Effects of Sertraline on Weight and Sleep
Sertraline can cause weight changes (typically weight loss initially, followed by potential weight gain with long-term use) and sleep disturbances including insomnia and somnolence as common side effects. 1, 2
Effects on Weight
Initial Weight Effects
- Sertraline is preferred over paroxetine for patients concerned about weight gain, as paroxetine causes significantly more weight gain compared to sertraline and fluoxetine 3
- In the short term, sertraline may cause decreased appetite and weight loss in some patients 2
- In pediatric studies, sertraline was associated with slight weight loss compared to placebo, with approximately 7% of children and 2% of adolescents experiencing clinically significant weight loss (>7% of body weight) 2
Long-term Weight Effects
- After initial weight loss during the first 8 weeks of treatment, patients may begin to gain weight with continued sertraline treatment 2
- Patients who completed 34 weeks of sertraline treatment showed weight gain similar to that expected using data from age-adjusted peers 2
- Regular monitoring of weight is recommended if sertraline treatment is continued long-term, particularly in pediatric patients 2
Effects on Sleep
Sleep Disturbances
- Sertraline commonly causes sleep disturbances, which can manifest as either insomnia or somnolence 1, 2
- Insomnia (difficulty falling or staying asleep) is reported as a common side effect of sertraline 2
- Somnolence (excessive daytime sleepiness) is also frequently reported, affecting approximately 59% of patients in some studies 4
- Sleep disturbances tend to be most pronounced during the initial phase of treatment and often improve with continued use 5
Management of Sleep-Related Side Effects
- Taking sertraline in the morning rather than evening may help reduce insomnia 1
- For patients experiencing excessive daytime sleepiness, evening dosing may be preferable 3
- Sleep disturbances often decrease in frequency with continued treatment as the body adjusts to the medication 5
Other Common Side Effects
- Gastrointestinal effects are common with sertraline, including nausea, diarrhea, and indigestion 1, 2
- Neurological effects include headache, dizziness, and tremor 1, 2
- Increased sweating is reported in approximately 38% of patients 4
- Sexual dysfunction, particularly ejaculatory disturbance in males, can occur 5
Clinical Considerations
- Start with a lower dose and gradually increase to minimize initial side effects, particularly sleep disturbances 1
- Monitor weight regularly, especially in pediatric patients and those with pre-existing weight concerns 2
- Sertraline may be preferred over other SSRIs like paroxetine when weight gain is a concern 3
- Sleep disturbances and most other side effects tend to be mild and transient, decreasing in frequency with continued treatment 5
Pitfalls and Caveats
- Abrupt discontinuation of sertraline may cause withdrawal symptoms, including sleep disturbances; gradual tapering is recommended 2
- Weight changes should be monitored particularly carefully in patients with eating disorders or metabolic conditions 2
- Patients should be advised not to drive or operate heavy machinery until they know how sertraline affects their alertness and coordination 2
- Combining sertraline with other serotonergic medications can increase the risk of serotonin syndrome, a potentially life-threatening condition 1