Sertraline (Zoloft): Drug Uses, Warnings, Dosage, & More

What Is Zoloft (Sertraline) & How Is it Used?

Sertraline works in the brain by increasing serotonin (neurotransmitter) levels. It is considered a first-line medication for treating various mental health conditions and is a commonly prescribed medication within the class of medications called SSRIs. Prescribers may start sertraline at the beginning of the treatment plan or after a patient feels that therapy alone is not beneficial. It is recommended that patients taking sertraline should participate in psychotherapy as a part of their treatment plan.

Sertraline is FDA approved to treat a range of issues, including:⁶

• As a medication for depression
• As a medication for social anxiety
• As a medication for OCD
• As a medication for panic disorders
• As a medication for PTSD
• As a medication for premenstrual dysphoric disorder (PMDD)

Sertraline is also sometimes used off-label. Off-label means that it is not FDA-approved but a doctor can use it for treating a certain condition because they believe the medication may offer a benefit. Common off-label uses include:

• As a medication for bulimia nervosa
• As a medication for premature ejaculation

Sertraline is similar to other SSRI medications and will make you feel similarly to how other antidepressants make you feel. While side effect profiles are similar between SSRIs, certain side effects may be more common with certain medications. Sertraline is known to have common gastrointestinal side effects.² SSRI medications differ from SNRI medications. SNRIs increase serotonin and norepinephrine. Norepinephrine can be stimulating and may cause increased anxiety, insomnia, heart rate, and blood pressure.

Sertraline is beneficial for many patients but does come with a black box warning for patients between the ages of 18-24. There is an increased risk of suicidal ideation for this age group.

History of Zoloft

Zoloft is an FDA-approved medication that was initially developed in the early 1970s. The FDA originally approved the drug in late 1999. It is currently still supported by the FDA. Zoloft is found in many different countries under different trade names.

What Are Common Zoloft (Sertraline) Dosages & Delivery Methods?

Sertraline is an oral medication that comes in tablet form. It is generally taken either in the morning or evening once a day. The dosage is based on the indication for treatment, but prescribers will usually start at 50mg and then adjust dosages up or down based on their efficacy or side effects after a few months of use.

Some typical dosages for Zoloft include:

• 25mg
• 50mg
• 100mg
• 150mg
• 200mg

Sertraline Warnings & Associated Risks

Anyone taking sertraline should know about the medication’s potential risks. Patients taking other SSRI or SNRI medications should not take sertraline due to the risk of serotonin syndrome. Serotonin syndrome is a life-threatening emergency that requires immediate medical attention. It is important to thoroughly discuss all your current medications with your prescriber before starting sertraline. There are other medications that should be avoided with sertraline and that can increase your risk for serotonin syndrome. You should talk with your doctor about any medications, herbs, or supplements you are taking before starting sertraline.

Sertraline also comes with a black box warning for certain patients due to the increased risk of suicidal ideations. You should talk with your doctor about this risk before starting sertraline.

9 Individuals who will need to weigh the risks and potential benefits of using sertraline include:²

1. Patients older than 65 years of age due to risk of falls and confusion
2. Patients with a history of Serotonin syndrome as they are susceptible to heart arrhythmia, tremors, and increased blood pressure
3. Patients with arrhythmias, specifically QT prolongation, due to the risk of life-threatening heart arrhythmia
4. Patients with liver disease
5. Patients with bleeding disorders due to blood clotting problems
6. Patients with bipolar disorder due to risk of a manic episode
7. Patients with a history of suicidal ideation
8. Pregnant patients
9. Patients with erectile dysfunction as they can experience impotence

You must talk with a doctor if you have any of the above to see if they think sertraline is the right and safe medication for you to take.

Side Effects of Zoloft (Sertraline)

Sertraline is generally well tolerated and used by many people. However, every medication has side effects that patients should be aware of before starting a treatment regimen.

