The prescription has been picked up, the first pill is waiting on the kitchen counter – and the questions have already started.
Can I take it after the morning coffee? Will I still feel like having sex? Will I feel even worse before I begin to feel better? Will I have to take it for the rest of my life?
These are the answers I would hope to find before jumping into sertraline.
1. What is sertraline?
Sertraline is an SSRI antidepressant and goes by the brand name Zoloft.
SSRIs work by affecting serotonin signaling in the brain – but don’t expect a happy pill or a sedative, which is why their effects often appear gradually with regular use.
2. Is it only used for depression?
Not exclusively – sertraline is also prescribed for OCD, panic attacks, PTSD, social anxiety and premenstrual dysphoric disorder.
The dosages may also vary, depending on the condition: for example, treatment for OCD often requires a longer course of treatment and/or higher dosages than depression.
3. When will I see a difference?
Not tomorrow.
Improvements in sleep patterns and anxiety often appear after a week or two of treatment, while changes in mood or sex drive usually take about a month. Treatment for OCD may require more time before any improvement is noticed.
On the other hand, mild side effects may also show up – and those tend to come sooner than any positive changes.
4. Why am I feeling so bad after starting it?
The most common side effects in the first week include nausea, restlessness, diarrhea, headache or being generally unsettled – with anxiety flares also being common.
Most of these resolve on their own after a week or two, but if you are having trouble sleeping, experience severe panic attacks or feel significantly worse overall, it’s a good idea to contact your prescriber. You won’t win any awards for toughing it out in such cases.
5. Should I take it in the morning or the evening?
It depends on how your body reacts to the drug.
If sertraline leaves you feeling tired, it may be a good candidate for evening use – on the other hand, if it stimulates you, it’s best to take it when you wake up. Allow at least a week or two before changing the timing, but avoid switching between morning and evening doses on a day-to-day basis.
6. Should I take it with food?
It isn’t mandatory, but doing so can reduce the risk of some side effects during the first few weeks.
In general, it’s a good idea to avoid very greasy food around the time of the dose – a meal after taking the tablet is often safer than a coffee before taking it on an empty stomach.
7. Can I expect diarrhea?
Unluckily, yes – sertraline has a reputation for irritating the digestive tract, especially during the first month of treatment.
Loose, watery stools are common, but they usually resolve after a couple of weeks. If they become profuse, persistent, or bloody, it’s important to see a doctor, as this points towards a more serious condition, such as severe dehydration.
8. Will it affect my sex drive?
Possibly – both men and women report loss of interest in sex while on sertraline, but the effects aren’t universal.
For some people, achieving an orgasm becomes significantly harder or takes much longer than usual. Men may also find that they have trouble maintaining an erection or having regular orgasms. These changes are common enough to be worth discussing with your prescriber – our guide to Zoloft and erectile dysfunction has more information.
9. Can it make me fat?
It can – but it doesn’t necessarily have to.
Weight gain is possible, especially later in the treatment, but many people report initial loss due to sertraline-induced nausea. Appetite often returns as depression lifts, unless the side effects persist, and long-term changes are highly individual.
10. I forgot to take a dose – what should I do?
Take it as soon as you remember, unless you’re close to the next dose – in which case, it’s better to simply wait.
Never make up for a missed dose by taking an extra tablet, as doubling up can cause potentially dangerous side effects.
11. Can I drink alcohol while on sertraline?
Alcohol is best avoided in the short term until you see how your body reacts to the combination.
Drinking while on sertraline can cause stronger intoxication, impaired coordination, and worse depression or anxiety the following day, depending on the dosage and your personal tolerance. Some people can have a drink without issue, while others will always feel ill after even a small amount.
12. Why do I feel so tired all the time?
Sertraline can cause fatigue, especially during the first weeks of treatment.
Depression itself can also leave you exhausted – so it’s important to take note if you feel sleepy during the day. Taking the dose in the evening instead of in the morning may help, but it’s best to discuss any changes with your prescriber first. If the tiredness persists, investigate other causes such as sleep apnea, anemia, or other conditions.
13. It’s keeping me awake – what can I do about it?
Move the dose to an earlier part of the day and cut out caffeinated drinks in the afternoon.
It’s a bad idea to drink an energy drink at 4 PM on a Friday if you’re already struggling to fall asleep – in more serious cases, contact your prescriber. Don’t simply add a sleeping tablet to your daily regimen without talking to your doctor first.
14. How much should I be taking?
Most adults start on either 25 or 50 mg of sertraline per day – with higher dosages (up to 200 mg) being reserved for particularly severe cases.
The right dose for you is the one allowing the best control of your symptoms while causing the fewest side effects.
15. Does a higher dose make it work faster?
No – higher dosages simply cause more and stronger side effects without accelerating improvement.
Sertraline is a drug with a long half-life, meaning that larger doses are spaced out so the body can tolerate them.
16. Is sertraline addictive?
Sertraline isn’t a narcotic, and doesn’t typically cause craving or abuse.
On the other hand, your nervous system can become partially dependent on the drug, which is why sudden cessation can cause withdrawal side effects such as anxiety, dizziness, nausea, vivid dreams, or strange sensations akin to electric shocks running down the spine. Your prescriber should be able to help you wean off the drug gradually.
17. Can I stop taking it if I don’t like it?
Talk to your prescriber and make an organized plan to discontinuous sertraline.
Even short-term use requires a tapering schedule – so it’s always better to ask.
18. What other drugs should I be careful about while on sertraline?
Avoid any MAOI antidepressants, as they can have dangerous interactions with SSRIs in general and sertraline in particular.
Other serotonin-affecting medications to avoid include tramadol, lithium salts, some migraine drugs, and St. John’s Wort extracts.
NSAIDs such as aspirin, ibuprofen, naproxen and blood-thinning medications can also be harmful – always check with the pharmacist before taking any other medications or supplements.
19. What is serotonin syndrome?
Serotonin syndrome is a potentially dangerous condition caused by abnormally high levels of serotonin in the brain.
It causes agitation, sweating, diarrhea, fever, tremor, stiff muscles, altered mental state, and an increased heart rate – among other symptoms. It typically develops due to a drug interaction or a dosage error rather than normal use of sertraline.
Serotonin syndrome is a medical emergency and requires immediate care.
20. When should I seek emergency medical help?
Suicidal or impulsive thoughts, severe agitation, hallucination or sudden manic episodes (where the patient feels elated and energetic even when nothing has happened to cause such a state) require immediate care.
Difficulty breathing, facial or throat swelling, an epileptic seizure, or a widespread rash also require emergency intervention. Young people, in particular, should be under close observation during the first few weeks after a dosage change or the initiation of treatment.
Zoloft can be a powerful ally in the fight against depression, but the early days are often fraught and full of unwanted side effects. Keeping a short diary of your condition will help you get the most out of the treatment – instead of asking vague questions such as “how did everything go this month?”, you’ll be able to provide specific details about your sleep and mood.
