Overview

Sertraline is available as sertraline hydrochloride (Zoloft), an antidepressant, in a tablet form and an oral solution.  Sertraline (Zoloft), like the earlier antidepressant fluoxetine (Prozac), works by enhancing the action of a brain chemical called serotonin. It belongs to the class of antidepressant drugs called serotonin reuptake inhibitors (SSRIs). This medication is prescribed to treat major depression, obsessive-compulsive disorder, panic disorders, social anxiety disorder, post traumatic stress disorder, and premenstrual dysphoric disorder.   

Although the FDA has not specifically approved its use for other purposes, doctors sometimes prescribe sertraline (Zoloft) to treat generalized anxiety, impulse control, and eating disorders.

People’s Pharmacy Perspective

Since the introduction of fluoxetine (Prozac) in 1987, the serotonin reuptake inhibitor (SSRI) class of antidepressants (citalopram-Celexa, escitalopram-Lexapro, fluoxetine- Prozac, fluvoxamine-Luvox, olanzapine plus fluoxetine-Symbyax, paroxetine-Paxil, sertraline-Zoloft) has been wildly popular with physicians, patients, and insurance companies.  Doctors believe SSRIs generally produce fewer side effects than traditional tricyclic antidepressants, though it is not clear whether there are fewer adverse events or just different ones. These drugs are perceived as less costly and time consuming than talk therapy, though a monthly prescription for a brand name SSRI-type antidepressant can cost more than $100.

The FDA now recognizes suicidal thoughts as a potential complication of virtually all antidepressant therapy for children, adolescents, and young adults (18-24 year olds) during the first few months of treatment and whenever there are dosage changes.  Why one would assume that suicidal thoughts would instantly stop at age 25 is a mystery to us. We think that anyone who is put on this type of antidepressant should be aware of the potential for violent, suicidal thoughts. Family members and friends must also be vigilant for any unusual changes and encourage immediate consultation with the prescriber.

When it comes to effectiveness, antidepressants can be helpful for some people, but trial and error may still be the only way to determine whether a given antidepressant is helpful.  There is no clear evidence that any one drug (including duloxetine-Cymbalta or venlafaxine-Effexor) is better than others.(1) There is also no clear data to demonstrate that these antidepressants are substantially better than placebo more than half the time.(2) More significantly, there is little evidence to show that they affect long-term outcomes or suicide rates.(3)

A recent review demonstrated that the medical literature is incomplete with regard to clinical trials. Favorable trials are published more frequently than trials showing no benefit beyond placebo.  As a result, doctors reading the published studies are likely to get a far more favorable impression of an antidepressant than may be warranted.(4)

For many, a long acting medication like fluoxetine (Prozac) is preferred for avoiding withdrawal symptoms (dizziness, nausea, insomnia, headache, sweating) experienced when stopping or switching from other antidepressants.  We have heard from many people that getting off drugs like venlafaxine-Effexor, paroxetine-Paxil or sertraline-Zoloft can be difficult.

The bottom line is that there are no “best choices” when it comes to antidepressants.  Patients must be open to trial and error when starting, be cautious to taper off antidepressants when ending or switching therapies, and constantly be under knowledgeable medical guidance throughout therapy.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention.  Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Special Precautions

There is increased risk of suicidal thoughts in children, adolescents, and young adults with major depressive or other psychiatric disorders especially during the first months of treatment with antidepressants.  Antidepressants are not approved for pediatric patients except for treating obsessive compulsive disorder.

Pregnancy/Breastfeeding:  Consult your prescribing physician and/or obstetrician if you are pregnant or planning a pregnancy, or will be breastfeeding while taking this medication.

Not recommended:  People who have had an allergic reaction to SSRIs, sertraline (Zoloft), or its components or who are taking the MAOI class of antidepressants (isocarboxazid-Marplan, phenelzine-Nardil, tranylcypromine-Parnate, selegiline-EmSam) or drugs with MAOI activity such as pimozide (Orap) or linezolid (Zyvox).  Potentially fatal interactions could occur between MAOI and SSRI antidepressants so MAOIs must be stopped for 14 days prior to beginning SSRI therapy and vice versa.

