Zoloft side effects in men and how to avoid them

Common Zoloft side effects | Sexual dysfunction | Serious side effects | Side effects timeline | Interactions | Safety measures | How to avoid side effects | How to treat side effects

Zoloft (sertraline) is a leading member of the first-line class of antidepressant medications, the selective serotonin reuptake inhibitors (SSRIs). By increasing serotonin levels in the synapses of the brain—the spaces between nerve cells—Zoloft can help relieve anxiety and depression symptoms. The drug has an array of uses besides generalized anxiety disorder and major depressive disorder, including Food and Drug Administration (FDA) indications for social anxiety disorder, post-traumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD). As you can see, the FDA has officially recognized Zoloft as having broad-based utility in mental health care for both men and women, but the governing body has also placed a warning about the side effects of this and other SSRIs. Knowing more about sertraline’s list of adverse effects, particularly ones of importance to men, can help you understand what to watch out for and report to your healthcare team.

Common side effects of Zoloft

Among the most common side effects of Zoloft are nausea, diarrhea, difficulty sleeping, and dry mouth, but others warrant attention as well.

Sexual dysfunction

One of the fears that men have when starting an antidepressant for mental illness is that it will negatively affect their sex life. Although the drug’s label only notes an incidence of 2% among men taking Zoloft, the subcategories of sexual dysfunction, such as problems with erections, reduced penile sensation, and decreased sex drive, push the chance of an issue higher. In fact, a survey of patients taking antidepressant medication like sertraline found that 46% of men reported some variety of sexual side effects.

Erectile dysfunction

Having difficulty achieving or maintaining an erection is one of the most feared adverse effects for men. The odds certainly favor not having erectile dysfunction from the medication, but according to the drug label, 4% of men taking Zoloft do experience some degree of impotence.

Ejaculation failure and disorder

Another sexual side effect of interest to men pertains to ejaculation, the process in which semen is ejected from the penis. The drug’s label states that 8% of men taking Zoloft experienced failure to ejaculate, and another 3% had ejaculation disorder, which may involve delayed ejaculation.

Loss of libido

Sex drive was diminished in 6% of people taking Zoloft in studies referenced in the FDA label. While this extent of loss of libido is of concern, another element to consider is that depression itself can diminish sexual desire. A topic review states that 25% to 75% of patients with depression experience loss of libido.

Insomnia

According to the Zoloft drug label, 20% of users experience insomnia. This is another example of the need to differentiate a drug side effect from a disease symptom since insomnia can be a symptom of depression. Perhaps reflective of this, 13% of patients taking inactive placebo pills had insomnia in clinical trials referenced in the FDA label.

Fatigue

A lack of energy is yet another symptom of depression, but it is also a potential adverse effect of antidepressants. The label indicates a rate of 12% for fatigue and 11% for somnolence—a strong desire to fall asleep. 

Nausea and diarrhea

While side effects that negatively impact sex life and energy are likely high on the list of men’s concerns about Zoloft, adverse gastrointestinal reactions need to be considered, too. The rates with sertraline are relatively high, with 26% experiencing nausea, 20% having diarrhea, and 14% having dry mouth.

Serious side effects of Zoloft

Less common but noteworthy, serious Zoloft side effects include:

• Suicidality
• QT prolongation
• Seizure
• Serotonin syndrome
• Depression exacerbation
• Mania
• Glaucoma
• Priapism (prolonged erection)
• Anaphylaxis or allergic reaction
• Stevens-Johnson syndrome (severe drug-related illness and rash)
• Hyponatremia (low sodium levels)
• Withdrawal, if stopped abruptly

How soon do Zoloft side effects start?

Beyond knowing what to look for when it comes to Zoloft side effects, you need to know when to look for the problems. Unfortunately, continued vigilant monitoring is required because adverse reactions can be recognized at different points during treatment. Nausea can pop up within hours of taking the first dose, for example. Suicidal thoughts may be more likely in the first weeks of antidepressant treatment, which is a particular concern in children and young adults and led the FDA to place a boxed warning on antidepressants. 

Serotonin syndrome and QT prolongation are two serious side effects that someone may not experience unless they take Zoloft with a drug that has similar adverse effects. Serotonin syndrome has an array of symptoms, including agitation, confusion, muscle twitching, dilated pupils, and fever. QT prolongation occurs to a minimal extent with sertraline compared to other SSRIs, but it involves slowed electrical conductivity within the heart, which can precipitate a life-threatening rhythm issue called torsade de pointes. Both of these uncommon side effects are more likely when SSRIs interact with another medication that can cause them. They can occur even years after first starting sertraline.

How long do Zoloft side effects last?

Thankfully, most side effects of Zoloft are short-lived. Nausea and fatigue may even resolve while still taking the medication. Others, such as sexual dysfunction, typically subside within a week of discontinuing the drug. The time frame depends on the particular side effect.

What are the long-term side effects of Zoloft?

Most people on Zoloft do not experience significant adverse effects, and side effects typically resolve quickly once they discontinue the drug. However, the umbrella category of sexual dysfunction is a concern for men who want resolution of their depression or anxiety symptoms but without permanent harm to their sex life. Case reports exist for permanent sexual dysfunction symptoms; however, these are not defined or proven.

Weight gain is another long-term issue that both men and women hope to avoid when taking antidepressants. Fortunately, sertraline was found to have a lower incidence of significant weight gain, occurring 4.5% in an open-label study, compared with other SSRIs.

