CYP2C19 and CYP2B6 are thought to be the key cytochrome P450 enzymes involved in the metabolism of sertraline. Unchanged sertraline was not detectable in urine, whereas 12 to 14% of unchanged sertraline was present in feces. In a small study of two males, sertraline was excreted to similar degrees in urine and feces (40 to 45% each within 9 days). The elimination half-life of sertraline is on average 26 hours, with a range of 13 to 45 hours. In addition to the cytochrome P450 system, sertraline can be oxidatively deaminated in vitro by monoamine oxidases; however, this metabolic pathway has never been studied in vivo. Based on in vitro studies, sertraline is metabolized by multiple cytochrome 450 isoforms; however, it appears that in the human body CYP2C19 plays the most important role, followed by CYP2B6.

Alcohol

The first changes you might notice include improvements in appetite, sleep, and energy levels. In many cases, you may begin to notice a change in your symptoms after about two weeks and greater improvement after about four to six weeks. Like all medications in its class, Zoloft does not perform optimally until you have taken it consistently for several weeks.

Sertraline may be more efficacious for the treatment of depression in the acute phase (first four weeks) than fluoxetine. Comparative clinical trials demonstrated that sertraline is similar in efficacy against depression to moclobemide, nefazodone, escitalopram, bupropion, citalopram, fluvoxamine, paroxetine, venlafaxine, and mirtazapine. However, it failed to find significant effects on depression in either the mildly or severely depressed, and the clinical relevance and accuracy of the positive effects found have been questioned. A major study of sertraline in a broad primary care population found improvements in general mental health, quality of life, and anxiety. However, as with other antidepressants, the nature and clinical significance of this effect remain disputed.

Common side effects such as headache, sleep difficulties, dry mouth, sweating, and loss of appetite are typically mild and may subside in a few days or weeks. Also, let your doctor know if you have a history of drug abuse. Discuss the benefits and risks with your child’s doctor before making a decision. Since 2005, all SSRIs have carried “black box” warnings from the FDA regarding a higher risk for suicidal ideation and behavior in children.

Some of its common side effects include fatigue, nausea, sleep issues, and sexual problems. When mothers take sertraline during pregnancy, there is research evidence that the newborn may experience sertraline withdrawal symptoms. However, sertraline can still be used in the UK for the treatment of OCD in children and adolescents. The group had to overcome initial bureaucratic reluctance to pursue sertraline development, as Pfizer was considering licensing an antidepressant candidate from another company.

Side Effects When Taking Zoloft

In 2016, sertraline was the most commonly prescribed psychotropic medication in the United States. All SSRIs, including Zoloft, carry a risk for a collection of withdrawal symptoms known as SSRI discontinuation syndrome. Although many young people successfully take these common medications, informed consent is important. Avoid alcohol and illegal drugs while using sertraline. Serotonin syndrome can be life-threatening and lead to symptoms such as anxiety, confusion, fever, high blood pressure, irregular heartbeat, and seizures. It takes time for the medication to reach a steady state in your body and gradually increase the serotonin in your brain.

Antidepressants: Selecting one that’s right for you

People who take lithium with sertraline may need to be closely monitored for serotonin syndrome and changes in heart rhythm. Healthcare providers will typically try to avoid prescribing these antipsychotic drugs with sertraline due to the serious risk. Still, it’s important to watch for symptoms of serotonin syndrome when using these combinations. Using it with other serotonin-increasing medications, like the attention deficit hyperactivity disorder (ADHD) medication Adderall, can raise your risk.

Depression

• Unchanged sertraline was not detectable in urine, whereas 12 to 14% of unchanged sertraline was present in feces.
• Zoloft, like other SSRIs, works by blocking the reabsorption of serotonin into neurons in the brain.
• In a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.
• Dextromethorphan—a common cough suppressant for colds and flu—can raise serotonin levels and increase the risk of serotonin syndrome when taken with sertraline.
• When taken together, the risk of bleeding may be significantly increased.
• It also covers important precautions to be aware of before taking this medication.

Zoloft is a medication sometimes prescribed to treat depression, anxiety, and other conditions. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions.

People can sometimes minimize these symptoms by taking Zoloft immediately after sex or adjusting treatment with their physician’s advice. Sexual side effects of sertraline include a loss of desire or sex drive and difficulties related to arousal and orgasm. However, some strategies can help people manage this side effect, such as taking the medication in the morning.

