Zoloft (sertraline HCl) is the fourteenth most prescribed medication in the United States. Nearly forty million Americans use Zoloft to relieve depression, improve their mood and energy, and increase their comfort in social situations. It also works to reduce panic attacks and the urge to perform repetitive compulsive tasks.
Zoloft is a prescription-only antidepressant medication that belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). It works by blocking the removal of serotonin from the brain which then increases serotonin levels and helps balance chemicals in the brain that can affect our mood.
Zoloft is a brand name for the generic drug called sertraline hydrochloride (HCl). It was first approved for medical use in 1991 by the U.S. Food and Drug Administration (FDA). The generic version of the drug became available in 2006 and is offered in both a tablet and liquid form.
Sertraline is approved by the FDA for the treatment of:
Major depressive disorder (MDD), also known as clinical depression, is a common and serious mood disorder that usually affects young adults, especially women, between the ages of 18-25. If you experience MDD, you continually feel sad and lose interest in daily activities that you used to enjoy. You may find it difficult to carry out everyday tasks and have the feeling that life is no longer worth living. You may also have physical symptoms such as chronic pain or digestive issues.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), to be diagnosed with major depressive disorder, you will have at least five of the following symptoms (including at least one of the first two symptoms listed) persistently almost every day for a minimum of two weeks:
Over 7% of American adults have at least one major depressive episode a year.
Obsessive compulsive disorder (OCD) is a condition where you become entangled in a cycle of obsessions and compulsions.
Obsessions are defined as repetitive, unwanted, and uncontrollable intrusive thoughts, images, or urges that trigger intensely distressing feelings, including the feeling that things need to be done ‘correctly’. Obsessions seen with OCD include obsessions related to contamination, losing control, fear of harm, perfectionism, religion, unwanted sexual thoughts, and more.
Compulsions are defined as behaviors you engage in to try and escape or abolish the obsessions and feel less distressed. Common compulsions include excessive washing and cleaning, checking, and repeating, as well as mental compulsions including mental reviewing, counting, praying, and others.
To be diagnosed with OCD, this cycle of obsessions and compulsions becomes so extreme that it takes up much of your time and prevents you from carrying out other activities you value and would like to do.
The FDA has approved the use of sertraline to treat OCD in adults and children aged 6-17 years.
According to the DSM-5, panic disorder is considered to be an anxiety disorder where diagnosis is based on the following:
Panic attacks are categorized as expected and unexpected. Expected panic attacks are typically linked to a specific fear such as being afraid of heights, whereas unexpected panic attacks have no known triggers and appear to occur out of the blue.
Post-traumatic stress disorder is caused by the experience of a traumatic situation or event such as an accident; being a victim or witness to a violent crime, war or terrorism, serious disease or natural disaster; or being a victim of physical or sexual abuse. Such a traumatic experience can cause you to feel intense fear, pain, or sorrow to the extent that you are fearful of serious harm or death. Afterwards you can relive these feelings to the extent that they may affect your daily activities and relationships.
Signs and symptoms of PTSD include:
It is estimated that nearly 3% of U.S. adults had panic disorder in the past year.
Social anxiety disorder, or social phobia, is the feeling of intense anxiety or fear of being judged, negatively evaluated or rejected in a social or performance situation. You may be concerned about acting or appearing visibly anxious, or being viewed as stupid, awkward, or boring. These worries can cause you to avoid social situations. You may also have physical symptoms, such as a rapid heart rate, nausea, sweating, and even full-blown anxiety attacks. You understand that your anxiety and fear is excessive, yet you can feel powerless to prevent it and it can cause you to lose out on forming social and romantic relationships, completing your studies, and gaining a career.
If you think you may have social anxiety disorder, make sure you get professional medical advice. You can be treated with an effective medication, such as sertraline, and avoid possible alcoholism as a result of your social phobia. Unfortunately, fewer than 5% of the ~15 million American adults who have this disorder seek an available and effective medical treatment.
Premenstrual dysphoric disorder is when you can have serious depression, irritability, and tension before menstruation. PMDD is a more severe form of premenstrual syndrome (PMS) and can prevent you from carrying out your normal activities and social interactions. In both PMDD and PMS, about five to eleven days before menstruation, you may experience a wide range of physical or emotional symptoms which will then cease once your period starts. It is clear that hormonal fluctuations are involved in these conditions but the specific causes are not yet known.
Sertraline is one of a group of antidepressants called selective serotonin reuptake inhibitors or SSRIs. These drugs work to relieve depression by acting in the brain to increase the levels of a mood-enhancing neurotransmitter or chemical called serotonin. More specifically, SSRIs prevent the reuptake or absorption of serotonin by neurons (brain nerve cells) so that serotonin levels are increased.
Sertraline should not be taken for any of its FDA approved uses without consultation with a doctor. You cannot take sertraline if you have an allergy or hypersensitivity to sertraline.
Before you take sertraline, your doctor will talk to you about your medical history and make sure that no other existing medical conditions or medications you have used or are using will affect your suitability for this medication. For instance, you cannot be prescribed sertraline, or your doctor will have you very carefully monitored, if you have or are at risk of:
If you are pregnant let your healthcare provider know immediately. There are certain circumstances in which Zoloft may be continued during pregnancy. Zoloft is considered one of the safest options for depression for breastfeeding women.
Sertraline can interact with various medications. These drug interactions can affect how well sertraline works for you and potentially cause serious but preventable side-effects.
You need to let your doctor know what other medications you are currently taking or have taken recently before you are prescribed sertraline. This is also true of over-the-counter (OTC) medications or off-the-counter supplements.
Do not use sertraline if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days because this can result in dangerously increased blood pressure and serotonin syndrome.
