Can Zoloft (sertraline) cause tardive dyskinesia?

Can Zoloft Cause Tardive Dyskinesia?

Yes, Zoloft (sertraline) can cause tardive dyskinesia, although it is much less common than with antipsychotic medications. While selective serotonin reuptake inhibitors (SSRIs) like Zoloft are not typically associated with tardive dyskinesia as frequently as antipsychotics, case reports document this adverse effect occurring with SSRI use 1, 2, 3.

Mechanism and Risk

Tardive dyskinesia (TD) is primarily associated with dopamine receptor blocking agents, but can also occur with medications that affect serotonergic pathways:

• SSRIs like Zoloft may cause TD through serotonergic agonism of dopaminergic pathways in the central nervous system 3
• The risk appears significantly lower than with typical antipsychotics
• In a comprehensive review of SSRI-induced movement disorders, tardive dyskinesia represented 11.3% of all reported movement disorders 3

Risk Factors for Developing TD with SSRIs

Patients at higher risk for developing TD with Zoloft include:

• Older adults
• Female patients (67.6% of SSRI-induced movement disorders occurred in females) 3
• Patients with existing neurological conditions
• Concurrent use of other medications that can cause movement disorders
• Longer duration of treatment

Monitoring and Detection

For patients on Zoloft, especially those with risk factors:

• Be alert for early signs of abnormal movements, particularly in the orofacial region
• The American Academy of Child and Adolescent Psychiatry recommends assessing for dyskinesias at least every 3-6 months during therapy with medications that can cause TD 4
• The Abnormal Involuntary Movement Scale (AIMS) is a useful tool for baseline and follow-up assessments 5, 4

Management if TD Develops

If tardive dyskinesia develops while on Zoloft:

1. Consider discontinuation of Zoloft if clinically feasible 4
2. If discontinuation is not possible, evaluate the risk-benefit ratio of continuing treatment
3. Some cases may resolve after medication discontinuation, while others may persist 6

Case Examples

Several case reports document the association between SSRIs and tardive dyskinesia:

• One case series reported three patients who developed abnormal movement patterns suggestive of tardive dyskinesia while taking fluoxetine (another SSRI) 6
• In one case, symptoms remitted after discontinuation, while in others, the abnormal movements persisted for months or even a year after withdrawal 6

Important Considerations

• The FDA label for sertraline does not specifically list tardive dyskinesia as a reported adverse effect, though it does mention other movement disorders like dyskinesia 7
• Tardive syndromes can be potentially irreversible, highlighting the importance of early detection 2
• The overall incidence of SSRI-induced TD appears to be much lower than with antipsychotics, but the exact risk is difficult to quantify

While Zoloft is less likely to cause tardive dyskinesia than antipsychotics, clinicians should remain vigilant for early signs of movement disorders in all patients taking SSRIs, particularly those with risk factors for developing TD.