Sertraline (Zoloft): What it is, How it Works, Uses & More

    Kristin Hall, FNP
    Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 7/16/2020

    Sertraline, widely known as Zoloft®, is a prescription medication that’s used to treat depression, obsessive-compulsive disorder and certain anxiety and panic disorders.

    Sertraline is an antidepressant. It belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. It works by changing the amount of certain chemicals, such as serotonin, that manage and contribute to your mental health and wellbeing.

    If you’ve been diagnosed with major depressive disorder (depression), social anxiety disorder, panic disorder, premenstrual dysphoric disorder or posttraumatic stress disorder (PTSD), your healthcare provider may recommend sertraline as a treatment option.

    Below, we’ve explained what sertraline is in more detail, as well as how it works to help people treat and manage the conditions listed above. We’ve also listed the side effects that can occur with sertraline and answered common questions related to this medication.

    What Is Sertraline (Zoloft)? 

    Sertraline is a selective serotonin reuptake inhibitor, or SSRI. It comes in tablet form and is used in a range of doses to treat mental health conditions such as depression, obsessive compulsive disorder (OCD), anxiety disorders and posttraumatic stress disorder (PTSD).

    Sertraline is also prescribed to treat premenstrual dysphoric disorder (PMDD), a condition that’s linked to depression, anxiety and irritability before and during your period.

    Sertraline is one of the most widely prescribed medications in the United States, with tens of millions of prescriptions every year.

    In the United States, sertraline is often sold under the brand name Zoloft. It’s also available as a generic medication under several different names. Sertraline is only available with a prescription and can’t be purchased over the counter. 

    Approved by the FDA in 1991, sertraline is newer and typically has fewer side effects than older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). 

    How Sertraline Works

    As a selective serotonin reuptake inhibitor (SSRI), sertraline works by slowing down your brain’s reabsorption of the neurotransmitter serotonin.

    Serotonin is a neurotransmitter that’s responsible for a large variety of biological functions within your body. Neurotransmitters work like a chemical messaging system for your body, transporting signals between neurons and other cells within your brain and body. 

    Different neurotransmitters are responsible for regulating everything from your energy level and heart rate to your appetite, sex drive and level of mental focus.

    Although serotonin manages a diverse range of biological functions, it’s best known for its role in regulating your mood. 

    Healthy levels of serotonin contribute to fewer feelings of anxiety and depression. On the other hand, lower levels of serotonin are linked to increased feelings of depression and anxiety, as well as conditions such as insomnia. 

    By slowing down your body’s reabsorption of serotonin, SSRI medications like sertraline boost the amount of serotonin that’s circulating throughout your brain and body at any time, reducing feelings of depression and anxiety.

    Sertraline Dosages

    Sertraline is available in a range of different dosages. Both generic sertraline and Zoloft come in three different strengths: 25mg, 50mg or 100mg per tablet. Zoloft is also available as an oral solution in a 20mg dosage. 

    Depending on the specific condition you have, your healthcare provider may prescribe sertraline at a starting dosage of 25mg to 50mg. It’s common for your sertraline dosage to be adjusted upwards over time in response to your symptoms.

    The maximum dosage of sertraline is 200mg per day. If you’re prescribed sertraline to treat any condition, closely follow the dosage instructions provided by your healthcare provider and use the medication only as directed. 

    Sertraline Side Effects and Interactions

    Like other antidepressants, sertraline may cause a range of potential side effects. Although the most common side effects of sertraline are typically not dangerous, there are several potentially severe side effects that you should be aware of before using sertraline. 

    Common side effects of sertraline include:

    • Palpitations
    • Visual impairment
    • Nausea
    • Diarrhea and/or loose stools
    • Dry mouth
    • Vomiting
    • Constipation
    • Dyspepsia (Acid reflux disease)
    • Decreased appetite
    • Fatigue
    • Tremor
    • Somnolence (Sleepiness or drowsiness)
    • Dizziness
    • Insomnia
    • Decreased libido
    • Agitation
    • Hyperhidrosis (Excessive sweating)
    • Erectile issues (Erectile dysfunction, ejaculation disorder/failure, etc.)

    Of these side effects, the most common is nausea. Nausea from sertraline is often temporary and may disappear over the course of several days or weeks. Other side effects of sertraline, such as dizziness, are also often transient and may resolve over time. 

