Can Zoloft (sertraline) cause dizziness?

Can Zoloft Cause Dizziness?

Yes, Zoloft (sertraline) commonly causes dizziness both during treatment and upon discontinuation, and this is a well-documented adverse effect that clinicians must anticipate and manage proactively.

Dizziness During Active Treatment

Dizziness is explicitly listed as a typical side effect of SSRIs, including sertraline, in clinical practice guidelines 1. Approximately 63% of patients receiving second-generation antidepressants experience at least one adverse effect during treatment, with dizziness being among the commonly reported symptoms alongside diarrhea, dry mouth, fatigue, headache, and nausea 1.

• The FDA drug label for sertraline specifically warns that dizziness can occur during treatment and lists it as a potential symptom requiring monitoring 2.
• In clinical trials examining zolpidem (though not sertraline directly), meta-analyses showed a small but measurable increase in dizziness risk (0.06 risk difference) compared to placebo, demonstrating that CNS-active medications commonly produce this effect 1.

Dizziness Upon Discontinuation

The most clinically significant dizziness associated with sertraline occurs when the medication is stopped abruptly or tapered too quickly 2.

• The FDA label explicitly warns that stopping sertraline too quickly may cause serious symptoms including "headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, confusion" 2.
• During marketing surveillance, spontaneous reports of adverse events upon SSRI discontinuation have consistently included dizziness, particularly when cessation is abrupt, along with dysphoric mood, irritability, agitation, sensory disturbances, anxiety, and confusion 2.
• Sertraline and paroxetine are the SSRIs most implicated in discontinuation-related dizziness because they have short half-lives and high selectivity for serotonin 3.

Mechanism of Discontinuation Dizziness

The vestibular nucleus complex (VNC) contains abundant serotonin receptors, and abrupt SSRI withdrawal causes a sudden decrease in serotonin levels in this region 3. This disrupts bilateral VNC neuronal function, producing dizziness that is exacerbated by head movement, indicating a vestibular origin rather than simple lightheadedness 3.

Clinical Management Strategies

During Treatment

• Monitor patients for dizziness, particularly during the first few weeks of treatment or when doses are adjusted 2.
• Assess for orthostatic hypotension, as sertraline withdrawal has been documented to cause orthostatic hypotension with dizziness in case reports 4.
• Rule out serotonin syndrome if dizziness occurs with other symptoms such as agitation, tremor, tachycardia, or confusion, especially if sertraline is combined with other serotonergic medications 2, 5.

Upon Discontinuation

A gradual dose reduction rather than abrupt cessation is mandatory to minimize discontinuation symptoms 2.

• If intolerable symptoms occur following dose reduction, resume the previously prescribed dose and then decrease more gradually 2.
• The guideline recommendation for discontinuing antidepressants is to taper over 10 to 14 days to limit withdrawal symptoms 1.
• For patients experiencing severe discontinuation symptoms, an extended titration period may be necessary 4.

Important Caveats

• Paradoxically, sertraline has been studied as a treatment for chronic subjective dizziness, with 73% of patients showing improvement in dizziness symptoms when treated with sertraline for vestibular disorders or psychogenic dizziness 6, 7. This therapeutic effect should not be confused with sertraline's potential to cause dizziness as an adverse effect.
• Patients with CNS deficits may be more vulnerable to dizziness from sertraline compared to those with peripheral vestibular conditions 7.
• When combined with other CNS depressants (such as lorazepam), sertraline may cause additive effects including increased sedation and dizziness, requiring dose adjustments 8.