Zoloft Side Effects First Week: What to Expect

What Are Zoloft Side Effects During the First Week?

Individuals taking Zoloft may initially experience an increase in panic attack severity. However, this is typically temporary and will gradually improve as their body becomes accustomed to the drug. Short-term side effects may also be reduced by taking a lower dose.

Sexual dysfunction may appear within the first week of starting Zoloft and may worsen during the first month, but long-term treatment may result in improvement. Women may be more likely to experience anorgasmia than men. At higher doses or at the start of the treatment, Zoloft may worsen agitation or anxiety.⁴

Common effects of Zoloft during the first week may include:*

• Nausea
• Diarrhea
• Difficulty sleeping
• Dry mouth
• Sleepiness

*All medications, including Zoloft, can cause side effects that can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and understand the potential side effects and benefits of any medication.

Can Zoloft Make You Feel Worse at First?

Yes, people may experience worsening panic attacks and anxiety when they take Zoloft for the first time. Therefore, It is important to inform doctors of the drug’s worsening side effects soon after they start it, as it may increase the risk of harmful behaviors for up to a week or even several weeks. Despite this initial period of worsening, people must continue taking medications prescribed by their doctors, as it may take up to 6 to 8 weeks to start having an effect on symptoms.

How Long Does it Take for Zoloft to Work?

Zoloft can take about 8 weeks of regular dosing to address symptoms. Typically, mood improvement may begin within the first 1 to 2 weeks of treatment. However, how long it takes for Zoloft to work may vary for individuals. Some may require a longer dosing duration based on age, weight, kidney and liver functions, and additional drugs you take for other health problems.

It takes about one week for Zoloft to build a steady level in the blood and then a few more weeks for a full drug effect for most uses. For anxiety, it can take six weeks to notice an improvement. It may take up to 12 weeks of continuous treatment for OCD or PTSD. When prescribed for PMDD, benefits may be seen as early as week one of the first menstrual cycle after starting treatment.⁵

Zoloft Dosage

The usual therapeutic dose range for Zoloft is from 50 to 200 mg. A dose of 25 mg or 50 mg per day is often recommended at the start. However, the Zoloft dose can be altered based on age, diagnosis, other health conditions, and the body’s response. If you have liver disease, you may be given a lower strength or less frequent dose. For children aged 6 to 12 years with OCD and adults with PD, PTSD, and SAD, the starting dose is 25 mg.

If you don’t get an adequate response with the first dosage, your prescriber may increase your dosage by 25 to 50 mg daily once a week. Depending on how well you tolerate it, your dosage may be increased up to a maximum of 200 mg per day. Zoloft should be taken orally once a day, either in the morning or evening. If Zoloft makes you sleepy, your prescriber may recommend that you take it in the evening. Additionally, taking Zoloft with food may improve its absorption.¹

Warnings & Precautions for Taking Zoloft

It is important to never skip or stop Zoloft without consulting your doctor, as untreated mood problems can have serious complications. Zoloft may increase suicidal thoughts or actions in individuals aged 24 and younger, particularly in the first few months of treatment or when the dosage is altered.

If you experience sudden changes in mood, behavior, actions, or thoughts, seek medical attention immediately. Zoloft may also cause a serious condition that affects the heart rhythm, resulting in a fast-irregular heartbeat, severe dizziness, and fainting needs medical attention right away.¹

Warnings and precautions for taking Zoloft include:

• Suicide risk: Zoloft may worsen depression and increase the risk of suicidal ideation. The risk is higher for individuals 24 years of age or younger, during the first few weeks of treatment or when the dose is changed. If you or someone else shows signs of suicidal thoughts or behaviors, seek medical help right away.
• Pregnancy: While using antidepressants while pregnant carries both risks and benefits, untreated depression can be harmful as well. However, sometimes it may result in early childbirth (before 37 weeks), increase the risk of heart defects, and late use in the third trimester may require hospitalization, tube feeding, and respiratory support.
• Growth inhibition in children: Decreased weight gain and growth may be observed in children and adolescents receiving Zoloft. The mechanism of growth inhibition in children may be due to the suppression of growth hormone secretion. It may increase the risk of suicidal ideation in children, adolescents, and young adults.
• Serotonin syndrome or neuroleptic malignant syndrome (NMS): Starting Zoloft within two weeks of discontinuing any monoamine oxidase inhibitor (MAOI) may lead to a potentially life-threatening condition called serotonin syndrome. Symptoms include fast heart rate, sweating, muscle stiffness or contractions, fever, and confusion. Seek medical help right away if you experience any of these symptoms.
• Bleeding: Zoloft raises the risk of bruising and bleeding if combined with blood thinners (anticoagulants, antiplatelets). Seek urgent medical help if you observe black-colored stools, pink or red-colored urine, coughing up or vomiting blood, or unusual bleeding from the nose or gums.
• Seizures: Use Zoloft cautiously in people with a seizure disorder. However, research supports treating depression in persons who are also experiencing the complex medical and psychosocial effects of seizures.⁶
• Mania or hypomania: Zoloft can trigger manic or hypomanic symptoms. Before starting Zoloft, your doctor will confirm if you have or are at risk for bipolar disorder.
• Angle-closure glaucoma: Zoloft can lead to or worsen angle-closure glaucoma. Contact your provider if you notice changes in your vision after starting Zoloft.
• Low blood sodium levels: In people 65 years and older, Zoloft may cause a dangerous condition characterized by impaired water excretion leading to low sodium levels, weakness, confusion, seizure, and coma (syndrome of inappropriate antidiuretic hormone). These serious symptoms warrant immediate medical attention.
• Abnormal heart rhythm: Abnormal heart rhythms can be serious and life-threatening and may be associated with taking Zoloft. If you feel chest pounding, shortness of breath, chest pain, or feel faint or lightheaded while taking Zoloft, seek emergency medical care right away.

