoloft): uses, side effects and what to know

Sertraline is an antidepressant in the selective serotonin reuptake inhibitor (SSRI) class. Zoloft is its brand name; it is also sold as generic sertraline, as tablets and as an oral solution. Per the FDA label and MedlinePlus, it is taken once a day, in the morning or in the evening, at about the same time each day.

It is a prescription medicine. The FDA label states that sertraline is not a controlled substance.

According to the FDA label for Zoloft, sertraline is approved for the uses below. All are for adults, except OCD, which is also approved for children aged 6 to 17.

Several of its approved uses are anxiety disorders (panic disorder and social anxiety disorder) or anxiety-related conditions (PTSD and OCD). Generalized anxiety disorder is not among the uses on the Zoloft label. So if anxiety is what you feel, the doctor first works out which kind it is and then explains your options. Read more about anxiety.

Dose. Per the FDA label, adults start at 25 or 50 mg once a day, depending on the use, and the maximum is 200 mg a day (for PMDD, up to 150 mg with daily dosing or 100 mg with luteal-phase-only dosing). The doctor decides the dose and adjusts it gradually based on how you respond; do not change it on your own.

How long it takes. MedlinePlus says it may take a few weeks or longer to feel the full benefit, and the National Institute of Mental Health (NIMH) says antidepressants usually take 4 to 8 weeks to work. Sleep, appetite and energy often improve before mood does. Keep taking it even when you feel better.

According to the FDA label, the most common sertraline side effects are:

The FDA label carries a boxed warning: antidepressants increased the risk of suicidal thoughts and behavior in children, teenagers and young adults. Per the FDA label, in studies the increase was seen in people under 18 and in adults aged 18 to 24, and the risk may be higher in the first months or when the dose changes.

At any age, speak up right away about new or worse depression, anxiety, agitation, insomnia, irritability or thoughts of harming yourself. If that happens, call Línea PAS at 1-800-981-0023 or 988.

Serotonin syndrome. It is rare but serious. It can happen when sertraline is combined with other medicines or supplements that raise serotonin, such as triptans for migraine or St. John's wort, per the NIMH. Signs include agitation, hallucinations, fever, sweating, a racing heart, tremor and muscle stiffness. If you have them, go to the ER.

Do not combine it with MAO inhibitors (MAOIs), or within 14 days of stopping one, or with pimozide, per the label. Nor is the oral solution used with disulfiram (Antabuse), because it contains alcohol.

Bleeding. Taking it with aspirin, anti-inflammatories such as ibuprofen or naproxen, or warfarin raises the risk of bleeding. Tell the doctor every medicine and supplement you take.

Other label warnings: in people with bipolar disorder it can trigger mania, which is why the doctor asks about that history before starting. It can also lower blood sodium, especially in older adults or people taking diuretics.

If you are pregnant, planning a pregnancy or breastfeeding, the decision is made with the doctor. Per the FDA label, use in the third trimester may raise the risk of breathing problems and withdrawal symptoms in the newborn, but untreated depression carries risks too. Low levels of sertraline pass into breast milk. Do not stop it on your own if you become pregnant: talk with the doctor first.

Per the FDA label, stopping sertraline abruptly can cause discontinuation symptoms: nausea, sweating, low mood, irritability, agitation, dizziness and odd skin sensations such as electric-shock feelings. If you want to stop or switch, the doctor tells you how to lower the dose gradually.

All three are SSRIs and work in a similar way, but their labels list different approved uses, and side effects vary from person to person. None is “best” for everyone: the doctor chooses with you based on your symptoms, history and other medicines. Read the guides on escitalopram (Lexapro) and fluoxetine (Prozac). Another SSRI is citalopram.