Can stopping Zoloft (sertraline) cause dizziness and nausea in a patient?

Antidepressant Discontinuation Syndrome with Sertraline (Zoloft)

Yes, stopping Zoloft (sertraline) can absolutely cause dizziness and nausea—these are well-documented withdrawal symptoms that occur when the medication is discontinued, particularly if stopped abruptly. 1

Evidence for Dizziness and Nausea as Withdrawal Symptoms

The FDA drug label for sertraline explicitly warns that stopping the medication too quickly may cause serious symptoms including dizziness and nausea, along with headache, sweating, electric shock-like sensations, shaking, and confusion. 1

High-quality evidence from randomized placebo-controlled trials (6,729 participants) demonstrates that patients discontinuing antidepressants experience significantly more withdrawal symptoms compared to placebo groups, specifically:

• Dizziness (documented in seven studies) 2
• Nausea (documented in six studies) 2
• Vertigo (documented in one study) 2

Clinical Characteristics of Sertraline Withdrawal

Timing and Duration

• Symptoms typically begin within 24-48 hours after discontinuation 3, 4
• Symptoms reach maximum intensity around day 5 3
• Duration typically lasts up to 3 weeks, though most resolve within 2-3 weeks 3, 5
• In documented cases, symptoms persisted for up to 21 days (mean 11.8 days) after onset 6

Severity Factors

Sertraline has a shorter half-life compared to fluoxetine, making withdrawal symptoms more likely. 6 In a retrospective study of 352 patients, withdrawal symptoms occurred in:

• 17.2% of patients on shorter half-life SSRIs (including sertraline) 6
• Only 1.5% of patients on longer half-life SSRIs like fluoxetine 6

The intensity of withdrawal symptoms depends on:

• Daily dose (higher doses = more severe symptoms) 3
• Duration of treatment (longer treatment = more severe symptoms; median 28 weeks in cases vs. 16 weeks in non-cases) 3, 6

Complete Symptom Profile

Beyond dizziness and nausea, patients may experience:

• Sensory disturbances: electric shock-like sensations, paresthesias 1, 4, 5
• Neurological: headache, lethargy, confusion 1, 6, 5
• Gastrointestinal: vomiting, diarrhea, abdominal cramps 4
• Psychiatric: anxiety, irritability, agitation, emotional lability, insomnia, vivid dreams 1, 6, 5
• Flu-like symptoms: malaise, muscular pains, asthenia 3, 4

Management Algorithm

Immediate Management

1. If symptoms are intolerable: Restart sertraline at the previous dose—symptoms resolve within 24 hours of restarting the medication 3, 6
2. Benzodiazepines do NOT relieve these symptoms 6

Prevention Strategy

The FDA label explicitly states: "A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible." 1

• Taper the dose over several weeks rather than stopping abruptly 1, 4
• If intolerable symptoms occur during tapering, resume the previous dose and decrease more gradually 1
• Patient education about potential withdrawal symptoms is essential 3

Critical Clinical Caveat

Do not confuse withdrawal symptoms with serotonin syndrome. If dizziness and nausea appear as part of a constellation including mental status changes, autonomic instability (racing heartbeat, high/low blood pressure, sweating, fever), muscle rigidity, or coordination problems, this represents serotonin syndrome—a life-threatening emergency requiring immediate discontinuation of all serotonergic medications. 7, 1