Anti depression side effects

Contents

What are the real risks of antidepressants?

Though common in use, SSRIs are not without their side effects.

Updated: March 19, 2019Published: March, 2014

Since the late 1980s, America and the world have been enjoying the benefits of the selective serotonin reuptake inhibitors (SSRIs). These antidepressants — fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro) — are among the world’s most widely prescribed medications. The range of their uses has expanded from depression to anxiety, obsessive-compulsive disorder, eating disorders, and many other psychiatric conditions.

These types of antidepressants are generally safe, but no medical treatment is without risk.

SSRI antidepressant side effects

Some patients taking SSRIs develop insomnia, skin rashes, headaches, joint and muscle pain, stomach upset, nausea, or diarrhea. These problems are usually temporary or mild or both. A more serious potential problem is reduced blood clotting capacity because of a decreased concentration of the neurotransmitter serotonin in platelets. Patients are at slightly increased risk for internal bleeding, especially if they are also taking aspirin or another NSAID, such as ibuprofen or naproxen..

Sexual effects from SSRIs

For many patients, SSRIs diminish sexual interest, desire, performance, satisfaction, or all four. In men, SSRIs can delay or inhibit ejaculation, and in women, delay or prevent orgasm.

Lowering the dose of the SSRI antidepressant may help, although the patient may lose the drug’s benefit. Another solution is adding or substituting bupropion (Wellbutrin), which works by a different mechanism and does not generally cause sexual side effects.

Drug interactions

SSRIs are broken down in the liver by a group of enzymes known as the cytochrome P450 system. Many other drugs are also metabolized by this same system. Depending on the interaction, there may be a higher or lower blood level of the two drugs. Sometimes only a dose adjustment is necessary, or it may be best to avoid one of the two drugs.

If an SSRI is taken along with another drug that enhances serotonin activity, a rare condition called the serotonin syndrome may develop — racing heart, sweating, high fever, high blood pressure, and sometimes delirium. In particular, SSRIs should not be mixed with certain other medications, especially the herbal remedy St. John’s wort, monoamine oxidase inhibitors such as phenelzine (Nardil), and clomipramine (Anafranil). The serotonin syndrome has also been reported when an SSRI is combined with lithium, the standard treatment for bipolar disorder.

Use of SSRI antidepressants in older people

SSRIs are safer than tricyclic antidepressants for older people because they do not disturb heart rhythms and rarely cause dizziness that results in falls. But liver function is less efficient in older people, so there is a greater risk of drug interactions involving the cytochrome P450 system. For that reason, older people do best with rapidly metabolized drugs like sertraline.

Loss of antidepressant effectiveness

Any antidepressant may lose its effect after months or years, sometimes because the brain has become less responsive to the drug (tolerance). Solutions include increasing the dose and switching to another antidepressant with a different mechanism of action.

SSRI antidepressant discontinuation symptoms

Symptoms that may occur on suddenly stopping an SSRI include dizziness, loss of coordination, fatigue, tingling, burning, blurred vision, insomnia, and vivid dreams. Less often, there may be nausea or diarrhea, flu-like symptoms, irritability, anxiety, and crying spells. “Discontinuation syndrome” is a better description than “withdrawal reaction,” a phrase associated with addiction. The syndrome is usually mild, but can be severe.

Although none of these types of antidepressants should be stopped abruptly, paroxetine tends to produce the most intense discontinuation symptoms. Here is a place where the longer-lasting drugs have an advantage; some clinicians switch to fluoxetine before gradually lowering the dose.

SSRI antidepressants and pregnancy

Potential risks to the fetus such as premature delivery and lower birth weight must be weighed against the considerable risks of untreated depression to both mother and child. More seriously depressed women are more likely to need antidepressant drugs while pregnant.

Breast-feeding

Similar cautions apply to nursing mothers. Paroxetine and sertraline may be preferred as they do not appear to reach significant levels in breast milk.

Suicide

The risk that antidepressants will incite violent or self-destructive actions is the subject of continuing controversy. In 2004, the FDA first initiated a Black Box Warning on SSRIs — its strongest available measure short of withdrawing a drug from the market. The warning is still placed on package inserts for all antidepressants in common use. It mentions the risk of suicidal thoughts, hostility, and agitation in children, teens and young adults.

The number of antidepressant prescriptions for children and teens, which rose rapidly throughout the 1990s, fell precipitously after the Black Box Warning was issued. However, there is the other side of under treatment of depression. The lifetime suicide rate of people with major depression is 15%, and depression can also be lethal in other ways; for example, a history of major depression doubles the risk of heart disease.

Regular follow-up and close monitoring can help prevent a bad outcome. Patients should be warned that there is a slight chance they will feel worse for a while, and they should let their prescribing clinicians know immediately if they begin to feel worse or develop new symptoms, especially after changing the medication or the dose.

Disclaimer:
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Sign Up for a Pregnancy Registry

Pregnancy Exposure Registries are research studies that collect information from women who take prescription medicines or vaccines during pregnancy.

Pregnancy registries can help women and their doctors learn more about how depression medicines affect women during pregnancy.

The FDA does not run pregnancy studies, but it keeps a list of registries. Check to see if there is a registry for your depression medicine or other medicines at: www.fda.gov/pregnancyregistries

Medicine for Depression

There are different kinds of medicine for depression.

  • Selective Serotonin Reuptake Inhibitors (SSRI)
  • Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
  • Tricyclic and Tetracyclic Antidepressants
  • Atypical Antidepressants
  • Monoamine Oxidase Inhibitors (MAOIs)
  • N-methyl D-aspartate (NMDA) Antagonist
  • Neuroactive Steroid Gamma-Aminobutyric Acid (GABA)-A Receptor Positive Modulator

Read the following information to find out some general facts about the different kinds of medicine for depression.

Like all drugs, depression medicine may cause side effects. Do not stop taking your medicine without first talking to your healthcare provider. Tell your healthcare provider about any problems you are having, including thoughts about suicide. Your healthcare provider will help you find the medicine that is best for you.
Tell your healthcare provider about any medicine that you are taking. Do not forget about cold medicines, supplements, and herbals like St. John’s Wort. Some of these can interact with antidepressants and cause unwanted side effects.

Order or our Free Medicine Record Keeper.

Questions To Ask Your Healthcare Provider

  • What medicine am I taking?
  • What are the potential side effects?
  • What other prescription medicine should I avoid while taking medicine for depression?
  • What foods, herbs (like St. John’s Wort), or over-the-counter medicine should I avoid?
  • When should I take each medicine?
  • How many times per day do I take each medicine?
  • Can I take my medicine if I am pregnant or nursing?

Selective Serotonin Reuptake Inhibitors (SSRIs)

Generic Name Brand Name
Celexa citalopram
Lexapro escitalopram
Paxil, Paxil CR, Pexeva paroxetine
Prozac, Prozac Weekly fluoxetine
Trintellix vortioxetine
Viibryd vilazodone
Zoloft sertraline

Warnings

  • Do not take with these medicines: Monoamine Oxidase Inhibitors (MAOIs), and in some cases thioridazine or Orap (pimozide).
  • Women should talk to their healthcare providers about the risks of taking these medicines during pregnancy.
  • Use with caution if you have narrow-angle glaucoma.

