What are the most common side effects when starting sertraline (selective serotonin reuptake inhibitor)?

Most Common Side Effects When Starting Sertraline

The most common side effects when starting sertraline include nausea, diarrhea, headache, insomnia, somnolence, dizziness, sexual dysfunction, and dry mouth, with gastrointestinal disturbances being the most frequent reasons for discontinuation. 1, 2

Initial Side Effects

Most adverse effects of sertraline emerge within the first few weeks of treatment and often decrease in frequency with continued use:

• Gastrointestinal effects:

  • Nausea and vomiting (higher incidence than other SSRIs) 1
  • Diarrhea (higher rate than other antidepressants) 1
  • Dry mouth 1
  • Heartburn/indigestion 1

• Neurological effects:

  • Headache 1
  • Dizziness 1
  • Somnolence (drowsiness) 1
  • Insomnia 1
  • Tremor 2

• Sexual dysfunction:

  • Ejaculatory delay in males 3
  • Decreased libido 2
  • Other sexual problems 2

• Other common effects:

  • Increased sweating (diaphoresis) 1
  • Fatigue 2
  • Anxiety or agitation 2

Timing and Duration of Side Effects

Side effects typically follow a predictable pattern:

• Most adverse effects appear within the first few weeks of treatment 1
• Many side effects are mild to moderate and transient, decreasing with continued treatment 3
• Gastrointestinal side effects like nausea and diarrhea are often early and temporary 3

Potentially Serious Side Effects to Monitor

While less common, some potentially serious adverse effects require monitoring:

• Behavioral activation/agitation (restlessness, insomnia, impulsiveness, aggression) - more common in younger patients and those with anxiety disorders 1
• Suicidal thinking and behavior (particularly in patients under 24 years) - FDA boxed warning for all SSRIs 1
• Serotonin syndrome (when combined with other serotonergic medications) 1
• Hyponatremia (low sodium levels) 1
• Abnormal bleeding 1

Differences from Other Antidepressants

Sertraline has some distinguishing characteristics in its side effect profile:

• Higher rate of diarrhea compared to bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine 1
• Less weight gain than mirtazapine or paroxetine 1
• Lower rate of sexual dysfunction than paroxetine (though still significant) 1
• Well tolerated with minimal anticholinergic and cardiovascular effects compared to tricyclic antidepressants 3

Management of Side Effects

Understanding how to manage common side effects can improve adherence:

• Gastrointestinal side effects may be reduced by taking sertraline with food 2
• Starting at a lower dose and slowly titrating up can minimize initial side effects 1
• For low doses of sertraline, twice-daily dosing may be required in some patients 1
• Close monitoring is recommended during the first few months of treatment and following dosage adjustments, particularly for signs of suicidality or behavioral activation 1

Special Considerations

• Sertraline has a relatively favorable drug interaction profile compared to some other SSRIs 4
• The elimination half-life of approximately 26 hours makes it suitable for once-daily dosing in most patients 3
• Most side effects of sertraline are similar in both younger and elderly patients 4

Understanding these common side effects and their typical course can help patients prepare for and manage them appropriately when starting sertraline treatment.