How Zoloft (Sertraline) Works

Interactions, Side Effects and Cautions

Pfizer antidepressant drug Zoloft is arranged at Skenderian. Credit: Bloomberg / Contributor / Getty Images

Zoloft (sertraline) is a selective serotonin reuptake inhibitor (SSRI). Although it is most commonly used to treat depression, obsessive-compulsive disorder (OCD), panic disorder and post-traumatic stress disorder (PTSD), Zoloft is sometimes prescribed for social phobia and other phobias.

How SSRIs Work

SSRIs are known as second-generation antidepressants since they are newer than monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

 SSRIs work by slowing the reabsorption of serotonin in the brain. Serotonin is a chemical neurotransmitter, which transmits electrical impulses from one neuron to the next. Normally, serotonin is quickly reabsorbed, but an SSRI lets the serotonin remain in the synaptic gap between neurons for a longer period of time. This allows the chemical to send additional messages to the receiving neuron, which in turn is thought to boost mood.

Taking Zoloft

Zoloft is available in a variety of strengths and is only sold by prescription. Both liquid and tablet forms of the medication are available.

Like all medications in its class, Zoloft does not perform optimally until you have taken it consistently for several weeks. You may or may not begin to feel the effects more quickly. Talk to your doctor if you have any concerns.

Drug Interactions

Avoid the liquid formulation of Zoloft if you are on Antabuse (disulfiram) because it contains alcohol.

Wait at least 14 days after your last dose of any MAOI before beginning sertraline treatment.

Zoloft interacts with a wide range of natural remedies. Ask your doctor before taking tryptophan, St. John's wort, or any other herbal or natural formulation.

In addition, Zoloft interacts with numerous prescription and over-the-counter medications, including NSAID pain relievers, diuretics, stomach medicines, blood thinners and treatments for certain mental illnesses.

Provide your doctor with a full list of all over-the-counter, prescription and natural products you use, and do not add anything new without your doctor's approval. Avoid alcohol and illegal drugs while using sertraline.

Cautions When Using Zoloft

Since 2005, all SSRIs have carried "black box" warnings from the FDA regarding a higher risk for suicidal ideation and behavior in children. The FDA expanded its warning in 2007 to include young adults under the age of 25. Although many young people successfully take these common medications, informed consent is important. Discuss the benefits and risks with your child's doctor before making a decision.

Your risks from Zoloft may be higher if you have certain medical conditions, including diabetes, low blood sodium levels, seizures and liver disease. Give your doctor a full medical history of all current and previous illnesses. Also let your doctor know if you have a history of drug abuse.

If you are currently breastfeeding or pregnant, or if you plan to become pregnant, discuss the risks and benefits of treatment with your physician.

Zoloft Side Effects

Like all medicines, Zoloft carries a risk for side effects. Common side effects such as headache, sleep difficulties, dry mouth, sweating and loss of appetite are typically mild and may subside in a few days or weeks.

Let your doctor know right away if you experience more severe side effects such as chest pain, skin rash, vomiting, anxiety, diarrhea, aggression or confusion.

SSRI Discontinuation Syndrome

All SSRIs, including Zoloft, carry a risk for a collection of withdrawal symptoms known as SSRI discontinuation syndrome. Common symptoms include odd electrical sensations known as "brain jolts" or "brain zaps," dizziness and headaches. Although the syndrome is not generally considered dangerous, the symptoms can be distressing, so do not lower your dose or suddenly stop taking Zoloft without your doctor's approval.

Sources:

Mayo Clinic. SSRIs. Retrieved February 27, 2013 from http://www.mayoclinic.com/health/ssris/MH00066

"Sertraline." PubMed Health, U.S. National Library of Medicine (2016).

Roy-Byrne MD, Peter. "SSRIs and Suicide Risk: A Concern for Adults, Too?" Journal Watch Psychiatry. March 9, 2005. Retrieved February 27, 2013 from http://psychiatry.jwatch.org/cgi/content/full/2005/309/1

"Sertraline (Zoloft)." National Alliance on Mental Illness (2013). Retrieved April 10, 2016.

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