 Those who are on disulfiram (Antabuse) should avoid liquid sertraline (Zoloft) due to its alcohol content.

 Another potentially fatal drug interaction could result from taking another SSRI with sertraline. This may lead to serotonin syndrome. Patients taking sertraline should avoid other SSRIs such as escitalopram (Lexapro) or a SNRI antidepressant (duloxetine-Cymbalta, venlafaxine-Effexor, Effexor XR), St. John’s wort, tramadol (Ultram), and migraine medications (sumatriptan-Imitrex, Zolmitriptan-Zomig).  The doctor must be notified immediately if there are sudden changes in cognition (confusion, agitation, headache) accompanied by shivering, sweating, fever, increased heart rate, muscle twitching or tremor.

Carefully monitor:  For people who have bipolar disorder and have had an episode of mania, there is a risk that manic symptoms could be triggered by sertraline (Zoloft).  Anyone with a history of seizures or suicide attempts must also be extremely vigilant. Family members and other caregivers should help monitor people on sertraline for suicidal thoughts, self-destructive behaviors, panic attacks, impulsivity, aggressiveness, or other unusual changes in behavior or symptoms of worsening depression or anxiety especially in the early months of treatment and when the dose is adjusted. The doctor must be notified immediately in such cases.

  People with liver problems may need to start on a reduced dose, as they may eliminate Zoloft less efficiently than otherwise healthy people.  Be certain to inform your doctor of any other conditions you may have as it may affect your dose, whether you should even take this medication, or require you to take special tests during treatment.

Taking the Medication

Sertraline (Zoloft) tablets should be taken with a full glass of
water roughly at the same time each day (to help you to remember to take it), with or without food.  

Stopping the Medication

It may take up to 4 weeks or longer before effects are felt.  Do not stop or change doses suddenly without first talking with your doctor.  If sertraline (Zoloft) is abruptly discontinued, withdrawal symptoms such as irritability, agitation, dizziness, electric shock sensations, anxiety, headaches, and increased manic episodes may occur.  Discontinuation is usually handled with a gradual reduction in dose.

Common Side Effects

•    Dizziness, drowsiness, nausea
•    Dry mouth, appetite changes
•    Sexual difficulties, changes in sex drive

Serious Side Effects

Call for emergency help if you have these signs of a potential allergic reaction:
•    Difficulty breathing, swelling of the face, throat, lips, or tongue, skin rash or hives.

-Call your doctor promptly if you have any of these serious side effects:  
•    Seizure (convulsions)
•    Serotonin Syndrome (rare, but potentially fatal condition in which serotonin levels are elevated to toxic levels by the action of a single or a combination of medications):
•    Uncontrolled muscle twitching, tremors, stiffness, or shivering
•    Fast heart rate, unusual sweating, fever
•    Agitation, confusion

There may be other side effects not listed here. Talk to your doctor if your condition worsens and about any side effect that seems unusual or is especially bothersome.

Drug Interactions

I.  DO NOT TAKE WITH sertraline (Zoloft):                                       
The following drugs have additive effects to SSRIs, so may increase the risk for serotonin syndrome, a (rare, but potentially fatal condition in which serotonin levels are elevated to toxic levels by the action of a single or a combination of medications):
•    Migraine medications: sumatriptan (Imitrex), zolmitriptan (Zomig), and others
•    Tramadol (Ultram), Lithium
•    All other antidepressant drug classes:  SNRIs (duloxetine-Cymbalta, venlafaxine-Effexor, Effexor XR), SSRIs (escitalopram-Lexapro, fluoxetine-Prozac, etc.), tricyclics (nortriptyline-Pamelor, protriptyline-Vivactil)
•    MAOI antidepressants; drugs with MAOI like activity: Phenelzine (Nardil), isocarboxazid (Marplan),  tranylcypromine (Parnate),  selegiline (EmSam) and linezolid (Zyvox).  These need to be stopped at least two weeks prior to starting sertraline (Zoloft). If sertraline is taken first, two weeks should elapse before starting on one of these other medicines as potentially fatal side effects could occur.
•    Pimozide (Orap):  increases risk of fatal cardiac complications.
•    Sibutramine (Meridia):  not recommended by manufacturer.  Use only under close medical supervision, particularly for signs of serotonin syndrome, since effects are additive to sertraline (Zoloft).
•    Muscle relaxers and cold, pain, anti-seizure, anti-anxiety and antidepressant medicines that could make you sleepy should also be avoided. 
•    Alcohol: increases drowsiness and dizziness 

