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Zoloft side effects: What to expect in the first week of taking Zoloft

Starting dose | Side effects | Missing a dose | Overdose | When to see a doctor

Living with mental health conditions like anxiety or depression can make daily life stressful. Luckily, there are many treatment options available for people who seek relief from anxiety or depression. Zoloft is a prescription medication used to reduce symptoms of anxiety and depression, and when taken properly, it can make daily life more manageable. Let’s take a more in-depth look at how to take Zoloft, what side effects to look out for in the first week, and what else to expect when you first start this medication.       

Starting Zoloft

Zoloft is the brand name of a generic medication called sertraline, which belongs to a group of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs like Zoloft are antidepressants that work by increasing levels of serotonin in the brain. An estimated 31% of all adults will experience an anxiety disorder at some point in their life, and statistics show that 264 million adults around the globe have anxiety. Doctors commonly prescribe Zoloft to treat anxiety, but it can also be used to treat depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic attacks, and premenstrual dysphoric disorder (PMDD).   

Just like with any medication, knowing as much as possible about the drug you’ll be taking is essential to making sure you maximize its potential benefits. Knowing how to take Zoloft properly is important to make sure it works as effectively as possible. When taken correctly, Zoloft can make people feel less anxious or fearful, and it can reduce the urge to perform repeated tasks. It can improve sleep quality, appetite, energy levels, restore interest in daily life, and reduce unwanted thoughts and panic attacks.  

Zoloft is available in tablet form in dosage strengths of 25 mg, 50 mg, or 100 mg. It’s also available as an oral solution, which must be diluted into four ounces of water, orange juice, lemonade, ginger ale, or lemon/lime soda before consumption.   

The standard dose of Zoloft for anxiety is 25 mg or 50 mg per day. According to the Food and Drug Administration (FDA), these are the standard doses of Zoloft for other disorders:

  • Major depressive disorder: 50 mg daily 
  • OCD: 50 mg per day for those older than 13 years of age 
  • Panic disorder: 25 mg daily
  • PTSD: 25 mg daily
  • Social anxiety disorder: 25 mg daily
  • PMDD: 50 mg per day during the luteal phase only   

It’s important to talk with your doctor about what dosage is right for you because the exact amount of medication you’ll need will vary based on your specific condition, how severe your symptoms are, and whether or not you have any other health problems.  

Once you start taking Zoloft in the right amount as prescribed by your doctor, you can expect it to start working in about two to six weeks. Zoloft isn’t the type of medication that will start working on the first day, so you’ll need a little bit of patience while you wait for it to start relieving your symptoms. 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 as soon as 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 show up.      

When you first start taking Zoloft, you may begin to notice a few side effects. One of the best ways to avoid side effects is to take the medication exactly as prescribed by your doctor. Your doctor will prescribe you a certain dose for a reason, and taking more Zoloft because you want it to work faster isn’t safe. Let’s take a look at some of the most common side effects of Zoloft you’ll want to be aware of when you start taking it.   

Zoloft side effects to expect in the first week

During your first week of taking Zoloft you may experience some initial side effects even if you’re taking the medication exactly as prescribed by your doctor. This happens because it takes time for the body to become used to the medication. Some of the most common side effects that people have during their first week of taking Zoloft include:

  • Headache
  • Nausea
  • Fatigue
  • Constipation 
  • Dry mouth
  • Sleepiness 
  • Nervousness
  • Drowsiness 
  • Trouble sleeping
  • Restlessness
  • Decreased sex drive 
  • Weight gain 
  • Dizziness
  • Loss of appetite
  • Increased sweating

Taking Zoloft may make you feel uncomfortable or weird at first as your body starts to process the medication. After a week or two these side effects will go away for most people as their bodies get used to the medication. It’s possible to experience some of these side effects sporadically throughout the duration that you’re taking Zoloft, especially if your doctor increases your dose. 

Although it’s rare, Zoloft can cause more serious side effects like: 

  • Unusual weight loss 
  • Low sodium levels 
  • An increased risk of bleeding 
  • Eye pain that indicates angle-closure glaucoma 
  • Sexual dysfunction such as delayed ejaculation 
  • Manic episodes for people with undiagnosed bipolar disorder
  • Allergic reactions  
  • Seizures 

Zoloft also comes with a box warning for suicidal thoughts and behaviors. Short-term studies have shown that antidepressants increased the risk of suicidality in children, adolescents, and young adults when compared to a placebo. If you’re taking Zoloft and start to have extreme mood changes and/or suicidal thoughts or behaviors, you should seek medical advice right away.  

Another thing to consider when taking Zoloft is that it shouldn’t be taken with certain medications. Giving a list of all the medications and over-the-counter supplements you’re taking to your doctor will help reduce your chances of experiencing more serious side effects from interactions with Zoloft. Here’s a list of medications that shouldn’t be taken at the same time as Zoloft: 

  • Medications that increase serotonin  
  • Triptans (migraine agents)
  • Tricyclic antidepressants  
  • Blood thinners such as warfarin 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)   
  • St. John’s Wort 
  • Lithium
  • Ultram (tramadol)  
  • Nardil (phenelzine) 
  • Parnate (tranylcypromine) 
  • Marplan (isocarboxazid) 
  • Azilect (rasagiline) 
  • Emsam (selegiline)
  • Orap (pimozide) 

Zoloft shouldn’t be taken at the same time as monoamine oxidase inhibitors (MAOIs) because this could lead to serotonin syndrome, which causes hallucinations, seizures, comas, tremors, delirium, and other serious side effects. This list of drug interactions is not exhaustive, so it’s so important to tell your doctor about all the medications you’re taking or thinking about taking.     

