How Zoloft (Sertraline) Is Used to Treat Social Anxiety Disorder

Zoloft (sertraline hydrochloride) is a prescription medication approved for the treatment of social anxiety disorder, a mental health condition marked by an irrational fear of being watched, judged, or of embarrassing or humiliating yourself.

Zoloft is a type of selective serotonin reuptake inhibitor (SSRI), which works to slow re-absorption of the neurotransmitter serotonin, a chemical that plays a role in the regulation of mood and anxiety. It is also used to treat other mental health problems, including major depressive disorder, obsessive compulsive disorder, premenstrual dysphoric disorder, and post traumatic stress disorder.

how to take zoloft
Illustration by Alexandra Gordon, Verywell

Precautions and Contradictions

Zoloft should be used with caution if you:

  • Are allergic to sertraline, which is the active ingredient in Zoloft
  • Are being treated with medication for alcohol abuse
  • Are breastfeeding
  • Are pregnant (third trimester is most at risk for complications) or planning to become pregnant
  • Have a bipolar disorder or a family history of bipolar disorder
  • Have impaired liver or kidney function, heart disease, diabetes, or a history of seizures

Zoloft has not been approved for the treatment of social anxiety disorder in people under 18 years of age. There is some evidence to suggest an increased risk of suicidal thoughts and behaviors in children taking Zoloft.

If you or your child 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.

Dosage

All listed dosages are according to the drug manufacturer. Zoloft is available in 25 mg, 50 mg, and 100 mg tablets and a 20 mg/ml oral solution. Check your prescription and consult your doctor to make sure you're taking the correct dose for you.

For people with social anxiety disorder, a typical tablet dosage of Zoloft starts at 25 mg, with an increase to 50 mg after one week. Weekly increases up to a maximum dose of 200 mg are permitted for patients who do not respond to lower doses.

Modifications

Certain populations may require an adjusted dosage and/or close monitoring by their healthcare provider, including:

  • Children 6 to 17 years old may require closer monitoring and a subsequent dosage change if during the first few months of taking Zoloft they experience significant weight loss and/or suicidal ideation.
  • Pregnant and nursing individuals will need to discuss the risk and benefits of taking Zoloft as it can pose a risk to the fetus during the third trimester as well as to the newborn while breastfeeding.
  • Older patients begin with dosages on the lower end to watch for adverse reactions prior to increasing their dosage if needed.

How to Take and Store

Zoloft comes in tablet or liquid form. In general, Zoloft is taken once daily, with or without food.

  • Swallow the tablets whole—not chewed or crushed.
  • When taking Zoloft, avoid grapefruit juice and eating grapefruits as it can interfere with how the medication is metabolized in your body.
  • If taking the liquid form of Zoloft, combine the prescribed amount of medication with one-half cup of liquid (water, ginger ale, lemon-lime soda, lemonade, or orange juice), and be sure to prepare each dose immediately before you take it, not in advance.
  • If you forget to take a daily dose, take it as soon as you remember. However, if it is close to the time of your next dose, skip the missed dose and take it at your regular time. Never take two doses of Zoloft at the same time.
  • When travelling, store Zoloft in your carry-on baggage in case your luggage gets lost.
  • It's important to continue taking Zoloft as long as your doctor instructs, even if you begin to feel better. If you abruptly stop taking Zoloft, you may experience withdrawal symptoms such as nausea, tremors, lightheadedness, muscle pains, weakness, insomnia, and anxiety.

Zoloft Overdose

If you have taken too much Zoloft, get help right away before the drug has a chance to cause unpleasant or dangerous symptoms. The risk of a fatal overdose of Zoloft is low. Symptoms of an overdose include dizziness, drowsiness, nausea, vomiting, increased or slow heart rate, and coma.

Side Effects

Side effects of Zoloft can range from mild to more serious.