    Sertraline may cause you to have a lower level of interest in sex, as well as sexual side effects delayed lubrication and anorgasmia (difficulty reaching orgasm). In men, sertraline may cause delayed ejaculation or difficulty ejaculating. 

    If you’re prescribed sertraline for anxiety, you may notice that your anxiety symptoms become more severe during the first few weeks of treatment. Like other side effects of sertraline, this is usually a temporary issue that improves over time. 

    If you experience persistent, bothersome side effects after using sertraline, talk to your healthcare provider. Depending on your side effects, they may adjust your dose or switch you to a different medication. 

    We’ve gone into more detail on the side effects of sertraline, as well as how common each side effect is, in our full guide to sertraline side effects. 

    FDA “Black Box” Warning: Suicidal Thoughts and/or Behavior

    Like other SSRIs, sertraline carries a “black box” warning from the FDA. This is the most serious type of FDA warning and is designed to provide important safety information about sertraline. 

    This warning notifies people of an increased risk of suicidal thoughts and/or behavior in children and young adults prescribed antidepressants. This risk is typically highest in the first few months of treatment, or after the prescribed dosage of sertraline or other antidepressant is adjusted.

    If you’re prescribed sertraline or any other antidepressant that may increase the risk of suicidal thoughts and/or behavior, contact your healthcare provider or healthcare professional as soon as possible if you experience any sudden changes in your behavior, mood or feelings. 

    Interactions Between Sertraline and Other Medications

    Sertraline may interact with certain other medications, supplements and substances. These may increase the level of sertraline in your body, stop the medication from working normally or cause a range of unwanted and potentially dangerous side effects. 

    You should not use sertraline with monoamine oxidase inhibitors (MAOIs), including phenelzine, isocarboxazid, tranylcypromine and others. Used with sertraline, these medications can result in a dangerous increase in serotonin levels called serotonin syndrome

    Inform your healthcare provider if you have used any MAOIs or other antidepressants within 14 days before you consider using sertraline. 

    Medications including tricyclic antidepressants, triptans, lithium, non-steroidal anti-inflammatory drugs (NSAIDs) and cimetidine can also interact with sertraline, causing increased side effects and an elevated risk of serotonin syndrome. 

    Finally, sertraline should not be taken serotonergic medications such as tramadol, trazodone or serotonergic herbal products such as St. John's wort. 

    To avoid interactions, make sure you inform your healthcare provider of any medications (including over the counter medications), supplements and other health products you’ve recently used before you discuss using sertraline. 

    Sertraline and Pregnancy

    Sertraline has a Category C rating from the FDA, meaning that while there aren’t adequate and well-controlled studies of how it affects humans during pregnancy, animal studies have shown adverse effects on the fetus. 

    Although a small number of studies have found an association between use of sertraline during pregnancy and certain birth defects, overall study data does not appear to show any increase in birth defects above the normal three to five percent risk level. 

    Nevertheless, if you’re planning to become pregnant, make sure you inform your healthcare provider of this before deciding to use sertraline. If you become pregnant while you’re using sertraline, contact your healthcare provider as soon as possible for guidance.  

    Your healthcare provider will be able to tell you about the best approach to continuing, adjusting or stopping your use of sertraline during pregnancy. 

    Sertraline and metabolites such as norsertraline can pass into breast milk in small amounts. If you’re currently breastfeeding, make sure you inform your healthcare provider before using sertraline or any other SSRI antidepressant medications. 

    Learn More About Medications for Depression

    Sertraline is one of several selective serotonin reuptake inhibitors (SSRIs) medications used to treat depression. 

    Depending on your symptoms and general health, your healthcare provider may prescribe sertraline or one of several other antidepressants. Our guide to medications for depression goes into more detail on the medications that are currently available to treat depression, how they work and more. 

    Frequently Asked Questions About Sertraline (Zoloft)

    How Should You Take Sertraline?

    Closely follow the instructions provided by your healthcare provider when you use sertraline. You can safely take sertraline with or without food at any time of day. For optimal results, it’s best to take your dosage of sertraline at roughly the same time every day. 

    Some people experience difficulty sleeping after taking sertraline. If sertraline affects your ability to fall asleep, consider taking it in the morning after you wake up.  

