Bipolar Disorder Treatment Medications Precautions You Should Take Before Taking Zoloft By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on October 13, 2021 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by John C. Umhau, MD, MPH, CPE Medically reviewed by John C. Umhau, MD, MPH, CPE John C. Umhau, MD, MPH, CPE is board-certified in addiction medicine and preventative medicine. He is the medical director at Alcohol Recovery Medicine. For over 20 years Dr. Umhau was a senior clinical investigator at the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Learn about our Medical Review Board Print Verywell / JR Bee Table of Contents View All Table of Contents Starting Zoloft Serious Side Effects Missing a Dose Overdose Stopping Zoloft Zoloft (sertraline) belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the level of available serotonin in the brain. Low levels of serotonin in the brain are linked to a depressed mood as well as other psychiatric symptoms. Besides major depressive disorder, Zoloft is also approved by the Food and Drug Administration (FDA) to treat the following psychiatric conditions: Post-traumatic stress disorder (PTSD)Panic disorder Obsessive-compulsive disorder (OCD)Social anxiety disorder (SAD)Premenstrual dysphoric disorder (PMDD) Starting Zoloft Learning how Zoloft works and what to watch out for when taking it can help you better cope with your illness and stick to your treatment plan. For example, it's important not to expect immediate results when taking Zoloft. People typically notice some improvement within a week or two, but it may take several weeks until you feel the full effects of the drug. Also, when you start taking Zoloft, you may experience some side effects. The most common ones include nausea or upset stomach, diarrhea, sweating, tremor, or a decreased appetite. Sexual side effects may also occur, most notably delayed ejaculation and decreased libido. If any of these side effects don't go away or are causing significant problems, contact your doctor. Sometimes simple remedies can ease Zoloft side effects, like taking it at a different time of day or changing the dose. Or your doctor may also recommend switching to a different SSRI or a different class of medication altogether. Serious Side Effects In addition to the common side effects mentioned above, there are some serious effects to be aware of if you are taking Zoloft. If you experience any of these, contact your doctor right away. Suicidal Thoughts and Behavior A "black-box warning" refers to a serious notice made by the FDA about a medication. The black-box warning for Zoloft indicates it may cause or increase thoughts of suicide in children and young adults. Monitor your loved one, or yourself if you're in this age group, for any signs of such thoughts, and seek help immediately if they occur. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Serotonin Syndrome Taking Zoloft may put you at risk for a rare, possibly life-threatening condition called serotonin syndrome. This risk is higher if you are also taking other serotonin-related medications like triptans (a common migraine medication), tricyclic antidepressants, or the pain medication Ultram (tramadol). But the syndrome can occur when taking Zoloft alone, as well. Signs and symptoms of this condition include: AgitationConfusionFluctuating blood pressureGastrointestinal problems like diarrheaHigh heart rateRigid muscles and/or coordination problemsTremors To be proactive in avoiding this rare syndrome, be sure to tell your doctor all the medications you are taking, including any over-the-counter drugs or supplements. Increased Risk of Bleeding There is an increased chance of bleeding when taking Zoloft along with medications that block platelets or medications that thin your blood. Examples include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and Coumadin (warfarin). Notify your doctor right away of any bleeding events, like nosebleeds or increased bruising. Seek medical attention immediately if you notice more serious bleeding events, such as blood in your stool. Mania or Hypomania Zoloft can trigger a hypomanic or manic episode in a person with bipolar disorder. Before taking Zoloft, tell your doctor if you have ever been diagnosed or suspected of having bipolar disorder, or have a family history of it. Low Sodium Levels Low sodium levels in the bloodstream (called hyponatremia) may occur with Zoloft and other SSRIs. In severe cases, hyponatremia can lead to seizures and other serious neurologic and medical issues. Signs and symptoms of hyponatremia include: ConfusionHeadacheMemory difficultiesProblems concentratingUnsteadiness and potentially fallingWeakness Allergic Reaction While not common, if you take Zoloft and develop signs or symptoms of an allergic reaction like rash, hives, swelling, or problems breathing, contact your doctor right away. Risks to Unborn Babies You should inform your doctor if you become pregnant while taking Zoloft or are planning a pregnancy. Zoloft use in the third trimester may increase a baby's chance of developing complications like a rare condition known as persistent pulmonary hypertension, which can cause breathing problems. In addition, third-trimester use of Zoloft may cause neonatal withdrawal symptoms. However, some women may need to continue taking Zoloft during pregnancy because the benefit of treating their illness outweighs the potential risks. Overall, this decision requires a careful and thoughtful discussion with both an obstetrician and mental health professional. Low levels of Zoloft may be present in breast milk, so lactating parents should consult with their doctors before nursing while taking this medication. Breastfeeding is typically encouraged unless there is a medical reason for the parent to avoid breastfeeding. Missing a Dose Try to take your Zoloft at the same time every day. Setting a timer on your phone may be helpful so you don't forget. If you do miss a dose, take it as soon as you remember, unless it is too close to your next dose. In other words, never take two doses of Zoloft at the same time. Simply take your next scheduled dose and then return to your usual schedule. Overdose Contact a poison control center and your doctor for guidance if you or a loved one overdoses on Zoloft. The most common signs and symptoms associated with Zoloft overdose include: AgitationDizzinessFast heart rateNauseaSleepinessTremorVomiting How to Tell If Someone Has Overdosed on Zoloft Stopping Zoloft Stopping Zoloft may result in symptoms of withdrawal, also known as SSRI discontinuation syndrome. This is one reason why it's important to consult with your doctor before stopping this medication. If you and your doctor decide it's best for you to stop Zoloft, they can provide you with a tapering strategy to minimize any withdrawal symptoms like irritability, increased anxiety, or flu-like symptoms. How to Taper Off Zoloft A Word From Verywell Before prescribing Zoloft, your doctor will take a thorough medical history. Even so, it's important for you to play an active role in your care. Inform your doctor of all the details of your health history, regardless of whether or not you think they are essential. Overall, Zoloft is a generally well-tolerated and safe medication and has significantly helped many people cope with their psychiatric conditions. You deserve to get well. The good news is that if Zoloft doesn't help, there are lots of other options to try. Was this page helpful? Thanks for your feedback! Dealing with racing thoughts? Always feeling tired? Our guide offers strategies to help you or your loved one live better with bipolar disorder. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 12 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Dale E, Bang-Andersen B, Sánchez C. Emerging mechanisms and treatments for depression beyond SSRIs and SNRIs. Biochem Pharmacol. 2015;95(2):81-97. doi:10.1016/j.bcp.2015.03.011 Koen N, Stein DJ. Pharmacotherapy of anxiety disorders: A critical review. Dialogues Clin Neurosci. 2011;13(4):423-37. doi:10.31887/DCNS.2011.13.4/nkoen Santarsieri D, Schwartz TL. Antidepressant efficacy and side-effect burden: A quick guide for clinicians. Drugs Context. 2015;4:212290. doi:10.7573/dic.212290 Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533-40. Eslami Shahrbabki M, Eslami Shahrbabaki A. Sertraline-related bleeding tendency: Could it be dose-dependent?. 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