II. TAKE with CLOSE MEDICAL MONITORING

•    Propafenone (Rythmol):  Certain SSRIs, including sertraline (Zoloft), may increase the level of this drug, so cardiac function should be carefully monitored.  Or, use an alternate antidepressant, such as citalopram (Celexa).

III. DOSE ADJUSTMENT may be required

•    Clozapine, risperidone, cyclosporine, seizure medications (phenytoin-Dilantin, ethotoin-Peganon), propafenone (Rythmol):  The dose of these drugs may need to be adjusted if they are taken with sertraline (Zoloft).
•    Cyproheptadine:  This antihistamine/allergy medication may block the activity of SSRI antidepressants, so its discontinuation may be advised if antidepressant effects seem blunted or the sertraline (Zoloft) dose may need to be adjusted.
•    Carbamazepine (Tegretol): Decreases effectiveness of sertraline (Zoloft), so sertraline dose may need to be adjusted.
•    Aspirin, ibuprofen, naproxen, diclofenac (Voltaren), etodolac (Lodine) warfarin (Coumadin) or other drugs that affect blood clotting:  Drugs that interfere with serotonin reuptake and these agents have been associated with an increased risk of abnormal bleeding, so the dose of these agents may need to be adjusted.

 Other Interactions
•    St. John’s wort (5):     Avoid taking the herb St. John’s wort with sertraline (Zoloft), since the effects are additive and could lead to serotonin syndrome. Switching between antidepressants and herbal treatment calls for medical guidance (physicians can find a suggested protocol for gradual substitution of St. John's wort in Hyla Cass's book, St. John's Wort: Nature's Blues Buster).
•    Grapefruit Juice (6):  Avoid taking sertraline (Zoloft) with grapefruit juice as this may result in elevated drug levels in the bloodstream.

There may be other herbal and dietary supplement or food interactions not listed here.  We are concerned for instance, about the potential for bleeding with herbs that may affect coagulation (Ginko biloba, etc).  Check with your doctor and pharmacist before taking any other supplements or over the counter medications to make sure you are aware of the risks the combination may carry.

References
1.  Khan, A. and Schwartz, K.  “Study Designs and Outcomes in Antidepressant Clinical
     Trials.”  Essent. Psychopharmacol.  2005;6:221-226.
2.    Moncrieff, J. and Kirsch, I.  “Efficacy of Antidepressants in Adults.”  BMJ  
2005;331:155-159.
3.    Rubinow, D.R. “Treatment Strategies After SSRI Failure—Good News and Bad News.”  N. Engl. J. Med. 2006;354:1305-1307.
4.    Turner, E. H., et al.  “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy.” N. Engl. J. Med. 2008; 358(3):252-260.
5.  Lantz MS, et al. "St. John's wort and antidepressant drug interactions in the elderly." <
em>J
    Geriatr Psychiatry Neurol. 1999;12:7-10. PubMed
6.  Lee AJ, et al. "The effects of grapefruit juice on sertraline metabolism: an in vitro and in vivo study." Clin Ther. 1999;21:1890-1899.

Be certain to consult a physician about your health, especially with regard to any signs or symptoms that may require diagnosis or medical attention.  Information provided is not a substitute for the medical advice or care of a physician or other health care professional.

Join Over 55,000 Subscribers at The People's Pharmacy

Each week we send two free email newsletters with breaking health news, prescription drug information, home remedies and a preview of our award-winning radio show. Join our mailing list and get the information you need to make confident choices about your health.

  1. Deborah
    Reply

    Brand name Zoloft works but Greenstone sertraline did not work AND caused problems. Zoloft costs a great deal more than the generic but I have to take the brand name.

