Disclaimer: This is not meant to be medical advice, and always discuss with your care manager, prescriber or other doctor before making any medication changes or taking action, unless otherwise indicated. Please refer to the package insert included with your medication.
What is Sertraline (Generic Zoloft®)?
Sertraline (brand name Zoloft™) is a prescription medication commonly used to treat depression and anxiety. It belongs to a class of medications known as selective serotonin reuptake inhibitors (SSRIs) and includes other medications like fluoxetine (Prozac™), citalopram (Celexa™), and escitalopram (Lexapro™).
Sertraline approved by the FDA for treatment of:
- Major depressive disorder
- Social anxiety disorder
- Panic disorder
- Premenstrual dysphoric disorder
- Obsessive-compulsive disorder
How does Sertraline (Generic Zoloft®) work?
There is extensive evidence for the use of sertraline and other SSRIs as first-line treatments for depression and anxiety disorders. Generally, SSRIs block the breakdown of the neurotransmitter serotonin in the brain, making more serotonin available to transmit messages among brain cells. There also may be a less potent effect on dopamine transmission. The neuroscience is likely more complicated, but extensive studies show that SSRIs really improve people’s mood and anxiety levels.
How long does it take Sertraline (Generic Zoloft®) to work?
Improvement in anxiety often takes place within 1 week of starting a reasonable dose. Mood benefits, such as no longer feeling depressed or feeling happier, may take longer (2 to 4 weeks). If you don’t experience improvement at higher doses, this medication may not work for you. However, if you have not improved at lower doses, it may be that the dose is just too low. Finding the right dose of a medication sometimes takes time, but your provider will help guide you through the process by closely following your symptoms and adjusting treatment as necessary.
How do I take Sertraline (Generic Zoloft®)?
You can take Sertraline in the morning or at night. Most people take it in the morning, but a small group feels mildly tired on it, and they take it at night. The most important thing is to pick a time when you are most likely to be consistent. You should speak with your Mantra-affiliated provider or your doctor before changing how you take Sertraline.
You can take Sertraline with or without food. Taking it with food reduces the most common side effects of Sertraline, a mild stomach upset or nausea. This nearly always goes away with time. You will likely not need to do this forever, but it is helpful when you are starting or when you are increasing the dose.
What if I miss a dose?
If it is almost time for your next dose, skip the missed dose and go back to taking at your normal time. Do not take 2 doses at the same time or extra doses. If you find yourself consistently missing your medication, let your prescriber know.
Store at room temperature, in a dry place, with the lid tightly sealed. Throw away unused or expired drugs.
Can I drink alcohol while taking Sertraline (Generic Zoloft®)?
There is no absolute rule that you cannot drink while on Sertraline. All SSRIs, including Sertraline, can increase your sensitivity towards alcohol. The most conservative psychiatrists will tell you that it makes 1 drink feel like 2. In our experience, most people can drink in moderation. However, we have heard from patients that when they drink, at a celebratory event for example, they find that they get more intoxicated than they expected, even at times leading to a blackout. Please be careful when drinking alcohol on SSRIs.
Important Safety Information
All medications have risks. While most of the side effects from Sertraline are either mild or very rare, you should discuss the risks and benefits of the medication. If you experience any side effects, please notify your provider immediately. If you have a serious side effect, contact your in-person health care provider immediately. If you are having an emergency, call 911 or go to your nearest emergency room.
What are the most common side effects?
- Gastrointestinal (GI): The most common side effects of SSRIs are GI side effects such as nausea, vomiting (rare), diarrhea (rare). These nearly always go away in time and are often improved by just taking the medication during a meal.
- Sexual side effects: decreased libido, decreased erection (men), decreased lubrication (women), loss of orgasm
-If you experience decreased libido or erection/lubrication, there are tips and tricks we can offer to improve this.
-If you experience loss of orgasm, please discuss with your prescriber if the benefits of the medication outweigh this side effect.
- Weight gain: When you follow the average American over 6 months in drug studies, you see weight gain in both the placebo and the medication groups. For example, a randomized trial showed a mean weight gain of 1.5 kg (3.3 lb) for Sertraline, compared to 1.8 kg (4.0 lb) for placebo (Doogan 1992). Thus, it is hard to know if weight gain, even with excellent data, is a true medication side effect or the result of recovery from depression and the reversal of undesired weight loss. However, clinical experience shows that some people (not all) do have a modest amount of weight gain on SSRIs. There is also likely a very small group of people who gain significant weight (20 pounds or more) on SSRIs. Please monitor and tell your prescriber if you experience weight gain so that you can make a plan together.
- Insomnia/agitation: The vast majority of people who start SSRIs feel calmer and less anxious. That said, a small group of people who start on Sertraline or an SSRI will either have unknown bipolar disorder or will get agitated by the medicine. If you experience significant irritability, insomnia, or agitation after starting, STOP the medication and tell your prescriber immediately. This may mean it is not a good fit for you.
