Zoloft Side Effects: What are They and What Can You Do About Them?

Depression and anxiety has reached epidemic levels in the United States. In 2017, 17.3 million American adults (7.1% of the population) reported experiencing an episode of major depression. This was before the world grappled with a global pandemic, lockdowns and uncertainty in many aspects of life. The challenges of COVID-19 have led to a spike in the incidence of depression and anxiety (1 in 4 Americans reporting symptoms and episodes) as documented by the CDC in June 2020. The reality is that most of us have experienced an impact on our mental health in some way by this global event.

The physical, mental, and emotional symptoms associated with depression and anxiety can be debilitating and make it challenging for people who are suffering to perform even daily tasks, and many completely lose the desire to do even activities they used to enjoy. Hoping for relief from their symptoms, millions of Americans each year turn to prescription medications like Zoloft.

Antidepressants like Zoloft can be very effective for some people, while others do not find them as useful. Often, side effects of medications like Zoloft are so bothersome that people stop taking the medications they need entirely.

Fortunately, patients taking medications like Zoloft don’t have to choose between experiencing depression or experiencing side effects from their medication.

What is Zoloft?

Zoloft is a brand name medication sold under the generic name sertraline. The drug belongs to a class of medications called selective serotonin reuptake inhibitors (SSRI), which are primarily used to treat depression and anxiety.

The U.S. Food and Drug Administration (FDA) approved Zoloft for use in the United States in 1991; today, Zoloft is one of the most commonly prescribed SSRIs on the market, with more than 38 million prescriptions for the medication written in 2017.

Prescriptions for Zoloft have increased by 20% in 2020 and triggered the FDA to put Zoloft on the drug shortage list and production has ramped up dramatically to meet demand.

How does it work?

Serotonin is a feel good neurotransmitter that sends signals between different neurons in the brain. Normally serotonin is quickly absorbed by surrounding neurons, but SSRI’s like Zoloft, prevent that absorption so more signals can be sent. This process is believed to boost mood.

Symptoms of anxiety appear to improve quickly with SSRI use (1-2 weeks) versus symptoms of depression take a longer period of time (6-8 weeks).

Surprisingly, SSRI’s like Zoloft may also work to improve mood through another mechanism of action: lowering inflammation.

Individuals using Zoloft for 8 weeks were found to have lower levels of inflammatory chemical messengers called cytokines and higher levels of anti-inflammatory cytokines.

Researchers are not sure if inflammation may cause depression and/or anxiety or be part of the disease process, but SSRIs provide therapeutic benefits to the multiple aspects of the disease process. 

What is Zoloft used to treat?

Zoloft is used to treat a number of different mental health conditions including:

• Major depressive disorder
• Anxiety and panic disorders (feelings of anxiety, fear and unwanted thoughts)
• Obsessive compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)
• Social anxiety disorder
• Premenstrual dysphoric disorder (PMDD)

Most healthcare professionals prescribe SSRI’s such as Zoloft as a first choice in the treatment of depression. 

What are the symptoms of depression?

Life is full of ups and downs, and everyone experiences high points and low points in regards to their emotions. However, when feelings of sadness, emptiness, or disinterest are intense, interfere with daily life, and last for an extended period of time (two weeks or more), individuals may be suffering from depression.

People with depression experience both physical and emotional symptoms that vary in type and intensity. Depression is believed to have a number of triggers, including genetic, psychological, biological, and environmental factors.

Many women experience depression as a result of hormonal changes or as a result of taking certain medications, such as oral contraceptives.

Symptoms of depression commonly include:

• Persistent sadness
• Feelings of hopelessness or pessimism
• Fatigue
• Difficulty concentrating
• Reduced libido
• Suicidal thoughts
• Aches
• Digestive problems
• Persistent anxiety
• Irritability
• Decreased energy
• A loss of interest in hobbies
• Change in appetite
• Suicide attempts
• Pains

What are the symptoms of anxiety?

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry
• Having the urge to avoid things that trigger anxiety

What are the side effects of Zoloft?

Possible side effects associated with Zoloft generally fall into two categories: common adverse effects and rare but serious ones. 

Common side effects associated with Zoloft include:

• Nausea
• Headache
• Sexual dysfunction including low libidio, delayed or inability to orgasm, erectile dysfunction, in men
• Weight gain  
• Trouble sleeping/tiredness
• Upset stomach
• Diarrhea 
• Dizziness
• Drowsiness
• Loss of appetite
• Dry mouth

Rare but serious side effects associated with Zoloft include:

• Angle-closure glaucoma
• Low sodium blood levels, as evidenced by weakness, difficulty concentrating and remembering
• Serotonin syndrome, as evidenced by shivering, severe muscle tightness, confusion, fever and more

Are there any risks associated with taking Zoloft?

The FDA has issued a black box warning, the most serious warning issued by the agency, for Zoloft due to an increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults who are taking the medication and suffering from major depressive disorder.

Patients with a diagnosis of major depressive disorder should be closely monitored while taking Zoloft.

