What is Sertraline and What are the Side Effects?
Dr. Angel Rivera
Depression is an epidemic in the United States. While there are many different types of depression, an estimated 17.3 million American adults, or 7.1 percent of the population, experienced a major depressive episode in 2017. Depression has both mental and physical symptoms that can make performing even simple daily functions challenging for those who are suffering from the condition. Medications like sertraline offer one option for people with depression and other mental health issues, and it is often prescribed in conjunction with talk therapy and lifestyle changes, such as exercising more regularly. Sertraline is a very popular depression medication, but besides depression, what is sertraline used for?
What is Sertraline?
Sertraline is the generic form of Zoloft, a medication that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRIs like sertraline are used to treat mental illnesses like depression and anxiety, in addition to a variety of other mental health conditions. Sertraline was approved by the U.S. Food and Drug Administration under the brand name Zoloft in 1991, and it is one of the most popular SSRIs on the market. More than 38 million prescriptions were written for sertraline in 2017 alone.
What is Sertraline Used to Treat?
Sertraline is approved for the treatment of many mental health conditions, including major depressive disorder (MDD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). A brief explanation of each of these conditions and their associated symptoms is provided below.
Clinical Depression/Major Depressive Disorder
The classic image that comes to mind when we think of depression usually consists of the symptoms of clinical depression, also known as major depressive disorder. People who suffer from clinical depression experience persistent and intense feelings of sadness for extended periods of time, impacting their mood and behavior. In addition to causing mental symptoms, depression frequently causes physical symptoms that affect a person's sleep habits and appetite. Those suffering from major depressive disorder frequently have difficulty performing normal daily tasks and activities, find themselves losing interest in hobbies and other things they once enjoyed doing, and may also experience suicidal thoughts or behaviors. Approximately seven percent of American adults experience a major depressive episode each year. Symptoms of depression and major depressive disorder include:
- Suicidal thoughts or behaviors
- Sleeping and eating more or less than usual
- Nervous energy
- Feeling sad, empty, or tearful
- Feelings of worthlessness, guilt, hopelessness, or helplessness
- Feelings of moving or thinking in slow motion
- Lost of interest in activities you used to enjoy
- Difficulty concentrating and low energy
Obsessive Compulsive Disorder
Obsessive compulsive disorder, or OCD, is a mental illness that is characterized by anxiety caused by obsessive, worrisome thoughts. As a result of their obsessive thoughts, people with OCD feel compelled to perform compulsive, repeated behaviors in order to relieve the source of their anxiety. Each person with OCD experiences the compulsions in a different way, but one major component of the condition is that people with OCD feel that they must perform the behaviors even when it is inconvenient or they would prefer not to. People are often first diagnosed with obsessive compulsive disorder as children or young adults and experience more intense behaviors later in life.
- Anxiety about germs and dirt
- Fear of contamination
- Need for symmetry and order, including obsessive cleanliness
- Feeling that you can protect other people by performing certain behaviors or rituals
- Difficulty throwing away things of little to no value (hoarding tendencies)
- Disturbing thoughts
People with obsessive compulsive disorder may experience some of the following symptoms:
- Excessive hand washing, showering, or repetitive cleaning
- Checking things over and over again, such as making sure the door is locked
- Hoarding unnecessary possessions of little value
- Rearranging things continuously to get them "just right"
Post-Traumatic Stress Disorder
Post-traumatic stress disorder, commonly referred to as PTSD, is a mental health condition that occurs after a patient experiences or witnesses a traumatic event, such as a serious accident, rape, terrorist act, war/combat, natural disaster, or personal assault. The condition is characterized by intense, disturbing thoughts and feelings of the experience that linger long after the event has ended, and many people relive the event regularly through nightmares, flashbacks, or even panic attacks.
