11 Sertraline Side Effects You Should Know About

Sertraline (Zoloft) is an antidepressant that’s FDA approved to treat a variety of mental health conditions. It belongs to a group of medications called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by raising the amount of serotonin in the brain. Serotonin is a chemical messenger that helps regulate your mood, sleep, and digestion.

Sertraline works well and has fewer side effects overall than some other SSRIs. But it’s still helpful to know what to expect and how to manage any side effects that occur.

Sertraline side effects at a glance

Some sertraline side effects are more likely when you start taking sertraline or after a dosage increase. These side effects tend to go away quickly on their own. Others are more serious and may require medical attention. Some of the most common and the most serious sertraline side effects are listed below.

1. Nausea

Nausea was the most common sertraline side effect reported in clinical trials. It’s most likely to occur when you first start taking sertraline or right after a dose increase.

Luckily, nausea with sertraline doesn’t tend to last. It usually improves over time as your body adjusts to the medication. Taking sertraline with food (especially bland foods, like crackers) may reduce nausea. Eating smaller, more frequent meals can also help.

If your nausea is severe or doesn’t go away, talk to your healthcare team. They may recommend lowering your sertraline dose. Or they may switch you to a different antidepressant that’s less likely to cause nausea.

2. Diarrhea

Diarrhea is also a common side effect of SSRIs. Sertraline is more likely to cause diarrhea than other medications in this class.

Diarrhea usually gets better on its own within a few weeks. In the meantime, antidiarrheal medications, such as loperamide (Imodium A-D), can help. But it’s best to get your prescriber’s OK before taking one. And be sure to drink plenty of fluids, since diarrhea can lead to dehydration.

If diarrhea persists, let your prescriber know. They can help determine the cause and the best next steps to manage it.

3. Dry mouth

Dry mouth affects some people taking sertraline. But it tends to be less common with SSRIs than other types of antidepressants, such as serotonin and norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

Some ways to combat dry mouth from sertraline include sipping on cold liquids throughout the day and chewing sugar-free gum. Over-the-counter (OTC) saliva substitutes may also be an option if other remedies haven’t worked.

If dry mouth doesn’t go away and it’s bothering you, talk to your healthcare team. They may be able to lower your dose of sertraline. Or they may try another antidepressant altogether.

4. Insomnia

Another possible sertraline side effect is insomnia (trouble sleeping). But insomnia can also be a symptom of depression itself. Usually, antidepressants (including sertraline) help improve sleep problems associated with depression. It just takes some time. So it’s a good idea to take sertraline for a few weeks to see if your sleep improves.

If sertraline is causing insomnia, ask your prescriber about taking your dose in the morning. Having good sleep hygiene may also help. This includes avoiding all screens at least 1 hour before bed and avoiding caffeine at least 6 hours before bed. Exercising and getting outside for some sunlight during the day can help too.

If insomnia continues after a few weeks, talk to your healthcare team. They may recommend lowering your dose. Or they may switch you to another antidepressant that’s less likely to cause insomnia.

5. Tiredness

While some people may have trouble sleeping while taking sertraline, others may feel more tired than usual. Usually this side effect goes away within a few weeks of starting sertraline. In the meantime, talk to your prescriber about taking sertraline at bedtime if this side effect is bothersome.

If after a few weeks your fatigue worsens or doesn’t improve, talk to your healthcare team. They can help determine what’s going on and how to proceed.

6. Sexual side effects

Sexual side effects can occur while taking sertraline. The most common sexual side effects are ejaculation problems, low libido (sex drive), and erectile dysfunction. Unlike the previous side effects, sexual side effects are less likely to improve over time.

If you’re experiencing sexual side effects from sertraline, don’t hesitate to reach out to your healthcare team for guidance. There are several options that may help, such as:

• Lowering your sertraline dose (with your prescriber’s guidance)

• Switching to another antidepressant that’s less likely to cause sexual side effects, such as bupropion (Wellbutrin SR, Wellbutrin XL) or mirtazapine (Remeron)

• Adding on a medication (such as bupropion) that can improve SSRI-related sexual side effects

• Taking sertraline in the morning, as some people notice stronger side effects in the hours immediately after taking sertraline

• Trying an erectile dysfunction medication, such as sildenafil (Viagra)

Don’t make any changes to your medications without talking to a healthcare professional first.

7. Weight gain or weight loss

Some people taking sertraline may notice a small amount of weight gain. However, it’s less common with sertraline compared to some other SSRIs. Weight gain is more likely if you take sertraline for more than 6 months.

On the other hand, there are also reports of weight loss while taking sertraline. This seems to be more common in kids and adolescents. These weight changes typically aren’t significant. But if your child is taking sertraline, their pediatrician may want to occasionally monitor their body weight as a precaution.

Talk to your healthcare team if you notice any unwanted weight changes while taking sertraline.

8. Suicidal thoughts and behaviors

Sertraline carries an increased risk of suicidal thoughts and behaviors in people under age 25. All SSRIs carry a boxed warning for this risk.

The risk for this side effect seems to be highest when first starting sertraline or after a dosage change. Let your prescriber know right away if you notice any negative changes in your mood while taking sertraline.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

9. Serotonin syndrome

Serotonin syndrome is a rare, but serious sertraline side effect. It occurs when there’s too much serotonin in your brain. So it’s more likely if you take sertraline along with other medications that can increase serotonin levels. This includes:

• Other antidepressants

• Opioid pain medications, such as tramadol (ConZip)

• Triptan migraine medications

• Dextromethorphan (Delsym)

Mild serotonin syndrome symptoms may include sweating, tremors, and a fast heart rate. But it can progress quickly into more severe symptoms, such as confusion, high blood pressure, and uncontrolled body movements.

Serotonin syndrome can be life-threatening if it’s not treated. If you start to experience symptoms of serotonin syndrome, contact your prescriber or seek emergency medical care right away.

10. Higher risk of bleeding

SSRIs can raise your risk of bleeding. As with serotonin syndrome, this side effect is more likely if you take sertraline with other medications that can raise your bleeding risk. Examples include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)

• Blood thinners, such as warfarin (Coumadin) or apixaban (Eliquis)

• Some supplements, such as omega-3 fatty acids or turmeric

Make sure your prescriber and pharmacist have a list of your current medications. They can help check if any of your medications raise the risk of bleeding when combined with sertraline.

Keep an eye out for any signs and symptoms of bleeding while taking sertraline, such as new or worsening bruising, bleeding from the nose or gums, or heavier menstrual periods than usual. Seek emergency care if you notice blood in your urine or stool or begin coughing or vomiting blood at any time while taking sertraline.

11. Yellow-colored skin or eyes

In very rare cases, sertraline may cause liver-related side effects. Make sure to notify your prescriber right away if you experience sudden abdominal pain or signs of jaundice (yellowing skin or eyes). You’ll likely need to stop taking sertraline if liver problems occur.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She currently practices as a clinical pharmacist at Buffalo General Medical Center.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD, MWC

Christina Aungst, PharmD, MWC is a senior pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019.

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