Severe side effects of sertraline may include: ^{2, 3}

• Manic episodes that can cause patients to put themselves in hazardous situations
• Suicidal ideation that can leading to self-isolation, self-harm, and death
• Serotonin syndrome, which can cause blood pressure irregularity, stroke, heart attacks, and even death
• Increased risk of bleeding that can cause blood in stool, urine, or vomiting of blood
• Arrhythmias that can be life-threatening and require immediate attention
• Decreased sodium levels which can cause headaches, confusion, and unsteadiness

Common side effects that are generally mild include:

• Nausea
• Vomiting
• Diarrhea
• Migraines
• insomnia
• Somnolence
• Nightmares
• Dizziness
• Dry mouth
• Exhaustion 

Allergic Reactions to Sertraline

All medications come with the side effect of potential allergic reactions. However, some patients allergic to certain medications are at increased risk of being allergic to sertraline. If a patient had an allergic reaction to paroxetine, they will likely have an allergic reaction to sertraline as well.⁴

Interactions with Zoloft (Sertraline)

Disclaimer: Taking certain medications, herbs, or supplements alongside sertraline can change how sertraline works in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some substances that negatively interact with sertraline include:

• Additional SSRI medications can increase the risk of serotonin syndrome
• NSAID (such as ibuprofen and naproxen) medications should be used with caution, as both sertraline and NSAIDs can cause bleeding in the stomach
• Antiplatelet or anticoagulant drugs, such as warfarin, as they can increase your risk of bleeding
• Sertraline can be a sedating medication and should not be with other sedating medications such as Benadryl
• Tricyclic antidepressants (TCAs) should not be used in conjunction with sertraline as it increases the risk of serotonin syndrome

What to Do If You Overdose

Sertraline is not a controlled medication by the FDA and does not have the risk of causing dependence like opioid addiction or benzodiazepine medications. Sertraline is not frequently abused. If someone takes too much sertraline purposely or accidentally, an overdose can be very dangerous and even fatal. Overdosages can cause seizures, damage to your heart, and serotonin syndrome. If you or someone you know may have overdosed on sertraline, you should seek emergency medical care or call 9-1-1 immediately.

What if I Miss a Dose of Sertraline?

Sertraline should be taken as prescribed and not stopped without discussion with a prescriber. Taking the dose every day is important to treat the indicated condition. A reminder alarm can be beneficial to help remember to take the dose every day. If a dose of sertraline is missed, take it as soon as it is remembered. If it is almost time for the next dose of medication, skip the missed dose and do not take two doses at the same time.

If you are experiencing side effects, talk with your doctor. It’s important not to stop taking your sertraline without a plan in place to prevent more side effects from occurring. Abruptly stopping the medication can cause antidepressant discontinuation syndrome and lead to a relapse of depressive symptoms. Discontinuation syndrome can cause nausea, headache, and vitals irregularity. It is essential to continue taking medication as prescribed for the entire length of treatment and safely taper off medication only after a physician’s directive.

Questions to Ask Your Health Team About Sertraline

Patients facing mental problems affecting their daily lives should discuss medication options in conjunction with therapy. They should know that there are other treatment options besides sertraline, both medically and non-medically. Before starting medications, patients and their doctor should discuss their medical history and review all other medicines they take.

Questions to ask your care team and foster helpful conversation about treatment before taking sertraline include:

• Is it safe to take Zoloft with my other medications?
• Will my insurance cover Zoloft?
• Does my medical history increase my risk of side effects?
• How long can I expect side effects to last?
• What side effects should I seek immediate medical attention for?
• How often should we check in while I am taking Zoloft?
• Should I let my therapist know I am taking this medication?
• What are the side effects I should watch out for?
• What is the dosage of my prescription?
• How often should I take my medication?
• How long does it take for Zoloft to work?
• Does Zoloft work for OCD symptoms?
• Are there Zoloft alternatives I can consider?
• How much does Zoloft cost, and are there ways I can save money on my prescription?
• How effective is sertraline for premature ejaculation?

Final Thoughts

Zoloft (sertraline) is an SSRI medication that individuals can take for various psychiatric conditions. It is commonly used in conjunction with therapy. It is not a controlled substance and is not addictive. It is generally well tolerated but has a risk of serious side effects, such as serotonin syndrome. It is critical to discuss with your physician whether or not sertraline is a suitable medication for treating your depression, anxiety, or other complex mental health conditions.

For Further Reading

• ZOLOFT (sertraline hydrochloride) FDA Label Information
• SAMHSA’s National Helpline
• Anxiety Disorders | MentalHealth.gov