Side Effects of Sertraline
Sertraline commonly causes gastrointestinal disturbances (nausea, diarrhea), sexual dysfunction, insomnia, somnolence, dizziness, headache, and sweating as its primary side effects. 1
Common Side Effects
Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) with a well-established side effect profile. The most frequently reported adverse events include:
Gastrointestinal effects:
- Nausea (24-27%)
- Diarrhea/loose stools (14%) - significantly more common with sertraline than other SSRIs 2
- Vomiting
- Indigestion
- Loss of appetite
Neurological effects:
- Headache (17-19%)
- Dizziness (11-12%)
- Tremor or shaking
- Somnolence (drowsiness)
- Insomnia
Sexual dysfunction:
- Decreased libido
- Ejaculation disorders in males
- Delayed orgasm
Other common effects:
Severe or Concerning Side Effects
While less common, more serious adverse effects can occur:
Discontinuation syndrome: Abrupt discontinuation may cause dysphoric mood, irritability, agitation, dizziness, sensory disturbances (like electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania 1
Serotonin syndrome: A potentially life-threatening condition characterized by:
- High fever
- Uncontrolled muscle spasms
- Stiff muscles
- Rapid changes in heart rate or blood pressure
- Confusion
- Loss of consciousness 1
Increased risk of bleeding: Especially when combined with aspirin, NSAIDs, warfarin, or other anticoagulants 1
Activation of mania/hypomania: Occurred in approximately 0.4% of sertraline-treated patients 1
Seizures: Rare but reported, especially in patients with pre-existing seizure disorders 1
Suicidality: SSRIs as a class may increase the risk for suicidal thinking or behavior, particularly in children, adolescents, and young adults 3
Special Populations
Elderly Patients
Sertraline is generally well-tolerated in elderly patients and lacks the marked anticholinergic effects that characterize tricyclic antidepressants. No dosage adjustments are warranted solely based on age 4.
Patients with Renal Disease
Caution is needed in patients with end-stage renal disease on hemodialysis, as there have been reports of serotonin syndrome in this population even at low doses (25mg) 5.
Pregnant and Breastfeeding Women
Third-trimester use of SSRIs including sertraline has been associated with neonatal complications including:
- Continuous crying
- Irritability
- Jitteriness
- Tremors
- Respiratory distress
- Feeding difficulties
- Sleep disturbance 3
Drug Interactions
Sertraline may interact with:
- Monoamine oxidase inhibitors (MAOIs): Contraindicated due to risk of serotonin syndrome
- Other serotonergic drugs: Including triptans, other antidepressants, St. John's Wort
- Drugs metabolized by cytochrome P450 enzymes: Though sertraline has less effect on metabolism of other medications compared to other SSRIs 3, 1
Practical Management Tips
- Start at low doses: Begin with lower doses and titrate up slowly to minimize side effects
- Take with food: May help reduce gastrointestinal side effects
- Taper gradually when discontinuing: To avoid withdrawal symptoms, taper over 10-14 days rather than stopping abruptly
- Monitor for worsening depression or suicidal thoughts: Especially in the first few weeks of treatment
- Be aware of drug interactions: Particularly with other medications that affect serotonin levels
Most side effects are mild to moderate and tend to decrease in frequency with continued treatment 6. The benefit-risk profile is generally favorable compared to older antidepressants like tricyclics, particularly regarding cardiovascular safety and toxicity in overdose.
Sertraline is well-tolerated by most patients and has a relatively low potential for drug interactions compared to some other SSRIs, making it a commonly prescribed option for depression, anxiety disorders, and other conditions.