About the Antidepressant Sertraline (Zoloft, Lustral)
Sertraline is the generic name for the blockbuster antidepressant medications Lustral and Zoloft. The medication was approved by the Food and Drug Administration in the United States to treat several forms of depression, including clinical depression, major depression, and depression with anxiety. It is also approved to be prescribed for panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, and social anxiety disorder. In some instances, it can be prescribed to treat premenstrual dysphoric disorder, which has symptoms like mood swings, breast tenderness, bloating, and irritability. Rarely, this antidepressant is used to treat chronic headaches and sexual problems including premature ejaculation. It can be prescribed in some instances when a person with autism experiences major depression.
This medication is one of the many selective serotonin reuptake inhibitors (SSRIs) available to treat depression and related conditions. SSRIs block receptors in the brain from absorbing the neurotransmitter serotonin, which allows this chemical transmitter to continue amplifying signals between neurons for longer. Serotonin is one of the neurotransmitters involved in influencing mood, and when more of it is present in the brain, or it is present for longer, low mood can elevate and energy can increase.
Who Manufactures Sertraline?
Zoloft is manufactured by Pfizer, and it was originally approved for the United Kingdom market in 1990. The brand name drug was approved by the FDA in 1999 for use among US consumers; generic sertraline was approved in 2006. It became the most popular prescription antidepressant in the United States by 2005, outpacing older prescription medications like Wellbutrin.
Once the generic sertraline was approved, several other manufacturers began producing this medication. A few include Accord Healthcare, Mylan Pharmaceuticals, Sun Pharma, Teva, and Zydus Pharmaceuticals.
Prescription versions of sertraline are available as a tablet, capsule, and concentrated liquid solution. These different forms have different dosage instructions, and the conditions they are prescribed to treat also involve different dosages.
Tablet sizes include:
- 25 mg
- 50 mg
- 100 mg
The oral concentrate should be diluted before ingesting it, but the general dose size is 20 mg per mL.
People who receive sertraline prescriptions to treat major depressive disorder, panic disorder, PTSD, and social anxiety disorder typically take a dose twice per day – once in the morning and once in the evening. Spreading the dose over 12 hours helps to maintain an even amount of sertraline in the body. Doses per day follow these rules:
- Major depressive disorder: 50 mg per day, which may increase 25 mg at intervals of one week; however, the dose should never exceed 200 mg per day
- Obsessive-compulsive disorder: 50 mg per day; like major depression, the dose can be increased 25 mg per week, but should not exceed 200 mg per day.
- Panic disorder, PTSD, and social anxiety disorder: 25 mg
- Premenstrual dysphoric disorder: 50 mg per day, once a day, throughout course of menstrual cycle
If the person receiving sertraline has kidney or liver problems, doses should be adjusted lower according to the severity of the impairment.
While these doses are general guidelines, a person should never take sertraline without a doctor’s prescription. Self-medicating is dangerous and considered illegal, even if the medication itself is legal for use with a prescription. Additionally, self-regulating a dose of any drug can lead to intense side effects.
Withdrawal from Sertraline
When a person taking sertraline, whether as prescribed or for nonmedical reasons, wants to end their use of this drug, they should consult a physician or therapist to begin tapering the medication to prevent or reduce withdrawal symptoms. These symptoms can include:
- Agitation or restlessness
- Depersonalization (feeling detached from surroundings or reality)
- Sleep disturbances, especially involving strange dreams
- Feeling “head zaps,” or electric shocks in the head or behind the eyes
- Numbness, or pins and needles, especially in extremities
- Tremors, shaking, or weakness
Sertraline is one of the more difficult SSRI medications to stop taking, so it is important for a person to work closely with their physician to safely taper the drug. About 20 percent of people who take antidepressants like sertraline experience withdrawal symptoms, even if they take the medication only as prescribed. Antidepressant withdrawal symptoms are called discontinuation syndrome, and it can be avoided if one works closely with a physician during the withdrawal process.
A common side effect of many antidepressants, including sertraline, is weight gain. While medical professionals do not understand the exact cause of this weight gain, it could be due to fluid retention, increased appetite, or changes to exercise routines. For people who are concerned about this side effect, their doctor can monitor their weight and advise on a plan to consume fewer calories and exercise more.
Other common side effects from sertraline include:
- Dry mouth
- Upset stomach, including nausea or diarrhea
- Difficulty sleeping
While these are not considered dangerous, if they get worse or disruptive, it is important to speak with a doctor to adjust the dose or consider another SSRI.
There are some serious side effects related to sertraline. Though rare, they can include:
- Decreased sexual interest
- Decreased sexual ability
- Weakness or muscle cramps
- Bruising or bleeding easily
- Unusual or rapid weight loss
- Shaking or tremors
- Black or blood stool
- Bloody vomit
One of the most dangerous potential side effects is the increased risk of suicide among people who take sertraline. This is true of SSRI antidepressants in general, and it especially affects younger people who may receive prescription sertraline. Children, teenagers, and young adults are more likely to experience suicidal thoughts when taking sertraline than people who are middle aged or older.
Symptoms of potential suicidal ideation, or signs that sertraline is not working as it should, include:
- Irritability or mood swings
- Restlessness or agitation
- Increased aggression or hostility
- Increased impulsiveness
- Deepening depression
- New or returned thoughts of suicide
Another potential side effect from SSRIs like sertraline is serotonin syndrome. This condition involves too much serotonin in the brain, which neurons cannot uptake fast enough to maintain safe levels. Taking one antidepressant at a time, and waiting for a reasonable detox period between them if they must be changed, helps to prevent serotonin syndrome; the primary cause of this condition is taking more than one antidepressant, especially if it involves older antidepressants like MAOIs or tricyclic antidepressants. Some other medications also increase serotonin, so it is important for patients to keep their doctors informed of all medications and dietary supplements before beginning sertraline.