Zoloft is also associated with a risk of withdrawal symptoms of the dosage of the drug is rapidly reduced or stopped abruptly, particularly in patients who have been taking the medication for at least six weeks.

Patients who are taking Zoloft should not change their dosage or stop taking their medication without guidance from a healthcare professional in order to avoid withdrawal symptoms. 

Symptoms of withdrawal from Zoloft include:

• Nightmares and insomnia
• Agitation
• Irritability
• Vertigo
• Nausea
• Gastrointestinal issues (diarrhea, nausea)
• Aggression
• Dizziness
• Confusion
• Flu-like symptoms
• Anxiety
• Tremors

Some medications can cause dangerous drug interactions with Zoloft, including monoamine oxidase inhibitors (MAOIs/MAO inhibitors) (particularly  rasagiline, selegiline, linezolid, isocarboxazid, methylene blue, phenelzine,moclobemide, procarbazine, safinamide, and tranylcypromine), drugs like clopidogrel that increase risk of bleeding or bruising, prescription or over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, blood thinners, other SSRIs like fluoxetine, citalopram, or paroxetine, St. John's wort, and certain selective serotonin and norepinephrine reuptake inhibitors (SNRIs).

How can the side effects of Zoloft be minimized or avoided?

It is important to get the treatment you need for your mental health. Many individuals are concerned about the potential side effects they may experience when starting Zoloft or unsure what to do when they find themselves experiencing side effects.

It is important to talk to your prescribing health care professional about your symptoms and potential solutions. While this process can feel disheartening and sometimes lonely, there are several things you can do to improve your experience while using antidepressants such as Zoloft. 

Many prescription medications have unpleasant side effects, but until recently, researchers had not made the connection between nutrient depletion and the incidence of side effects.

Nutritional deficiencies in several vitamins and minerals, including omega-3 fatty acids, vitamin D, magnesium, vitamin B-6, vitamin B-12, folate, amino acids, iron, zinc, iodine, and selenium, have been linked to higher rates of depression.

For example, a study of older women with severe depression found that more than a quarter of the study participants were deficient in vitamin B-12.  Low folate levels have also been tied to depression, as only seven percent of people with low folate levels respond to treatment with antidepressants like Zoloft, while those with high folate levels report a 44 percent response.

Similarly, approximately half of American adults are deficient in magnesium, which is a mineral linked to relaxation. Women with hormonal imbalances, such as those experiencing menopause, can also benefit from nutritional support that helps to support balanced hormones and reduce the side effects of hormonal imbalance, such as depression.

It stands to reason that receiving support from a  dietary supplement that is specially formulated to address the nutritional deficiencies associated with depression, anxiety, and certain side effects can help to minimize the experience of side effects in patients taking medications like Zoloft.

When the missing vitamins and minerals are received at therapeutic doses in addition to mitochondrial antioxidants, individuals may be able to better tolerate this crucial medication. 

There are several actions you can take to minimize common complaints of antidepressants such as Zoloft. They include the following steps:

Assess yourself before you start

Keep a journal. Start tracking digestive function, weight, sleep habits, occurrence of headaches and sexual health and more before you begin SSRI therapy and continue throughout your course in order to determine if changes may be linked to their use of medication. 

Take your medical history into account

Work with your healthcare professional and review your medical history as well as your family history. Individuals with a history of diabetes, kidney or liver problems, consume more than 2 alcoholic drinks per day may be at higher risk for experiencing side effects of SSRIs.  

Factor in your lifestyle 

Focus on staying hydrated, getting quality sleep, eating nutrient rich foods and less junk food, aiming for movement most days of the week, and finding meaningful community and work. This can go very far to support your overall health while taking antidepressant medication.

Monitor your bloodwork 

Work with your healthcare professional to monitor biomarkers associated with common complaints of antidepressants. These include key nutrients known to be depleted while using antidepressants (FIGLU - a marker for folate status, red blood cell magnesium, zinc, selenium,).

Tap into nutrient therapy 

Medication Induced Nutrient Depletions (M.I.N.D.) are important to address to ensure long term success with your medication use. Using therapeutic doses of required nutrients can ensure a great tolerance of your antidepressant long term. 

Every medication has benefits and risks, but knowledge is power. Talk to your healthcare professional about your unique medication history and health goals. There are many ways to get the benefits of statins while feeling your best. 

Sources:

https://www.healthline.com/health/depression/effects-brain 

https://www.medicalnewstoday.com/articles/263773 

https://medlineplus.gov/druginfo/meds/a697048.html 

https://www.webmd.com/drugs/2/drug-1/sertraline-oral/details 

https://www.drugs.com/sertraline.html 

https://www.healthline.com/health/sertraline-oral-tablet 

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd 

https://www.statista.com/statistics/781658/sertraline-hydrochloride-prescriptions-number-in-the-us/ 

https://www.everydayhealth.com/columns/therese-borchard-sanity-break/nutritional-deficiencies-that-may-cause-depression/