What are the side effects of sertraline?

Sertraline Side Effects

Sertraline commonly causes gastrointestinal disturbances (nausea, diarrhea), sexual dysfunction (decreased libido, ejaculatory delay), sleep changes (insomnia or increased sleepiness), increased sweating, tremor, and headache—with approximately 63% of patients experiencing at least one adverse effect during treatment. 1

Common Side Effects

Gastrointestinal Effects

• Nausea and diarrhea are the most frequently reported side effects, occurring in a substantial proportion of patients and representing the most common reasons for medication discontinuation 1
• Indigestion, loss of appetite, and loose stools are also common 2, 3
• These gastrointestinal effects are typically mild and transient, decreasing in frequency with continued treatment 3

Sexual Dysfunction

• Sexual problems occur frequently, including decreased libido and ejaculatory failure in males 1, 2
• Sertraline causes sexual dysfunction in approximately 14% of males (ejaculatory failure) and 6% of females (decreased libido) 4
• Sertraline has a more favorable sexual side effect profile compared to paroxetine (70.7% sexual dysfunction rate), though it still causes significant dysfunction 4
• Delayed or absent orgasm is common in both sexes 4

Central Nervous System Effects

• Headache, dizziness, and tremor or shaking are frequently reported 1, 2
• Insomnia or increased sleepiness can occur, representing changes in sleep habits 2
• Feeling tired or fatigued is common 2
• Initial anxiety or agitation may occur, particularly in the first few weeks, but typically resolves with continued treatment 4, 5

Other Common Effects

• Increased sweating 1, 2
• Dry mouth 6
• Taste abnormalities 6
• Constipation 6

Serious but Less Common Side Effects

Serotonin Syndrome

• Signs include tremor, diarrhea, delirium, neuromuscular rigidity, and hyperthermia 1
• Occurs in approximately 14-16% of SSRI overdoses 1
• Risk increases when combining sertraline with other serotonergic medications (triptans, tramadol, other antidepressants, St. John's Wort) 1, 2
• Seek immediate medical attention if experiencing high fever, uncontrolled muscle spasms, stiff muscles, rapid changes in heart rate or blood pressure, confusion, or loss of consciousness 2

Suicidality Risk

• All SSRIs carry FDA black box warnings for treatment-emergent suicidality, particularly in adolescents and young adults under age 24 5
• Close monitoring is essential during the first 1-2 weeks after initiation or dose changes 5

Hyponatremia

• All SSRIs can cause low sodium levels through syndrome of inappropriate ADH (SIADH), with symptoms including confusion, headache, and weakness 4
• Regular monitoring of serum sodium is advised, particularly in older adults reporting cognitive complaints or "brain fog" 4

Bleeding Risk

• Sertraline may increase bleeding risk, particularly when combined with aspirin, NSAIDs, or anticoagulants like warfarin 2

Special Population Considerations

Children and Adolescents

• Additional side effects include abnormal increase in muscle movement or agitation, nosebleed, urinating more often, urinary incontinence, aggressive reaction, and heavy menstrual periods 2
• Possible slowed growth rate and weight changes warrant monitoring of height and weight during treatment 2

Elderly Patients (≥60 years)

• The tolerability profile is generally similar in younger and elderly patients 6
• Most frequently reported adverse events include dry mouth, headache, diarrhea, nausea, insomnia, somnolence, constipation, dizziness, sweating, and taste abnormalities 6
• Sertraline lacks the marked anticholinergic effects that characterize tricyclic antidepressants, making it safer for elderly patients 6

Pregnancy and Breastfeeding

• Antidepressant use during pregnancy may increase the risk of preterm delivery compared with untreated women who have depression 1
• Conflicting findings exist regarding persistent pulmonary hypertension of the newborn (PPHN) with late pregnancy SSRI exposure; a meta-analysis suggested a number needed to harm of 286-351 1
• Some sertraline may pass into breast milk; discuss risks and benefits with your healthcare provider 2

Discontinuation Syndrome

• Abrupt discontinuation can cause withdrawal symptoms including dizziness, nausea, and sensory disturbances 5
• Always taper gradually when stopping sertraline to minimize discontinuation symptoms 4, 5
• Sertraline has a lower risk of discontinuation syndrome compared to paroxetine 5

Drug Interactions

• Sertraline has minimal inhibition of cytochrome P450 enzymes, resulting in a lower risk of drug interactions compared to fluoxetine, fluvoxamine, and paroxetine 5, 6
• Never combine with MAOIs; allow at least 2 weeks washout when switching 5, 2
• Exercise caution with other serotonergic medications, blood thinners, and medications metabolized by CYP2D6 2

Overdose Safety

• Sertraline has a wide therapeutic index and favorable safety profile in overdose 3, 7
• SSRIs were involved in 89 fatalities according to 2012 National Poison Data System data, trailing only analgesics and sedatives/hypnotics in toxic exposures among adults 1

Timeline of Side Effects

• Most adverse effects emerge within the first 2-4 weeks and typically subside with continued treatment 4, 5
• Full therapeutic benefit may take 6-8 weeks to achieve 5