Sertraline, sold under brand names like Zoloft, is a selective serotonin reuptake inhibitor (SSRI) prescribed for various mental health conditions [1.3.2]. It is FDA-approved to treat major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD) [1.3.2]. The medication works by increasing the levels of serotonin, a neurotransmitter in the brain that helps regulate mood [1.3.4, 1.3.6]. While effective for many, it comes with a range of potential side effects, with one being more prevalent than others.
What is the most common side effect of sertraline?: Nausea
Across numerous clinical studies and patient reports, nausea stands out as the most common side effect of sertraline [1.2.2, 1.4.4, 1.7.5]. In clinical trials, nausea was reported by up to 26% of adult participants [1.7.5, 1.4.2]. This gastrointestinal issue occurs because serotonin receptors are not only in the brain but also in the gut. As sertraline increases serotonin levels, it can stimulate these receptors in the gastrointestinal tract, leading to feelings of sickness [1.4.2].
This side effect is most likely to occur when first starting the medication or after a dosage increase [1.4.4]. For most individuals, nausea is transient and tends to improve or resolve entirely within the first couple of weeks as the body adjusts to the new serotonin levels [1.9.1, 1.9.2].
Other Frequent Side Effects
While nausea is the most common, sertraline is associated with several other frequently reported side effects. These often improve over the first week or two of treatment [1.5.6].
- Gastrointestinal Issues: Besides nausea, diarrhea is another very common side effect, affecting up to 20% of users. Dry mouth is also common, reported in up to 14% of patients [1.7.5].
- Sleep Disturbances: Insomnia (trouble sleeping) is a very common psychiatric side effect, affecting up to 21% of people [1.7.5]. Conversely, some individuals may experience somnolence (drowsiness or sleepiness) [1.2.5, 1.7.1].
- Neurological Effects: Headache (up to 22%), dizziness (up to 12%), and tremor are also frequently noted [1.7.5].
- Sexual Dysfunction: Problems such as ejaculation failure (up to 14%), decreased libido, and other sexual performance issues are common and often do not diminish over time without intervention [1.7.5, 1.5.6].
- Other Effects: Increased sweating (hyperhidrosis) and fatigue are also common complaints [1.2.2, 1.2.5].
How to Manage Common Side Effects
Patients can take several steps to mitigate the initial, more common side effects like nausea:
- Take with Food: Taking sertraline with a meal can help lessen nausea unless otherwise directed by a doctor [1.4.3, 1.4.4].
- Adjust Meal Habits: Eating smaller, more frequent meals can be beneficial. Avoiding spicy or rich foods may also help [1.4.3, 1.7.2].
- Stay Hydrated: Drinking plenty of fluids like cool water can help, especially if experiencing diarrhea [1.4.5, 1.7.2].
- Consider Timing: If sertraline causes drowsiness, taking it at bedtime may be an option, with a doctor's approval. If it causes insomnia, taking it in the morning is recommended [1.4.5, 1.7.2].
- Use Simple Remedies: Sucking on sugar-free hard candy or chewing sugarless gum can help with dry mouth [1.4.5]. Ginger tea or flat ginger ale may also help soothe nausea [1.4.2].
Sertraline vs. Other Common SSRIs
Sertraline's side effect profile is broadly similar to other SSRIs, but some differences exist.
| Side Effect Profile | Sertraline (Zoloft) | Fluoxetine (Prozac) | Escitalopram (Lexapro) |
|---|---|---|---|
| Nausea | More likely than Lexapro [1.6.1] | Common [1.6.4] | Less likely than Zoloft [1.6.1] |
| Diarrhea | More likely than Prozac and Lexapro [1.6.1, 1.6.4, 1.2.5] | Less common than Zoloft [1.6.6] | Less common than Zoloft [1.6.1] |
| Sleep Issues | Can cause insomnia or drowsiness; may be more likely than Lexapro to cause trouble sleeping [1.6.1] | More likely to cause sleep disturbances and insomnia than Zoloft [1.6.4, 1.6.6] | Less likely than Zoloft to cause trouble sleeping [1.6.1] |
| Weight Changes | Generally not associated with significant weight gain in long-term studies [1.2.5] | Less likely to cause weight gain [1.2.5] | Can cause weight changes |
| Sexual Side Effects | Common; may have a slightly lower risk than some other SSRIs [1.6.5] | Common [1.6.4] | Common |
Serious and Long-Term Side Effects
While most side effects are mild and temporary, there are serious and long-term risks to consider. It is crucial to contact a healthcare provider if these occur.
Serious Adverse Reactions
- Suicidal Thoughts and Behaviors: Sertraline has an FDA boxed warning for an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults under 25, especially during the initial months of treatment or after a dose change [1.2.4, 1.2.5].
- Serotonin Syndrome: A potentially life-threatening condition caused by excessive serotonin levels. Symptoms include agitation, confusion, rapid heart rate, high blood pressure, muscle stiffness or twitching, and diarrhea [1.7.3, 1.7.4]. The risk increases when taken with other serotonergic medications [1.7.1].
- Abnormal Bleeding: SSRIs can increase the risk of bleeding events, such as nosebleeds, gastrointestinal bleeding, or bruising more easily [1.2.3, 1.5.6].
- Manic Episodes: In individuals with bipolar disorder, sertraline can trigger a manic or hypomanic episode [1.7.4].
- Low Sodium Levels (Hyponatremia): Can cause headache, weakness, confusion, and difficulty concentrating [1.7.2, 1.7.4].
- Allergic Reactions: Severe reactions can include swelling of the face or throat, difficulty breathing, and severe skin rashes [1.7.2, 1.7.3].
Potential Long-Term Effects
Long-term use of sertraline is generally considered safe for most people, but some persistent effects can occur [1.5.1].
- Sexual Dysfunction: This is one of the most persistent long-term side effects and can sometimes continue even after stopping the medication (Post-SSRI Sexual Dysfunction, or PSSD) [1.5.1, 1.5.2].
- Weight Gain: While less common initially, some studies suggest long-term use can be associated with an increased risk of weight gain over time [1.5.2, 1.5.4].
- Emotional Blunting: Some users report feeling emotionally numb or a reduced ability to experience both positive and negative emotions [1.5.2, 1.5.4].
- Bone Health: Long-term use may be associated with low bone mineral density and an increased risk of fractures, especially in older adults [1.5.6].
Conclusion
While sertraline is a widely used and effective medication for many, understanding its side effect profile is crucial for anyone beginning treatment. Nausea is the most common side effect, typically emerging at the start of therapy and subsiding as the body adapts [1.4.4, 1.9.1]. Simple management strategies, such as taking the medication with food, can often alleviate this discomfort [1.7.2]. While other common effects like headaches, sleep changes, and diarrhea are frequent, they also tend to be temporary [1.5.6]. It is essential for patients to be aware of the signs of more serious reactions, such as serotonin syndrome or an increase in suicidal thoughts, and to communicate openly with their healthcare provider about any side effects they experience. Do not stop taking sertraline abruptly without consulting a doctor, as this can lead to withdrawal symptoms [1.7.1].
For more information from an authoritative source, you can visit the NHS page on Sertraline.