Missing a dose of Zoloft

Nobody is perfect, and missing a dose of Zoloft is bound to happen at one point or another. Taking your medication consistently as prescribed by your doctor is important, but missing a dose isn’t the end of the world if you know what to do when it happens. 

“Take your dose as soon as you remember,” says Brian Wind, Ph.D., a clinical psychologist and the chief clinical officer of JourneyPure. “If it is nearly time to take the next dose, don’t take an extra dose to make up for the one you missed. Simply take the next dose. You can experience side effects and an increased risk of relapse if you suddenly stop your medication.”

The side effects you might experience if you stop or miss a dose of your medication are mild withdrawal symptoms that happen because of something called antidepressant discontinuation syndrome. According to American Family Physician, antidepressant discontinuation syndrome occurs in about 20% of patients who abruptly discontinue an antidepressant after taking one consistently for at least six weeks. Missing a dose of Zoloft may cause you to have flu-like symptoms, nausea, insomnia, imbalance, or hyperarousal.  

The best thing you can do if you miss a dose, just as Dr. Wind says, is to take your next dose as soon as you remember. If you’ve been experiencing any symptoms because of your missed dose, they should go away once you start taking Zoloft consistently again. It may also be a good idea to contact your doctor if you miss a dose, just to check in and make sure you don’t need to do anything else.   

Zoloft overdose

Overdosing on Zoloft is more serious than missing a dose. There are no reported cases of fatal Zoloft overdoses, but taking too much medication can cause serious side effects or health complications. Accidentally or purposefully taking two or more doses of Zoloft could cause:

  • Nausea
  • Vomiting
  • Dizziness
  • Agitation
  • Confusion
  • Fever
  • Fainting
  • Hallucinations
  • Changes in blood pressure 
  • Rapid heartbeat
  • Tremors
  • Seizures 

In rare cases, taking too much Zoloft can also cause serotonin syndrome, which results in dangerously high levels of the neurotransmitter serotonin in the brain. When there’s too much serotonin in the brain this can cause confusion, diarrhea, and headaches. More severe symptoms may include seizures, hallucinations, muscle rigidity, and comas.     

If you think you’ve overdosed on Zoloft and/or start to experience one or more of these symptoms you should seek medical attention right away or call the Poison Control hotline at 1-800-222-1222. The Poison Control hotline is free for anyone to use and offers callers expert and confidential advice.  

When to see a doctor for Zoloft side effects

Zoloft can be a great medication to treat symptoms of anxiety and depression if it’s taken properly. Being prepared to experience potential side effects is an important part of taking any medication, and knowing what to expect can remove some of the anxiety that oftentimes comes from taking a new medication.  

If you start taking Zoloft and have some mild side effects it’s important to remember that that’s normal. It’s also important to remember at what point you should see your doctor because of the side effects you’re having. As mentioned throughout this article, more serious side effects like confusion, hallucinations, allergic reactions, seizures, and vomiting require medical attention. If you start to experience worsening depression or anxiety, suicidal thoughts, panic attacks, severe irritability or aggression, then you should seek immediate medical help.  

Zoloft isn’t the only antidepressant that can treat anxiety and depression. Zoloft can be very effective, but if it doesn’t work for you or if it causes too many side effects, then an alternative antidepressant may be needed. Clinical trials have shown that 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.   

If you’re experiencing too many side effects from Zoloft, then you might consider talking with your healthcare provider about other options. Here are some of the most popular alternatives to Zoloft: 

  • Celexa (citalopram): Celexa is an SSRI that’s FDA approved to treat depression, and even though it’s mainly prescribed for depression, doctors can sometimes prescribe it to help alleviate symptoms of anxiety.
  • Effexor Xr (venlafaxine hcl er): Effexor is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that can treat depression, improve moods, and improve energy levels. 
  • Lexapro (escitalopram): Lexapro is an SSRI used to treat generalized anxiety disorder and major depressive disorder.
  • Paxil (paroxetine): Paxil is an SSRI used to treat depression and other psychological conditions. 
  • Prozac (fluoxetine): Prozac is an SSRI used to treat major depressive disorder, OCD, bulimia nervosa, and panic disorder. 
  • Xanax (alprazolam): Xanax is a benzodiazepine that relieves anxiety in the short-term. Xanax is a controlled substance because of its potential for abuse/dependence. 

The potential to experience side effects from a medication shouldn’t keep you from getting the treatment you need for your anxiety or depression. Talking with your healthcare provider is the best way to come up with a treatment plan that will work best for you and cause the least amount of side effects for you on your journey to find relief from your symptoms.