    Like many other medications, sertraline can interact with grapefruit juice and increase your risk of experiencing certain side effects. As such, you should not take sertraline with grapefruit juice.

    If you miss a dose of sertraline, take the missed dose as soon as you remember. If you forget to take a dose and it’s already close to the time for your next dose, skip the missed dose and take your regular dose as normal. Do not take two doses of sertraline at once. 

    If you accidentally take too much sertraline and experience vomiting, dizziness, an overly fast heart rate, tremors, seizures, sedation or other serious side effects, contact 911 for emergency medical assistance. 

    Is It Safe to Drink Alcohol While Using Sertraline? 

    While using sertraline, you should either avoid alcohol completely. 

    Alcohol may increase the severity of some side effects of sertraline, such as drowsiness, fatigue and dizziness. Consuming alcohol while using sertraline may affect your ability to concentrate or think clearly.

    If you’re prescribed sertraline to treat depression, your healthcare provider may recommend avoiding alcohol completely. Not only can alcohol potentially worsen the side effects of sertraline, but it may also worsen your depression symptoms. 

    How Long Does It Take for Sertraline to Work?

    Sertraline can take several weeks to start working as a treatment for depression, anxiety, PTSD and other conditions.

    After starting sertraline, your appetite, sleep habits and energy may begin to improve during the first two weeks of treatment. It may take up to six to eight weeks for your mood, level of interest in certain activities and other symptoms to show improvement.

    What Is a Normal Dose of Sertraline?

    Sertraline is prescribed at a dosage of 25mg to 200mg per day. 

    Based on your symptoms, general health and other factors, your healthcare provider may prescribe sertraline at a dosage of 25mg to 50mg, which may be adjusted over time based on your response to the medication. 

    How Long Does Sertraline Stay in Your System?

    Sertraline has a half-life of between 24 and 26 hours, meaning it takes about one full day for the concentration of sertraline in your body to decrease by 50 percent. Total clearance of sertraline typically takes five and a half to six days. 

    How Long Do Sertraline Side Effects Last?

    It’s common to experience some mild side effects after you start using sertraline. Many people who are prescribed sertraline experience nausea, headaches, tiredness and other side effects during the first few weeks of treatment.

    These side effects typically go away over the course of a few weeks. If you have persistent side effects from sertraline, do not stop taking the medication. Instead, contact your healthcare provider if you do not experience any improvement over time. 

    Can You Stop Taking Sertraline?

    If you’re prescribed sertraline by your healthcare provider to treat depression, anxiety or any other condition, you should not suddenly stop taking it. Sudden cessation of sertraline may cause discontinuation syndrome, which could involve nausea, anxiety, tremors, insomnia and other symptoms.

    You may also experience worse depression, anxiety or other symptoms if you suddenly reduce your sertraline dosage or completely stop using this medication. 

    If you would like to stop using sertraline, talk to your healthcare provider or medical professional. 

    Depending on your symptoms, they may advise you to gradually reduce your dosage of sertraline to reduce your risk of side effects, or to switch to an alternative SSRI or other antidepressant. 

    Can Sertraline Cause Weight Gain?

    Sertraline, like other antidepressants, is linked to weight gain. While there’s limited data specific to sertraline, a large-scale, population based cohort study from 2018 found that antidepressants including sertraline may contribute to a long-term increased risk of weight gain. 

    Despite this, sertraline’s effects on weight gain appear to be milder than other antidepressants, particularly older tricyclic antidepressant medications. Currently, experts aren’t sure exactly why antidepressants often lead to weight gain. 

    Interestingly, other studies of sertraline have concluded that it may help to promote weight loss in some patients.  

    If you experience significant weight gain, weight loss or other changes in body composition after starting sertraline and feel concerned about this, talk to your healthcare provider. 

    Does Sertraline Affect the Birth Control Pill?

    Sertraline does not affect the birth control pill or any other hormonal contraception, meaning you can use it without an increased risk of pregnancy. It’s also safe to use sertraline with emergency contraception such as the morning-after pill. 

    Is It Safe to Use Sertraline with Cold Medicine?

    Sertraline can interact with certain antihistamines used in over-the-counter cold medicines, such as chlorpheniramine. If you take sertraline and have a cold, make sure to contact your healthcare provider or pharmacist for advice on treatments that are safe for you to use. 

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    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.