Side effects of Sertraline

A review of all the Sertraline (Zoloft) side effects you’ll need to be aware of

What is Sertraline prescribed for?

More commonly known as Zoloft, which is the trade name Pfizer uses, sertraline is an antidepressant that is widely used as a treatment for depression, anxiety disorder, post-traumatic stress, and obsessive compulsive disorder. Over 35 million prescriptions for sertraline are issued in the United States annually. A sertraline treatment typically lasts a couple of years until the targeted mental disorders have disappeared. 

 

Sertraline can also treat premature ejaculation when taken in low dosage 4-8 hours before sex. Even though this usage is infrequent (perhaps several times a month), it still requires a prescription from a doctor. 

 

Understanding Sertraline (Zoloft) side effects

Whether you take sertraline regularly as an antidepressant or only occasionally to improve your sex life, it’s a serious drug that will affect the chemistry of your brain. After all, that’s its purpose by design. There is a wide range of side effects, most of which are mild and only occur during the first few weeks of using sertraline as body and brain are still adapting to the drug. 

 

Major side effects are rare though, and sertraline in general is well-tolerated and used by millions of people every year without problems. That said, you’ll need to be fully aware of potential side effects. 

 

Common but mild to moderate side effects of Sertraline 

Sertraline (Zoloft) sexual side effects

Let’s start with one of the most notorious side effects: the impact on your libido. This is a common issue not just for sertraline but for all antidepressants from the SSRI class (including Paxil and Prozac). At least 40 percent and up to 65 percent of sertraline users can experience lower sex appetite or difficulties with achieving orgasm during the early stages of sertraline treatment. Both men and women can be affected by this.

 

For men, the most common effect are ejaculation and orgasm difficulties. The cause of this is the same mechanism that makes sertraline useful for treating premature ejaculation. It may comfort you that these sexual side effects often disappear with time as your body gets accustomed to sertraline. 

 

If the sexual side effects do not go away after 2 months of treatment or even get worse, have an open discussion with your doctor about the problem. He or she then will decide whether to switch you to another antidepressant or whether to prescribe medications that can ease the sexual side effects.  

 

Dizziness

A common side effect during the first several weeks on sertraline is a feeling of mild dizziness and/or lightheadedness, which will last for up to 3-4 weeks into the treatment. In particular, this is common for sertraline users who take their pills in the morning. Try taking your daily dose in the evening instead. That reduce daytime dizziness, but may come at the cost of reduced nighttime sleep quality (see more below).

 

In the event that dizziness reoccurs regularly beyond the fourth week of treatment, speak to your doctor about it. 

 

Exhaustion and tiredness

These two side effects are experienced by most sertraline (or SSRI in general) users during the initial weeks. You will feel tired and worn out; certain activities you normally do with ease may require a greater effort. Like with the other side effects, this tiredness seems to be part of the body’s adjustment process to sertraline. After a month of treatment, your energy levels should be back to normal. If that’s not the case, you’ll need to see your doctor about it. 

 

Reduced sleep quality

Studies have shown that SSRI drugs, including sertraline, affect users’ sleep quality. Many people complain that they find it harder to fall asleep at night or more frequently wake up during the night. In extreme cases this can lead to insomnia. 

 

Again, these effects are short-term and normally disappear once the body’s sertraline levels have reached a steady state within 3-4 weeks. Taking your daily sertraline dose in the morning, rather than evening, will improve sleep quality, but by doing so you are more likely to experience dizziness. So, it really is a trade-off. You’ll need to figure out which side effect you can tolerate best. Moreover, during that one month of initial sertraline use, try to avoid caffeine, codeine, and other stimulating substances (think coffee, energy drinks, sodas, etc.).

 

How sertraline can impact your weight

SSRIs like sertraline raise your appetite, spurring you to eat more than before. So, the drug doesn’t change how you digest food, but simply pushes you to eat more. A British 10-year follow-up study on over 300,000 men and women found that SSRI users had a moderately greater risk of weight gain. In the second treatment year, the number of SSRI users who had gained more than 5 percent of their previous body weight was 46.3 percent more than in the control group. 

 

Another study quantifies the SSRI-associated weight gain at close to 0.6lbs (~0.30kg) for every year of treatment. Yet other studies say it’s up to 3lbs per year. While there is uncertainty about the magnitude of the weight gain effect, all studies agree that you are likely to gain a few pounds when using sertraline. 

 

However, on the upside, how bad this side effect will get is entirely within your control. Talk to your doctor about how to adjust and monitor your eating habits and nutrient intake in order to avoid weight gain.  

 

Digestive side effects of sertraline

During the first weeks of sertraline treatment loose stool and diarrhea can be common side effects on the body’s digestive system. Studies indicate that around 15 percent of people may repeatedly experience diarrhea and or milder bowel disturbances. Other SSRI drugs, such as fluoxetine or paroxetine are easier on the digestive system. If diarrhea lasts for several weeks without signs of improvement, your doctor may consider switching you to these alternative treatments.

