Zoloft side effects to expect in the first week

Getting a Zoloft prescription | Starting dose | Side effects first week | Precautions | Missed dose | Overdose | When to see a doctor | Stopping Zoloft | Zoloft alternatives | Is Zoloft safe?

Living with mental health conditions like anxiety or depression can make daily life stressful. 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. 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. 

RELATED: What is Zoloft?

What is Zoloft prescribed for?

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. Zoloft is approved by the Food and Drug Administration (FDA) to treat the following conditions:

• Major depressive disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Panic disorder
• Social anxiety disorder
• Premenstrual dysphoric disorder (PMDD)

Off-label uses for Zoloft include:

• Anxiety
• Binge eating disorder
• Body dysmorphic disorder
• Bulimia nervosa
• Premature ejaculation
• Hot flashes due to menopause

Starting Zoloft

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. These are the starting doses of Zoloft for other disorders:

It’s important to talk with your healthcare provider 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.  

Zoloft is typically given once per day. The manufacturer of Zoloft does not specify that it should be taken in the morning or evening, just that it should be taken at the same time each day. There is some data from initial trials for Zoloft that suggests it can cause somnolence for some individuals. If you notice that it causes somnolence when you take it, it may be best to take it every day in the evening. Your healthcare professional may make a recommendation to change your dosage time to alleviate other side effects as well.

How long does it take for Zoloft to work?

Once you start taking Zoloft in the right amount as prescribed by your healthcare provider, 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 patience while waiting 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.

Remember to be patient while assessing any positive impacts Zoloft may be having on your depression or anxiety. Most prescribers will require a follow up at four, six, or eight weeks to assess how it is working for you. They may use a type of questionnaire to measure your symptoms more objectively and compare them to where you were before starting Zoloft. If you begin to get frustrated because you are not feeling the results you expected with Zoloft, make sure to speak to your healthcare provider first before discontinuing the medication. You should not discontinue Zoloft abruptly, as it can cause worsened anxiety, agitation, confusion, headache, and insomnia. Your healthcare provider may ask you to give the drug more time, or they may suggest transitioning to a different drug. This is a decision you should make with your doctor.

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. They 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 the first few days on Zoloft you may experience some initial side effects even if you’re taking the medication exactly as prescribed by your healthcare provider. 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

Up to two-thirds of patients discontinue antidepressant therapy in the first 90 days of treatment due to side effects. It is important to know what to expect as therapy begins and have an open dialogue with your prescriber about your concerns. Do not abruptly stop treatment without speaking to your prescriber.

For some of these side effects, men and women may experience them at a different rate or intensity. For example, a study evaluating SSRI-induced sexual dysfunction found that men suffer from sexual dysfunction related to this class of drugs more often than women, but when women do, it is more intense. Sexual dysfunction can be characterized by decreased libido, delayed orgasm, delayed or inability to ejaculate, and impotence.

Women also have to be concerned with the effects of Zoloft on their unborn child if they take this medication during pregnancy. Zoloft has been linked to cardiac defects as well as defects in the formation of the baby’s skull. Zoloft is not recommended during pregnancy unless the benefits clearly outweigh the risks, especially in the last trimester.

Can Zoloft make you feel worse at first?

Zoloft does not provide immediate relief of symptoms, and for some, it may leave you wondering if what you are feeling is actually worse than before you started the medication. Depending on what primary condition you are treating, you may have a different response and a different timeline for improvement than others. There is data to suggest that Zoloft begins helping with anxiety symptoms in the first few weeks after you start treatment. Relief from depressive symptoms may not come until closer to the 12 week mark. While depression and anxiety are often hand-in-hand, the delay in improvement of depression may leave you feeling “worse” than you did initially.

Zoloft is known to increase suicidal thoughts in teens and young adults, and this is especially true when anxiety and depression are uncontrolled. It is important to monitor this group of patients closely as their risk for these thoughts is highest until their anxiety and depression are better controlled.

How long do Zoloft side effects last?

