Can Sertraline Cause Drowsiness?
Yes, sertraline can cause drowsiness (somnolence), though it is generally considered neither strongly sedating nor stimulating and may even have a slight alerting effect in some patients.
Incidence of Drowsiness with Sertraline
The FDA drug label provides clear evidence that somnolence occurs with sertraline across multiple conditions 1:
- Major Depressive Disorder: 13% of patients on sertraline vs. 6% on placebo 1
- OCD: 15% vs. 8% on placebo 1
- Panic Disorder: 15% vs. 9% on placebo 1
- PTSD: 13% vs. 9% on placebo 1
- Social Anxiety Disorder: 9% vs. 6% on placebo 1
The FDA label explicitly lists "change in sleep habits including increased sleepiness or insomnia" as a common side effect and warns that "sertraline can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly" 1.
Clinical Characteristics of Sertraline's Sedation Profile
Sertraline occupies a middle ground in terms of sedation among SSRIs 2:
- Compared to other SSRIs: The American Family Physician guidelines note that SSRIs as a class can cause "insomnia or somnolence" as typical side effects 2
- Dose-dependent effects: Research shows sedative potential becomes evident only at doses of 200 mg or more, with perceived sedation increasing at doses of 100 mg or higher 3
- Paradoxical effects: While some patients experience drowsiness, sertraline may have a slight alerting effect (increased critical flicker fusion threshold), making it neither strongly stimulating nor sedating overall 3
Practical Management Considerations
Timing of administration can be adjusted based on individual response:
- If drowsiness occurs, consider evening dosing 2
- The medication can be taken morning or evening (25-200 mg per day) 2
- Sertraline does not impair psychomotor performance, including simulated car driving, in most patients 3
Important safety warning: Patients should not drive, operate heavy machinery, or perform dangerous activities until they know how sertraline affects them individually 1.
Common Pitfalls to Avoid
- Don't assume all patients will experience drowsiness: Only 9-15% of patients report somnolence, and some may experience the opposite effect 1
- Don't overlook the insomnia paradox: Sertraline can cause both drowsiness AND insomnia (16-25% incidence), sometimes in the same patient at different times 1
- Don't combine with alcohol: This is explicitly contraindicated as it may potentiate sedative effects 1
- Monitor elderly patients carefully: While the tolerability profile is similar across age groups, elderly patients receiving sertraline 50-150 mg/day commonly report somnolence 4, 5
Special Population Considerations
In elderly patients (≥60 years), somnolence is among the most frequently reported adverse events, though sertraline remains well-tolerated overall and lacks the marked anticholinergic sedating effects of tricyclic antidepressants 4, 5.