What are the potential side effects of Zoloft (sertraline)?

From the Guidelines

Zoloft (sertraline) can cause several side effects, including common ones like nausea, diarrhea, and headache, as well as more serious but less common side effects like serotonin syndrome and increased risk of bleeding. The most recent and highest quality study on this topic is from 2020 1, which provides a comprehensive overview of the potential side effects of sertraline. Some key points to consider include:

• Common side effects: nausea, diarrhea, indigestion, headache, insomnia or drowsiness, dizziness, dry mouth, increased sweating, sexual dysfunction (including decreased libido and delayed orgasm), and fatigue
• More serious but less common side effects: serotonin syndrome (characterized by agitation, hallucinations, rapid heart rate, fever, muscle stiffness, and coordination problems), increased risk of bleeding (especially when combined with blood thinners), low sodium levels (hyponatremia), seizures, and allergic reactions
• Zoloft may also cause activation of mania in people with bipolar disorder and can increase suicidal thoughts or behaviors, particularly in young adults and adolescents during the first few months of treatment
• The medication typically starts at 25-50mg daily and may be gradually increased to 50-200mg daily depending on response
• Side effects occur because sertraline works by increasing serotonin levels in the brain, which can affect multiple body systems beyond just mood regulation It's essential to discuss these potential side effects with your healthcare provider before starting treatment and to monitor your response to the medication closely. If you experience severe or persistent side effects, contact your healthcare provider immediately rather than stopping the medication abruptly, as this can cause withdrawal symptoms.

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 potential side effects of Zoloft (sertraline) include:

• Serious side effects: feeling anxious or trouble sleeping
• Common side effects:
  • Gastrointestinal issues: nausea, loss of appetite, diarrhea, indigestion
  • Sleep disturbances: increased sleepiness, insomnia
  • Increased sweating
  • Sexual problems: decreased libido, ejaculation failure
  • Tremor or shaking
  • Fatigue
  • Agitation
• Side effects in children and adolescents:
  • 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 2 Additional side effects are also listed, including psychiatric disorders, reproductive issues, respiratory system disorders, and more 2

From the Research

Potential Side Effects of Zoloft (Sertraline)

The potential side effects of Zoloft (sertraline) include:

• Gastrointestinal disturbances such as nausea, diarrhea, and loose stools 3, 4, 5, 6
• Male sexual dysfunction, primarily ejaculatory disturbance 3
• Headache and tremor 4, 5
• Dizziness and sweating 5
• Diarrhea, which was reported at a higher rate in sertraline users compared to users of other SSRIs 5
• Other side effects such as agitation, weight loss, and dermatological reactions, although these are more commonly associated with fluoxetine 4

Comparison to Other Antidepressants

Compared to other antidepressants, sertraline has been found to have:

• A similar distribution of adverse events to other SSRIs 5
• A higher rate of diarrhea compared to other SSRIs 5
• A lower rate of discontinuation due to adverse effects compared to fluvoxamine 4
• A trend towards being more effective and acceptable than some other antidepressants, such as fluoxetine and amitriptyline 6

Serious Adverse Events

Sertraline has been associated with serious adverse events, including:

• Seven adverse events, four of which were in the sertraline group, in a study of 655 patients 7
• One serious adverse event that was classified as possibly related to study medication 7