11 Sertraline Side Effects You Should Know About

Sertraline (Zoloft) is an antidepressant medication that’s FDA approved to treat a variety of mental health conditions. It belongs to a group of antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by raising the amount of serotonin in the brain. Serotonin is a chemical messenger that’s involved in multiple processes in the body. This includes regulating your mood, sleep, and digestion.

Sertraline works well and has fewer side effects than some other SSRIs. But side effects are still possible, and it’s helpful to know what to expect and how to manage them if they happen.

Sertraline side effects at a glance

Some sertraline side effects are more likely when you start taking sertraline or when you increase your dose. These side effects tend to go away quickly on their own. Others are more serious and require medical attention. Some of the most common sertraline side effects and the serious side effects reported in clinical trials are listed below.

Common sertraline side effects

• Nausea

• Diarrhea

• Dry mouth

• Insomnia

• Tiredness

• Tremor

• Indigestion

• Decreased appetite

• Increased sweating

• Decreased sex drive

• Erectile dysfunction

• Minor weight changes

Rare or serious sertraline side effects

• Liver problems

• Increased risk of bleeding

• Serotonin syndrome

• Suicidal thoughts and behaviours

• Increased risk of seizures

Let’s take a closer look at 11 noteworthy sertraline side effects and how to manage them.

1. Nausea

The most common side effect of sertraline in clinical trials was nausea. About 25% of people taking sertraline experienced it. It’s most likely to occur when you first start sertraline or right after a dose increase.

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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 help lessen nausea.  Food, tea, or supplements that contain ginger may also help.

If nothing works, or your nausea 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 antidepressants, especially sertraline. Sertraline is the most likely of the SSRIs to cause diarrhea. Research shows it may occur in up to 20% of people taking sertraline.

Many side effects of antidepressants, including diarrhea, usually get better within a few weeks. Antidiarrheal medications — like loperamide (Imodium A-D) — may help in the short term. But these medications can also have side effects and shouldn’t be taken for more than a few days. It’s best to get your prescriber’s OK before starting them.

If diarrhea persists, let your prescriber know. They might recommend another antidepressant.

3. Dry mouth

Dry mouth may occur in up to 14% of people taking sertraline. But it tends to be less common with SSRIs than some other antidepressants, such as tricyclic antidepressants (TCAs).

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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) products known as 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

About 20% of people report trouble sleeping (insomnia) when taking sertraline. But it’s important to know that 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.

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. Usually this side effect goes away within a few weeks of starting sertraline. And keep in mind that like insomnia, being tired or fatigued is a common symptom of depression as well. Antidepressant medications can help improve symptoms of depression (including tiredness) over time.

Still, if you find that you’re too tired to complete your daily responsibilities, talk to your healthcare team. They may recommend taking your sertraline at night or suggest another antidepressant.

6. Sexual side effects

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

If you have sexual side effects from sertraline, there’s a few things you can try, such as:

• Lowering your dose of sertraline with your prescriber’s guidance

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

• Adding on a medication (like bupropion) that can improve 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)

• Talking to your healthcare team about other potential causes of sexual problems

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 several other SSRIs. Paroxetine (Paxil) is the SSRI that’s most often connected to weight gain. Antidepressants and weight gain are discussed more in another GoodRx Health article.

On the other hand, weight loss from sertraline has also been reported. Most cases, though, have been in kids and adolescents. Thankfully, these weight changes are typically minor. But if your child is taking sertraline, their pediatrician may want to occasionally monitor their body weight as a precaution.

Because sertraline’s effects on body weight can vary, make sure to talk to your healthcare team if you notice any weight changes that are undesirable, bothersome, or don’t go away.

8. Suicidal thoughts and behaviors

Sertraline carries an increased risk of suicidal thoughts and behaviors in people who are younger than 25 years old. All SSRIs carry a boxed warning (the strongest warning the FDA can assign to a medication) for this risk.

The risk 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.

9. Serotonin syndrome

Serotonin syndrome is a serious side effect that can happen with medications like SSRIs that increase serotonin levels. Serotonin syndrome can occur when there’s too much serotonin in your brain. It’s most likely to occur when SSRIs are combined with other medications that also increase serotonin levels. This includes other antidepressants, some pain medications (like tramadol), and triptans. Even some OTC medications — like dextromethorphan (Delsym) — can increase your risk of serotonin syndrome with sertraline.

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. And sertraline may be one of the SSRIs that’s more likely to cause bleeding and bruising. Symptoms may include:

• New or worsening bruising

• Bleeding from the nose or gums

• Tarry or black stools

• Rectal bleeding

• Bright red vomit

• Pink or red urine

• Heavier menstrual periods than usual

The risk of bleeding is higher if you’re taking other medications that can cause bleeding. This includes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). It also includes anticoagulants, such as warfarin (Coumadin, Jantoven), apixaban (Eliquis), and rivaroxaban (Xarelto).

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.

11. Skin or whites of eyes turning yellow

Your liver plays a big role in breaking down sertraline. If it’s not working as well as it could, sertraline could build up in your body and cause additional side effects. Because of this, your prescriber will likely start with a lower dose of sertraline if you have liver problems.

In very rare cases, liver-related side effects are also a possible sertraline side effect. Make sure to notify your prescriber right away if you experience sudden abdominal pain or signs of jaundice (yellowing skin or eyes).

How long does it take for sertraline side effects to improve?

Many of sertraline’s side effects may begin within the first week of starting it. This includes nausea, diarrhea, and dry mouth. Sleep changes can also appear early on in treatment. But most of these side effects should go away after you’ve been taking sertraline for a month or so (about 4 weeks). Sexual side effects, however, are less likely to improve with time.

Keep in mind that the reverse is true for sertraline’s benefits. It may take 4 to 8 weeks before sertraline’s full effects kick in. So even if you’re having side effects and not feeling great with sertraline at first, you should start feeling better if you stick with it and give your body time to adjust.

Still, make sure to listen to your body. If you’re experiencing side effects that are interfering with your daily life or don’t go away after a few weeks, talk to your prescriber. They’re there to help.

In other cases, it's a good idea to seek medical attention as soon as you can. Signs of excessive bleeding or bruising, severe symptoms of serotonin syndrome, and/or liver problems may warrant a trip to the closest emergency room.

What side effects can you expect when you stop taking sertraline?

If you’re interested in stopping sertraline, don’t make any changes without talking to your prescriber. They can help you weigh the pros and cons of stopping sertraline. And they can help you come up with a plan to lower your dose slowly.

That’s because antidepressant discontinuation syndrome can happen if you stop taking an antidepressant abruptly. The symptoms may feel similar to flu symptoms, like tiredness and muscle aches. But symptoms can also include anxiety and irritation. Antidepressant discontinuation syndrome is usually mild and lasts anywhere from 1 to 2 weeks. But it may be more serious for some people.

Following your prescriber’s directions for stopping sertraline will help you avoid unwanted side effects related to antidepressant withdrawal.

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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 was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

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

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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