Common Side Effects

  • Nausea
  • Tremor (shaking)
  • Nervousness
  • Problems sleeping
  • Sexual problems
  • Sweating
  • Agitation
  • Feeling tired

Less Common, but Serious, Side Effects

  • Seizures
  • Abnormal bleeding or bruising
  • Withdrawal symptoms

Ask your healthcare provider about serotonin syndrome.

For up-to-date information about the risks and side effects for each drug, check [email protected]

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

Brand Name Generic Name
Cymbalta duloxetine
Effexor, Effexor XR venlafaxine
Fetzima levomilnacipran
Pristiq, Khedezla desvenlafaxine

Warnings

  • Do not take with MAOIs.
  • Use with care if you have liver or kidney problems.
  • Use with caution if you have narrow-angle glaucoma.

Common Side Effects

  • Nausea
  • Vomiting
  • Dry mouth
  • Constipation
  • Fatigue
  • Feeling drowsy
  • Dizziness
  • Sweating
  • Sexual problems

Less Common, but Serious, Side Effects

  • Increase in blood pressure
  • Abnormal bleeding or bruising
  • Seizures

Ask your healthcare provider about serotonin syndrome.

For up-to-date information about the risks and side effects for each drug, check [email protected]

Tricyclic and Tetracyclic Antidepressants

Brand Name Generic Name
Asendin amoxapine
Elavil amitriptyline
Ludiomil maprotiline*
Norpramin desipramine
Pamelor nortriptyline
Sinequan doxepin
Surmontil trimipramine
Tofranil imipramine
Vivactil protriptyline

*This is a tetracyclic. The others listed are tricyclic.

Warnings

  • Do not take with MAOIs.
  • Use with caution if you have narrow-angle glaucoma.

Common Side Effects

  • Dry mouth
  • Constipation
  • Blurred vision
  • Drowsiness
  • Low blood pressure

Less Common, but Serious, Side Effects

  • Problems urinating
  • Confusion
  • Fainting
  • Seizures
  • Life-threatening irregular heartbeat

For up-to-date information about the risks and side effects for each drug, check [email protected]

Atypical Antidepressants

Brand Name Generic Name
Desyrel trazodone
Serzone nefazodone

Warnings

  • Do not take with MAOIs, and, for nefazodone, if you are taking triazolam, alprazolam, pimozide, or carbamazepine.
  • Cases of life-threatening liver failure have been reported in patients taking nefazodone. Patients should be advised to be alert for signs and symptoms of liver dysfunction (jaundice, anorexia, gastrointestinal complaints, malaise, etc.) and to report them to their healthcare provider immediately if they occur.
  • Use caution if you drink alcohol or take barbiturates while taking this medicine.

Common Side Effects

  • Dry mouth
  • Dizziness
  • Blurred vision
  • Feeling drowsy or sleepy
  • Constipation

Less Common, but Serious, Side Effects

  • Painful erection that lasts a long time
  • Low blood pressure
  • Fainting
  • Confusion
  • Liver failure

For up-to-date information about the risks and side effects for each drug, check [email protected]

Atypical Antidepressants

Brand Name Generic Name
Remeron mirtazapine

Warnings

  • Do not take with MAOIs.
  • Use caution if you have a personal history or family history of heart disease or irregular heart rhythm.

Common Side Effects

  • Feeling drowsy or sleepy
  • Weight gain
  • Dizziness

Less Common, but Serious, Side Effects

  • Agranulocytosis (drop in white blood cell count)
  • Increase in cholesterol
  • Increase in liver enzymes

Ask your healthcare provider about Serotonin Syndrome.

For up-to-date information about the risks and side effects for each drug, check [email protected]

Brand Name Generic Name
Wellbutrin, Wellbutrin SR, Wellbutrin XL bupropion

Warnings

  • Use caution if you drink alcohol while taking this medicine.
  • Use caution if you take levodopa.
  • Use caution if you have seizures or take medicines that raise your chance of having a seizure.

Common Side Effects

  • Dizziness
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision

Less Common, but Serious, Side Effects

  • Seizures
  • Blood pressure changes

For up-to-date information about the risks and side effects for each drug, check [email protected]

Monoamine Oxidase Inhibitors (MAOIs)

Brand Name Generic Name
Emsam (Skin Patch) selegiline
Marplan isocarboxzaid
Nardil phenelzine
Parnate tranylcypromine

Warnings

  • Do not take MAOIs if you are also taking other medicines for depression or central nervous system stimulants or depressants.
  • Do not eat certain foods like cheese, wine, protein foods that have been aged, or any food containing tyramine.
  • Do not take cold pills or decongestants.

Common Side Effects

  • Nausea
  • Restlessness
  • Problems sleeping
  • Dizziness
  • Drowsiness

Less Common, but Serious, Side Effects

  • Headache
  • Stroke
  • Fainting
  • Heart palpitations
  • Blood pressure changes

For up-to-date information about the risks and side effects for each drug, check [email protected]

N-methyl D-aspartate (NMDA) Antagonist

Brand Name Generic Name
Spravato (nasal spray) esketamine

Important Information:

  • Esketamine must be taken with an oral antidepressant.
  • Esketamine should be used only in patients who have tried other depression medicines that did not work for them.
  • Patients may experience sedation (tiredness) and dissociation (difficulty with attention, judgment, and thinking) after administration.
  • Because of these risks, esketamine is available only through a restricted program, called the Spravato REMS.
  • Esketamine is a nasal spray that must be administered in a healthcare setting that is certified in the REMS program where the healthcare provider can monitor the patient for sedation and dissociation for two hours after each dose.

Warnings:

  • Risk for temporary sedation (tiredness) and dissociation (difficulty with attention, judgment, and thinking) after administration.
  • Esketamine is a federal controlled substance and has the potential to be misused and abused.
  • May cause temporary difficulty with attention, judgment, thinking, reaction speed, and motor skills.
  • Do not drive or operate machinery until the next day after a restful sleep.
  • May harm an unborn baby. Patients should talk to their healthcare provider about the risks of taking this medicine during pregnancy.