Symptoms of serotonin syndrome include:
- Rapid heart rate
- Loss of coordination
- Severe dizziness
- Twitches or spasms
- Abdominal cramping, nausea
- Vomiting or diarrhea
- Restlessness or agitation at unusual levels
Addiction or patterns of substance abuse involving sertraline are rare, but it is a potential side effect. People who have struggled with alcohol or drug abuse before receiving a prescription for sertraline are more at risk than others.
Sertraline’s Interactions with Other Drugs
Sertraline should not be taken with other antidepressant medications, including other SSRIs, as well as SNRIs, MAO inhibitors, or tricyclic antidepressants. One specific warning is for patients to inform their doctors if they have taken an MAOI in the past 14 days before starting sertraline, as the medication could still interact with the new antidepressant. If a person takes serotonin-adjusting medications, they could develop serotonin syndrome, which could be very dangerous.
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen could lead to bruising or bleeding more easily.
Other medications, both prescription and over the counter, that may affect sertraline include:
- Cold or allergy medication
- Sedatives, including sleep aids
- Opioid pain medications
- Muscle relaxers
- Medications to treat seizure disorders, epilepsy, or similar conditions
- Medications to ease addiction and help detox, including methadone or buprenorphine
- Birth control
- John’s wort
Alcohol is dangerous when combined with many drugs, including prescription antidepressants like sertraline. Although sertraline is considered a predominantly safe SSRI, there are dangerous side effects, and consuming alcohol in any amount while taking the drug can increase the risk of side effects. Sertraline and other antidepressants can be especially dangerous if a person routinely abuses alcohol or binge drinks.
It is possible to overdose on sertraline. Symptoms of overdose include:
- Tremors or shaking
- Agitation or anxiety
- Extreme drowsiness
- Falling unconscious
- Rapid heart rate
- Acute pancreatitis
Pregnancy and Breastfeeding
Women who are pregnant or breastfeeding should be cautious when taking sertraline. Some women may consider stopping their prescription temporarily if they wish to become pregnant. About 10 percent of women ages 18 and older have a prescription for an antidepressant, including sertraline. While animal and human studies are not conclusive about potential harm to the fetus or infant during pregnancy or breastfeeding, it is important to speak with a medical professional about these concerns.
For pregnant women who take sertraline or other SSRIs, the risk of birth defects is low, but some studies have found that SSRIs can increase the risk of birth defects, especially in the third trimester. Infants may show withdrawal symptoms after birth, including shaking, excessive crying, shivering, irritability, and, rarely, seizures. Respiratory distress could also be linked to SSRI use during pregnancy. However, antidepressants could be lifesaving medications for women who struggle with serious depression, PTSD, or other mental health conditions. The woman and her doctor, together, should weigh the risks against the benefits.
A meta-analysis from 2004 indicates that women who are breastfeeding while taking antidepressants may do some harm to their infants; however, sertraline was found to leave the body quickly in most new mothers, so the medication poses very little risk during breastfeeding.
Sertraline’s Interactions with Other Physical and Psychological Conditions
People who have prescriptions for other medications, who take dietary supplements, or who take over-the-counter medications on a regular basis should speak with their doctor about potential interactions of these drugs. The doctor could change the dose to avoid side effects or negative interactions, or may choose a different medication instead of sertraline.
There are other conditions that can interact with sertraline. For example, if a person has allergic reactions to several medications, prescription or over the counter, they may experience an allergic reaction to sertraline. People who have mental health conditions like bipolar disorder or cyclothymic disorder, or who otherwise experience manic episodes, should not take sertraline since it could make manic episodes more frequent or more extreme.
People with the following physical conditions should be cautious when taking sertraline, and keep their doctor informed of side effects:
- Liver or kidney problems
- Any heart condition
- Bleeding disorders, especially gastrointestinal bleeding
Children or adolescents may experience more intense side effects than adults. One indication of this is the potential for younger users to experience suicidal ideation when taking sertraline. There are few studies that indicate real problems involving children or adolescents aside from the risk of suicide, and sertraline has been approved for use in several age groups.
Similarly, elderly patients may be more prone to experiencing side effects from sertraline due to biological changes from aging. Older adults are also more likely to have multiple prescriptions for other medications, which could lead to side effects. While medical research has not indicated any serious increased risk among elderly adults who take sertraline, doctors should monitor this age group for problems.
Get Help for Depression, Sertraline Addiction, and Other Chronic Health Issues
People who struggle with psychiatric conditions, including depression, anxiety, and bipolar disorder, are more likely to suffer from substance abuse problems. When the person pursues appropriate therapeutic treatment, which is typically a combination of medication and therapy, they are more likely to avoid substance abuse problems and overcome their mental health condition. However, some individuals may have experienced substance abuse problems before getting the prescription medication and therapeutic help they need; this can lead to abuse of the prescription medication.
Those who struggle with addiction or substance abuse, especially involving a co-occurring mental health disorder, should seek help with detox and immediately enter a rehabilitation program. As the link between mental health and substance abuse is better understood, rehabilitation programs are better equipped to help people struggling with co-occurring disorders to effectively manage both conditions.