From the Guidelines
Sertraline can cause several potential side effects, including common effects like nausea, diarrhea, and sexual dysfunction, as well as more serious but less common effects like serotonin syndrome and increased risk of suicidal thoughts, particularly in young adults and adolescents. The most commonly reported adverse events associated with sertraline include constipation, diarrhea, dizziness, headache, insomnia, nausea, sexual adverse events, and somnolence 1. Some key points to consider when prescribing sertraline include:
- Starting with a low dose and gradually increasing as needed and tolerated to minimize adverse effects 1.
- Monitoring for symptoms of serotonin syndrome, particularly when combining sertraline with other serotonergic medications 1.
- Being aware of the potential for increased risk of suicidal thoughts and behavior, especially in young adults and adolescents, and closely monitoring patients during the first few weeks of treatment and after dosage adjustments 1.
- Considering the potential for drug-drug interactions, particularly with medications that affect the CYP2D6 enzyme, and adjusting the dose or monitoring as needed 1.
- Educating patients and their families about the potential side effects of sertraline and the importance of reporting any concerning or persistent symptoms to their healthcare provider promptly 1.
From the FDA Drug Label
Sertraline hydrochloride and other antidepressant medicines may cause serious side effects, including: Suicidal thoughts or actions: Serotonin Syndrome Severe allergic reactions: Abnormal bleeding: Seizures or convulsions Manic episodes: Changes in appetite or weight Low salt (sodium) levels in the blood. Common possible side effects in people who take Sertraline hydrochloride 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 sertraline include:
- Serious side effects: suicidal thoughts or actions, serotonin syndrome, severe allergic reactions, abnormal bleeding, seizures or convulsions, manic episodes, and low salt levels in the blood.
- Common side effects: nausea, loss of appetite, diarrhea, change in sleep habits, increased sweating, sexual problems, tremor, feeling tired, and agitation.
- Side effects in children and adolescents: 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
From the Research
Potential Side Effects of Sertraline
The potential side effects of sertraline, a selective serotonin reuptake inhibitor (SSRI), are varied and can be categorized based on their frequency and severity. Some of the commonly reported side effects include:
- Gastrointestinal disturbances such as nausea, diarrhea, and loose stools 3, 4, 5, 6
- Male sexual dysfunction, primarily ejaculatory disturbance 3, 4, 5
- Headache 4, 6
- Insomnia 4, 6
- Somnolence 4, 6
- Dry mouth 4, 6
- Dizziness 6
- Sweating 6
- Taste abnormalities 6
- Constipation 6
Less Common Side Effects
Less common side effects of sertraline may include:
- Orgasmic dysfunction 4
- Anticholinergic effects, although sertraline is known to have minimal anticholinergic activity 3, 5, 6
- Cardiovascular effects, although sertraline is essentially devoid of cardiovascular effects 3, 5
Special Considerations
In elderly patients, sertraline is generally well tolerated and lacks the marked anticholinergic effects that characterize the adverse event profiles of tricyclic antidepressants (TCAs) 6. However, the most frequently reported adverse events in patients aged > or =60 years with major depressive disorder receiving sertraline 50-150 mg/day were dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 6. Additionally, sertraline has a low potential for drug interactions at the level of the cytochrome P450 enzyme system, and no dosage adjustments are warranted for elderly patients solely based on age 6.
Laboratory Values
Sertraline therapy was not noted to cause any significant changes in serum sodium levels, although hyponatremia has been seen with each of the SSRIs 7. There was no relationship between maximum sertraline dose, age, and changes in routine blood chemistry results, with the exception of a small contribution of maximum sertraline dose to variance in serum creatinine levels 7.