Common Side Effects:

  • Dissociation (difficulty with attention, judgment, and thinking))
  • Dizziness
  • Nausea
  • Sleepiness
  • Spinning sensation
  • Decreased feeling or sensitivity
  • Anxiety

Less Common, but Serious, Side Effects:

  • Increase in blood pressure

For up-to-date information about the risks and side effects for each drug, check [email protected]

Neuroactive Steroid Gamma-Aminobutyric Acid (GABA)-A Receptor Positive Modulator

Brand Name Generic Name
Zulresso (This medicine is given as an intravenous infusion.) brexanolone

Important Information:

  • Brexanolone is approved for the treatment of postpartum depression (PPD) in adults.
  • Brexanolone is given by continuous intravenous (IV) infusion over a total of 60 hours.
  • Patients may experience excessive tiredness or sudden loss of consciousness or changes in their state of consciousness while brexanolone is being given.
  • Because of these risks, brexanolone is available only through a restricted program called the Zulresso REMS. It can only be administered in a healthcare facility that is certified in the Zulresso REMS.
  • Patients must be monitored while brexanolone is being given and report any signs and symptoms of excessive tiredness to a healthcare provider.
  • Before starting brexanolone, tell your healthcare provider if you may be pregnant.

Warnings:

  • Risk for sedation (tiredness) and sudden loss of consciousness.
  • Brexanolone is a federal controlled substance and has the potential to be misused and abused.
  • Taking brexanolone with opioids or certain other medicines called CNS depressants may increase the risks of tiredness or sudden loss of consciousness.
  • Risk for suicidal thoughts and behaviors
  • Brexanolone can be abused or lead to dependence.

Common Side Effects:

  • Sedation (tiredness)
  • Dry mouth
  • Loss of consciousness
  • Flushing

Less Common, but Serious, Side Effects:

  • Suicidal thoughts and behaviors

Depression and Your Children

Like adults, children and teens can also feel depressed. You should watch your children for signs of depression. Talk to your children if you notice changes in their behavior. Talk to your child’s healthcare provider if you are still concerned.

Prozac (fluoxetine) is the only medicine that is approved by FDA for use in children with depression. Prozac (fluoxetine) and Lexapro (escitalopram) are the only FDA-approved medicines for teens with depression. Talk to your healthcare provider about important warnings for children and teens who take medicine for depression.

Important Warnings

Some children and teens who take antidepressants may be more likely to think about hurting or killing themselves when starting treatment or when dose is changed.

Call a healthcare provider or 911 if the person:

  • Tries to hurt or kill himself/herself
  • Talks about specific ways they plan to hurt or kill himself/herself
  • Talks about or tries to harm others

Call your healthcare provider right away if the person shows any of these signs:

  • Talks about dying or suicide
  • Starts acting very differently
  • Is abnormally active
  • Has severe problems sleeping
  • Becomes violent or abnormally angry
  • Becomes agitated or can’t sit still

Depression medicines and information is current as of September 2019. For the most up-to-date information about the risks and side effects of medicines for treatment of Depression, please see [email protected]

To Learn More:

National Institute of Mental Health (NIMH)
Web: www.nimh.nih.gov
Phone: 1-866-615-6464
TTY/TDD: 1-866-415-8051

Resources For You

  • Depression/HHS Office of Women’s Health
  • Free Publications For Women
  • Women’s Health Topics
  • Office of Women’s Health
  • An Invitation to Collaborate

Zoloft Side Effects

Generic Name: sertraline

Medically reviewed by Drugs.com. Last updated on Dec 6, 2018.

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Tips
  • Interactions
  • More

Note: This document contains side effect information about sertraline. Some of the dosage forms listed on this page may not apply to the brand name Zoloft.

In Summary

Common side effects of Zoloft include: diarrhea, dizziness, drowsiness, dyspepsia, fatigue, insomnia, loose stools, nausea, tremor, headache, paresthesia, anorexia, decreased libido, delayed ejaculation, diaphoresis, ejaculation failure, and xerostomia. Other side effects include: abdominal pain, agitation, pain, vomiting, anxiety, hypouricemia, and malaise. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to sertraline: oral solution, oral tablet

Warning

Oral route (Solution; Tablet)

Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders in short-term studies. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults older than 24 years, and there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Sertraline hydrochloride is not approved for use in pediatric patients except for patients with obsessive compulsive disorder (OCD).

Along with its needed effects, sertraline (the active ingredient contained in Zoloft) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking sertraline:

More common

  • Decreased sexual desire or ability
  • failure to discharge semen (in men)

Less common or rare

  • Aggressive reaction
  • breast tenderness or enlargement
  • confusion
  • convulsions
  • diarrhea
  • drowsiness
  • dryness of the mouth
  • fast talking and excited feelings or actions that are out of control
  • fever
  • inability to sit still
  • increase in body movements
  • increased sweating
  • increased thirst
  • lack of energy
  • loss of bladder control
  • mood or behavior changes
  • muscle spasm or jerking of all extremities
  • nosebleeds
  • overactive reflexes
  • racing heartbeat
  • red or purple spots on the skin
  • restlessness
  • shivering
  • skin rash, hives, or itching
  • sudden loss of consciousness
  • unusual or sudden body or facial movements or postures
  • unusual secretion of milk (in females)

Incidence not known

  • Abdominal or stomach pain
  • bleeding gums
  • blindness
  • blistering, peeling, or loosening of the skin
  • bloating
  • blood in the urine
  • bloody, black, or tarry stools
  • blue-yellow color blindness
  • blurred vision
  • chest pain or discomfort
  • chills
  • clay-colored stools
  • cough or hoarseness
  • darkened urine
  • decreased urine output
  • decreased vision
  • depressed mood
  • difficulty with breathing
  • difficulty with speaking
  • difficulty with swallowing
  • drooling
  • dry skin and hair
  • eye pain
  • fainting
  • feeling cold
  • feeling of discomfort
  • feeling, seeing, or hearing things that are not there
  • general feeling of discomfort, illness, tiredness, or weakness
  • hair loss
  • high fever
  • high or low blood pressure
  • hoarseness or husky voice
  • hostility
  • increased clotting times
  • indigestion
  • inflamed joints
  • irritability
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • lethargy
  • lightheadedness
  • loss of appetite
  • loss of balance control
  • loss of bladder control
  • lower back or side pain
  • muscle aches
  • muscle cramps and stiffness
  • muscle trembling, jerking, or stiffness
  • muscle twitching
  • painful or difficult urination
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pale skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rapid weight gain
  • rash
  • red, irritated eyes
  • red, sore, or itching skin
  • right upper stomach pain and fullness
  • severe mood or mental changes
  • severe muscle stiffness
  • shuffling walk
  • sore throat
  • sores, ulcers, or white spots in the mouth or on the lips
  • sores, welting, or blisters
  • stiffness of the limbs
  • sweating
  • swelling of the face, ankles, or hands
  • swollen or painful glands
  • talking or acting with excitement you cannot control
  • tightness in the chest
  • troubled breathing
  • twisting movements of the body
  • twitching
  • uncontrolled movements, especially of the face, neck, and back
  • unexplained bleeding or bruising
  • unpleasant breath odor
  • unusual behavior
  • unusual tiredness or weakness
  • vomiting of blood
  • weight gain
  • yellow eyes and skin

Some side effects of sertraline may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Acid or sour stomach
  • belching
  • decreased appetite or weight loss
  • diarrhea or loose stools
  • heartburn
  • sleepiness or unusual drowsiness
  • stomach or abdominal cramps, gas, or pain
  • trouble sleeping

