Can someone experience restlessness after several months of being on Zoloft (sertraline)?

From the Guidelines

Yes, someone can experience restlessness after several months of being on Zoloft (sertraline). This symptom, often called akathisia or psychomotor restlessness, can develop even after a period of stable medication use. Restlessness on Zoloft may manifest as an inability to sit still, constant fidgeting, pacing, or an inner feeling of agitation. This side effect can emerge at any point during treatment, not just when starting the medication. If you're experiencing new restlessness after months on Zoloft, it's essential to contact your healthcare provider rather than stopping the medication abruptly. Your doctor might consider adjusting your dosage, switching to a different antidepressant, or adding a medication to manage this side effect. The biological mechanism behind this delayed-onset restlessness likely involves changes in serotonin and dopamine regulation in the brain that develop over time with continued SSRI use, as noted in studies such as 1. Some people are more genetically predisposed to these effects than others, which explains why not everyone experiences this side effect.

Key Points to Consider:

• Restlessness can occur at any point during Zoloft treatment, not just at the beginning.
• The side effect may manifest as an inability to sit still, fidgeting, pacing, or inner agitation.
• If experiencing new restlessness, it's crucial to consult a healthcare provider before making any changes to the medication regimen.
• The healthcare provider may adjust the dosage, switch to a different antidepressant, or add a medication to manage the side effect.
• Genetic predisposition plays a role in who experiences this side effect, as indicated by research such as 1 and 1.

Recommendations for Healthcare Providers:

• Monitor patients for signs of restlessness or akathisia, especially during the initial months of treatment but also during long-term use.
• Consider adjusting the treatment plan if a patient reports restlessness, including dosage adjustments or switching to a different medication, as suggested by guidelines like those found in 1 and 1.
• Educate patients about the potential for restlessness as a side effect and the importance of reporting any changes in their condition, as emphasized in studies such as 1, 1, 1, and 1.

From the FDA Drug Label

Call your healthcare provider right away if you have any of the following symptoms, or call 911 if an emergency, especially if they are new, worse, or worry you: ... feeling agitated, restless, angry or irritable Stopping sertraline too quickly may cause serious symptoms including: ... feeling restless

Restlessness can be a symptom that occurs during treatment with sertraline or when stopping the medication too quickly. The FDA drug label does not specify a time frame for when restlessness can occur, but it does mention that it can happen, especially when the dose is changed or when stopping the medication. Therefore, it is possible for someone to experience restlessness after several months of being on Zoloft 2.

From the Research

Akathisia and Restlessness

• Akathisia is a syndrome characterized by the unpleasant sensation of "inner" restlessness that manifests itself in the inability of sitting still or not moving 3.
• Many types of medicaments can cause akathisia as an adverse event of their use, including antipsychotics, antidepressants, antiemetics, antihistamines, and psychoactive substances 3.
• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), can induce akathisia 4.

Risk of Akathisia with Antidepressants

• The risk of akathisia with antidepressants is not well established, but it is recognized as a potential side effect 4.
• A systematic review of prospective studies found that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an antidepressant 5.
• Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements, while bupropion may reduce restless legs syndrome symptoms 5.

Time Frame for Akathisia

• Akathisia can occur at any time during treatment with antidepressants, including after several months of use 3, 4.
• The exact time frame for the development of akathisia is not well established, but it is recognized that it can occur during the course of treatment with antidepressants 3, 4.

Diagnosis and Treatment

• Recognizing akathisia is important because it can be very bothersome and may cause suicidal ideations 4.
• Treatment options for akathisia include the addition of a centrally acting beta-blocker, a benzodiazepine, or an anticholinergic agent 4.
• Pharmacists can play an active role in recognizing akathisia by being aware of its characteristics, conducting a thorough medication history to identify causative agents, and using the Barnes Akathisia Rating Scale (BARS) to evaluate patients 4.