Does sertraline (Zoloft) cause bloating?

From the Guidelines

Bloating is a common side effect of sertraline, and to manage it, taking the medication with food and staying well-hydrated can help alleviate symptoms. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1, most adverse effects of SSRIs, including sertraline, emerge within the first few weeks of treatment. These side effects can include gastrointestinal symptoms such as nausea, diarrhea, and changes in appetite, which may contribute to bloating.

To manage sertraline-related bloating, several strategies can be employed:

• Taking the medication with food, particularly a light meal, which can reduce gastrointestinal side effects
• Staying well-hydrated and maintaining regular physical activity to help alleviate bloating
• Dietary modifications such as reducing salt intake, avoiding carbonated beverages, and limiting foods known to cause gas (like beans, cabbage, and onions) may provide additional relief
• If bloating persists or becomes severe, consulting a healthcare provider is recommended, as they may adjust the dosage, recommend taking the medication at a different time of day, or suggest over-the-counter remedies like simethicone 1.

It is essential to note that sertraline affects the digestive tract because serotonin receptors are abundant in the gut, and the medication's influence on these receptors can alter gut motility and fluid balance, leading to bloating and other gastrointestinal symptoms. Therefore, it is crucial to work closely with a healthcare provider to manage any side effects and adjust the treatment plan as needed to minimize the risk of adverse effects while maximizing the benefits of the medication.

From the FDA Drug Label

Gastrointestinal Disorders Abdominal Pain225567 Anorexia3211272 Constipation866473 Diarrhea/Loose Stools1892410209 Dyspepsia63104108 Nausea261230112918

The FDA drug label does not specifically mention bloating as a side effect of sertraline. However, it does list other gastrointestinal disorders such as abdominal pain, anorexia, constipation, diarrhea/loose stools, dyspepsia, and nausea.

• Key points:
  • No direct mention of bloating
  • Other gastrointestinal side effects are reported
• Clinical decision:
  • Monitor patients for gastrointestinal side effects
  • Consider alternative treatments if side effects are severe 2 2

From the Research

Bloating and Sertraline

• Bloating is not explicitly mentioned in the provided studies as a side effect of sertraline.
• However, studies have investigated the effects of sertraline on gastrointestinal symptoms and side effects 3, 4.
• A study published in 2002 found that sertraline had no effect on gastric sensitivity or compliance in healthy humans 3.
• Another study published in 2021 found that escitalopram and sertraline were associated with a higher rate of gastrointestinal side effects, including nausea, diarrhea, and abdominal pain, compared to other antidepressants 4.
• Common gastrointestinal side effects associated with sertraline include:
  • Nausea
  • Diarrhea
  • Abdominal pain
  • Dyspepsia
• It is essential to note that these side effects may not be directly related to bloating, but rather to other gastrointestinal symptoms.

Mechanism of Action and Side Effects

• Sertraline, like other selective serotonin reuptake inhibitors (SSRIs), works by inhibiting the presynaptic reuptake of serotonin, increasing serotonin levels in the brain 5.
• The mechanism of action of SSRIs can contribute to gastrointestinal side effects, as serotonin plays a role in regulating gut function and motility.
• A review of SSRIs published in 2021 highlighted the importance of considering the potential adverse effects of these medications, including gastrointestinal side effects, when prescribing them to patients 5.

Real-World Evidence and Adherence

• A real-world evidence analysis published in 2021 found that patients who achieved a stable daily dose of sertraline had improved adherence and persistence with treatment, compared to those who did not stabilize on their initial prescription 6.
• The study also found that simplifying the treatment regimen and decreasing pill burden improved adherence and persistence with sertraline therapy.
• However, this study did not specifically investigate the relationship between sertraline and bloating.

Serotonin Syndrome and Drug-Drug Interactions

• A study published in 2025 analyzed the risk of serotonin syndrome associated with SSRIs, including sertraline, and found that all SSRIs were associated with this risk 7.
• The study also found that combinations of SSRIs with other medications, such as antidepressants and opioids, increased the risk of serotonin syndrome.
• However, this study did not investigate the relationship between sertraline and bloating.