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Reviewed by Daniel Z. Lieberman, MD
Written by Our Editorial Team
In the wide world of antidepressant medication, you have many options — which can be great but also kind of frustrating. What option is best? How do they all work? What are the dosages? So many questions — that’s where we step in.
We’re here to give you the low-down on everything you need to know about certain antidepressants, from uses to side effects and more.
Specifically, we’ll take a look at sertraline (widely known as Zoloft®). This commonly prescribed antidepressant is used for several mental health conditions, including major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Fair warning: More acronyms are ahead.
If you’ve been wondering, How does Zoloft work? or Is Zoloft an antidepressant?, consider this your one-stop guide on everything about this medication.
First things first: Is Zoloft an antidepressant medication? Yes, it is.
Despite being approved by the U.S. Food and Drug Administration (FDA) the same year as season 1 of The Fresh Prince of Bel-Air (1991, that is), Zoloft is a relatively new antidepressant medication. Sertraline is currently one of the most widely prescribed medications in the United States every year.
It comes as a tablet that’s taken orally, typically once a day. Since it’s only available as a prescription drug, Zoloft can’t be purchased over the counter.
As mentioned above, several mental health conditions are treated with Zoloft, with both FDA-approved and off-label use.
Zoloft is most often a first-line of treatment for major depressive disorder (also known as depression).
If you struggle with certain anxiety disorders, such as panic disorder or social anxiety disorder, Zoloft is also approved as a first-line treatment for managing symptoms.
Panic disorder is characterized by unexpected panic attacks that occur with other panic attack symptoms, like sweating, shaking and shortness of breath. Meanwhile, social anxiety disorder is an intense or persistent fear of being watched or judged in social settings.
Other Zoloft uses include the treatment of obsessive-compulsive disorder and post-traumatic stress disorder.
Zoloft is also an FDA-approved prescription drug for premenstrual dysphoric disorder (PMDD), a severe form of PMS linked to depression, anxiety and irritability before and during your period.
There are also several off-label uses for Zoloft, which simply means the drug is prescribed for a different purpose than what the FDA approved it for. Zoloft use is sometimes recommended for binge eating disorder, bulimia, generalized anxiety disorder (GAD) and body dysmorphia.
It’s great that this medication has so many different uses, but you might still be wondering, How does Zoloft work? This is a fair question — it’s definitely good to know how prescription drugs might help your mental health.
The active ingredient of Zoloft, sertraline, belongs to a class of medications known as selective serotonin reuptake inhibitors (SSRIs). The name isn’t just to make things more difficult (that’s what taxes and traffic are for) — it refers to how the medication is believed to work.
Selective serotonin reuptake inhibitors work by slowing down your brain’s reabsorption of a particular brain chemical called serotonin.
Different chemicals (or neurotransmitters) are responsible for regulating everything from your energy levels and appetite to your sex drive and mental focus.
Although serotonin manages a diverse range of biological functions, it’s best known for its role in regulating your mood.
Low serotonin is linked to increased feelings of depression and anxiety. By slowing down your body’s reabsorption of serotonin, SSRI medications like sertraline boost the amount of serotonin circulating throughout your brain and body.
Zoloft is available in a number of dosages, but which one you need depends on various factors, such as your symptoms and what side effects you experience.
Depending on the specific condition you have, your healthcare provider may prescribe sertraline at a starting dose of 25 to 50 mg. The maximum dosage is 200 mg.
Like any medication, Zoloft can come with side effects. There are also certain Zoloft interactions to be aware of.
While the most common side effects of Zoloft typically aren’t dangerous, there are several potentially severe side effects you should be aware of.
Common side effects of Zoloft include:
Nausea or vomiting
Diarrhea or loose stools
Dyspepsia (indigestion or an otherwise uncomfortable feeling in the stomach)
Sleepiness or drowsiness
Insomnia or trouble sleeping
Excessive sweating (hyperhidrosis)
Erectile issues (such as erectile dysfunction or ejaculation failure)
Though antidepressants may have a reputation for weight gain, some people say they experience Zoloft weight loss due to the medication causing a loss of appetite. However, everyone’s medication journey is unique, and whether you’ll lose weight is hard to predict.
Sertraline may cause sexual problems, such as a decreased interest in sex. You could also experience sexual side effects, like delayed lubrication and anorgasmia (difficulty reaching orgasm).
More severe (but rare) side effects of sertraline may include:
Low sodium blood levels
Swelling around the eyes
Increased heart rate
But if you experience continuing or worsening side effects after a couple of weeks, seek medical advice from your healthcare provider. They may adjust your dose or switch you to a different medication.
It’s also good to know about drug interactions between Zoloft and other drugs, supplements or substances. Why should you know about these Zoloft interactions? They 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 shouldn’t use Zoloft with:
Monoamine oxidase inhibitors (MAOIs). Taking Zoloft with an MAOI, such as phenelzine, isocarboxazid, tranylcypromine or methylene blue, can result in a dangerous increase in serotonin levels called serotonin syndrome.
Tricyclic antidepressants (TCAs). Another type of antidepressant, TCAs can interact with sertraline, causing increased side effects and an elevated risk of serotonin syndrome.
Non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants. Drugs like ibuprofen, naproxen or warfarin can increase your bleeding risk when taken with Zoloft.
Serotonergic medications. These include medications, such as tramadol, as well as some serotonergic herbal products like St. John’s wort.
