Can Zoloft (Sertraline) cause diarrhea?

From the Guidelines

Yes, Zoloft (sertraline) can cause diarrhea as a side effect, with a higher rate of diarrhea compared to other SSRIs, as reported in a study published in 2008 1.

Overview of Zoloft and Diarrhea

The study found that sertraline had a higher rate of diarrhea than other SSRIs, including bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine. This side effect typically occurs during the first few weeks of treatment and often improves or resolves completely as the body adjusts to the medication.

Mechanism of Diarrhea

The diarrhea happens because Zoloft affects serotonin levels not only in the brain but also in the gut, where serotonin plays a role in regulating digestive processes. As noted in a study published in 2020, SSRIs, including sertraline, can cause a discontinuation syndrome characterized by various symptoms, including diarrhea, when the medication is stopped abruptly or the dose is reduced too quickly 1.

Management of Diarrhea

If you experience diarrhea while taking Zoloft, staying hydrated is important. Taking the medication with food may help reduce this side effect. If diarrhea is severe, persistent, or disruptive to your daily life, you should contact your healthcare provider, as they might suggest adjusting your dosage, switching to a different antidepressant, or recommending over-the-counter remedies to manage this side effect.

Key Points to Consider

• Diarrhea is a common gastrointestinal side effect of Zoloft, affecting approximately 18% of patients who take the medication.
• The risk of diarrhea is higher with sertraline compared to other SSRIs.
• The side effect typically occurs during the first few weeks of treatment and often improves or resolves completely as the body adjusts to the medication.
• Staying hydrated and taking the medication with food may help reduce the severity of diarrhea.
• If diarrhea is severe, persistent, or disruptive to your daily life, you should contact your healthcare provider for further guidance.

From the FDA Drug Label

Common possible side effects in people who take sertraline include: nausea, loss of appetite, diarrhea or indigestion Serotonin syndrome symptoms may include ... gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) Among 634 overdoses in which sertraline hydrochloride was the only drug ingested, 8 resulted in fatal outcome, 75 completely recovered, and 27 patients experienced sequelae after overdosage to include ... diarrhea

Diarrhea is a possible side effect of sertraline, as well as a symptom of serotonin syndrome and a sequela of overdosage 2, 2, 2.

From the Research

Gastrointestinal Side Effects of Zoloft (Sertraline)

• Zoloft (Sertraline) is associated with gastrointestinal side effects, including diarrhea, as reported in several studies 3, 4, 5, 6.
• A systematic review and meta-analysis found that sertraline was one of the least tolerated antidepressants on the gastrointestinal tract, associated with all considered side effects except constipation and increased appetite 3.
• Another study found that sertraline had the highest probability of digestive side effects among the selective serotonin reuptake inhibitors (SSRIs) examined, with a probability of 0.611 5.
• Common adverse effects of sertraline include nausea, headache, sedation, dry mouth, insomnia, sexual dysfunction, and constipation, with nausea being the most commonly reported 6.
• A case report also highlighted the rare adverse effect of antidepressants, including sertraline, causing adynamic ileus and diarrhea 7.

Comparison with Other Antidepressants

• Sertraline was found to have a higher incidence of gastrointestinal symptoms compared to other SSRIs, such as fluoxetine and escitalopram 4, 5.
• Escitalopram was found to be better than paroxetine and sertraline in terms of gastrointestinal tolerability 5.
• Fluoxetine was found to have the lowest probability of digestive side effects among the SSRIs examined 5.

Clinical Implications

• The specific tolerability profile of each antidepressant, including sertraline, should be considered by clinicians when prescribing treatment to improve adherence and increase positive outcomes in patients with major depressive disorder 3.
• Clinicians should be aware of the potential gastrointestinal side effects of sertraline, including diarrhea, and monitor patients accordingly 3, 4, 5, 6, 7.