Sertraline (Zoloft): Uses, Dosage, Side Effects, and What to Expect

Sertraline (brand name: Zoloft) is a selective serotonin reuptake inhibitor (ssri). Sertraline works by blocking the reabsorption (reuptake) of serotonin in the brain, increasing the amount of serotonin available in the synaptic cleft. This enhanced serotonin signaling helps regulate mood, anxiety, and emotional processing. Sertraline is one of the most selective SSRIs, meaning it has relatively little effect on norepinephrine or dopamine reuptake compared to some other antidepressants.

• Major Depressive Disorder (MDD)
• Obsessive-Compulsive Disorder (OCD)
• Panic Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Social Anxiety Disorder
• Premenstrual Dysphoric Disorder (PMDD)

Common off-label uses:

• Generalized Anxiety Disorder
• Binge Eating Disorder
• Body Dysmorphic Disorder
• Premature Ejaculation

Adults typically start at 25-50 mg once daily, with gradual increases every 1-2 weeks. Therapeutic doses range from 50-200 mg/day. For OCD, higher doses (up to 200 mg) are often needed. Sertraline is usually taken in the morning with or without food.

Initial effects on anxiety and sleep may appear within 1-2 weeks. Full antidepressant effects typically take 4-6 weeks. OCD response may take 8-12 weeks.

• Nausea (especially during first 1-2 weeks)
• Diarrhea or loose stools
• Headache
• Insomnia or drowsiness
• Sexual dysfunction (delayed ejaculation, decreased libido)
• Dry mouth
• Dizziness
• Increased sweating

• Serotonin syndrome (when combined with other serotonergic drugs)
• Increased suicidal thoughts in young adults under 25 (FDA black box warning)
• Hyponatremia (low sodium, particularly in older adults)
• Abnormal bleeding (especially with NSAIDs or anticoagulants)
• Discontinuation syndrome if stopped abruptly

Sertraline should not be combined with MAOIs (wait at least 14 days between). Use caution with other serotonergic drugs (triptans, tramadol, St. John's Wort). Sertraline is a moderate inhibitor of CYP2D6, which can increase levels of some medications. It has fewer drug interactions than fluoxetine or paroxetine.

FDA Pregnancy Category C. SSRIs as a class carry small risks of neonatal adaptation syndrome and persistent pulmonary hypertension of the newborn (PPHN). However, sertraline has one of the lowest rates of placental transfer among SSRIs and is often considered when antidepressant treatment is needed during pregnancy. The decision should weigh risks of untreated depression against medication risks.

Taper gradually over 2-4 weeks to avoid discontinuation syndrome (dizziness, nausea, irritability, electric shock sensations). Sertraline has a shorter half-life than fluoxetine, making gradual tapering more important.