What to Know About Zoloft (Sertraline)

An Antidepressant With Many Uses

In This Article

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 cognitive impairment.

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. This medication is only available as the Zoloft brand. It is available as tablets and an oral solution.

Your doctor may prescribe Zoloft
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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. And Zoloft doesn’t stop or reverse acute symptoms—it is used as a daily maintenance treatment to prevent symptoms. It can take several weeks before Zoloft begins to have noticeable therapeutic effects. 

Conditions for which Zoloft is approved are:

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.

Zoloft prolongs the action of serotonin by preventing its reuptake into nerve endings.

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 it has effects.

Zoloft has been prescribed for children for conditions besides OCD, including depression. For adults, Zoloft is 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 cognitive symptoms associated with cerebrovascular disease, with promising results. It has also shown some positive effects in managing symptoms of traumatic brain injury.

Sertraline has been used in investigational research as an adjunctive treatment for cryptococcal meningitis for patients who have human immunodeficiency virus (HIV), along with other standard anti-microbial treatment. In the research setting, the addition of sertraline was associated with a decreased duration of the infection and fewer infection relapses. 

Before Taking

You may not be able to use Zoloft if you have a high risk of side effects. If you have had an allergic reaction or another negative reaction to Zoloft, you should let your doctor know about it before trying it again. 

Zoloft hasn’t been verified as safe for children under age 18 for any indication besides OCD or under age 6 for OCD, and your child’s doctor would prescribe Zoloft with caution when it’s being used off-label.

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 failure: You may need to take a lower than standard dose of Zoloft if you have mild liver failure, and you may not be able to take the medication at all if you have severe liver failure. 
  • Bipolar disorder: Zoloft can induce mania. Before you take Zoloft, your doctor may screen you for signs of bipolar disorder or warn you about signs of mania and hypomania. 
  • Epilepsy: Zoloft can 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.

Manufacturer recommended dose for Zoloft
Condition Initial dose Maximum recommended dose
Depression 50 mg per day 200 mg per day
OCD (age 13 and older) 50 mg per day 200 mg per day
OCD (age six to 12) 25 mg per day 200 mg per day
Panic disorder 25 mg per day 200 mg per day
PTSD 25 mg per day 200 mg per day
Social anxiety disorder 25 mg per day 200 mg per day
Premenstrual dysphoric disorder 50 mg per day 150 mg per day

After you start taking Zoloft, your doctor might not increase your dose if you are having an adequate improvement in your symptoms. If needed, your dose can be increased every week by 25 to 50 mg per day until you experience an improvement in your symptoms.

Modifications

If you have liver failure, your doctor may prescribe half the recommended dose of Zoloft for you—at the start and as maintenance. If you are taking Zoloft off-label, your prescription may be for a lower dose than what is recommended for the approved indications.

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, do not take both at the same time. You can take your next scheduled dose a few hours early and then wait until your following scheduled dose and resume your schedule. 

You can take Zoloft tablets with or without food.

The oral solution has to 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 doctor. You and your doctor 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 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
  • Tachycardia (rapid heart rate)
  • Severe bleeding 
  • Confusion 
  • Behavioral changes
  • Seizures 
  • Liver failure 

Zoloft can cause increased thoughts of suicide, especially among young people. You should get urgent medical attention if you start to experience any thoughts about harming yourself.

Warnings and Interactions

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

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 doctor 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 can cause severe muscle stiffness and convulsions.
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Article Sources
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  4. Rhein J, Morawski BM, Hullsiek KH, et al. Efficacy of adjunctive sertraline for the treatment of HIV-associated cryptococcal meningitis: an open-label dose-ranging study. Lancet Infect Dis. 2016;16(7):809-818. doi:10.1016/S1473-3099(16)00074-8

  5. Food and Drug Administration. Zoloft label. Updated December 2016.

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