Common

The most common side effects of Zoloft include:

  • Nausea
  • Drowsiness
  • Sweating
  • Dizziness
  • Dry mouth
  • Diarrhea
  • Decreased appetite
  • Sexual dysfunction
  • Insomnia

Severe

When first starting Zoloft, or when changing dosage, report any of the following side effects to your doctor immediately:

  • Allergic reaction symptoms like hives, rash, difficulty swallowing or breathing, severe dizziness, and swelling of the face, mouth, throat, or tongue
  • Agitation
  • Changes in urine or stools (dark or increased urine, black stools)
  • Nervousness
  • Persistent vomiting or nausea
  • Seizures
  • Severe abdominal pain
  • Suicidal thoughts and behaviors
  • Tremors
  • Yellowing of the eyes or skin
  • Symptoms of serotonin syndrome, including agitation, confusion, sweating, hallucinations, abnormal reflexes, muscle spasms, and rapid heartbeat

When to Go to the ER

If your doctor is unavailable and you're experiencing severe symptoms, head to the emergency room immediately. Tell them about the medication and dosage you are currently taking and when your symptoms first began.

Warnings and Interactions

Zoloft should be taken as directed unless your healthcare provider provides other guidance. To ensure Zoloft is safe for you, disclose to your doctor your mental health and family history as well all current or past prescription or over-the-counter medications, or any other substances that you are taking or plan to take.

Warnings and interactions when taking Zoloft include:

  • Zoloft is not approved for use by children under age 6.
  • Zoloft should not be taken in combination with, or within weeks of taking, monoamine oxidase inhibitors (MAOIs), pimozide, and disulfiram (when taken with liquid Zoloft).
  • Zoloft should not be taken with such supplements as St. John's Wort , 5-HTP, or SAMe due to the risk of serotonin syndrome.
  • Zoloft should not be taken with aspirin, anticoagulants, and nonsteroidal anti-inflammatory drugs, which may increase the risk of bleeding.
  • Consumption of illegal drugs and alcohol is not advised while taking Zoloft.
  • Zoloft may make you feel drowsy and less alert. It is important not to drive, operate dangerous machinery, or participate in hazardous activities unless you are sure that Zoloft is not affecting you in this way.
  • Be mindful of any unusual changes in behavior or mood six to eight weeks after beginning Zoloft. If symptoms worsen, contact your doctor immediately.
  • Those who are pregnant or breastfeeding, older adults, those who are taking diuretics, and children diagnosed with mental health disorders other than OCD are at greater risk for complications and may not be prescribed Zoloft.
  • Do not quit Zoloft cold turkey. Talk to your doctor who will help you slowly taper your dosage when you stop taking Zoloft. Discontinuing the medication on your own could lead to potentially serious withdrawal symptoms.

Black-Box Warning

The black-box warning for Zoloft indicates that it may cause or increase thoughts of suicide in children and young adults (under 25), especially in the first few weeks after starting the drug or after the dose is changed.

A Word From Verywell

It's important to note that this article does not indicate every possible outcome of taking Zoloft. Be sure to follow the guidelines outlined by your doctor and consult your healthcare provider or pharmacist right away if you have any questions or concerns.

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Article Sources
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  1. U.S. National Library of Medicine, National Institute of Health. ZOLOFT- sertraline hydrochloride tablet. Updated September 20, 2019.

  2. Pfizer. Zoloft: tablets and oral concentrate. Updated August 2011.

  3. Lee AJ, Chan WK, Harralson AF, Buffum J, Bui B-CC. The effects of grapefruit juice on sertraline metabolism: An in vitro and in vivo study. Clinical Therapeutics. 1999;21(11):1890-1899. doi: 10.1016/S0149-2918(00)86737-5

  4. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991

  5. Simon LV. Serotonin syndrome. National Center for Biotechnology Information (NCBI), U.S. National Library of Medicine, NIH. Published September 29, 2019. 

  6. Pfizer. Zoloft (sertraline hydrochloride) tablets, oral solution. Updated January 2018.

  7. Foong AL, Grindrod KA, Patel T, Kellar J. Demystifying serotonin syndromeCan Fam Physician. 2018;64(10):720-727. PMID: 30315014