  2. SRG
    Reply

    I’m having the same exact problems with my new prescription. Its the greenstone generic. How long before the stomach pain went away???????? I stopped taking it immediately as the pain was VERY bad. Have you tried Zoloft?? I used zoloft in the past and had NO problems of any kind with it. and now this???

  3. Hasan
    Reply

    This is the first time I’ve taken antidepressant medications and my Dr. prescribed Asentra/Sertraline for me but when I took the first pill I had a burning feeling in my stomach, esophagus and throat plus having problems in balance. I lost my appetite and it’s like my stomach is inflamed. Now, after about 15 hours I still feel my stomach is enlarged and then although I get hungry but I can not finish my normal meal.

  4. M.J.
    Reply

    After having been on Sertraline in the past (with little side effects but no real mood improvement), I wanted to try the drug again. This time around (three months ago), Walgreens gave me the Northstar generic. It was horrible! I asked myself, how could two generics of the same drug be so different? The answer is simple: they can be and they often are! That is, judging from personal experience. Due to the side effects, I was forced to quit the med. Thereafter, I gave generic Effexor and Prozac a try with no real success. I am going back on Sertraline but will never take Northstar or Teva (bad experiences also), again.
    People forget that many of these generics are manufactured in countries like Israel (Teva) or India where the FDA does not have the same type of influence as it does in the U.S. Although the FDA claims to inspect these international facilities regularly, there is clearly something to all of the claims regarding generic drug problems versus their brand name counterparts, particularly regarding anti-depressants. I assume there are many generics that work as well as brand drugs, but not so with most anti-depressants for some reason. On a side note, I recently received a $4 co-pay card for brand Zoloft in the mail and will go that route if I have to. In the end, it’s worth it.

  5. Sara
    Reply

    I don’t mind taking generics, I can’t afford the brand names, but their efficacy varies so widely it’s frustrating. I’ve been on the Walgreen’s Greenstone sertraline for a few weeks now and I am feeling better. Camber made me dizzy, gave me tremors and only worked at about 50% efficacy compared to the dosing of other generics on depression & anxiety. Hopefully I will be able to get the Greenstone one for years to come.

  6. Tara
    Reply

    I agree too. I switched to generic Lupin for Zoloft. I started to feel badly. I would not recommend to anyone using generic medicine in mental health!

  7. Sara
    Reply

    In December I transitioned beautifully from Effexor XR to Northstar sertraline from Target. I continued to take Northstar sertraline in January. When I switched my rx from Target to CVS in February they gave me the Camber sertraline, after a week I started feeling more depressed, my p-doc doubled the dose and that kept me from sinking farther but did not have the same wonderful effects as the Northstar sertraline at the lower dose (huge reduction in anxiety and depression). In March I switched back to Northstar sertraline from Target. It’s time to refill now, in April, and Target has also switched to Camber! So has Walmart. So I am frantically trying to find Northstar or another sertraline that is also effective for me.

  8. LT
    Reply

    Thank you all for your comments and thoughts. This website has been such a comfort this past year to learn of other people’s experiences w/zoloft/zoloft generics. I’d like to share my experience and see if anyone might know Zoloft (I use the Greenstone generic) works over time, as well as when one weans oneself off of it.
    I took 50 mg of Zoloft for about seven months, and after the first couple of weeks felt much better. Then I dropped to 25 mg for about a month. After something had happened in my life, I increased again to 50 mg thinking I might need the higher dosage. The funny thing is though, I started to feel worse. In January of this year (after taking Zoloft for about 11 months), I was feeling very bad, and very tired. It was as though Greenstone (the manufacturer of my generic) had changed the formulation or labs that makes their drugs.
    Anyway, after contacting Pfizer with the simple question to see if they had changed anything in their formulation and not getting a response from them, I dropped from 50 mg to 25 mg and IMMEDIATELY started feeling better. About a month after that, still feeling a little tired, I dropped to 25 mg every other day. Again I started feeling better. It’s as though at this point the less Zoloft I take the better I feel.
    I’m now down to 25 mg ever three days. Interestingly, it’s the morning after taking the zoloft (I take it at night), that I feel the worst! Does anyone know why this would be? Do your neurotransmitters get full and then the drug has an opposite effect, ie, no longer makes you feel better, but actually makes you feel worse?
    Thank you in advance for any thoughts you might have. Best wishes to everyone and Happy Easter!