St. John’s wort is an herbal supplement used to treat depression and it should not be combined with sertraline or any other depression or anxiety medications. Other medications that can interact with sertraline and cause serious problems include:
Avoid drinking alcohol with sertraline as this can also cause unpleasant but preventable side effects. Sertraline may impair your thinking and reactions so take extra care when driving or carrying out other activities where you need to be alert.
Sertraline is available as either an oral tablet or a liquid. You will need to take it once a day at the same time, either in the morning or evening. It can be taken with or without food. If taken as a liquid, make sure to measure it accurately with a dosing spoon or oral syringe and then dilute it in a drink such as water or juice.
Sertraline comes in the following strengths:
The following are the recommended dosages for sertraline. After the initial dose, your doctor can slowly increase your dose, if needed, until you reach the optimal dose for you.
*For intermittent dosing starting 14 days before your anticipated date of your period through to the first day of your period and repeated with each new cycle. For daily dosing, the maximum dose is 150 mg.
Store your medicine at room temperature away from moisture and heat.
Always take your medication according to your doctor’s instructions and what it says on the information sheet that comes with your tablets. If you miss a dose, take it as soon as possible. However, if it is nearly time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not try to compensate for your missed dose by taking a double dose.
You will see improvements in your energy, sleep, or appetite within the first two weeks of taking sertraline. This is a good sign that your medicine is working. However, it will take 6-8 weeks before you see improvements in relieving your depression or lack of interest in your daily activities.
Make sure that you complete regular follow-up appointments with your doctor to make sure you are continuing on the best dosage for you.
Do not stop taking sertraline, even if you feel better, without discussing it first with your doctor. If it is time to stop taking sertraline, discuss with your doctor on how to gradually reduce your dose first. Stopping your medication suddenly can cause you unpleasant withdrawal symptoms. These can include irritability, nausea, dizziness, vomiting, nightmares, headaches, and/or tingling prickly skin.
Common Zoloft or sertraline side effects include but are not limited to:
These side effects will usually improve over the first week or two as you continue to take the medication. The exception to this are sexual side effects, such as problems with orgasm or ejaculatory delay.
You may gain some weight when taking sertraline. It is not clear why this happens. Possible reasons are that SSRIs increase your appetite or that these drugs change your body’s metabolism so that it does not efficiently use the calories you take in with your food.
Sertraline is not the ideal medication to treat everyone. For example, sertraline should not be taken by someone with a pre-existing medical condition or medication that would interact with sertraline.Talk with your doctor to see whether you can try other medications, various therapies such as cognitive-behavioral therapy, psychotherapy, acceptance and commitment therapy (ACT), or other ‘talk therapies’. Many people who experience depression and other mood disorders find such therapies to be of great benefit.
Both Zoloft and Lexapro belong to the same drug class called selective serotonin reuptake inhibitors. Therefore, they both work in the brain in a similar manner to reduce depression and anxiety. However, Zoloft has more FDA approved uses including obsessive compulsive disorder in both adults and children, panic disorder, and premenstrual dysphoric disorder, while Lexapro is only used off-label for these conditions.
Both Zoloft and Lexapro have similar common side effects, similar drug-interactions (for instance, with MAOIs), and can cause unpleasant withdrawal symptoms if you abruptly stop taking them.
Both Zoloft and Prozac are SSRIs and therefore have a similar way they work in the brain to reduce depression and other mood disorders. Both medications are FDA approved to treat MDD, OCD, PD, and PMDD. However, Prozac is also used to treat bulimia nervosa, while Zoloft can also treat PTSD and social anxiety disorder. These drugs are approved to treat adults who have these conditions but Zoloft can also treat children 6 years and above for OCD, while Prozac can treat children 8 years and above for MDD.
Both Zoloft and Prozac share common side effects, have similar drug-interactions (including with MAOIs), and should not be stopped suddenly which can cause unpleasant withdrawal symptoms.
As with all medications, some people may find one drug more suitable for them than another. In other words, it depends on each individual how they are going to react to a particular drug. Having said that, studies have found that both Zoloft and Prozac are generally similarly effective for treating clinical depression. However, one clinical trial found that Zoloft had a lower severity of side effects compared to Prozac with significantly fewer people withdrawing from Zoloft compared to those withdrawing from Prozac.
Zoloft and Xanax are both used to treat anxiety disorders and panic attacks but they work differently in the brain. This is because they belong to two different drug classes; Zoloft is an SSRI, whereas Xanax is a benzodiazepine. This means that Zoloft works to increase the amount of mood-enhancing serotonin chemical in the brain, while Xanax acts to inhibit the effects of a chemical in the brain called GABA. Too much GABA is thought to cause anxiety and other mood disorders.
Both Zoloft and Xanax have various side effects in common but unlike Zoloft, Xanax can be addictive and cause serious dependency problems. Neither drug should be stopped suddenly so as to avoid unpleasant withdrawal symptoms.
Clinical depression and other mood disorders do not need to take over your life. Your doctor can guide you to suitable and effective treatments. You will then feel much more in control and can live your life more enjoyably.
Once you are on sertraline, it is very important that your family and close friends are aware you’re taking this medication. This is because sertraline and other similar SSRI antidepressants can increase the risk of suicide thoughts or actions in young people aged up to 25 years when first taking an antidepressant. If you notice mood changes or suicidal ideation, especially in the beginning of treatment, notify your doctor or seek medical attention straight away.
If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.
If you are taking sertraline, be sure to get immediate emergency medical assistance if you have signs of a rare allergic reaction to sertraline. Look out for:
In the rare case you have a serious side effect, call your doctor without delay. Serious side effects include:
If you think you have overdosed on sertraline, call 911 or call Poison Control at 1-800-222-1222. Symptoms of overdose can include:
