From the Guidelines
Zoloft (sertraline) can cause several side effects, including nausea, diarrhea, dizziness, headache, insomnia, and sexual dysfunction, which are the most commonly reported adverse events 1. These side effects can vary in severity and impact on the patient's quality of life. According to the study published in the Annals of Internal Medicine 1, the most commonly reported adverse events included:
- Constipation
- Diarrhea
- Dizziness
- Headache
- Insomnia
- Nausea
- Sexual adverse events
- Somnolence It's essential to note that sertraline had a higher rate of diarrhea than other SSRIs, and bupropion had a significantly lower rate of sexual adverse events than fluoxetine or sertraline 1. Additionally, suicidality, including suicidal thinking or behavior, is a severe adverse event that should be monitored, although studies showed no differences among second-generation antidepressants 1. Other severe adverse events, such as seizures, cardiovascular risks, hyponatremia, hepatotoxicity, or serotonin syndrome, are scarce but should be kept in mind when treating patients with sertraline 1. If you experience concerning side effects, it's crucial to contact your healthcare provider immediately rather than discontinuing the medication on your own.
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 possible side effects of Zoloft (sertraline) include psychiatric disorders, reproductive issues, respiratory system disorders, special senses issues, and urinary system disorders. Common side effects include nausea, loss of appetite, diarrhea, change in sleep habits, increased sweating, and sexual problems. Serious side effects can also occur, such as feeling anxious or trouble sleeping. Children and adolescents may experience abnormal increase in muscle movement, nose bleed, urinating more often, and heavy menstrual periods. 2 2
From the Research
Zoloft Side Effects
The side effects of Zoloft (sertraline) are similar to those of other selective serotonin-reuptake inhibitors (SSRIs). Some common side effects include:
- Gastrointestinal disturbances
- Headache
- Sedation
- Insomnia
- Activation
- Weight gain
- Impaired memory
- Excessive perspiration
- Paresthesia
- Sexual dysfunction 3
Comparison with Other Antidepressants
Studies have compared the side effects of Zoloft with other antidepressants, such as fluoxetine, paroxetine, and venlafaxine. One study found that nefazodone, a new antidepressant, caused fewer complaints of nervousness, insomnia, and tremors, but a higher incidence of confusion, dizziness, and vision disturbance compared to other advanced generation antidepressants 4.
Dose-Response Relationship
A systematic review and dose-response meta-analysis found that the lower range of the licensed dose of SSRIs, including Zoloft, achieves the optimal balance between efficacy, tolerability, and acceptability in the acute treatment of major depression 5. The study suggested that doses of SSRIs between 20 mg and 40 mg fluoxetine equivalents may be optimal.
Combination Therapy
Combining Zoloft with other medications, such as bupropion, may be effective in treating patients who do not respond to monotherapy. One study found that combining bupropion with Zoloft improved sexual dysfunction and depression symptoms in some patients 6.
Long-Term Follow-Up
A prospective cohort study found that the prophylactic efficacy of Zoloft and other SSRIs in preventing recurrence of major depressive disorder was limited, with a recurrence rate of 82.0% for SSRI-only treatment. However, concomitant cognitive behavioral therapy (CBT) may improve outcomes, with a recurrence rate of 59.0% 7.