What to Know About Zoloft (Sertraline)

Zoloft (sertraline) is an antidepressant that is used for the treatment of a number of conditions, such as post-traumatic stress disorder (PTSD) and social anxiety disorder (SAD). It is also used off label for managing a variety of medical problems, ranging from neuropathic pain to certain types of sexual dysfunction.

Zoloft is considered a safe medication, but it can produce side effects, such as decreased appetite and tremors, and there are certain precautions you need to consider before taking Zoloft.

Sertraline is the generic name for Zoloft. It is available as tablets and an oral solution.

Uses

Zoloft is approved for use in adults age 18 and over for treating several different mood and behavioral conditions. It is also approved for use in children over the age of 6 for the treatment of obsessive-compulsive disorder (OCD). 

Zoloft is used to help manage symptoms, but it does not cure any illnesses. It can take several weeks before Zoloft begins to have noticeable therapeutic effects. 

Conditions for which Zoloft is officially FDA-approved are:

• Major depressive disorder age 18 and older
• OCD age 6 and older
• Panic disorder age 18 and older
• PTSD age 18 and older
• Social anxiety disorder age 18 and older
• Premenstrual dysphoric disorder age 18 and older

Zoloft is a selective serotonin reuptake inhibitor (SSRI). Serotonin is a neurotransmitter that plays a role in modulating mood, pain, and other neurological and psychological functions. The reuptake of serotonin into nerve endings terminates its action.

Off-Label Uses

Zoloft is frequently used off-label. As with its use for its approved indications, when taken off-label, it typically has to be taken every day for at least a few weeks before its full effects are noticed.

Zoloft has been prescribed for children for conditions besides OCD, including depression. For adults, Zoloft is sometimes used off-label to prevent neuropathic pain and as migraine prophylaxis.

Sertraline, the generic form of Zoloft, has been investigated as a possible treatment for certain cognitive symptoms associated with cerebrovascular disease. It has also shown some positive effects in managing certain symptoms of traumatic brain injury.

Before Taking

Let your healthcare provider know if you have had any adverse reactions to any antidepressants. Although Zoloft is sometimes used in children, its only official FDA indication for this age group is in children with OCD who are six years old or older.

This medication can cause side effects or withdrawal in a newborn when a pregnant mother uses it late in the pregnancy.

Precautions and Contraindications

You may have a high risk of adverse effects from taking Zoloft if you have certain conditions. 

Use Zoloft with caution if you have:

• Liver problems: You may need to take a lower than standard dose of Zoloft if you have liver dysfunction.
• Bipolar disorder: Zoloft can induce mania. Before you take Zoloft, your healthcare provider+ may screen you for signs of bipolar disorder or warn you about signs of mania and hypomania. 
• Epilepsy: Zoloft may increase the risk of seizures if you are predisposed to them. 
• Angle-closure glaucoma: Zoloft can exacerbate this condition, especially if it is untreated. You may need to be screened for glaucoma if you are at risk. 

Other Antidepressants

Other SSRIs include Prozac (fluoxetine), Paxil (paroxetine), Celexa (citalopram), Luvox (fluvoxamine), and Lexapro (escitalopram). Other types of antidepressants include tricyclic antidepressants like Elavil (amitriptyline) and monoamine oxidase inhibitors (MAOIs) like Eldepryl (selegiline).

Dosage

Zoloft is available in 25-milligram (mg), 50-mg, and 100 mg-tablets. The oral solution comes in a strength of 20 mg per milliliter. The dosing for Zoloft is different for each condition that it is used to treat.

Your healthcare provider may start you on a different dosage. After you start Zoloft, your healthcare provider will generally gradually increase your dose until your symptoms are optimally managed or side effects emerge.

How to Take and Store

Be sure to take Zoloft at the same time each day. If you miss a dose, you can make it up within a few hours. However, if you miss your dose and it is almost time for your next dose, just take your regularly scheduled dose, do not take both at the same time.

You can take Zoloft tablets with or without food.

The oral solution should be diluted before use, but it shouldn’t be prepared in advance. To prepare Zoloft oral solution:

• Use the dropper provided.
• Mix the required amount of Zoloft with 4 ounces (1/2 cup) water, ginger ale, lemon/lime soda, lemonade or orange juice.

Do not mix Zoloft oral solution with anything besides these liquids.

Zoloft tablets and oral solution should be stored at a temperature of 68 degrees Fahrenheit (F) to 77 F. 

Side Effects

Zoloft is generally considered a safe medication, but it can cause side effects. Most side effects are mild and can improve over time or with an adjusted schedule, but serious side effects can occur as well.

Common

If you experience side effects, you should talk to your healthcare provider. You and your practitioner can weigh the benefits of taking Zoloft with the side effects to decide if you should continue taking it. 

The most common side effects that occur as a result of taking Zoloft are:

• Nausea
• Diarrhea/loose stool
• Tremor or twitching
• Indigestion
• Decreased appetite or weight loss
• Hyperhidrosis (excessive sweating)
• Ejaculation/orgasm problems
• Decreased libido 
• Bruising
• Muscle aches
• Anxiety

Severe

Certain life-threatening side effects can occur as a result of taking Zoloft. If you develop severe side effects, you should seek prompt medical attention. 

Serious side effects of Zoloft include:

• Serotonin syndrome: Diarrhea, confusion, seizures, rapid heart rate can occur due to excess serotonin in the body. 
• Suicidal ideation
• Changes in heart rhythm
• Bleeding 
• Confusion 
• Behavioral changes
• Seizures 
• Liver injury

Warnings and Interactions

If you are planning to stop taking Zoloft, it’s important that you discuss a schedule with your healthcare provider.

You could develop the effects of withdrawal if you quit abruptly, including confusion, dizziness, disturbed dreams, nausea, and agitation. 

Zoloft interacts with some prescription medications. Your healthcare provider or pharmacist can tell you if any of the medications you take interact with Zoloft. 

Zoloft drug interactions include:

• Antidepressants: Taking Zoloft with other SSRIs or with MAOIs or tricyclic antidepressants can increase the likelihood of serotonin syndrome.
• Blood thinners: Taking Zoloft while taking blood thinners can increase the risk of bleeding. 
• Pimozide: Zoloft increases the concentration of Pimozide (an antipsychotic) and can cause arrhythmias (irregular heart rhythm) as a result of this interaction. 
• Phenytoin: Zoloft can increase the concentration of phenytoin, an anti-seizure medication. 
• Disulfiram: The combination of disulfiram and the oral Zoloft solution, which contains alcohol,can cause severe reactions.