Sertraline (Zoloft): Approved Uses, Side Effects and Warnings

What sertraline is

Sertraline is an antidepressant in the group called selective serotonin reuptake inhibitors, or SSRIs. Zoloft is its brand name, and generic sertraline is also sold. MedlinePlus describes it as a tablet and a liquid concentrate, and capsule versions have their own FDA labels.

This page is general information taken from the FDA label and MedlinePlus. It is not advice about your own treatment, and it does not replace the Medication Guide that comes with your prescription.

What sertraline is approved for, and off-label uses

The Zoloft label lists these approved uses:

• Major depressive disorder.
• Obsessive-compulsive disorder (OCD).
• Panic disorder.
• Posttraumatic stress disorder (PTSD).
• Social anxiety disorder.
• Premenstrual dysphoric disorder (PMDD).

Who the approval covers, and what falls outside it

Approval can differ by age and product. For people under 18, the Zoloft label says safety and effectiveness are established only for OCD, in ages 6 to 17. The sertraline capsule label lists only depression in adults and OCD. Generalized anxiety disorder is not on the Zoloft label.

For PTSD, the VA's National Center for PTSD says sertraline and paroxetine are the only medicines FDA-approved for it, and that the 2023 VA/DoD guideline recommends both as having the most robust evidence. That is a statement about the evidence, not about which medicine suits any one person.

MedlinePlus says sertraline is also sometimes used off-label for headaches and sexual problems. Off-label means a use that is not on the FDA label.

How sertraline is thought to work

Serotonin is a natural chemical messenger in the brain. The label says sertraline blocks nerve cells from taking serotonin back up, which increases serotonin activity. It has only very weak effects on two other messengers, norepinephrine and dopamine, based on animal studies described in the label.

What taking sertraline can be like

MedlinePlus says it may take a few weeks or longer to feel the full benefit, and that people should keep taking it even when they feel well. The first few months, and any time the dose changes, are when the label asks for the closest watch on mood and behavior.

A few practical points are specific to sertraline. The liquid concentrate must be diluted before use and contains alcohol, according to MedlinePlus and the label. The label also says sertraline can cause a false-positive result on urine screening tests for benzodiazepines, so it is worth telling whoever orders such a test that you take it.

Do not stop sertraline suddenly. MedlinePlus lists withdrawal symptoms such as nausea, sweating, mood changes, irritability, dizziness, headache, confusion, tiredness, seizures and ringing in the ears. Talk with your prescriber before making any change.

Side effects and warnings for sertraline

Boxed warning: antidepressants increased the risk of suicidal thoughts and behaviors in children, teens and young adults in short-term studies. Anyone taking sertraline should be watched closely for worsening mood or new suicidal thoughts, and families and caregivers are asked to watch too. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. You can also see our crisis resources.

The label says the most common side effects were nausea, diarrhea or loose stool, tremor, indigestion, decreased appetite, heavy sweating, ejaculation failure and decreased sex drive. The label reports sexual side effects in both men and women.

Other dangers and combinations named on the label:

• MAOIs: sertraline is contraindicated with these medicines, or within 14 days of stopping one, because of serotonin syndrome. This includes linezolid and intravenous methylene blue.
• Pimozide: contraindicated, because of heart rhythm risk. The oral solution is also contraindicated with disulfiram. A known allergy to sertraline or its ingredients is another contraindication.
• Serotonin syndrome: a potentially life-threatening reaction, with risk raised by triptans, lithium, tramadol, fentanyl, amphetamines, St. John's wort and others. Signs include agitation, fever, sweating, fast heartbeat, stiffness and twitching.
• Bleeding: the risk rises with aspirin, NSAIDs and blood thinners such as warfarin.
• Mania or hypomania, seizures, angle-closure glaucoma, low sodium and changes in heart rhythm (QTc prolongation).

Can sertraline be managed online in Pennsylvania and New York

The Zoloft label says sertraline is not a controlled substance. A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine, treats anxiety, depression and trauma by secure video for people physically located in Pennsylvania or New York during each visit. Read more about care in Pennsylvania or New York.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, using our contact form. Ask us too about fees, insurance and the ages he sees. Our therapists do not prescribe, and they see clients in Pennsylvania, West Virginia, Arizona, Colorado and Florida, not New York. If you are in New York, psychiatry is available here but therapy is not. You can compare other medicines on our medications list.