From the Guidelines
Zoloft (sertraline) can cause several side effects, including nausea, diarrhea, and sexual dysfunction, which are commonly reported, as noted in studies such as 1.
Common Side Effects
- Nausea
- Diarrhea
- Indigestion
- Headache
- Insomnia or drowsiness
- Dizziness
- Dry mouth
- Increased sweating
- Sexual dysfunction (including decreased libido and delayed orgasm)
- Fatigue These side effects typically occur during the first few weeks of treatment and often improve with time, as seen in the study 1.
Serious Side Effects
More serious but less common side effects include:
- 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
- Allergic reactions Zoloft may also cause activation of mania in people with bipolar disorder, as mentioned in 1.
Special Considerations
Some patients experience withdrawal symptoms if the medication is stopped abruptly, so dosage should be gradually reduced under medical supervision, as advised in 1. Children, adolescents, and young adults may experience increased suicidal thoughts when first starting sertraline, requiring close monitoring during the initial treatment period, as noted in 1 and 1.
Monitoring and Dosage
It is essential to monitor patients for these side effects and adjust the dosage accordingly, as suggested in 1, to minimize the risk of adverse events and ensure the best possible outcome in terms of morbidity, mortality, and quality of life. The most recent and highest quality study, 1, provides guidance on the safe and effective use of sertraline, emphasizing the importance of careful monitoring and gradual dosage adjustments.
From the FDA Drug Label
Psychiatric Disorders-Frequent: yawning, other male sexual dysfunction, other female sexual dysfunction; Infrequent: depression, amnesia, paroniria, teeth-grinding, emotional lability, apathy, abnormal dreams, euphoria, paranoid reaction, hallucination, aggressive reaction, aggravated depression, delusions; Rare: withdrawal syndrome, suicide ideation, libido increased, somnambulism, illusion Reproductive-Infrequent: menstrual disorder, dysmenorrhea, intermenstrual bleeding, vaginal hemorrhage, amenorrhea, leukorrhea; Rare: female breast pain, menorrhagia, balanoposthitis, breast enlargement, atrophic vaginitis, acute female mastitis Respiratory System Disorders-Frequent: rhinitis; Infrequent: coughing, dyspnea, upper respiratory tract infection, epistaxis, bronchospasm, sinusitis; Rare: hyperventilation, bradypnea, stridor, apnea, bronchitis, hemoptysis, hypoventilation, laryngismus, laryngitis Special Senses-Frequent: tinnitus; Infrequent: conjunctivitis, earache, eye pain, abnormal accommodation; Rare: xerophthalmia, photophobia, diplopia, abnormal lacrimation, scotoma, visual field defect Urinary System Disorders-Infrequent: micturition frequency, polyuria, urinary retention, dysuria, nocturia, urinary incontinence; Rare: cystitis, oliguria, pyelonephritis, hematuria, renal pain, strangury 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 side effects of Zoloft (sertraline) include psychiatric disorders, reproductive issues, respiratory problems, special senses issues, and urinary system disorders. Common side effects are nausea, loss of appetite, diarrhea, change in sleep habits, increased sweating, sexual problems, tremor, feeling tired, and agitation. Other side effects in children and adolescents include abnormal increase in muscle movement, nose bleed, urinating more often, urinary incontinence, aggressive reaction, heavy menstrual periods, and possible slowed growth rate and weight change 2 2.
From the Research
Side Effects of Zoloft (Sertraline)
The side effects of Zoloft (sertraline) can be understood by examining the properties and clinical uses of this medication.
- Gastrointestinal disturbances, such as nausea and diarrhea/loose stools, have been associated with sertraline, although these effects are usually mild and transient, decreasing in frequency with continued treatment 3.
- Male sexual dysfunction, primarily ejaculatory disturbance, has also been reported as a side effect of sertraline 3.
- Other side effects of selective serotonin reuptake inhibitors (SSRIs), the class of medications to which sertraline belongs, include headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 4.
- A black box warning for increased risk of suicidality in children and young adults aged 18-24 has been associated with SSRIs, including sertraline 5.
- Adults without certain risk factors do not seem to carry this increased risk of suicidality 5.
Tolerability and Safety
- Sertraline has been found to possess tolerability advantages over tricyclic antidepressants, with minimal anticholinergic activity, essentially no cardiovascular effects, and a wide therapeutic index 3.
- The medication may be administered to elderly patients or those with underlying cardiovascular disorders 3.
- Sertraline has a good tolerability profile and low fatal toxicity 6.