- Driving: Because any psychoactive drug may impair judgment, thinking, or motor skills, use caution when driving or operating machinery, until you are certain that sertraline does not affect you negatively.
What are the potentially serious side effects?
- Suicidal thoughts or behaviors: In short term studies, SSRIs did increase the risk of suicidal thoughts and behavior in patients 24 years old and younger. If you have worsening mood, signficant changes in behavior or new thoughts of suicide, stop the medication and contact your local health care provider immediately.
- Mania/manic episode: SSRIs may precipitate a manic episode in patients at risk for bipolar disorder. If you develop new elevated/euphoric mood, decreased need for sleep, worsening irritability and new odd/impulsive behavior, let your health provider know immediately as these may be signs of a manic episode. Let your doctor know if you have a family history of bipolar disorder, mania, or hypomania.
- Bleeding risk: In rare circumstances, sertraline can impair your body’s ability to form blood clots and can increase the risk of bleeding events. This risk is higher in people who take aspirin, NSAIDs (examples include ibuprofen and naproxen), warfarin (Coumadin™, Jantoven™) or other anticoagulants. This can range from minor bruising to life-threatening bleeding. If you notice new bruising or bleeding, you should stop the medication and contact your local health care provider immediately.
- Glaucoma: Certain patients may be susceptible to eye problems with Sertraline, specifically narrow-angle glaucoma. If you experience vision changes, eye redness, eye swelling or eye pain, call your healthcare provider immediately. If you have a history of eye problems, let your provider know.
- Low sodium (hyponatremia): Patients on SSRIs, like Sertraline, can rarely develop low sodium, through a condition known as SIADH. Patients who don’t drink enough water and/or are on diuretics are at increased risk. This can lead to symptoms such as headache, confusion, weakness and can, in extreme circumstances, lead to seizures and death. If you experience any of these symptoms, contact your medical provider immediately or go to your nearest emergency room.
- Serotonin syndrome: This is not a subtle adverse reaction. You will feel agitation, restlessness, increased body temperature, increase in your reflexes (for example knee jerk), muscle twitching or rigidity, sweating, diarrhea, headache. If you get these symptoms and they are moderate-severe, you should go to the emergency room immediately.
- Allergic reaction. Symptoms include a new rash; hives; itching, red, swollen, blistered, or peeling skin, including face and lips; fever; wheezing and chest/throat tightness and subsequent difficulty talking, breathing or swallowing.
Who should NOT take sertraline?
- Do not take if you are currently taking or have used MAOIs (including linezolid or methylene blue) within the past 14 days. If you are not sure what these medications are, ask your doctor or pharmacist.
- Do not use at the same time as pimozide (this can cause cardiovascular problems)
- Do not use if you have a history of allergic reaction/hypersensitivity (including anaphylaxis) to sertraline or any component of the medication. Please look at the medication guide for a full list of ingredients.
- Do not take Sertraline if you have taken disulfiram (Antabuse™)
- Do not take sertraline if you take any other medications that contain Sertraline (examples include Sertraline hydrochloride)
Can I combine Sertraline with other medications?
It is important you tell your healthcare provider what other medications you take. Some medications must be taken very carefully or cannot be taken with SSRIs as the combination can cause a serious condition called serotonin syndrome. Common examples include:
- Triptans (used for migraines)
- Cyclobenzaprine (Flexeril™)
- Saint John’s Wort
- Dextromethorphan (used in many cough and cold meds)
- Drugs like ecstasy, cocaine, and LSD
What about pregnancy/lactation?
Discuss with your healthcare provider the risks and benefits of taking Sertraline while pregnant. Babies born to mothers who take Sertraline may experience some withdrawal symptoms at birth. There are very rare instances of lung problems at birth.
If you are breastfeeding or plan to breastfeed: It is important to know that a small amount of Sertraline can pass into breast milk. Discuss with your healthcare provider the best way to feed your newborn while on Sertraline.
Do not stop sertraline before discussing with your healthcare provider
Stopping Sertraline abruptly can precipitate several uncomfortable symptoms. These symptoms include feeling anxious, irritable, restless, new insomnia, headaches, nausea, dizziness, sweating, and shock-like sensations in your body. These symptoms can largely be avoided by decreasing the dose slowly in consultation with your healthcare provider.
We know this is a lot of information to process. Ask your Mantra-affiliated prescriber for advice on whether Sertraline may be appropriate for you.
Tell your healthcare providers
Telemedicine does not replace your primary care physician. It is important to keep your primary care physician, other healthcare providers, and pharmacist informed of all medications you are taking, including those prescribed by your Mantra-affiliated provider, as they can interact with other medicines you may be taking.