Zoloft for anxiety: how is it used?

Anxiety is one of the most common mental health conditions reported today. Anxiety symptoms such as panic attacks, palpitations, or tremors can bring down your quality of life.

Fortunately, there are treatment strategies that can help you gain control of your anxiety. These include medications, therapy, and lifestyle changes. One medication that has proven helpful for anxiety is Zoloft. Taking Zoloft for anxiety has been shown to be safe and effective in multiple studies. 

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Zoloft (sertraline) is a prescription medication. It must be ordered by your healthcare provider. Zoloft was approved by the U.S. Food and Drug Administration (FDA) in 1991. It soon became one of the most prescribed drugs in the U.S. (Kane, 2020.).

It is used to treat several psychiatric disorders both on and off label, including anxiety disorders and depression (Singh, 2020).

Zoloft is a selective serotonin reuptake inhibitor (SSRI). This is a class of medication most often used to treat depression, anxiety, and other related mental illnesses (Chu, 2020).

It is thought that anxiety and depression are partly caused by low levels of the neurotransmitter serotonin. SSRI medications work by preventing some of the serotonin in the synapses between the neurons in the brain from being reabsorbed (Chu, 2020). 

This allows more serotonin to build up in the brain. Over time, having more serotonin available in the brain can help regulate your moods (Chu, 2020).

Other common selective serotonin reuptake inhibitors include (Chu, 2020):

• Fluoxetine (Prozac)

• Paroxetine (Paxil, Brisdelle)

• Citalopram (Celexa)

• Escitalopram (Lexapro)

In a 12-week trial of Zoloft for generalized anxiety disorder, people taking the drug showed significant improvement versus those taking a placebo (Allgulander, 2004).

Another clinical study reported, “evidence that sertraline led to reduced anxiety symptoms, better mental health-related quality of life, and self-reported improvements in mental health” (Lewis, 2019).

Zoloft is approved by the FDA to treat several conditions. Most are related to depression and anxiety. These are (Pfizer, 2019):

• Major depressive disorder (MDD)

• Obsessive-compulsive disorder (OCD)

• Panic disorder (PD)

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder (SAD)

• Premenstrual dysphoric disorder (PMDD)

It is also frequently used off-label to treat other types of anxiety disorders, eating disorders, and premature ejaculation (Skånland, 2019).

Zoloft is taken by mouth once a day. It can be taken in the morning or the evening. Some people report drowsiness after taking Zoloft. These people may prefer to take it in the evening. Zoloft may be absorbed better when taken with food (Singh, 2020).

Zoloft comes in the following forms (Singh, 2020):

• 25 mg tablets

• 50 mg tablets

• 100 mg tablets

• 20 mg/ml liquid solution

The FDA recommends adults start at a dose of 50 mg/day when using Zoloft for anxiety or depression. This can be increased weekly up to a maximum of 200 mg/day (Singh, 2020). Follow your healthcare provider’s instructions when it comes to any dose adjustments. 

Zoloft drug interactions

You should not take Zoloft if you are taking another type of antidepressant called a monoamine oxidase inhibitor (MAOI) or within 14 days of stopping an MAOI (Pfizer, 2019).

Don’t take Zoloft if you have had an allergic reaction or are sensitive to sertraline or if you take a medicine called pimozide (Orap) (Pfizer, 2019).

The sertraline oral solution should not be taken if you are also taking disulfiram (Antabuse), as it can cause a reaction (Pfizer, 2019).

Medical conditions

Your doctor should assess whether you have any of the following medical conditions before you start Zoloft. You may need to be monitored more closely while on Zoloft or a different medicine may be more appropriate if you meet the following criteria (Pfizer, 2019):

• You take other medicines or supplements that increase serotonin levels.

• You use aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs, warfarin, or any other blood thinners.

• You have bipolar disorder.

• You have a history of seizures.

• You have glaucoma.

• You have a heart condition called QTc prolongation.

• You are pregnant or breastfeeding.

Unlike some other types of medications, the effects of SSRIs such as Zoloft can’t be felt immediately. 

One study of 550 adults randomly assigned people to receive either sertraline or a placebo. Participants were assessed at two, six, and 12 weeks. Some participants self-reported feeling improvements at the two-week mark. However, most reported a maximum impact between 6–12 weeks (Lewis, 2019).

All medications carry the risk of some side effects. Your healthcare provider can help you decide if the benefits of Zoloft outweigh any potential risks. Some of the most common side effects that have been reported include (Pfizer, 2019):

• Nausea

• Diarrhea

• Tremor

• Indigestion

• Loss of appetite

• Hyperhidrosis (sweating)

• Ejaculation failure

• Decreased libido

Less common, but more serious side effects include (Singh, 2020):

• Risk for increased bleeding

• Prolonged QT interval

• Increased suicidal ideation

• Serotonin syndrome

Black box warnings

Black box warnings are the FDA’s strictest labeling requirement. These are used to highlight serious or life-threatening potential adverse reactions.

The black box warning for Zoloft states (Pfizer, 2019): 

“Antidepressants increased the risk of suicidal thoughts and behavior in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors.”

This warning is due the fact that it’s believed Zoloft increases a person’s motivation before it improves their mood, potentially making a suicidal person more likely to act on their feelings. Your healthcare provider will monitor you closely while beginning Zoloft to make sure that you don’t start to feel worse. If you do feel more depressed or start to have suicidal thoughts, you should tell your healthcare provider immediately.

Serotonin syndrome

Serotonin syndrome is a rare, but potentially life-threatening condition caused by too much serotonin in the body. It can be caused by taking too much medication that increases serotonin or by combining your medication with illicit drugs that also elevate serotonin (Simon, 2021).

Symptoms of serotonin syndrome include (Simon, 2021):

• Seizures

• Agitation

• Tremors

• Elevated body temperature

• Sweating

Most cases of serotonin syndrome will get better within 24–72 hours, as long as the drugs or medications causing it are stopped. Severe cases will need more treatment in the hospital (Simon, 2021).

If you think you are experiencing serotonin syndrome, you should seek medical advice immediately.

Zoloft is not addictive in the traditional sense of the term. Some other types of medications often used to treat anxiety, such as benzodiazepines, can lead to abuse or addiction. This is not the case with SSRIs (Davies, 2018).

Some people do report antidepressant withdrawal or discontinuation syndrome when stopping Zoloft. Withdrawal symptoms commonly reported include (Davies, 2018):

• Increased anxiety

• Flu-like symptoms

• Insomnia

• Nausea

• Loss of balance

• Sensory disturbances

• Hyperarousal

The risk of experiencing discontinuation syndrome increases when antidepressants are stopped abruptly. These withdrawal symptoms are not dangerous and usually only last about 1–2 weeks, but let your healthcare provider know if you are experiencing these symptoms. They may be able to help (Davies, 2018).

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

April 21, 2021

Written by

Ellyn Vohnoutka, BSN, RN

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.