Less common

  • Agitation, anxiety, or nervousness
  • bladder pain
  • burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
  • changes in vision
  • cloudy urine
  • constipation
  • difficult, burning, or painful urination
  • flushing or redness of the skin, with feeling of warmth or heat
  • frequent urge to urinate
  • increased appetite
  • pain or tenderness around the eyes and cheekbones
  • stuffy or runny nose

Incidence not known

  • Flushed, dry skin
  • fruit-like breath odor
  • increased hunger
  • increased urination
  • redness or other discoloration of the skin
  • severe sunburn
  • swelling of the breasts (in women)
  • unexplained weight loss
  • unusual secretion of milk (in women)

For Healthcare Professionals

Applies to sertraline: oral concentrate, oral tablet

General

The most commonly reported side effect was nausea, which was dose dependent and often transient in nature. The most common side effects associated with discontinuation of sertraline (the active ingredient contained in Zoloft) treatment at an incidence at least twice that for placebo and at least 1% for sertraline in clinical trials included abdominal pain, agitation, diarrhea, dizziness, dry mouth, dyspepsia, ejaculation failure, fatigue, headache, hot flushes, insomnia, nausea, nervousness, palpitation, somnolence, and tremor.

The overall profile of side effects in pediatric clinical trials was generally similar to that seen in adult studies. Fever, hyperkinesia, urinary incontinence, aggressive reaction, sinusitis, epistaxis, and purpura were reported in clinical trials in pediatric patients at an incidence of at least 2% and at a rate of at least twice that of placebo. In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder, the incidence of discontinuation due to side effects was reported at 9%; the most common reactions leading to discontinuation were agitation, suicidal ideation, hyperkinesia, suicide attempt, and aggravated depression.

Psychiatric

Antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. An increased risk of suicidal thinking and behavior in children, adolescents, and young adults (aged 18 to 24 years) with major depressive disorder (MDD) and other psychiatric disorders has been reported with short-term use of antidepressant drugs.

Adult and pediatric patients receiving antidepressants for MDD, as well as for psychiatric and nonpsychiatric indications, have reported symptoms that may be precursors to emerging suicidality, including anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia, hypomania, and mania. Causality has not been established.

In a 12-week placebo-controlled study in pediatric patients with OCD, side effects observed at an incidence of at least 5% and at a statistically significant increased level for sertraline (the active ingredient contained in Zoloft) compared with placebo were insomnia and agitation in 6 to 12 year olds, and insomnia in 13 to 17 year olds.

In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder, agitation was reported at a frequency of at least 2% and at least twice that of placebo. Suicide attempt was reported in the same number of patients in the sertraline (2 out of 189) and placebo (2 out of 184) groups. Suicide ideation was reported by 3 sertraline-treated patients and no placebo-treated patients; however the difference was not statistically significant.

Mania, affect lability were also commonly reported in controlled trials in pediatric patients.

Very common (10% or more): Insomnia (up to 21%)

Common (1% to 10%): Affect/emotional lability, aggravated depression, aggressive reaction, aggression, agitation, anxiety, bruxism/teeth grinding, decreased libido, depersonalization, depression, nervousness, nightmare, mania, paroniria, suicidal ideation, suicide attempt

Uncommon (0.1% to 1%): Abnormal dreams, Abnormal thinking, apathy, euphoria/euphoric mood, hallucination

Rare (less than 0.1%): Conversion disorder, drug dependence, paranoia, psychotic disorder, sleep walking, suicide behavior

Frequency not reported: Psychomotor hyperactivity, irritability

Postmarketing reports: Depressive symptoms, intense dreams, manic reaction, psychosis, sleep disturbances, withdrawal syndrome

Nervous system

Very common (10% or more): Headache (up to 22%), somnolence (up to 13%), dizziness (up to 12%),

Rare (less than 0.1%): Choreoathetosis, coma, dyskinesia, hyperesthesia, sensory disturbance

Frequency not reported: Akathisia, ataxia, cerebrovascular spasm (including reversible cerebral vasoconstriction syndrome and Call-Fleming syndrome), confusional state/confusion, decreased alertness, dystonia, extrapyramidal symptoms, gait abnormalities, gait disturbance, movement disorders, neuroleptic malignant syndrome, sensory disturbances, serotonin syndrome

Postmarketing reports: Oculogyric crisis

In a 12-week placebo-controlled study in pediatric patients with OCD, side effects observed at an incidence of at least 5% and at a statistically significant increased level for sertraline compared with placebo were headache (in 6 to 12 year olds) and tremor (in 13 to 17 year olds). In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder, hyperkinesia and tremor were reported at a frequency of at least 2% and at least twice that of placebo.

Potentially life-threatening serotonin syndrome has been reported with SSRIs and SNRIs as monotherapy, but particularly with concomitant use of other serotonergic drugs and drugs that impair the metabolism of serotonin. Signs and symptoms associated with serotonin syndrome or neuroleptic malignant syndrome included agitation, confusion, diaphoresis, diarrhea, fever, hypertension, rigidity, and tachycardia and were in some cases associated with concomitant use of serotonergic drugs.

Cardiovascular

Common (1% to 10%): Chest pain, hot flush, palpitations

Uncommon (0.1% to 1%): ECG QT prolonged/QTc prolongation, flushing, hypertension, peripheral edema, tachycardia

Rare (less than 0.1%): Bradycardia, cardiac disorder, myocardial infarction, peripheral ischemia, vasodilation procedure

Frequency not reported: Edema, hemorrhage, vasodilation

Postmarketing reports: Atrial arrhythmias, AV block, torsade de pointes, vasculitis, ventricular tachycardia

Gastrointestinal

Very common (10% or more): Nausea (up to 26%), diarrhea/loose stools (up to 20%), dry mouth (up to 14%)

Common (1% to 10%): Abdominal pain, constipation, dyspepsia, flatulence, vomiting

Uncommon (0.1% to 1%): Dysphagia, eructation, esophagitis, hemorrhoids, salivary hypersecretion, tongue disorder

Frequency not reported: Gastrointestinal bleeding, pancreatitis, rectal hemorrhage

There are two cases in the literature in which the use of Lactobacillus acidophilus capsules were reported to have been very helpful in the treatment of persistent, sertraline-induced diarrhea.

A study of 26,005 antidepressant users has reported 3.6 times more upper GI bleeding episodes with the use of SSRIs relative to the population who did not receive antidepressant medications. Upper gastrointestinal tract bleeding was observed in 4.1 times more frequently in patients receiving sertraline.

In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder diarrhea, vomiting, and dry mouth were reported at a frequency of at least 2% and at least twice that of placebo.

Metabolic

The results of one study appear to indicate that treatment with selective serotonin reuptake inhibitors may cause an increase in serum total cholesterol, HDL cholesterol, and/or LDL cholesterol. However, additional studies are necessary to confirm these findings.

