Zoloft Side Effects

Zoloft Side Effects:  Zoloft, generic name sertraline, is available in 25, 50 and 100 mg oral doses and as a 20 mg/ ml syrup.  Zoloft is one of several drugs used to treat depression, anxiety, obcessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD) and post-traumatic stress disorder (PTSD).   Zoloft side effects closely mirror the typical side effects of the whole class of medications known as selective serotonin reuptake inhibitors (SSRIs).  These drugs have been extremely popular since Prozac was introduced as the first in the class because they generally do not lead to the side effects common to almost all of the previously available medications used to treat these psychiatric disorders.  Zoloft side effects like those of the whole SSRI class generally do not include severe sedation, anticholinergic side effects and the generally drugged effects caused by the tricyclic antidepressants and the tetracyclic antidepressants.   See amitriptyline side effects for an example of the earlier medications.

Black Box Warnings:  Like all of the SSRI drugs Zoloft side effects that warrant the FDA black box warnings include the risk of suicidality.  Suicide risk is especially noted in adolescents and adults age <25 years old.  The risk of suicide in patients over 24 years old has not been shown, and the suicide risk in patients over 65 may be decreased with Zoloft use.  Zoloft is only approved for use in pediatrics for OCD.  Counseling parents and care providers to watch younger patients carefully and to communicate with the prescribing provider if change in behavior or concern for suicide is noted.

Common Zoloft Side Effects:  In most physicians practice the most common Zoloft side effects are sexual dysfunction and nausea.  The nausea is usually minor and often subsides after a few weeks on therapy.  The sexual dysfunction is most often orgasmic dysfunction, anorgasmia or delayed orgasm in women, and delayed ejaculation or inability to ejaculate in men.  Decreased libido is sometimes noted and erectile dysfunction is not commonly noted.  Common psychiatric Zoloft side effects include anxiety or nervousness,  insomnia, and somnolence.  Gastrointestinal Zoloft side effects commonly include nausea, diarrhea, dyspepsia, constipation and anorexia.  Tremor, headache, asthenia, rash and abnormal vision are also seen reasonably common as Zoloft side effects.

Serious Zoloft Side Effects:  Suicide, worsening of depression and mania (especially in undiagnosed bipolar disorder) are among the psychiatric serious Zoloft side effects.  Serotonin syndrome can be seen with Zoloft and tends to present with hypertension, sweating, and dehydration.  The list of serious potential but uncommon Zoloft side effects is long and includes neuroleptic malignant syndrome, withdrawal syndrome, seizures, hyponatremia, SIADH, altered platelet function leading to bleeding, acute closed angle glaucoma, priapism, hypoglycemia, and as with essentially all drugs serious anaphylactoid reactions.  In neonates whose mothers took Zoloft in late pregnancy side effects in the baby can include persistent neonatal pulmonary hypertension, neonatal serotonin syndrome and a neonatal withdrawal syndrome.   Consult the manufacturers prescriber information for more complete and detailed information on Zoloft side effects.

Cautions and Drug Interactions:  Caution is advised in patients under 25 years old, in the elderly, in patients with hepatic dysfunction, hyponatremia, dehydration, seizure disorder, excessive alcohol use or in bipolar patients with mania or a history of mania.  Also caution is advised for use in pregnant women past 20 weeks gestation. Zoloft is contraindicated in patients on non-selective MOA inhibitors, thioridazine and pimozide.  THe list of drugs where caution is advised is very long and only more commonly used drugs are listed here.  This list includes haloperidol, other drugs in the SSRI class, sibutramine, venlavaxine, St. John’s wort, and duloxetine.  Use should be monitored closely when Zoloft is used with thiazide diuretics, many anticonvulsants, beta blockers, opioids, NSAIDs, promethazine, trazodone and warfarin.  See the manufacturers prescribing information for a more complete list of known drug-to-drug interactions.

Pregnancy and Lactation:  Zoloft is pregnancy category C (see specific trimester risks in the manufacturers prescribing guidelines) and is felt safe in lactation.

Unusual Zoloft Side Effects:  The orgasmic dysfunction that is likely the most common Zoloft side effect is likely among the most unusual Zoloft side effect.   Hyponatremia and the odd syndrome of feeling off balance, empty-headed, and sometimes having electrical shock like symptoms are pretty unusual too.