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 provider increases your dose. If they increase the dose, it will take a couple of weeks for your body to fully appreciate the new dose. From there, it can be several more weeks before you may see an improvement in symptoms. Most healthcare professionals will allow for 4-8 weeks between dose adjustments to make sure the full effect of the new dose is realized. 

You may be wondering if you should discuss your drug therapy with those around you. Your family and friends have likely noticed the impact depression and anxiety can have on you, but the decision to share your treatment choice is absolutely up to you. Yes, some of the side effects of drug therapy may also be noticeable. Like untreated anxiety and depression, the effects of drug therapy can also impact your daily functioning. Speak to your healthcare professional about the best way to handle any potential impacts on your job or performance of daily activities. While your boss at work should not hold against you that you are seeking treatment for your disorder, you may not feel comfortable sharing this information. Your doctor will be able to walk you through your best options of treating your disorder while maintaining performance expectations along with your privacy.

Serious side effects of Zoloft

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

Black box warning: Zoloft and suicidal thoughts

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. You can also reach out to the National Suicide Prevention Lifeline at 1-800-273-8255.

Precautions to take when starting Zoloft

You should not take Zoloft if you have a history of an allergic reaction to sertraline or one of its other ingredients. Zoloft therapy is also contraindicated in patients receiving treatment with a class of drugs known as monoamine oxidase inhibitors (MAOIs). Examples of MAOIs include isocarboxazid, selegiline, and phenelzine. If you are taking one of these drugs, you must notify your doctor.

Do not abruptly stop Zoloft or any SSRI without first consulting your prescriber. This can lead to sleep and sensory disturbances, anxiety, and agitation. 

Suicidal thoughts and ideation may occur in adolescents, teens, and young adults who take Zoloft. This may be worse during the initial few months of therapy or after dose changes. Caregivers and loved ones should monitor this population closely during this time for unusual changes in behavior and irritability.

Tell your healthcare provider if you have a history of seizure disorders (epilepsy) or cardiac disorders such as QT prolongation as Zoloft therapy could make these worse.

If you have liver disease, your dose may need to be adjusted by your prescriber.

You should take your first dose while you are home and not needing to drive. Zoloft has been known to cause somnolence in some patients, and you should avoid driving after taking Zoloft until you know how it affects you. 

Zoloft has been linked to birth defects, especially when taken late in pregnancy. Zoloft should only be taken during pregnancy if the benefits clearly outweigh the risks.

Drug interactions

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 healthcare provider 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 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.

Foods to avoid while taking Zoloft

Like with many other drugs, grapefruit and grapefruit juice can interact with Zoloft absorption. It can slow the metabolism of Zoloft, therefore increasing blood levels of available Zoloft. This is typically only a problem if the intake of grapefruit products is inconsistent. If you are going to ingest grapefruit products, it is best to ingest a consistent amount daily.

RELATED: Can you drink coffee while taking Zoloft?

Missed 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 healthcare provider 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 often 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.

Side effects of stopping Zoloft

If it is determined by your healthcare professional that discontinuing Zoloft is best for you, you should do so gradually with dose tapering. This will decrease the likelihood of unwanted side effects of abrupt discontinuation such as dizziness, nausea, vomiting, insomnia, irritability, and agitation. If you abruptly stop Zoloft, it will be completely eliminated in a little over 5 days, even if you have taken it for a long time. Do not discontinue Zoloft without the direct advice of your prescriber. Long-term treatment with Zoloft is safe, but your prescriber may choose to reevaluate your drug choice if your symptomology changes or your side effects are bothersome. Sleep disturbances and weight gain are some of the most common adverse events associated with long-term therapy.

Zoloft alternatives

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.

RELATED: A beginner’s guide to antidepressant side effects

Bottom line: Is Zoloft safe?

Side effects, some potentially dangerous, are possible with Zoloft. However, for most people, Zoloft is a very safe and effective treatment for depression and anxiety. Studies have shown that while Zoloft may cause more adverse events than Lexapro or Prozac in the same class, it has fewer safety concerns than drugs in related classes.

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.

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