Numerous cases of hyponatremia have been reported following treatment with a selective serotonin reuptake inhibitor (SSRI). Risk factors for the development of SSRI- associated hyponatremia including advanced age, female gender, concomitant use of diuretics, low body weight, and lower baseline serum sodium levels have been identified. Hyponatremia tends to develop within the first few weeks of treatment (range 3 to 120 days) and typically resolves within 2 weeks (range 48 hours to 6 weeks) after therapy has been discontinued with some patients requiring treatment. The proposed mechanism for the development of hyponatremia involves the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) via release of antidiuretic hormone.

In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder, anorexia was reported at a frequency of at least 2% and at least twice that of placebo. In a 12-week placebo-controlled study in pediatric patients with OCD, anorexia was observed at an incidence of at least 5% and at a statistically significant increased level for sertraline (the active ingredient contained in Zoloft) compared with placebo in 13 to 17 year olds.

Common (1% to 10%): Anorexia, increased/decreased appetite, weight increased/decreased

Uncommon (0.1% to 1%): Thirst

Rare (less than 0.1%): Diabetes mellitus, hypercholesterolemia, hypoglycemia

Frequency not reported: Hyperglycemia, hyponatremia

Other

Very common (10% or more): Fatigue (up to 12%)

Common (1% to 10%): Fever/pyrexia, malaise, tinnitus

Uncommon (0.1% to 1%): Asthenia, chills, ear pain, injury, otitis externa

Rare (less than 0.1%): Drug tolerance decreased, otitis media

Frequency not reported: Lethargy

Postmarketing reports: Abnormal clinical laboratory results

Genitourinary

In placebo-controlled trials ejaculation failure (primarily delayed ejaculation) in men was reported as a treatment-emergent side effect in 14% of men taking sertraline (the active ingredient contained in Zoloft) compared to 1% in the placebo group. The estimates of the incidence of untoward sexual experience and performance may underestimate their actual incidence, partly because patients and physicians may be reluctant to discuss this issue.

In clinical trials in children and adolescents aged 6 to 17 years with major depressive disorder urinary incontinence was reported at a frequency of at least 2% and at least twice that of placebo.

Very common (10% or more): Ejaculation failure (up to 14%)

Common (1% to 10%): Ejaculatory delay/disorder, erectile dysfunction, menstrual irregularities, other male/female sexual dysfunction, urinary incontinence, urinary retention, vaginal hemorrhage

Rare (less than 0.1%): Abnormal semen, atrophic vulvovaginitis, balanoposthitis, diverticulitis, galactorrhea, gastroenteritis, genital discharge, hematuria, increased libido, menorrhagia, oliguria, premature ejaculation, priapism, urinary hesitation

Postmarketing reports: Enuresis

Dermatologic

Common (1% to 10%): Acne, hyperhidrosis/increased sweating, rash, urticaria

Rare (less than 0.1%): Bullous eruption, follicular rash, hair texture abnormal

Frequency not reported: Bullous dermatitis, erythematous/maculopapular rash

Postmarketing reports: Exfoliative skin disorders, hematoma, photosensitivity reaction, severe cutaneous skin reactions (SCAR)/fatal SCAR, skin reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis

Endocrine

Endocrine side effects including two cases of galactorrhea have been reported in association with sertraline (the active ingredient contained in Zoloft) therapy. Two cases of breast discomfort and enlargement without galactorrhea have also been reported.

Case reports have suggested that sertraline, like other serotonin- specific reuptake inhibitors, may induce the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Seven cases of hyponatremia have been reported, four of which were associated with SIADH. Six of the seven patients were over 60 years of age.

Uncommon (0.1% to 1%): Hypothyroidism

Frequency not reported: Gynecomastia

Postmarketing reports: Hyperprolactinemia, syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Hematologic

Uncommon (0.1% to 1%): Anemia

Rare (less than 0.1%): Lymphadenopathy

Frequency not reported: Abnormal bleeding, altered platelet function, leukopenia, thrombocytopenia

Postmarketing reports: Agranulocytosis, aplastic anemia, increased coagulation times, pancytopenia

Hepatic

Uncommon (0.1% to 1%): Abnormal hepatic function, ALT/AST increased

Frequency not reported: Elevated hepatic enzymes, hepatitis, jaundice, liver failure, severe liver events

Postmarketing reports: Acute liver failure, asymptomatic elevations in serum transaminases, fatal liver failure

The majority of liver events appear to be reversible upon sertraline treatment cessation.

Hypersensitivity

Uncommon (0.1% to 1%): Hypersensitivity

Rare (less than 0.1%): Anaphylactoid reaction

Frequency not reported: Allergy, anaphylaxis

Postmarketing reports: Allergic reaction, angioedema, serum sickness

Immunologic

Uncommon (0.1% to 1%): Herpes simplex

Musculoskeletal

Common (1% to 10%): Arthralgia, myalgia

Uncommon (0.1% to 1%): Back pain, muscle weakness, muscle twitching, osteoarthritis

Rare (less than 0.1%): Bone disorder

Frequency not reported: Muscle cramps/spasms, tightness, twitching

Postmarketing reports: Bone fracture, lupus-like syndrome, rigidity, trismus

Epidemiological studies, primarily in patients aged 50 years or older, have shown an increased risk of bone fractures in patients receiving SSRIs or TCAs.

Ocular

Common (1% to 10%): Abnormal vision, visual disturbance/impairment

Uncommon (0.1% to 1%): Eye pain, mydriasis, periorbital edema

Rare (less than 0.1%): Diplopia, glaucoma, hyphema, lacrimal disorder, photophobia, scotoma, visual field defect

Frequency not reported: Blurred vision, unequal pupils

Postmarketing reports: Blindness, cataract, optic neuritis

Oncologic

There was one case of neoplasm reported in one patient receiving sertraline (the active ingredient contained in Zoloft) compared to no cases in the placebo-treated group.

Rare (less than 0.1%): Neoplasm

Renal

Uncommon (0.1% to 1%): Cystitis

Postmarketing reports: Acute renal failure

Respiratory

Common (1% to 10%): Pharyngitis, yawning

Uncommon (0.1% to 1%): Bronchospasm, dyspnea, epistaxis, rhinitis, upper respiratory tract infection

Rare (less than 0.1%): Dysphonia, hiccups, hyperventilation, hypoventilation, laryngospasm, stridor

Frequency not reported: Interstitial lung disease

Postmarketing reports: Pulmonary hypertension

1. “Product Information. Zoloft (sertraline).” Roerig Division, New York, NY.

2. Cerner Multum, Inc. “UK Summary of Product Characteristics.” O 0

3. Cerner Multum, Inc. “Australian Product Information.” O 0

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.

Related questions

  • Can I take tramadol with sertraline?
  • What is the difference between Prozac and Zoloft?
  • What is the difference between Lexapro and Zoloft?
  • What is the difference between Celexa and Lexapro?

