What to Keep in Mind If Your Doctor Prescribes Zoloft

Zoloft (sertraline) belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the level of serotonin in the brain. Low levels of serotonin in the brain are linked to a depressed mood in addition to cognitive difficulties like poor memory.

Besides major depressive disorder, Zoloft is also FDA-approved to treat the following psychiatric conditions:

• PTSD
• Panic disorder 
• OCD
• Social anxiety disorder
• Premenstrual dysphoric disorder

Learning how Zoloft works and what to watch out for when taking it can help you cope with your illness better and stick to your treatment plan.

Starting Zoloft

It's important that you don't 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 ejaculation failure and decreased libido.

If any of these the side effects don't go away or are giving you significant problems, be sure to contact your doctor. Sometimes simple remedies can ease the side effects of taking Zoloft like taking it at a different time of day or changing the dose.

Other times, if the side effects are too bothersome, your doctor may recommend switching to a different SSRI or a different class of medication altogether.

What to Watch out for When Taking Zoloft

In addition to the common side effects mentioned above, there are some serious effects to be on the lookout for if you are taking Zoloft.

Suicidal Thoughts and Behavior
A "black-box-warning" refers to a serious notice made by the U.S. Food and Drug Administration about this 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 contact your doctor immediately if they occur.

Serotonin Syndrome 
Taking Zoloft may put you at risk for a rare, but possibly life-threatening condition called serotonin syndrome. This risk is higher if a person is also taking other serotonin-related medications like triptans (a common migraine medication), tricyclic antidepressants, or the pain medication, Ultram (tramadol), but can occur with taking Zoloft alone, as well.

Some of the signs and symptoms of this condition are agitation, confusion, a high heart rate, fluctuating blood pressure, rigid muscles and/or coordination problems, tremor, and gastrointestinal problems like diarrhea. 

To be proactive in avoiding this rare syndrome from occurring, 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).

Please notify your doctor right away of any bleeding events like nosebleeds or increased bruising. Seek medical attention right away if you notice more serious bleeding events like blood in your stool. 

Mania or Hypomania
Zoloft can trigger a hypomanic or manic episode in a person with bipolar disorder. Remember to 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, in addition to other SSRIs.

Signs and symptoms of hyponatremia include:

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

In more severe cases, hyponatremia can lead to seizures, hallucinations, and death. It's important for your doctor to follow you closely while taking your antidepressant. He may want to check your sodium level after you have been on Zoloft.

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.

Pregnancy
Zoloft is a pregnancy category C medication, so inform your doctor if you become pregnant on Zoloft or are planning a pregnancy. Zoloft use in the third trimester may increase a baby's chance of developing persistent pulmonary hypertension which can cause breathing problems. In addition, third-trimester use of Zoloft may cause neonatal withdrawal symptoms like temperature instability, feeding problems, and constant crying.

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. 

Missing a Dose of Zoloft

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. But 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.

Contact Poison Control and your doctor for their guidance if you do overdose on Zoloft. The most common signs and symptoms associated with Zoloft overdose include sleepiness, vomiting, a fast heart rate, nausea, dizziness, agitation, and tremor. 

Stopping Zoloft

Stopping sertraline may result in symptoms of withdrawal, also known as SSRI discontinuation syndrome. This is one reason why it's important to not stop taking Zoloft on your own. If you and your doctor decide it's best for you to stop Zoloft, he can provide you with a tapering strategy to minimize any withdrawal symptoms like irritability, increased anxiety, or confusion.

A Word From Verywell

Before prescribing Zoloft, your doctor will perform a thorough medical history. Even so, it's important for you to play an active role in your healthcare. In other words, inform your doctor of all 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 condition. You deserve to get well, and the good news is that if after trying Zoloft you find it doesn't help, there are lots of other options available.

Sources:

FDA. (2015). Zoloft (sertraline HCI) Prescribing Information.

Jenkins TA, Nguyen JCD, Polglaze KE, Bertrand PP. Influence of tryptophan and serotonin on mood and cognition with a possible role of the gut-brain axis. Nutrients. 2016 Jan;8(1):56.