Sertraline (Zoloft): dosage, uses, side effects

Zoloft is one of the most frequently prescribed medications for people with depression (Luo, 2020). But healthcare providers use it to treat many other conditions as well. Here’s what you should know about Zoloft, its potential benefits, and some of the possible risks.

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Sertraline (brand name Zoloft) is an antidepressant medication used to treat depression and other mental health conditions. Zoloft belongs to the group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) (Singh, 2020).

These medications work by increasing serotonin levels in your brain. Serotonin is a chemical that helps regulate many processes in your body, including mood, fear, sleep, appetite, and sexual behavior. Researchers believe that people suffering from depression may have low serotonin levels. SSRIs, like Zoloft, help correct this imbalance (Sahli, 2016).  

The Food and Drug Administration (FDA) approves Zoloft for the treatment of (Pfizer, 2016):

• Major depressive disorder

• Obsessive-compulsive disorder (OCD)

• Panic disorder (panic attacks) 

• Post-traumatic stress disorder (PTSD) 

• Premenstrual dysphoric disorder (PMDD) (a severe form of premenstrual syndrome, or PMS) 

• Social anxiety disorder 

Zoloft can also be used “off-label” to treat other conditions, meaning the FDA didn’t explicitly approve it for those uses. Healthcare providers can prescribe drugs for an unapproved use if they decide it’s the correct treatment for their patients.

Off-label uses for Zoloft include (Singh, 2020):

• Binge eating disorder 

• Body dysmorphic disorder (obsessing over perceived flaws in physical appearance) 

• Bulimia nervosa

• Generalized anxiety disorder 

• Premature ejaculation 

Zoloft is usually a well-tolerated medication. Many people are able to receive treatment with few or minor side effects, but they do occur. Nausea and diarrhea are very common, particularly when starting Zoloft or after a dose increase (Kelly, 2008; Pfrizer, 2016). Taking your Zoloft with food may help. Let your healthcare provider know if these symptoms don’t go away or become bothersome. They may recommend an anti-nausea or anti-diarrheal medication to help with your symptoms (Kelly, 2008). 

If you’ve been doing some research on antidepressants, you’ve likely come across a side effect many people worry about—sexual dysfunction. 

SSRI antidepressants, like Zoloft, do tend to cause high rates of sexual problems, affecting between 40–65% of both men and women who take them. Delayed ejaculation is most common, but other issues can occur. You may experience a decrease in your sex drive, inability to achieve orgasm, or erectile dysfunction (difficulty getting and maintaining an erection) (Jing, 2016).

Don’t hesitate to let your healthcare provider know about any symptoms you are having. They may suggest waiting a few weeks to see if your sexual function improves, decreasing the dose of your Zoloft, or adding on a medication to help with your symptoms. 

Be on the lookout for some of these other common side effects (Pfizer, 2016):

• Agitation 

• Drowsiness or tiredness 

• Dry mouth

• Loss of appetite  

• Sweating 

• Tremors 

• Trouble sleeping  

• Upset stomach 

Less frequently, people experience other adverse effects such as low sodium levels and eye problems. While rare, it is important to let your healthcare provider know if you notice any symptoms related to these serious side effects:

• Low sodium levels (hyponatremia): You may be at increased risk of developing low sodium levels if you are over 65 or take certain diuretics (commonly nicknamed water pills). Signs that your sodium levels may be too low include headache, difficulty concentrating, trouble with your memory, confusion, weakness, and unsteadiness (Pfizer, 2016). 

• Acute angle-closure glaucoma: Rarely, SSRIs like Zoloft have been associated with an eye condition called acute angle-closure glaucoma. This condition can cause blindness if left untreated. Your risk may be increased if you are older, female, of Asian descent, or have certain eye problems. Let your healthcare provider know if you develop eye pain or any changes in your vision (Yang, 2019). 

Zoloft is available in doses of 25 mg, 50 mg, and 100 mg tablets, as well as an oral solution for those who have trouble swallowing pills. The typical starting dose is 25–50 mg per day. Your healthcare provider may slowly increase your dose depending on your symptoms and side effects. The maximum dose for Zoloft is usually 200 mg per day (Pfizer, 2016). 

Zoloft is commonly taken once a day, and you can take it with or without food. Some people have trouble sleeping with Zoloft, while others experience drowsiness. Depending on how Zoloft affects you, you can choose to take your medication in the morning or at night to help avoid these effects (Pfrizer, 2016). 

If you take the liquid form of Zoloft, you must dilute the solution before each dose. Taking the oral solution without diluting it first can cause your tongue to become numb for at least a day, even if you rinse out your mouth (ISMP, 2018).

Follow the directions on your prescription and only mix your dose with the listed fluids (such as water, ginger ale, or orange juice). The dropper that comes with the solution contains natural rubber, so be sure to let your provider know if you have a latex allergy. They can recommend an alternative method for measuring your dose (Pfizer, 2016).

Before starting Zoloft, you should familiarize yourself with the warning associated with this medication. Discuss any concerns you have with your healthcare professional.  

Suicidal thoughts and behaviors

All antidepressants, including Zoloft, have a boxed warning from the FDA—their strongest warning—regarding the potential for suicidal thoughts and behaviors in children and young adults. People over the age of 24 did not show an increased risk, and those 65 years and older actually have a decrease in these behaviors (Friedman, 2014). 

