What is Sertraline (Zoloft)?
Sertraline, widely known by the brand name Zoloft, is a prescription medication classified as a selective serotonin reuptake inhibitor (SSRI) [1.5.2, 1.11.3]. It was first approved for medical use in the United States in 1991 [1.11.3]. Sertraline works by increasing the levels of serotonin, a natural substance in the brain that helps maintain mental balance [1.5.2]. Due to its action on serotonin, it is commonly prescribed to treat a variety of conditions, including:
- Major Depressive Disorder (MDD) [1.5.1]
- Obsessive-Compulsive Disorder (OCD) [1.5.1]
- Panic Disorder [1.5.1]
- Post-Traumatic Stress Disorder (PTSD) [1.5.1]
- Social Anxiety Disorder (SAD) [1.5.1]
- Premenstrual Dysphoric Disorder (PMDD) [1.5.1]
As of 2023, sertraline was the 11th most prescribed medication in the U.S., with over 42 million prescriptions dispensed [1.11.2, 1.11.3]. Its widespread use underscores its efficacy, but like all medications, it comes with a profile of potential side effects.
Does Sertraline Cause Burning Sensations?
Yes, sertraline can cause burning sensations, although it is considered a less common side effect [1.2.2, 1.2.3, 1.10.3]. This symptom is medically termed paresthesia, which encompasses a range of abnormal skin sensations, including burning, tingling, prickling, crawling, itching, or a 'pins and needles' feeling [1.2.2, 1.10.2]. According to the FDA drug label, paresthesia occurs in about 2% of patients taking sertraline [1.9.1].
These sensations can manifest in various parts of the body, such as the hands, feet, arms, legs, and even the chest [1.2.1, 1.2.3]. While often transient and resolving as the body adjusts to the medication, persistent or severe burning feelings should always be discussed with a healthcare provider [1.2.1]. In rare cases, sertraline has also been associated with Burning Mouth Syndrome (BMS) [1.2.5].
The Neurological Connection: Why Does It Happen?
The exact mechanism by which SSRIs like sertraline cause paresthesia is not fully understood, but it is believed to be related to their primary function of modulating serotonin levels [1.11.3]. Serotonin receptors are not only in the brain but also located throughout the central and peripheral nervous systems, including on nerves that transmit sensory information from the skin [1.4.1].
By altering serotonin activity, sertraline may inadvertently affect these sensory pathways, leading to the misfiring of nerves and resulting in abnormal sensations like burning or tingling [1.6.2]. This phenomenon is known as a sensory disturbance [1.3.3].
A burning sensation can also occur as part of a discontinuation syndrome if sertraline is stopped abruptly [1.6.3]. This withdrawal effect is characterized by symptoms such as dizziness, nausea, headache, and sensory disturbances like burning or 'electric-shock' feelings [1.3.2, 1.6.4, 1.6.5].
Comparison of Neurological Side Effects: Sertraline vs. Fluoxetine
Sertraline and fluoxetine (Prozac) are both popular SSRIs. While they share similar efficacy, their side effect profiles can differ slightly [1.8.3]. Below is a comparison table focusing on common neurological and sensory side effects.
| Side Effect | Sertraline (Zoloft) Incidence | Fluoxetine (Prozac) Incidence | Notes |
|---|---|---|---|
| Paresthesia | Occurs in 1% to 10% of users [1.9.2]. | Known to occur, but specific incidence varies by study. | Includes burning, tingling, and numbness. Both medications can cause this. |
| Headache | Up to 22% [1.9.2]. | Commonly reported. | One of the most frequent side effects for both drugs, often diminishing over time [1.7.1]. |
| Tremor | 9% [1.5.1]. | Less frequent compared to sertraline in some analyses. | A noticeable shaking or trembling. |
| Dizziness | 12% [1.5.1]. | Commonly reported. | Can contribute to feelings of imbalance. |
| Insomnia | 20% [1.5.1]. | A common side effect, with some studies showing higher rates than sertraline [1.8.1]. | Difficulty sleeping is a well-documented issue with many SSRIs. |
| Agitation/Anxiety | 8% [1.5.1]. | Higher incidence than sertraline in some direct comparisons [1.8.1]. | Paradoxically, medications for anxiety can sometimes increase it initially. |
Managing Sertraline-Related Burning Sensations
If you experience a burning sensation while taking sertraline, it is crucial not to stop the medication without consulting your doctor. Here are some general management strategies:
- Wait for Adjustment: Many side effects, including mild paresthesia, are transient and may disappear within the first few weeks as your body gets used to the medication [1.7.3].
- Dose Adjustment: The sensation might be dose-dependent [1.2.3]. Your doctor may suggest lowering your dose to see if the symptom subsides while maintaining therapeutic benefits.
- Lifestyle Modifications: Simple measures can sometimes help. The NHS suggests that if you feel dizzy or weak along with other sensations, you should sit or lie down until you feel better [1.7.1]. Avoid alcohol, as it can worsen side effects [1.7.2].
- Medical Evaluation: Your doctor will need to rule out other potential causes for the burning sensation, such as diabetic neuropathy, vitamin deficiencies, or other neurological conditions [1.2.1].
- Switching Medications: If the burning sensation is severe, persistent, or intolerable, your healthcare provider may recommend switching to a different antidepressant with a different side effect profile, such as another SSRI or a medication from a different class (e.g., SNRI) [1.7.3].
When to See a Doctor
You should report any new or bothersome side effects to your healthcare provider. It is especially important to seek medical attention if the burning sensation is:
- Severe, painful, or debilitating.
- Accompanied by muscle weakness, confusion, or changes in heart rate [1.5.3].
- Associated with a skin rash, hives, or swelling, which could indicate an allergic reaction [1.4.2, 1.4.5].
- Coupled with symptoms of serotonin syndrome, a potentially life-threatening condition that includes agitation, hallucinations, high fever, muscle stiffness, and rapid heartbeat [1.5.1].
Conclusion
While sertraline is a highly effective and widely used antidepressant, it can, in a small percentage of users, cause a burning sensation known as paresthesia [1.9.1]. This side effect stems from the medication's influence on serotonin pathways that regulate sensory information [1.6.2]. It can also be a symptom of withdrawal if the medication is stopped suddenly [1.6.3]. Though often mild and temporary, any instance of a burning feeling should be communicated to a healthcare professional. They can properly diagnose the cause, rule out other conditions, and determine the best course of action, whether it's adjusting the dose, waiting for the body to adapt, or trying a different medication. Never alter your dosage or stop taking sertraline without medical guidance [1.3.2].
For more information on sertraline and its side effects, you can visit the National Alliance on Mental Illness (NAMI).
