Is sertraline (Selective Serotonin Reuptake Inhibitor) associated with diarrhea?

From the Guidelines

Sertraline can cause diarrhea as a side effect, and if you're experiencing it, you should consult your healthcare provider, as they may recommend managing symptoms or adjusting your treatment plan. Sertraline, a commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressant, can cause diarrhea in approximately 15-20% of patients, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. The diarrhea often improves within 1-2 weeks as your body adjusts to the medication. To manage symptoms, take sertraline with food, stay hydrated, and consider over-the-counter remedies like loperamide (Imodium) for temporary relief.

Some key points to consider when taking sertraline and experiencing diarrhea include:

• The medication can cause a discontinuation syndrome characterized by various symptoms, including diarrhea, when missed doses or acute discontinuation occurs, especially with shorter-acting SSRIs like sertraline 1.
• The American Gastroenterological Association (AGA) suggests against using SSRIs in patients with Irritable Bowel Syndrome (IBS) due to low certainty in evidence that they improve global symptoms or abdominal pain 1.
• Sertraline causes diarrhea by increasing serotonin levels in the gut, which stimulates intestinal motility and secretion. Most patients develop tolerance to this side effect over time, but if diarrhea continues beyond 2-3 weeks or is accompanied by severe abdominal pain, fever, or blood in stool, seek immediate medical attention as these could indicate more serious conditions.

Your doctor might recommend reducing your dose temporarily and then gradually increasing it again, or switching to a different antidepressant if diarrhea persists or is severe. It's essential to work closely with your healthcare provider to manage any side effects and find the best treatment plan for your specific needs.

From the FDA Drug Label

Common possible side effects in people who take sertraline include: nausea, loss of appetite, diarrhea or indigestion The FDA drug label states that diarrhea is a possible side effect of sertraline.

• Key points:
  • Diarrhea is listed as a common possible side effect of sertraline 2
  • Other gastrointestinal symptoms such as nausea, loss of appetite, and indigestion are also possible side effects of sertraline 2
  • In cases of overdose, diarrhea has been reported as a sequelae after overdosage 2

From the Research

Sertaline and Diarrhoea

• Sertaline is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression and other psychiatric disorders 3.
• Studies have shown that SSRIs, including sertraline, can cause gastrointestinal side effects, including diarrhoea 4.
• A meta-analysis of 304 studies found that sertraline was one of the least tolerated antidepressants on the gastrointestinal tract, associated with all considered side effects except constipation and increased appetite 4.
• The exact mechanism of how sertraline causes diarrhoea is not fully understood, but it is thought to be related to its effect on serotonin levels in the gut 4.
• Clinicians should consider the potential gastrointestinal side effects of sertraline when prescribing it to patients, particularly those with a history of gastrointestinal disorders 4.

Treatment Options for Diarrhoea

• Current treatment options for irritable bowel syndrome with diarrhoea (IBS-D) are limited, but may include medications such as loperamide, bile acid sequestrants, and antispasmodics 5.
• Newer treatments, such as eluxadoline and rifaximin, have shown promise in treating IBS-D, but their effectiveness in treating diarrhoea caused by sertraline is unknown 5.
• Patients experiencing diarrhoea as a side effect of sertraline may need to be switched to a different antidepressant or have their dosage adjusted to minimize gastrointestinal side effects 4.