  9. Temporal_Anonymous
    Reply

    > Generics
    It could be the case. I mean, I’ve been taking 100mg of sertraline twice daily for the past two or three years. However, last Thursday (03/07/2013) I switched from Greenstone to Northstar. I know that, partly from imagination, the Northstar sertraline does not seem to be as effective as the Greenstone version. I’ve been feeling dazed, nausea, hypomanic, aggressive, dizzy, and anxious.
    See, here is the funny thing about generics: the active ingredient needs to be FDA approved. Inactive ingredients (polymers, dyes, starches, etc.) are not subject to regulation. In addition, some of these generic medications are made in places that lack proper heating/air conditioning. Like with foods, excessive heat and/or cold may damage the medication, making it less effective. For example, the pharmaceutical powerhouse GlaxoSmithKline has a manufacturing plant in India (http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_India). I doubt that any sensitive product could make the journey from India to America (I’m just assuming you live here; please forgive me if I am incorrect) unscathed.
    So here’s my solution: Find out what company manufactured your sertraline. Once you do that, see if your pharmacy can special order it. I don’t know what pharmacy you obtain your medication from, but I suspect that they would be able to acquire it. The only problem with this is insurance. You’d have to check, but I would think that your insurance provider wouldn’t fully cover it. Still though, it’s worth a shot.
    Anyway, I hope this helps you out! Stay strong!

  10. ccgramm
    Reply

    The generics seems to vary quite a bit. The original insert said SSRIs do not create dependency and there is no withdrawal effect. This of course was not true. Given the nightmare of w/d from Paxil, et. al. — the total inadequacy of manufacture or FDA warning about this devastating aspect of these drugs,it may be prudent to question everything that the manufacturers have ever said about this class of drugs.
    It may be that not only is a huge dependency created, but that the dependency is to the particulars of a brand, and that this is the reason for differences in efficacy.
    Also, SSRIs have a well known “poop out” effect–meaning they all decline in effectiveness over time.

  11. LT
    Reply

    Hi Sam,
    Yes, a decline in the quality/efficacy of the Greenstone generic. I feel like the quality has deteriorated, it’s effects are almost like those I experienced using the Lupin pharmacy product. I feel better when I DON’T take the pills!! : )

  12. Sam
    Reply

    Hi, LT –
    Just to be perfectly clear, you’re talking about a declining efficacy of the Greenstone generic, not a switch *to* Greenstone generic, right?

  13. LT
    Reply

    Hello,
    Has anyone noticed any changes to the efficacy of the Greenstone Sertraline general 50mg?
    Thank you very much!

  14. Truth Seeker
    Reply

    Zoloft is a terrific help to me. I have suffered with anxiety since childhood with ebbs and flows. I finally got on an antidepressant in my forties. However, being a person who is desirous of no medications, if at all possible, I got off. I made the disastrous mistake of getting a family practice doctor to prescribe an antidepressant during one of the flows when I was experiencing acute anxiety. When I found no relief, I got off too quickly and asked for a different seratonin uptake inhibitor.
    The doctor complied with that and also gave me a prescription for my lack of sleep. When nothing worked to relieve my anxiety and I lacked sleep and I could not get in to see a psychiatrist for weeks and I was reeling from getting on and off of prozac and lexapro, I took an overdose in desperation. Long story short, it was not God’s timing for the end of my days. With hospitalization, support from loved ones, therapy, exercise and submission to a good and wise psychiatrist, I am very healthy and blessed.
    I tell all this story in order to urge others to not take treat medications with any lack of respect. Submission to a doctor who has mental health expertise is important. I am only on 50 mg. of Zolofft and was on multiple times stronger meds at my worst point. It was a slow uphill climb from that low point but there is help available and I rejoice that it was there for me. I do not care to wean off and really only will if my doctor advises me that way.