It is important to remember that untreated depression is a risk for suicidal thoughts and behaviors as well. You and your healthcare provider must consider this when deciding whether or not to start treatment with Zoloft. The FDA recommends all people who are started on antidepressants be monitored for any worsening in their symptoms. Seek medical care right away if you experience any suicidal thoughts or behaviors (Friedman, 2014). 

Serotonin syndrome 

Serotonin syndrome is a potentially life-threatening condition that occurs when there is too much serotonin in the brain. Rarely, Zoloft can cause this condition, especially if combined with other medications that affect serotonin levels. Certain drugs, such as monoamine oxidase inhibitors (MAOIs), should never be taken with Zoloft due to the increased risk of serotonin syndrome (Foong, 2018). 

Symptoms of serotonin syndrome include diarrhea, agitation, tremor, and muscle spasms. Severe cases involve fever, stiff muscles, muscle breakdown, and confusion. If any of these symptoms occur, you must seek medical advice right away, as the condition can progress quickly (Foong, 2018).  

Discontinuation syndrome

Withdrawal symptoms can occur after stopping Zoloft, especially if it is stopped abruptly or there is a large decrease in the dose. Symptoms can start within 1–10 days and typically resolve 2–3 weeks later. You may experience flu-like symptoms, trouble sleeping, dizziness, anxiety, agitation, confusion, or a tingling or burning sensation (Jha, 2018). 

If you’re interested in stopping Zoloft, speak with your healthcare provider first. They will help you make a plan to decrease your dose slowly, minimizing withdrawal reactions. 

Pregnancy and breastfeeding 

SSRI antidepressants, like Zoloft, are the most commonly used antidepressants during pregnancy (Wichman, 2015). They are generally considered safe, with very low risks of birth defects or pregnancy complications. However, you may be more likely to develop excessive bleeding after delivery (postpartum hemorrhage) (Palmsten, 2013).

Additionally, babies exposed to Zoloft during the third trimester of pregnancy may have withdrawal-type reactions shortly after birth, including excessive crying, difficulty sleeping, and trouble eating. Babies’ withdrawal symptoms typically resolve a few hours to a few days after delivery (Wichman, 2015). 

If you decide to breastfeed your baby, there’s no need to stop taking your Zoloft. Zoloft is present in low levels in breastmilk but is considered one of the preferred antidepressants for use during breastfeeding (Drugs and Lactation Database, 2021).

Other conditions 

Certain medical conditions can increase your risk of developing complications from Zoloft. Let your healthcare provider know if you have a history of seizures or if you or a family member has been diagnosed with bipolar disorder (Pfizer, 2016).

Many drugs can interact with Zoloft—way  Other conditions too many to list here. We’ll discuss some of the more common drug interactions but always check with your healthcare professional before starting anything new, even non-prescription, over-the-counter products. 

Medications that affect serotonin levels can increase the risk of serotonin syndrome if taken with Zoloft. MAOIs and Zoloft should never be taken together. You must wait 14 days after you stop an MAOI before starting Zoloft (Pfizer, 2016). Examples of MAOIs include (Foong, 2018): 

• Certain antidepressants, like phenelzine (brand name Nardil) and isocarboxazid (brand name Marplan)

• Parkinson’s disease medications, such as selegiline (brand name Zelapar) and rasagiline (brand name Azilect) 

• An antibiotic called linezolid (brand name Zyvox)

Caution should be used with other drugs that affect serotonin levels. These include (Foong, 2018):

• Other SSRIs, like fluoxetine (brand name Prozac) and paroxetine (brand name Paxil)

• Serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants, such as venlafaxine (Effexor XR) and duloxetine (brand name Cymbalta) 

• Tricyclic antidepressants (TCAs), like imipramine and amitriptyline 

• Pain medications including tramadol, fentanyl, and methadone 

• Cough and cold products containing dextromethorphan (“DM”) or chlorpheniramine 

• Natural health products, such as St. John’s wort, tryptophan, or diet pills 

• Drugs of abuse like amphetamine, cocaine, or ecstasy (MDMA) 

Zoloft should never be taken with pimozide (a medication used to treat Tourette syndrome). Taking these two medications together can affect the electrical activity in your heart and lead to serious heart rhythm problems (Pfizer, 2016). 

Disulfiram (a medication used to treat alcohol use disorder) cannot be taken with the oral solution form of Zoloft. The oral solution contains alcohol, which can react with disulfiram and cause sweating, rapid heart rate, facial flushing, nausea, vomiting, and difficulty breathing (Pfizer, 2016). 

Zoloft can increase your risk of bleeding, such as bruising, nose bleeds, or bleeding in the stomach. Speak with your healthcare provider before starting any of the following, as these medications can increase your risk of bleeding when taken with Zoloft (Pfizer, 2016):

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen 

• Blood thinners like warfarin, apixaban (brand name Eliquis), and rivaroxaban (brand name Xarelto) 

• Antiplatelet drugs including clopidogrel (brand name Plavix) and ticagrelor (brand name Brilinta)

If you’re struggling with depression or another mental illness, Zoloft may be an option for you. Discuss any concerns you have with your healthcare provider before starting Zoloft. Together, you can develop a plan to get you feeling your best and back to doing the things you enjoy. 

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Current version

July 09, 2021

Written by

Christina Varvatsis, PharmD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.