 

Another side effect that impacts the digestive system can be reduced appetite, but that’s also just a temporary effect. Longer term, sertraline most likely will raise your appetite, as discussed in the weight gain section above. 

 

Serious side effects of Sertraline

Suicidal thoughts and aggression

 

Although rare, SSRI in general can trigger suicidal thoughts, particularly in people aged 24 and younger, as trials by the U.S. FDA in 2005-06 showed. Similarly, SSRI can raise aggression levels in this age group. The FDA results were confirmed by later studies, including a 2017 extensive review of 70 trials from across Europe. 

 

For people older than 24 SSRI in general and sertraline in particular are safer to use as the risks of suicidal thoughts and aggression fall in line with normal levels in a given population. Moreover, it appears that for people older than 65 taking SSRI may lower the risk of getting suicidal thoughts.

 

While for adults past the age of 24 there’s little risk of suicidal thoughts and heightened aggressive behavior, it’s very important that you closely monitor your first few weeks on sertraline or other SSRI and share your experience with your doctor and loved ones, so that they can help you monitor mood and behavior changes.   

 

Excessive bleeding

Sertraline makes your blood thinner, which in rare instances can inhibit blood clotting, i.e., wounds will continue bleeding and not close up. This could be a concern for internal bleedings and it’s for this reason that Tylenol, aspirin and naproxen are not recommended to be used in combination with sertraline. They also act as blood thinners.

 

Other rare but serious side effects

  • Acute and intense chest pain
  • Long, painful erections
  • Extreme dizziness or drowsiness
  • Allergic reactions, which includes skin rashes (accompanied by fever in serious cases) 

 

A warning: don’t take sertraline or any other SSRI during pregnancy as this may result in miscarriage. Ask your doctor for more advice if you are pregnant and think you have depression or another mental condition requiring treatment. 

 

In summary: don’t panic, but know what signs to look for

Our guide to sertraline side effects offers an intimidating list of things that can happen. As said initially though, U.S. doctors write over 35 million sertraline prescriptions every year. For the vast majority of users, sertraline treatment will not entail major side effects and any initial discomfort will disappear once the drug’s levels in the body have stabilized. If your doctor thinks sertraline could help you overcome depression or anxiety or help you deal with premature ejaculation, you shouldn’t be afraid to give sertraline a try.

 

Do your homework by reading up on all possible side effects and discuss them with your doctor(s). During the first weeks of treatment as sertraline levels ramp up in your body, pay close attention to your physical and mental response. Frequently talk with your doctor and family about any changes you observe. Keeping a treatment diary, where you document your body’s response to sertraline, may also be something you’d find useful.    

  

References

  1. Jing, Elizabeth, and Kristyn Straw-Wilson. “Sexual Dysfunction in Selective Serotonin Reuptake Inhibitors (SSRIs) and Potential Solutions: A Narrative Literature Review.” Mental Health Clinician, vol. 6, no. 4, July 2016, pp. 191–196, https://doi.org/10.9740/mhc.2016.07.191.
  2. Wichniak, Adam, et al. “Effects of Antidepressants on Sleep.” Current Psychiatry Reports, vol. 19, no. 9, 9 Aug. 2017, https://doi.org/10.1007/s11920-017-0816-4. Accessed 13 Dec. 2019.
  3.  Gafoor, Rafael, et al. “Antidepressant Utilisation and Incidence of Weight Gain during 10 Years’ Follow-up: Population Based Cohort Study.” BMJ, 23 May 2018, p. k1951, www.bmj.com/content/361/bmj.k1951, https://doi.org/10.1136/bmj.k1951. Accessed 13 Dec. 2019.
  4. Arterburn, David, et al. “Long-Term Weight Change after Initiating Second-Generation Antidepressants.” Journal of Clinical Medicine, vol. 5, no. 4, 13 Apr. 2016, p. 48, https://doi.org/10.3390/jcm5040048. Accessed 13 Dec. 2019.
  5. Sanchez, Connie, et al. “A Comparative Review of Escitalopram, Paroxetine, and Sertraline.” International Clinical Psychopharmacology, vol. 29, no. 4, July 2014, pp. 185–196, www.ncbi.nlm.nih.gov/pmc/articles/PMC4047306/, https://doi.org/10.1097/yic.0000000000000023. Accessed 13 Dec. 2019.
  6. Adshead, Gwen. “Antidepressants and Murder: Case Not Closed.” BMJ, 2 Aug. 2017, p. j3697, https://doi.org/10.1136/bmj.j3697. Accessed 13 Dec. 2019.
  7. Sharma, Tarang, et al. “Suicidality and Aggression during Antidepressant Treatment: Systematic Review and Meta-Analyses Based on Clinical Study Reports.” BMJ, 27 Jan. 2016, p. i65, https://doi.org/10.1136/bmj.i65. Accessed 13 Dec. 2019.

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