Other anxiety disorders

They may recommend resuming your medication, switching to a different type of antidepressant, or treating your condition with psychotherapy. If you begin experiencing depression, anxiety, or other mental health concerns. Although the syndrome is not generally considered dangerous, the symptoms can be distressing. Common sertraline withdrawal symptoms include odd electrical sensations known as “brain jolts” or “brain zaps,” dizziness, and headaches. Let your doctor know right away if you experience more severe zoloft and pepcid side effects such as chest pain, skin rash, vomiting, anxiety, diarrhea, aggression, or confusion. Like all medicines, Zoloft carries a risk for side effects.

There are differences between sertraline and some other antidepressants in their efficacy in the treatment of different subtypes of depression and in their adverse effects. Zoloft can also interact with other medications and substances that increase serotonin levels, including other antidepressants. Some other psychiatric medications, painkillers, antibiotics, supplements, and drugs such as amphetamines, cocaine, and LSD can also increase serotonin. Clinical reports indicate that interaction between sertraline and the MAOIs isocarboxazid and tranylcypromine may cause serotonin syndrome.

Coping With Zoloft Side Effects

Speak with your healthcare provider if you experience bothersome side effects or if these effects don’t go away. Knowing what to expect and finding ways to cope can help you better manage these side effects. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary.

During the discussion, Paul Leber, the director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a “tough decision”, since the treatment effect on outpatients with depression had been “modest to minimal”. The FDA committee achieved a consensus that sertraline was safe and effective for the treatment of major depression. Desmethylsertraline, while pharmacologically active, is substantially (50-fold) weaker than sertraline as a serotonin reuptake inhibitor and its influence on the clinical effects of sertraline is thought to be negligible.

Concomitant intake of sertraline with food slightly increases sertraline peak levels and total exposure. The mood improvement resulting from the treatment with sertraline sometimes counteracted these side effects, so that sexual desire and overall satisfaction with sex stayed the same as before the sertraline treatment. While nefazodone and bupropion do not have negative effects on sexual functioning, 67% of men on sertraline experienced ejaculation difficulties versus 18% before the treatment. Abrupt interruption of sertraline treatment may result in withdrawal or discontinuation syndrome. In children and adolescents taking sertraline for six weeks for anxiety disorders, 18 out of 20 measures of memory, attention, and alertness stayed unchanged.

This warning is based on statistical analyses conducted by two independent groups of FDA experts that found a 100% increase of suicidal thoughts and behavior in children and adolescents, and a 50% increase in the 18–24 age group. More severe cases are often successfully treated by temporary reintroduction of the drug with a slower tapering-off rate. It typically occurs within a few days from drug discontinuation and lasts a few weeks. Sertraline has a low level of exposure of an infant through the breast milk and is recommended as the preferred option for the antidepressant therapy of breast-feeding mothers. The large weight gain was observed only among female members of the sertraline group; the significance of this finding is unclear because of the small size of the group.

Finding the right antidepressant

• For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain statistically significant results.
• Common side effects often last one to two weeks until you get used to your medication.
• While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents (clomipramine, imipramine, clonazepam, alprazolam, and fluvoxamine) indicates approximate equivalence of these medications.

Taking multiple antidepressants, especially SSRIs like sertraline, can increase serotonin levels and the risk of serotonin syndrome. Dextromethorphan—a common cough suppressant for colds and flu—can raise serotonin levels and increase the risk of serotonin syndrome when taken with sertraline. Combining opioid pain medications with sertraline can increase the risk of serotonin syndrome. The combination of a triptan with sertraline can increase the risk of serotonin syndrome, especially after starting sertraline or with a dose increase.

Similarly, the analysis conducted by the UK MHRA found a 50% increase of odds of suicide-related events, not reaching statistical significance, in the patients on sertraline as compared to the ones on placebo. Over more than six months of sertraline therapy for depression, people showed no significant weight increase. Sertraline has not been approved for the treatment of generalized anxiety disorder; however, several guidelines recommend it as a first-line medication referring to good quality controlled clinical trials. With depression in dementia, there is no benefit of sertraline treatment compared to either placebo or mirtazapine.