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7 Antidepressant Side Effects

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) are among the most common medications prescribed in America today. For the most part, these medications are safe and effective, but all medications have side effects.

“Side effects from antidepressants depend on the class of medication you are using, but in most cases when we talk about side effects, we are talking about SSRIs,” says Madhukar Trivedi, MD, a psychiatry professor and director of the Depression Center at the University of Texas Southwestern Medical Center in Dallas. According to a report in the journal Psychiatry, about 40 percent of people taking antidepressants have side effects, and about 25 percent of those side effects are considered very bothersome. Two of the most common ones (sexual side effects and weight gain) are serious enough to cause people to stop or change antidepressant medications.

Here are seven important antidepressant side effects you need to be aware of:

Physical Symptoms. When you first begin antidepressant treatment, depression medication side effects can be physical symptoms like headache, joint pain, muscle aches, nausea, skin rashes, or diarrhea. These symptoms are usually mild and temporary. A study published in the journal Clinical Therapeutics looked at more than 40,000 people who had recently started on antidepressants. The most common early side effects of theses meds were headache and nausea. “Many people build up a tolerance to these early side effects, and they rarely require discontinuation of medications,” says Dr. Trivedi.

Sleep Disturbance. “Many people notice trouble sleeping when they first start taking an antidepressant — trouble falling asleep or that they wake up easily during the night,” says Trivedi. Other types of depression medication-related sleep disturbances common with SSRIs include nightmares and sleepwalking. A review of sleep disturbances in people taking SSRIs, published in the journal Frontiers in Psychiatry, reported that about 22 percent of those on these prescription meds experience some type of sleep disturbance.

Daytime Sleepiness. “Daytime sleepiness can be a side effect of sleep disturbance at night or a direct sedative effect of an antidepressant,” explains Trivedi. “If an antidepressant causes sedation, taking it at bedtime may solve the problem.” Medication side effects of SSRIs in particular can include both sedation that causes daytime sleepiness and insomnia that causes nighttime wakefulness. About 25 percent of people on SSRI meds will have one or both of these two side effects.

Migraine Headache. Because migraines tend to be more common in people with depression, Trivedi says, “people who take medications for migraines need to be careful when taking SSRIs.” Medications used for migraine treatment, called triptans, and SSRIs both increase the brain chemical serotonin. Serotonin syndrome, which causes flushing, rapid heart rate, and headache, can occur if these medications are taken together. Ask your doctor about how to avoid serotonin syndrome if you’re taking prescription meds for both conditions.

Weight Gain. “Weight gain is a late side effect of antidepressants and one of the most common reasons that patients stop taking them or need to change medications,” says Trivedi. “Getting 30 minutes of exercise on most days of the week is the best remedy.” The likelihood of gaining weight depends on the antidepressant you’re taking. With paroxetine hydrochloride (Paxil), a commonly used depression medication, about 25 percent of people will gain more than 7 percent of their body weight.”

Suicide. The risk that taking an antidepressant will increase the risk of suicidal thinking has been extensively studied. According to most of the research, when compared with taking a placebo, taking an SSRI or another antidepressant doubles the risk for suicidal thinking. The overall risk of this depression medication side effect for children, teens, and adults is 2 to 4 percent. One reason why antidepressants may lead to suicide is that they may give a person enough energy to carry out a suicide plan. Regular follow-up with your doctor is the best way to prevent this side effect.

Sexual Side Effects. Sexual side effects are the most common long-term side effects caused by SSRIs. They include decreased sexual desire, delayed ejaculation in men, and the inability to have an orgasm in women. Up to 60 percent of people on SSRIs may have one of these depression medication side effects. “Sexual side effects are one of the long-term side effects that many people cannot tolerate,” Trivedi says. “For any side effect, early or late, you need to work with your doctor; there are usually options that can help. But discontinuing your medication on your own is never a good option.”

A Complete Guide to Sertraline Side Effects

With tens of millions of prescriptions in the United States alone, sertraline is one of the most widely used SSRI medications on the market. Sertraline has been in use since the early 1990s. Safe and effective, it’s used by tens of millions of people every year without major side effects. However, like all SSRIs, sertraline side effects do exist, and you should be aware of them before you consider treatment.

Like other SSRIs, most sertraline side effects occur in the first few weeks of treatment and disappear over time. However, some can last for several months or occur at any time while using the medication.

Although rare, it’s possible to experience several more serious side effects if you use sertraline to treat depression, anxiety or any other condition.

Below, we’ve listed the common and uncommon side effects of sertraline. We’ve also linked to relevant studies and other data to provide some more context on how common or uncommon these side effects really are.

Common Sertraline Side Effects

Sertraline belongs to a class of medications known as selective serotonin reuptake inhibitors, or SSRIs. Like other SSRIs, it can cause a range of mild side effects that typically occur during the first few weeks of treatment. We’ve listed these common side effects below.

Fatigue and Tiredness

Fatigue and tiredness are two of the most common side effects of sertraline, as well as several other SSRIs.

If you’re using sertraline to treat depression, fatigue and tiredness from the medication can also be compounded by the effects of depression on your mood. It’s very common to feel a little low in energy during the first few weeks of taking sertraline.

While there’s no consensus on why this happens, researchers believe it could be triggered by the effects of SSRIs like sertraline on neurotransmitters such as acetylcholine.

Dealing with fatigue and tiredness from sertraline can be a frustrating experience, but it usually passes. As the medication reaches a steady state in your body, you’ll generally start to notice a less pronounced effect on your energy levels before this side effect fades completely.

If you have persistent fatigue or tiredness after starting sertraline that doesn’t disappear within one month, it’s best to contact your doctor.

Sexual Side Effects

Sertraline and other SSRIs can cause a variety of sexual side effects, from difficulty achieving orgrasm to a decreased libido and erectile dysfunction.

Sexual side effects are some of the most common side effects of sertraline and other commonly used SSRI medications. According to certain studies, between 40 and 65% of people who take SSRIs experience some side effects related to sexual desire and performance.

These side effects can affect both men and women. In men, the most common side effect is a higher level of difficulty achieving orgasm and ejaculating. Some men also experience a lower general level of interest in sex after using SSRIs such as sertraline.

In women, the most common sexual side effect of sertraline and other SSRIs is a lower level of interest in sex.

Like many other side effects of sertraline, sexual side effects can often fade over time as your body gets used to the medication. If persistent, sexual side effects can be treated by adjusting your dosage or switching to a different medication.

Insomnia

Insomnia and a general reduction in sleep quality are both common side effects of SSRIs and other antidepressants. Many people who use sertraline find it more difficult than normal to fall asleep, or find themselves waking up frequently throughout the night.

While it doesn’t list the effects of sertraline specifically, a 2017 study notes that it’s common for antidepressants to affect sleep. Like many other SSRI side effects, the study states that these effects are most common in the short term.

There are several ways to deal with insomnia from sertraline. The first is to wait it out, as this side effect tends to fade away as the medication reaches a steady state in your body. It’s also possible to take sertraline in the morning to reduce its concentration by the time you sleep.

