From the Guidelines
Sertraline is associated with a range of side effects, including nausea, diarrhea, headache, dizziness, and sexual dysfunction, which can impact morbidity, mortality, and quality of life. When considering the potential side effects of sertraline, it is essential to weigh the benefits of treatment against the risks. According to the American College of Physicians guideline 1, sertraline is associated with a higher rate of diarrhea compared to other SSRIs, and bupropion has a lower rate of sexual adverse events than sertraline.
Common Side Effects
- Nausea
- Diarrhea
- Headache
- Dizziness
- Dry mouth
- Increased sweating
- Insomnia
- Fatigue
- Sexual dysfunction (decreased libido, delayed orgasm)
- Mild tremors These side effects are usually mild to moderate and may improve within a few weeks of starting treatment.
Serious Side Effects
- Serotonin syndrome (confusion, rapid heart rate, high fever, muscle rigidity)
- Allergic reactions
- Abnormal bleeding
- Seizures
- Suicidal thoughts, particularly in young adults and adolescents during the first few weeks of treatment It is crucial to monitor patients closely for these serious side effects, especially during the initial treatment period. The U.S. Food and Drug Administration advises that all patients receiving antidepressants be closely monitored on a regular basis for increases in suicidal thoughts and behaviors 1.
Management of Side Effects
Starting with a lower dose (typically 25-50mg daily) and gradually increasing can help minimize initial side effects. If side effects persist or become bothersome, consult your healthcare provider, as dosage adjustments or medication changes may be necessary. Never stop taking sertraline abruptly as this can cause withdrawal symptoms; always taper off under medical supervision 1.
From the FDA Drug Label
Sertraline may cause serious side effects, including: Feeling anxious or trouble sleeping Common possible side effects in people who take sertraline include: nausea, loss of appetite, diarrhea or indigestion change in sleep habits including increased sleepiness or insomnia increased sweating sexual problems including decreased libido and ejaculation failure tremor or shaking feeling tired or fatigued agitation Other side effects in children and adolescents include: abnormal increase in muscle movement or agitation nose bleed urinating more often urinary incontinence aggressive reaction heavy menstrual periods possible slowed growth rate and weight change.
The possible side effects of sertraline include:
- Serious side effects: feeling anxious or trouble sleeping
- Common side effects: nausea, loss of appetite, diarrhea, change in sleep habits, increased sweating, sexual problems, tremor, feeling tired, agitation
- Side effects in children and adolescents: abnormal increase in muscle movement, nose bleed, urinating more often, urinary incontinence, aggressive reaction, heavy menstrual periods, possible slowed growth rate and weight change 2
From the Research
Sertraline Side Effects
- Nausea is the most commonly reported adverse effect of sertraline, along with other reported adverse effects such as headache, sedation, dry mouth, insomnia, sexual dysfunction, and constipation 3
- Sexual dysfunction is a common side effect of sertraline, with studies showing that it can cause decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, and impotence 4
- The incidence of sexual dysfunction with sertraline can be significant, with one study showing that 58% of patients experienced sexual dysfunction when directly questioned by physicians 4
- Sertraline-induced sexual dysfunction can be positively correlated with dose, and patients may experience substantial improvement in sexual function when the dose is diminished or the drug is withdrawn 4
- Brief drug holidays may allow for significant improvement in sexual functioning without a significant return of depressive symptoms in some patients taking sertraline 5
- Post-selective serotonin reuptake inhibitor sexual dysfunction (PSSD) is a condition where sexual side-effects of psychotropic medication can persist even after the medication has been withdrawn, and sertraline is one of the medications that can cause this condition 6