Precautions You Should Take Before Taking 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.

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: 

• Agitation
• Confusion
• Fluctuating blood pressure
• Gastrointestinal problems like diarrhea
• High heart rate
• Rigid muscles and/or coordination problems
• Tremors

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:

• Confusion
• Headache
• Memory difficulties
• Problems concentrating
• Unsteadiness and potentially falling
• Weakness

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:

• Agitation
• Dizziness
• Fast heart rate
• Nausea
• Sleepiness
• Tremor
• Vomiting

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.

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.