  15. becca
    Reply

    do you mean Camber?

  16. becca
    Reply

    After reading these posts I now believe I know what happened when I was switched to Camber brand Zoloft after many years on Northstar. I went into full SSRI withdrawal. When taking the camber brand results in nausea –it’s a symptom of withdrawal from SSRIs. Finally there is awareness of ssri dependence and severe withdrawal, contrary to the manufacturers insistence that there is no dependence cased by SSRIs. That’s a big fat lie.
    In 2004 there was a large settlement awarding those who suffered from Paxil withdrawal. But it was one of the many big pharma closed door settlements that received little publicity. Paxil Plaintiffs got big cash settlements in return for verdict of no drug company liability. Those million dollar secret settlements are a tiny cost of doing business for big pharma. I have tried many times to withdraw from zoloft but the harrowing withdrawal effects have been too disabling. So I know well the withdrawal effects and I am certain that taking the Camber brand of zoloft after many years on a different generic is why I went into withdrawal.
    As we know, many generic drug maker facilities around the world have been shut down due to shoddy conditions. Whether the Camber brand has the active ingredient or not, the fillers or the way its suspended in the pill caused me great harm. I also believe that after one has been on a particular generic of sertraline for a long time that the dependency created is a dependency to the particular action of the specific generic one takes and that is why people can’t just switch generics without devastating results.
    The managers of FDA are former pharmaceutical company employees. It is indeed the fox guarding the hen house.

  17. becca
    Reply

    by “camden” do you mean Camber brand of Zoloft?

  18. becca
    Reply

    Northstar

  19. becca
    Reply

    yes. I had severe effects from Camber sertraline. It put me into full ssri withdrawal.

  20. AP
    Reply

    Amen!

  21. AP
    Reply

    I am so sorry! I threw up for two weeks, but prob from the panic attacks. I am on a different generic (greenstone) everyone seems to like.

  22. MR
    Reply

    Does anyone else get severe nausea (as in, I throw up every time I take my medicine) from the Camden generic of Zoloft? I am so frustrated!!!

  23. LT
    Reply

    Zoloft can be really helpful (18 years on it!). However, it does kill emotional life and sex drive at certain doses. Tried going off twice, and too much anxiety/fear, etc, so went back on. But when I went off last time and back on (maybe 5 years ago) when I went back I was more or less aware of where to stop the dosage so that I wouldn’t be numbed emot. or sexually. That dose is 50 mg for me. I remember going back on it, as it was kicking in, I was crying, and thanking God for the med! I have to have something, but I don’t need super high does. Would they help me ‘function’ better, etc. Probably most likely. But I need my emotions, libido, etc. to feel human. I love that part of life too!
    So all in all in, Zoloft has been very good for me. However, right now, August 2012, I read about some research that they are not connecting it to bone loss! I am 66 and have bone loss. So now I am going to go off it. Also had began to get more depressed, but did not want to up Zoloft for reasons stated. Am starting on Cymbalta, very low doses, except I feel ‘weird’ on it also, spacey, and I know that can lower libido also, but as get lower on the Zoloft, my sex drive is coming back. That part feels good, to feel alive and human! I’m not sure about the Cymbalta, I feel spacey, etc. Time will tell. But overall, my experience with Zoloft was very positive, at low doses it did what I needed. Thank you.

  24. Elizabeth
    Reply

    My mother was prescribed sertraline 100mg. She took it for 5 days then died. She was 69 years old with no known heart disease or high blood pressure. We are still awaiting the detailed toxicology report. Right now the coroners report states “accidental”. This happened in May.

  25. mary
    Reply

    I think your Doctor prescribing it should know.

  26. julie h.
    Reply

    I take 300 mgs of Zoloft per day. I’m wondering if there are certain organs in the body that could be hurt from taking such a large dose?

What Do You Think?

Share your thoughts with others, but be mindful of protecting your own and others' privacy. Not all comments will be posted. Advice from web visitors is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. In posting a comment, you agree to our commenting policy and website terms and conditions.