Zoloft interactions

Zoloft does not have a lot of major interactions with other drugs, but it does have some that warrant discussion with your medical provider about whether you should take any precautions. Some of the important drug interactions involving sertraline include:

• Monoamine oxidase inhibitors are contraindicated with Zoloft and should not be taken within 14 days of one another in order to avoid the serious risk of serotonin syndrome. The concern with this class is high, leading to strict avoidance of the combination.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may entail more bleeding risk when taken concurrently with Zoloft. 
• Anticoagulant drugs taken alongside Zoloft could have a heightened risk of bleeding.
• SSRIs or other antidepressants, such as bupropion and buspirone, may increase the risk of serotonin syndrome if taken with Zoloft. 
• Zofran (ondansetron) is a medication for nausea that has a serotonin-related mechanism that could increase the risk of serotonin syndrome if taken with Zoloft.
• Dextromethorphan is an over-the-counter (OTC) cough suppressant that can raise the risk of serotonin syndrome when taken with Zoloft.  
• QT-prolonging agents like Zoloft can have additive effects, meaning they may cause more intense and dangerous side effects when taken with other medications with additive effects. The risk is not as high with Zoloft, compared with other QT-prolonging drugs, however. Examples include certain antipsychotics, quinolone antibiotics, and thiazide diuretics.
• Thyroid hormones may have less of an effect when taken together with Zoloft. 
• Alcohol could elevate the risk of impaired thinking or movements when taking Zoloft. 
• Grapefruit juice can impair the metabolism of Zoloft, meaning drug levels and side effect risk could be higher. 

It’s important to inform your healthcare provider of any medications you’re taking so they can prevent adverse drug interactions and side effects. If the risk of a drug interaction exists, they may recommend a Zoloft alternative.

Safety measures while using Zoloft

Certain health situations call for additional caution related to taking Zoloft. In these circumstances, getting specific guidance from your healthcare professionals is worthwhile.

Liver disease

Impaired liver function typically leads to reduced Zoloft dosing in order to lessen the risk of adverse effects. However, if the degree of liver function impairment is severe, Zoloft is often avoided.

Suicidal thoughts in young men

A boxed warning from the FDA on antidepressants, including Zoloft, calls attention to the risk of suicidal thoughts and behaviors in children and young adults taking the medication. The warning on the drug label advises close monitoring rather than medication avoidance. If you are a young man with depression, this warning does not mean you cannot take sertraline, but rather that you should talk to your doctor specifically about this risk.

Seizures

Cautious use of Zoloft is often advised for those with a seizure history or risk, including anyone with alcoholism. An adverse effect of more seizures is possible with Zoloft, making a discussion with the healthcare provider necessary.

Mania

Manic episodes are marked by symptoms including heightened mood, talking faster than normal, a feeling of inflated importance, delusions, poor judgment, and agitation. People with bipolar disorder who take Zoloft may be at risk for manic episodes, according to the National Alliance on Mental Illness. 

Withdrawal

Zoloft is not habit-forming, but upon discontinuing the medication, you may experience withdrawal syndrome. Symptoms include dizziness, headache, vision changes, electric-shock sensations, nausea, anxiety, and confusion. Setting a plan with your doctor’s guidance to gradually reduce the dosage can help prevent or lessen withdrawal symptoms. If Zoloft is working well for you but the expense is making you consider stopping Zoloft, you can look into coupons or a Singlecare discount card for financial assistance.

Overdose

The maximum daily dose of Zoloft for adults is listed as 200 milligrams for most conditions. An overdose can entail serious risk, including serotonin syndrome, and necessitates emergency medical attention. You can also call Poison Control at 1-800-222-1222.

How to avoid Zoloft side effects

Consider the following advice to avoid potential Zoloft side effects:

• Take Zoloft exactly as it is prescribed to you, being careful not to miss doses.
• Take Zoloft at about the same time each day, but if you forget, take it as soon as possible unless the next dose is almost due, in which case you should skip the forgotten dose.
• Take Zoloft in the morning if it causes you insomnia or in the evening if it makes you drowsy.
• Take Zoloft with food if it makes you nauseous.
• Do not stop Zoloft without speaking to your healthcare provider.
• If you are instructed to stop Zoloft, be sure to understand how to taper off the drug gradually.
• When initiating Zoloft treatment and periodically throughout treatment, review your list of prescription drugs, OTC medications, supplements, and health conditions with your prescriber and pharmacist so they can identify any interactions.
• Avoid or limit alcohol and grapefruit juice while taking Zoloft. Your healthcare provider can advise you on how strict you should be about this. 

How to treat side effects of Zoloft

If you experience Zoloft side effects, the best treatment will depend on the severity and nature of those symptoms. For example, you can address mild nausea by taking the drug with food or waiting a few days for the next dose if you are just starting the drug. Likewise, you can circumvent mild drowsiness when starting Zoloft by moving dosing to bedtime. On the other hand, more serious issues, like symptoms of mania or serotonin syndrome, require urgent medical attention. Suicidal thoughts also warrant help immediately, such as calling the Suicide and Crisis Lifeline at 988.

Bottom line: Is Zoloft safe?

Zoloft is one of the first-line antidepressants for both men and women. The reason for this standing is that Zoloft and other SSRIs are usually the safest medications for depression. Being aware of what side effects to watch out for, what food and drug interactions exist, and which health conditions exacerbate the risk of adverse effects puts you in a position to be a well-informed, active participant in your healthcare decisions. By having a dedicated conversation about it, you and your healthcare provider can determine how best to avoid and respond to side effects.