Zoloft Withdrawal Symptoms

People discontinuing Zoloft abruptly may have symptoms due to Zoloft withdrawal, also called antidepressant discontinuation syndrome. These symptoms can include dizziness, nausea, upset stomach, tiredness, anxiety, shaking, sweating, agitation, restlessness, sleep problems, seizures, electric shock sensations, confusion, and headaches.

The severity and duration of withdrawal symptoms may be influenced by factors like dose, duration, characteristics, and past experiences with the drug. Some effects are common, some severe, some rare, and some may warrant immediate medical attention. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible.⁷

Drug Interactions With Zoloft

Zoloft can interact with many medications, including some antidepressants, antianxiety, anticonvulsant, mood stabilizing, and antipsychotic drugs, as well as with various allergy, cold, heart, blood pressure, or blood thinner drugs. It may worsen the side effects of both, and your doctor may reduce the drug dose or prescribe a different drug to avoid any drug interactions. This is not a comprehensive list of possible interactions with Zoloft. You should talk with your prescriber and pharmacist about any medications, supplements or herbs you take before starting a new medication.¹

Medications that can negatively interact with Zoloft include.

• Monoamine oxidase inhibitors (MAOIs): MAOIs like linezolid may increase serotonin due to blockage of MAO-A, a key regulatory enzyme for normal brain function. Using them together may result in serotonergic syndrome (muscle contractions, sweating, shivering, agitation, and high fever).
• Tricyclic antidepressants (TCAs): Combining TCAs like imipramine with Zoloft can affect how imipramine is processed, which can amplify its effect. Using the two together can increase irregular heartbeats and serotonin levels.
• Drugs metabolized by CYP2D6 liver enzyme: Using Zoloft with a blood pressure drug such as metoprolol may cause metoprolol toxicity and its side effects.
• Pimozide: Zoloft is avoided due to irregular heart rate, as it can boost Pimozide’s effect by decreasing its breakdown
• Serotonergic Drugs: Zoloft can increase the risk of serotonin syndrome when combined with any serotonergic drug due to high serotonin levels.
• Phenytoin: Zoloft may increase phenytoin concentrations.
• Wellbutrin: Zoloft increases levels of Wellbutrin by affecting liver enzyme metabolism. Taking them together raises the risk of seizures,
• Blood Thinners: Bleeding risk can increase if blood thinners, including drugs known as NSAIDs (ibuprofen) are taken with Zoloft due to blood platelet activation. Side effects can include dizziness, lightheadedness, red or black tarry stools, vomiting fresh coffee grounds or dried blood, severe headache, and weakness.

What if You Miss a Dose of Zoloft?

If you forget to take or stop taking Zoloft you may experience withdrawal symptoms like anxiety, irritability, mood swings, restlessness, changes in sleep patterns, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion. It is important to take the missed dose as soon as you remember.

If your next dose is due soon, skip the missed one and take your next scheduled dose. Never take two doses at once, and do not stop taking Zoloft without consulting your doctor. The doctor may suggest gradually tapering the dose to avoid unpleasant side effects. But, if intolerable your doctor may recommend the previous dose.

Because it takes several weeks or longer for Zoloft to become effective, and as the body adjusts, the side effects may be difficult before you feel better. It is important to continue taking your medication until your prescriber helps you stop taking the medication.⁸

Questions to Ask Your Healthcare Provider About Zoloft Side Effects in the First Week

It is important to discuss the potential side effects of Zoloft with your doctor, psychiatrist, or therapist you may experience immediately after starting the treatment. Ask them whether these side effects will disappear on their own or if any intervention is needed. Also, many online psychiatry services are available with convenient access to mental health care for depression and anxiety problems. Individuals may even change prescribers and get a mental health evaluation, diagnosis, and personalized treatment plan.

Questions to ask your care team about Zoloft side effects in the first week may include:

• How long will it take for me to adjust to taking Zoloft?
• How quickly can Zoloft cause side effects?
• What are the first days of Zoloft side effects like?
• Am I at risk for more severe symptoms if I am already taking other anxiety or depression medications?
• What is the best dosage to ensure fewer side effects, especially in the first week?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• If I’m not able to tolerate the side effects, are there Zoloft alternatives to consider?
• How should I cope with side effects?
• What to do if the side effects do not disappear after the first week?
• Can I skip or lower a dose to avoid the side effects?
• Can I switch the drug if the side effects last longer or get worse?
• What to do if there is an emergency?
• Is it safe to take Adderall and Zoloft together?

In My Experience

In my experience, Zoloft is a safe treatment for mood and anxiety disorders due to its effectiveness, tolerability, and self-cured side effects. It has shown favorable results in various age groups, including children, adolescents, elderly, and is considered safe for pregnant and nursing women. Additionally, Zoloft has fewer side effects and is easier to administer, which may lead to better adherence to treatment plans. It is important to contact your doctor first if you are struggling with side effects without discontinuing treatment.

For Further Reading

• Zoloft (Sertraline) Withdrawal: Symptoms, Duration, & How to Cope
• Lexapro Vs. Zoloft: Choosing Which Is Right for You
• Why Zoloft?
• Zoloft: Mother to Baby
• Common Questions About Zoloft (sertraline)
• How Long Does Zoloft Take to Work?