You may have also heard about Zoloft and grapefruit being a no-go combo. Older research on grapefruit and antidepressants found that the combination could increase serotonin in the blood. Although not life-threatening, this could lead to some unpleasant side effects, but it’s. only a problem if you eat grapefruit regularly. An occasional grapefruit or glass of grapefruit juice isn’t a problem.
To avoid interactions, let your healthcare provider know of any medications (including over-the-counter drugs), supplements and other health products you’ve recently used before starting Zoloft.
Like other SSRIs, sertraline carries a black box warning from the FDA. Although the name is ominous, this label isn’t meant to scare you — it’s simply the most serious type of FDA warning designed to provide important safety information about sertraline.
The warning notifies people of an increased risk of suicidal thoughts and behaviors in children and young adults who are prescribed antidepressants. This risk is typically highest in the first few months of treatment — or after the prescribed dosage of sertraline is adjusted.
If you’re prescribed Zoloft, generic sertraline or any other antidepressant that may increase your risk of suicidal thoughts or behaviors, contact your healthcare provider or another healthcare professional as soon as possible if you experience any sudden changes in your behaviors, moods or feelings.
What if you’re pregnant or breastfeeding and taking Zoloft?
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.
However, study data doesn’t appear to show any increase in birth defects above the normal 3 to 5 percent risk level.
If you have concerns about taking Zoloft while breastfeeding, you may be relieved to learn that such small amounts of the drug are transferred to breast milk that it’s not detectable in breastfed babies. What’s more, sertraline is the preferred antidepressant while breastfeeding.
You can learn more about Zoloft and breastfeeding in our complete guide.
Regardless, if you’re trying to conceive, make sure to inform your healthcare provider before deciding to use sertraline. If you become pregnant while using sertraline, contact your 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 Zoloft during pregnancy.
We’ve covered just about everything you need to know about Zoloft. But before we sign off, here are a few tips on how to use Zoloft safely.
Use only as directed. This might go without saying, but use the medication only as directed. Closely follow the dosage instructions, and if your healthcare provider wants to increase your Zoloft dosage over time, don’t worry — it’s common for sertraline dosages to be adjusted in response to your symptoms.
Avoid drinking alcohol on sertraline. Whether you have a glass of wine every night or only indulge once in a while, the combination of Zoloft and alcohol isn’t recommended, as alcohol may exacerbate side effects and worsen depression or anxiety symptoms. Limiting yourself to one or two drinks on special occasions (maybe a couple times a month) is the best way to go.
Be mindful of Zoloft interactions. Certain drugs can cause allergic reactions, while others can increase the risk of serotonin syndrome. Be sure to let your healthcare provider know about any medications or supplements you’re using before starting Zoloft to avoid drug interactions.
Don’t abruptly stop taking Zoloft. It may be tempting to stop using medication if you don’t see improvements with your depression or are experiencing awful side effects. However, abruptly stopping can cause withdrawal symptoms, which you can learn about in our Zoloft withdrawal guide. If needed, your healthcare provider will give a taper-down schedule to follow and safely wean off the medication.
Reach out to your healthcare provider. Seek medical advice if you notice any serious side effects, plan to become pregnant or start using another drug — really, anything. Your provider will be able to provide more information and next steps. You can also read through our sertraline FAQs for more information.
We just covered a whole lot of information about sertraline (generic for Zoloft). Here’s a recap:
Is Zoloft an antidepressant? Yes — in addition to treating depression, it’s also prescribed for certain anxiety disorders like social anxiety and panic disorder, as well as post-traumatic stress disorder, premenstrual dysphoric disorder and obsessive-compulsive disorder.
How does Zoloft work? As a selective serotonin reuptake inhibitor (SSRI), sertraline is thought to prevent your brain from reabsorbing the chemical serotonin, which affects mood and focus, among other functions. This lessens the symptoms of anxiety and depression.
What are the side effects? The side effects of Zoloft are vast but, fortunately, pretty mild. They may include increased heart rate, dry mouth, constipation, fatigue, or decreased interest in sex.
What drug interactions should you know about? Certain drugs interact negatively with Zoloft, such as MAOIs, TCAs and serotonergic medications. Zoloft and grapefruit may also have a negative interaction, leading to too much serotonin in the bloodstream.
What are the other risks? Zoloft also comes with a black box warning about an increased risk of suicidal thoughts.
Depending on your symptoms and general health, your healthcare provider may prescribe sertraline (or one of several other antidepressants). You can set up a consultation through our online psychiatry services to determine if sertraline is the right medication for you.
Sertraline is also often just one part of depression or anxiety treatment. Therapy is another highly recommended treatment and is often used in conjunction with medication.
Daniel Z. Lieberman, MD is a Clinical Professor of Psychiatry and Behavioral Sciences at George Washington University, where he has received awards for teaching and research.
During his 26-year tenure on the full-time faculty at George Washington University, he taught both medical students and psychiatry residents, and served as the Vice Chair for Clinical Affairs, the Chairman of the Institutional Review Board and the Director of the Clinical Psychiatric Research Center.
Dr. Lieberman is the co-author of the international bestseller The Molecule of More, which has been translated into more than 20 languages, and is also the author of Spellbound: Modern Science, Ancient Magic, and the Hidden Potential of the Unconscious Mind. He has published extensively in peer-reviewed journals and leading psychiatric textbooks.
Dr. Lieberman is a Distinguished Fellow of the American Psychiatric Association. He also has provided insight on psychiatric topics for the US Department of Health and Human Services, the US Department of Commerce and the Office of Drug and Alcohol Policy.
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