Finally, it’s important to avoid caffeine and other stimulants that could prevent you from falling asleep in a normal amount of time. Try to restrict your consumption of coffee, caffeinated soda and energy drinks to before noon to avoid them affecting you when it’s time to fall asleep.

Dizziness

It’s not uncommon to feel dizzy during the first few weeks of using sertraline. Like other common side effects, this is thought to be a result of your body adjusting to the medication. Dizziness is a short-term side effect of sertraline that usually doesn’t persist for longer than two to four weeks.

Interestingly, sertraline is linked to lower levels of dizziness in the long term in studies, indicating that it could help you feel less dizzy once the medication reaches a steady state in your body.

If you notice frequent dizziness or lightheadedness after using sertraline that lasts for more than four weeks, it’s important to contact your doctor. This side effect can often be treated by using a lower dose of the medication or by taking sertraline at night, rather than in the daytime.

Weight Gain

Sertraline and other SSRIs are associated with weight gain, although not all people who take these medications will gain weight.

Around 25% of people who use antidepressants gain weight while on their medication. Most of the weight gain caused by antidepressants is mild, with a 2017 study from Australia finding that, on average, high-dosage antidepressant users gain 0.28kg (about 0.6lbs) per year.

In a 2018 UK study, researchers concluded that antidepressants may contribute to a long-term increased risk of weight gain. Another study found that antidepressant use is associated with a higher total calorie intake.

Unlike other medications, SSRIs like sertraline don’t appear to have a direct effect your body’s metabolism. However, over the long term, they could affect your appetite, causing you to eat a larger amount of food that can contribute to an increase in body mass.

If you’re concerned about weight gain from sertraline, it’s best to talk to your doctor. Most of the time, you can avoid changes in your body mass and composition by monitoring your food intake and maintaining your pre-treatment eating habits while using sertraline.

Reduced Appetite

This might sound unbelievable after the side effect listed above, but sertraline could potentially cause you to have a reduced appetite.

Like other side effects of sertraline, this is usually temporary. Many people prescribed sertraline feel less hungry during the first few weeks of treatment before noticing a stronger appetite over the long term.

Just like with weight gain, the key to avoiding weight loss from sertraline is to talk to your doctor and monitor your food intake. By staying consistent with your eating habits and activity level, it’s easier to maintain your body mass and composition while using sertraline or any other SSRI.

Diarrhea

Diarrhea is a common side effect of sertraline. In studies of sertraline and other SSRIs, about 14 to 16% of people who are prescribed sertraline at a typical dose will experience diarrhea during the course of treatment.

Like many other side effects, diarrhea usually occurs in the first few weeks of treatment. Most of the time, diarrhea becomes less frequent and disappears completely as your body adjusts to the medication and your dosage of sertraline reaches a steady state.

If you have persistent diarrhea from sertraline, the best approach is to contact your doctor. This side effect can often be treated by reducing your dosage of sertraline or switching to a different antidepressant, such as paroxetine or fluoxetine, which are both less likely to cause diarrhea.

Headaches

It’s common to experience headaches after you start using sertraline, particularly in the first few weeks of treatment. Like other common side effects, headaches usually disappear after two to four weeks of use as the medication reaches a steady state in your body.

While some painkiller can interact with sertraline, it’s safe to take paracetamol if you experience headaches after starting sertraline.

If you have persistent or severe headaches from sertraline that don’t improve over time, it’s best to talk to your doctor. Simple changes to your sertraline usage such as taking your medication at a different time of day or reducing your dosage can help to limit or get rid of headaches.

Dry Mouth

Finally, dry mouth is a common side effect of sertraline and other antidepressants. While there’s no clear reason for this, researchers believe that the effects of sertraline and other SSRIs on the brain can also affect your gastrointestinal system.

Studies show that between 35% and 46 of people prescribed antidepressants experience some level of dry mouth. Although sertraline is slightly less likely to cause dry mouth than other drugs in this category (in trials, it affects about 16% of people), it’s still fairly common.

There are several ways to treat dry mouth from sertraline. Like other side effects, dry mouth is often temporary, meaning it should go away on its own over the course of several weeks as the medication reaches a steady state in your body.

It’s also possible to reduce the severity of dry mouth by avoiding caffeine, alcohol, tobacco, any spicy foods and other substances that can cause dehydration. Sugar-free gums can also help to stimulate saliva production and keep your mouth and throat properly hydrated.

Finally, if you have persistent dry mouth from sertraline, you should talk to your doctor. Just like many other side effects of sertraline, dry mouth can often be avoided by adjusting your dosage or switching to a different SSRI medication.

Serious Side Effects of Sertraline

Most people who use sertraline won’t experience any side effects, or will only experience a few of the mild side effects listed above. However, it’s also possible for sertraline to cause a variety of potentially serious effects in some users.

Below, we’ve listed the serious potential side effects of sertraline. If you experience any of these side effects, you should contact your doctor as soon as possible for medical assistance.

Fainting and Extreme Dizziness

Although it’s very rare, fainting is a potential side effect of sertraline. A very small percentage of people who use sertraline also experience severe dizziness and lightheadedness, often shortly after taking the medication.

If you feel faint, weak or severely dizzy after taking sertraline, you should seek medical help as soon as possible.

Chest Pain

A small number of people who use sertraline have reported severe chest pain after taking the medication.

In one study, an elderly woman experienced severe, crushing chest pain after taking a normal dose of sertraline. The woman was hospitalized and received treatment using a range of drugs used to treat heart conditions.

If you experience severe or unusual chest pain after taking sertraline, you should seek medical help as soon as possible.

It’s important to point out that this side effect is extremely rare. Overall, sertraline is a safe and effective drug that’s widely used successfully, including by people with certain heart conditions that make other SSRIs unsuitable.

Persistent Bleeding

Sertraline is one of several SSRIs that can act as a blood thinner, meaning it could affect your body’s ability to from blood clots. This means that if you injure yourself in a way that results in bleeding while using sertraline, your body might have difficulty forming a normal blood clot.

Clotting issues from sertraline use are rare and can potentially occur as a result of interactions with other medications, such as blood thinners. If you use other medications that could affect your clotting ability, it’s essential that you inform your doctor before considering sertraline.

Priapism

Sertraline and other antidepressants have the potential to cause priapism, a condition that can result in a long-lasting, painful erection. Priapism can cause the penis to stay erect for hours at a time, resulting in severe discomfort and potentially causing damage to penile tissue.

Priapism is a very rare side effect of sertraline and other SSRIs. If you experience a persistent, painful erection after taking sertraline or any other antidepressant, you should seek immediate medical assistance.

Suicidal Thoughts

Sertraline and several other widely used antidepressants can increase your risk of experiencing suicidal thoughts. The risk of suicidal thoughts appears to be the highest in people aged under 25 who take antidepressants to treat non-depression conditions such as anxiety.

