Zoloft for anxiety: Is Zoloft good for anxiety and when does it start working?

Zoloft for anxiety | Dosage | How long does it take Zoloft to start working? | Side effects | Warnings | Interactions | Alternatives

Living with anxiety can make daily life difficult. Fortunately, there are many treatment options available for anxiety that can help people find relief from their symptoms. Zoloft is one medication that may help. In this guide, we’ll explain to you what Zoloft is and how to take it for anxiety.

Taking Zoloft for anxiety

Anxiety is a prevalent condition that affects people all over the world. An estimated 31% of all adults will experience an anxiety disorder at some point in their life, and SingleCare’s anxiety survey found that 62% of respondents experienced some degree of anxiety. Zoloft is the brand name of a generic medication called sertraline. It’s a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) that treats anxiety by slowing down the reabsorption of serotonin. Zoloft treats several mental health conditions:  

• Social anxiety disorder
• Panic disorder
• Depression (also known as major depressive disorder) 
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Premenstrual dysphoric disorder

Zoloft may treat anxiety if psychological treatments, like cognitive behavioral therapy, aren’t working or if your healthcare professional/psychiatrist thinks it will improve your quality of life in combination with other methods like therapy. 

What’s the right Zoloft dosage for anxiety?

The right dosage of Zoloft for anxiety varies by the severity of anxiety and whether the patient has other medical conditions. In general, though, the initial therapeutic dosage of Zoloft for anxiety is 25 mg or 50 mg per day.  

Zoloft tablets are available in three dosage strengths: 25 mg, 50 mg, and 100 mg. The maximum dose of Zoloft is 200 mg per day (which can be taken as two 100 mg tablets).   

Most studies suggest that the most effective dose of Zoloft is 50 mg per day. This dose is proven to be the most effective and tolerable dose for most patients. People who don’t respond to 50 mg per day may be advised by their doctor to increase their dose of Zoloft by 50 mg per day at weekly intervals to a maximum of 200 mg per day. For example, a doctor might recommend taking 50 mg daily for one week, then 100 mg daily for one week, etc. Always follow your healthcare provider’s instructions for use—and only change doses under the guidance and direction of your provider. Do not initiate dosage changes on your own. 

Zoloft is also available in liquid form as an oral solution. The oral solution comes as a clear, colorless solution with a menthol scent that contains 20 mg of sertraline per mL, at 12% alcohol. It comes in a 60 mL bottle with a calibrated dropper with 25 mg and 50 mg measuring marks. Zoloft oral solution must be mixed (just before taking) into 4 ounces (one-half cup) of water, orange juice, lemonade, ginger ale, or lemon or lime soda before consumption.   

Always follow your healthcare provider’s instructions for use and do not change the dose of Zoloft on your own. Symptoms of a Zoloft overdose may include seizures, coma, heart problems, high blood pressure, and serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition that can occur from the buildup of excess serotonin and requires emergency medical attention. If you think you overdosed on Zoloft, you can call Poison Control at 1-800-222-1222, but if your symptoms seem severe or life-threatening, you should call 911 and go directly to the emergency room. 

When does Zoloft start working for anxiety?

Zoloft doesn’t work immediately, so don’t stop taking Zoloft if your symptoms don’t improve right away. It takes two to six weeks to start reducing anxiety symptoms. Some people may feel a reduction in their anxiety symptoms within the first week of taking Zoloft, but this shouldn’t be expected for everyone. 

How does Zoloft make you feel?

According to the National Alliance on Mental Illness, some of the earliest signs that Zoloft is working are improvements in sleep, energy, or appetite. These improvements could happen one to two weeks into taking the medication. 

More significant changes, like feeling less depressed or regaining interest in daily life, may take six to eight weeks to occur. Over time, many people will notice a substantial difference in their anxiety symptoms, and some people may eventually have no symptoms at all.

Side effects

Here are the most common side effects of Zoloft you may experience when you start taking it: 

• Dizziness 
• Loss of appetite
• Lightheadedness 
• Dry mouth
• Nausea
• Diarrhea
• Increased sweating
• Restlessness
• Sexual side effects like sexual dysfunction
• Fatigue
• Trouble sleeping
• Nervousness 

Some side effects may be more noticeable at first, but then disappear as your body gets used to the medicine. 

Sexual side effects

Sometimes, individuals who take an antidepressant like Zoloft may experience sexual side effects. In men, symptoms may include delayed ejaculation, decreased sex drive, and/or problems getting or maintaining an erection—and in women, decreased sex drive and problems having an orgasm. Patients who are experiencing sexual side effects should consult their healthcare provider. Although it may feel uncomfortable to talk about these issues with your prescriber, it is very common and there are solutions available. 

Serious side effects

Although it’s rare, Zoloft may cause more serious side effects like unusual weight loss, low sodium blood levels, increased risk of bleeding (especially when combined with certain drugs like blood thinners or NSAIDs), seizures, and serious allergic or skin reactions. 

Serious allergic or skin reactions

While rare, having a serious allergic or skin reaction can be life-threatening and cause death. People with symptoms of an allergic reaction (hives, difficulty breathing, swelling of the face, lips, tongue, or throat) should get emergency medical help right away. Likewise, those with symptoms of a serious skin reaction (hives, blistering or peeling skin, red or purple rash, fever, burning eyes, sore throat) should seek emergency medical attention. 