Social Anxiety Disorder
Social anxiety disorder is a mental health disorder characterized by a persistent, intense fear of being judged and watched by others. People who suffer from this disorder have feelings of fear and anxiety in situations like dating, meeting new people, going to a job interview, talking to a cashier at a store, or answering a question in class. Any behavior performed in front of other people causes feelings of anxiety or fear. People who have social anxiety disorder often experience the following symptoms:
- Feelings of nausea
- Blushing, sweating, trembling
- Rapid heart rate
- Rigid body posture
- Finding it difficult or scary to be around other people, particularly those they do not know
- Feeling self-conscious, awkward, or embarrassed in front of other people
- Feeling afraid of judgment
- Avoiding places where other people are present
Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) is a mental health condition that is characterized by extreme episodes of irritability, depression, and tension prior to menstruation. These symptoms are common among many women prior to menstruation, but the experiences are extreme in women with PMDD.
How Do I Know What Dose of Sertraline to Take?
Your healthcare professional will determine the right dose of sertraline for you based on the condition to be treated and your age. Many people taking sertraline and other SSRIs need to have their dosage adjusted several times before finding the appropriate dose. Sertraline is available in oral tablets at 25 mg, 50 mg, and 100 mg strengths and in an oral solution at a strength of 20 mg/mL. Adults suffering from major depressive disorder generally take 50 mg of sertraline per day as their initial treatment dose. Doctors may increase your dose every few weeks as needed; the maximum dose of sertraline is 200 mg per day.
If your dosage of sertraline is changed or stopped abruptly, the medication can cause withdrawal symptoms, especially if the patient has been taking the medication for six weeks or more. Therefore, patients should not stop taking sertraline or change their dose without receiving guidance to do so from their doctor. Symptoms of withdrawal include:
- Nightmares and insomnia
- Gastrointestinal issues (diarrhea, nausea)
- Flu-like symptoms
What are the Side Effects of Sertraline?
Possible side effects associated with Sertraline generally fall into two categories: common adverse effects and rare but serious ones.
Common side effects associated with Sertraline include:
- Loss of appetite
- Upset stomach
- Dry mouth
- Increased sweating
- Trouble sleeping/tiredness
Rare but serious side effects associated with sertraline include:
- Low sodium blood levels, as evidenced by:
- Difficulty remembering
- Difficulty concentrating
- Angle-closure glaucoma, as evidenced by:
- Eye pain
- Changes in vision
- Swelling or redness in or around the eye
- Serotonin syndrome, as evidenced by:
- Severe muscular tightness
- QT prolongation and ventricular arrhythmia including changes in the electrical activity of your heart
- Teeth grinding
Who Should Not Take Sertraline?
Sertraline's drug information includes a black box warning from the FDA (the most serious warning issued by the agency) due to the increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults suffering from major depressive disorder when taking the prescription drug. Patients with a diagnosis of major depressive disorder should be closely monitored while taking sertraline.
People who take certain types of medications known to cause dangerous drug interactions with sertraline, including monoamine oxidase inhibitors (MAOIs/MAO inhibitors) (particularly isocarboxazid, methylene blue, phenelzine, rasagiline, selegiline, linezolid, moclobemide, procarbazine, safinamide, and tranylcypromine), drugs that increase risk of bleeding or bruising such as clopidogrel, prescription or over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, blood thinners, other SSRIs like fluoxetine, citalopram, or paroxetine, St. John's wort, and certain SNRIs.
Other people may also be at risk when taking sertraline, so it is important to be careful and give a thorough medical history to your healthcare provider. Make sure to specifically note any personal or family history examples of:
- Bipolar disorder
- Hyponatremia (low sodium in the blood)
- Purpura (brownish-red or purplish discoloration of the skin)
- Liver disease
- Bleeding problems
- Mania or hypomania
Older adults may be at an increased risk of side effects when taking sertraline, especially as they pertain to bleeding, loss of coordination, or QT prolongation. Older adults are more likely to experience falls as a result of loss of coordination, and are more likely to develop a salt imbalance (hyponatremia) than younger people.