Despite this, a meta-analysis of studies of SSRIs such as sertraline found that SSRIs do not cause any measurable increase in suicide rates. There’s also only weak evidence of increases in self-harm among people who use SSRIs.

If you experience suicidal thoughts after you start using sertraline, it’s important to seek medical assistance as soon as possible.

Learn More About Sertraline

While many of the side effects listed above can look alarming, it’s worth remembering that most people who use sertraline either experience no side effects at all, or light, transient side effects that disappear as they become accustomed to the medication.

Sertraline is one of the most common, widely used antidepressants in the world, with more than 37 million prescriptions in the US alone. For the vast majority of users, it’s a safe, effective and important medication that provides real benefits.

In addition to the side effects listed above, sertraline can potentially interact with a wide range of other medications and substances, including alcohol. Our 101 guide to sertraline goes into more detail on these interactions, as well the essentials of how sertraline works as a medication.

Selective serotonin reuptake inhibitors

SSRI stands for Selective Serotonin Reuptake Inhibitor. SSRI antidepressants are a type of antidepressant that work by increasing levels of serotonin within the brain.

Serotonin is a neurotransmitter that is often referred to as the “feel good hormone”. It carries messages between brain cells and contributes to well-being, good mood, appetite, as well as helping to regulate the body’s sleep-wake cycle and internal clock.

SSRIs increase levels of serotonin in the brain by preventing the reuptake of serotonin by nerves. Having more serotonin available in the nerve synapse means that it can transmit messages easier. All SSRI antidepressants are thought to work in this way.

Antidepressants relieve the symptoms of depression. SSRIs are one type of antidepressant. Other types include tricyclic antidepressants (TCAs), serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), monoamine oxidase inhibitors (MAOIs), and the atypical antidepressants.

What are SSRI antidepressants used for?

SSRI antidepressants help to relieve symptoms of depression such as low mood, irritability, feelings of worthlessness, restlessness, anxiety, and difficulty in sleeping.

They are one of the most commonly prescribed antidepressants because they are effective at improving mood with fewer or less severe side effects compared to some other antidepressants.

In addition to depression, SSRIs may also be used to treat a range of other conditions, for example:

  • Anxiety
  • Bulimia nervosa
  • Fibromyalgia
  • Hot flashes
  • Obsessive-compulsive disorder
  • Panic disorder
  • Post-Traumatic Stress Disorder
  • Premenstrual dysphoric disorder

Some reduction in symptoms may be noticed within one to two weeks; however, it may take six to eight weeks of treatment before the full effects are seen.

What are the differences between SSRI antidepressants?

Although all SSRI antidepressants are thought to act in the same way, there are differences between individual SSRIs with regards to how long they remain in the body, how they are metabolized, and how much they interact with other medications. For example, fluoxetine, fluvoxamine, and paroxetine are more likely to interact with other medications than citalopram, escitalopram and sertraline.

Generic name Brand name examples
citalopram Celexa
escitalopram Lexapro
fluoxetine Prozac, Sarafem
fluvoxamine Luvox
paroxetine Brisdelle, Paxil, Pexeva
sertraline Zoloft
vilazodone Viibryd

Are SSRI antidepressants safe?

When taken at the recommended dosage, SSRI antidepressants are considered safe. However, they have been associated with a few serious, potentially fatal, severe side effects such as:

  • An increase in suicidal thoughts and behaviors, particularly in children and young adults under the age of 25 years. This is most likely to occur when starting therapy
  • Serotonin syndrome – this is caused by excessive levels of serotonin in the body and is more likely to occur with higher dosages of SSRIs or when SSRIs are administered with other medications that also release serotonin (such as dextromethorphan, tramadol, and St. John’s Wort). Symptoms include agitation, confusion, sweating, tremors, and a rapid heart rate
  • An increase in the risk of bleeding, especially if used with other medications that also increase bleeding risk.

In addition, some SSRIs, such as citalopram have been associated with abnormal heart rhythms with higher dosages.

What are the side effects of SSRI antidepressants?

Not everybody experiences side effects with SSRIs antidepressants. Some of the more commonly reported side effects include:

  • Blurred vision
  • Dizziness
  • Drowsiness (fluoxetine is more likely to cause insomnia)
  • Dry mouth
  • Gastrointestinal upset (such as constipation, diarrhea, or nausea)
  • Headache
  • Sexual dysfunction (such as reduced desire or erectile dysfunction).

Several SSRIs have been associated with a discontinuation syndrome when they have been stopped suddenly. For this reason, it is best to withdraw all antidepressants slowly.

For a complete list of side effects, please refer to the individual drug monographs.

Antidepressants – Side effects

Symptoms of severe serotonin syndrome include:

  • a very high temperature (fever)
  • seizures (fits)
  • irregular heartbeat (arrhythmia)
  • unconsciousness

If you experience symptoms of severe serotonin syndrome, seek emergency medical help. Telephone 999 and ask for an ambulance.

Hyponatraemia

If you are elderly and you take antidepressants, you may notice a severe fall in sodium (salt) levels. This is hyponatraemia. This may lead to a build-up of fluid inside the cells of the body, which can be dangerous.

SSRIs can block the effects of a hormone that regulates levels of sodium and fluid in the body. Fluid levels become more difficult for the body to regulate as people age.

Mild hyponatraemia can cause the following symptoms:

  • feeling sick
  • headache
  • muscle pain
  • reduced appetite
  • confusion

More severe hyponatraemia can cause the following symptoms:

  • feeling listless and tired
  • disorientation
  • agitation
  • psychosis
  • seizures (fits)

The most serious cases of hyponatraemia can cause you to stop breathing or enter a coma.

If you suspect mild hyponatraemia, call your GP for advice and stop taking SSRIs for the time being.

If you suspect severe hyponatraemia, call 999 and ask for an ambulance.

Hyponatraemia can be treated by feeding a sodium solution into the body through a drip.

Diabetes

Long-term use of SSRIs and TCAs have been linked to an increased risk of developing type 2 diabetes. But it’s not clear if the use of these causes diabetes to develop directly. Treating depression has been linked with reducing the risk of heart disease, particularly in men. This may be because of their effect on improving the body’s immune and anti-inflammation response.

Some people gain weight when using antidepressants. This may increase the risk of developing type 2 diabetes.

Your doctor may suggest other activities, for example:

  • exercise
  • good diet
  • social activities that boost your mood and connect you with people in your community

Suicidal thoughts

In very rare cases, people have suicidal thoughts or a desire to self-harm when they start antidepressants. Young people under 25 seem particularly at risk. Treating depression with medication and talking treatments greatly reduces the risk of suicide.

Contact your GP, or go to a hospital immediately, if you have thoughts of killing or harming yourself.

It may be useful to tell a relative or close friend if you’ve started taking antidepressants. Ask them to read the leaflet that comes with your medication. Then ask them to tell you if they think your symptoms are getting worse. Or if they’re worried about changes in your behaviour.

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