Increased risk of bleeding

SSRI drugs, including Zoloft, can increase the risk of bleeding (which may range from mild to life-threatening), especially when taken with certain other medications. Examples of these medicines include:

• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as Celebrex (celecoxib), Mobic (meloxicam), or Motrin (ibuprofen)
• Anticoagulants such as Coumadin (warfarin)
• Antiplatelet drugs such as Plavix (clopidogrel)

Patients should discuss all the drugs they take with their healthcare professionals before taking Zoloft. This includes prescription and OTC drugs, vitamins, and supplements.

Warnings

Zoloft also comes with a black box warning for suicidal thoughts and behaviors. A black box, or boxed, warning, is the strongest warning required by the US Food and Drug Administration (FDA). Short-term studies have shown that antidepressants increased the risk of suicidality in children, adolescents, and young adults compared to a placebo. However, people of any age who take Zoloft should be monitored, so seek medical advice right away if you’re taking Zoloft and start to have mood changes and/or suicidal thoughts or behaviors.

Contraindications

Zoloft is not safe for everyone. Zoloft should not be used in:

• People who are allergic to sertraline or any SSRI medication such as Paxil (paroxetine), Prozac (fluoxetine), or Lexapro (escitalopram)
• People who have taken an MAOI drug in the last 14 days
• People with moderate to severe liver problems (Child-Pugh Class B-C)

Additionally, Zoloft should never be stopped abruptly (with few exceptions, such as in the event of a life-threatening reaction). When it is time to stop taking Zoloft, the healthcare professional will provide a tapering schedule so that the medication is stopped safely and slowly, over a period of time. Stopping Zoloft abruptly can cause withdrawal symptoms such as nausea, sweating, vertigo, shock sensations, confusion, sleep problems, and seizures. 

There are also certain instances when Zoloft may be used with caution and close monitoring. Before taking Zoloft, tell your prescriber about all of the medications you take and all of your medical conditions, especially if you:

• Consume alcohol
• Are at risk of bleeding
• Have liver problems
• Have mental health conditions or a history of mental health conditions
• Have glaucoma
• Have electrolyte abnormalities
• Have (or have a history of) heart or heart rhythm problems 
• Have a history of seizures 

Interactions

Talk to your doctor about how to take Zoloft if you’re taking any of the following medications:

• Other medications that increase serotonin because of the risk of serotonin syndrome (such as other antidepressants, opioid pain medications, muscle relaxants, cough suppressants, or migraine medications in the triptan drug class)
• Disulfiram
• Blood thinners such as warfarin 
• NSAIDs such as ibuprofen 
• St. John’s Wort 
• Lithium 
• Nardil (phenelzine) 
• Parnate (tranylcypromine) 
• Marplan (isocarboxazid) 
• Azilect (rasagiline) 
• Emsam (selegiline)
• Orap (pimozide) 

Zoloft taken with monoamine oxidase inhibitors (MAOIs) or other drugs that increase serotonin (such as other antidepressants, triptans, and dextromethorphan which is found in cough and cold products) could cause serotonin syndrome, a life-threatening emergency that can cause hallucinations, seizures, comas, tremors, delirium, and other serious side effects.   

RELATED: Is it safe to take anti-anxiety medication with alcohol?

What is the most effective antidepressant for anxiety?

There is no single antidepressant that’s best for treating anxiety. What works for one person may not work for another. Depression symptoms will completely go away for about 1 out of every 3 people who take SSRIs, but more research still needs to be done on why SSRIs work for some people and not for others. Your healthcare provider is the best person to ask which antidepressant will be most effective for you.  

“Other SSRI medications can be effective for anxiety such as Prozac or Celexa or Paxil, yet each has some side effects—notably lowered libido and weight gain,” says Uma Naidoo, MD, a psychiatrist at Mass General Hospital in Boston. “Benzodiazepines are very effective in the short term while under the care of a doctor, but these are potentially addicting medications and must be used with immense caution and only as a short-term measure, e.g., grief following the death of a family member,” says Dr. Naidoo. Benzodiazepines are controlled substances, and have the potential for abuse and dependence, and include drugs such as Klonopin (clonazepam) and Xanax (alprazolam). 

As mentioned earlier, your healthcare provider is the best person to ask about how to treat anxiety. Medications can be effective in treating anxiety, but Dr. Naidoo says you may have other options as well. Some additional ways to combat anxiety, in combination with your prescription medication, may include:

• Talk therapy: Patients with anxiety can benefit from regular sessions with a therapist.
• Physical exercise: Regular physical exercise (as approved by your doctor) can be helpful to many people, improving symptoms of anxiety and helping you sleep better, in addition to improving overall health. Talk to your doctor about an exercise plan that is appropriate for you. 
• Mindfulness and breathing exercises: Mindfulness can help people focus on the present and help reduce anxiety and depression. 
• Dietary changes: Eating regular, healthy meals will help keep your blood sugar steady, avoiding that jittery feeling from low blood sugar, which may add to anxiety. A registered dietician is often covered by insurance and can be a very helpful resource in instituting dietary changes. 

Your physician can help you come up with a treatment plan that will fit well into your life.   

When to see a doctor

If you are experiencing anxiety that is interfering with your quality of life, do not hesitate to seek treatment. Start with your primary care provider, who can often recommend some lifestyle changes, start you on a medication, and/or provide recommendations for a therapist. You will be on your way to feeling better soon, and you will be glad you reached out for help.