Fatigue, insomnia, and nausea are common, but usually go away on their own Its anti-Cp effect is indeed due to its serotonergic activity and not its other effects. Specifically, Palit & Ali 2008 find that sertraline kills almost all promastigotes of Leishmania donovani.

Weight Gain

Reduction, hydroxylation, and glucuronide conjugation of both sertraline and desmethylsertraline also occur. The principal metabolic pathway for sertraline is N-demethylation into desmethylsertraline (N-desmethylsertraline) mainly by CYP2B6. Sertraline is subject to extensive first-pass metabolism, as indicated by a small study of radiolabeled sertraline in which less than 5% of plasma radioactivity was unchanged sertraline in two males. Similarly, the clinical relevance of sertraline’s blockade of the dopamine transporter is uncertain. Although there could be a role for the σ1 receptor in the pharmacology of sertraline, the significance of this receptor in its actions is unclear.

Alcohol

In addition to decreasing the frequency of panic attacks by about 80% (vs. 45% for placebo) and decreasing general anxiety, sertraline resulted in an improvement in quality of life on most parameters. The sertraline dosages necessary for the effective treatment of OCD are higher than the usual dosage for depression. Sertraline is equivalent to imipramine for the treatment of depression with co-morbid panic disorder, but it is better tolerated.

When to Avoid Sertaline Completely

Sertraline has been the most sought-after antidepressant worldwide before, during, and after the COVID-19 pandemic, according to Google Trends data. The US patent for Zoloft expired in 2006, and sertraline is available in generic form and is marketed under many brand names worldwide. Until 2002, sertraline was only approved for use in adults ages 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe OCD. The most potent and selective (+)-isomera was taken into further development and eventually named sertraline.

  • In contrast, CYP2B6 poor metabolizers have 1.6-fold higher levels of sertraline and intermediate metabolizers have 1.2-fold higher levels.
  • According to the prescribing information, people who take sertraline should avoid drinking alcohol.
  • Since 2005, all SSRIs have carried “black box” warnings from the FDA regarding a higher risk for suicidal ideation and behavior in children.
  • Most antidepressants help relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells.

Blood Thinners

Plasma, serum or blood concentrations of sertraline and norsertraline, its major active metabolite, may be measured to confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. The more complete data submitted later by the sertraline manufacturer Pfizer indicated increased suicidal behavior. For the above analysis, the FDA combined the results of 295 trials of 11 antidepressants for psychiatric indications to obtain statistically significant results. The withdrawal symptoms for sertraline are less severe and frequent than for paroxetine, and more frequent than for fluoxetine. The unique effect of sertraline on dopaminergic neurotransmission may be related to these effects on cognition and vigilance.

However, sertraline affinity for its main target (SERT) is much greater than its affinity for σ1 receptor and DAT. By binding to the serotonin transporter (SERT) it inhibits neuronal reuptake of serotonin and potentiates serotonergic activity in the central nervous system. As expected from in vitro data, sertraline did not alter the human metabolism of the CYP3A4 substrates erythromycin, alprazolam, carbamazepine, clonazepam, and terfenadine; neither did it affect metabolism of the CYP1A2 substrate clozapine. Bupropion is metabolized by CYP2B6, which is inhibited by sertraline, and this may result in an interaction between sertraline and bupropion. Considered separately, sertraline use in adults decreased the odds of suicidal behavior with a marginal statistical significance of 37% or 50% depending on the statistical technique used.

Metabolism

While imprecise, comparison of the results of trials of sertraline with separate trials of other anti-panic agents (clomipramine, imipramine, clonazepam, alprazolam, and fluvoxamine) indicates approximate equivalence of these medications. Double-blind comparative studies found sertraline to have the same effect on panic disorder as paroxetine or imipramine. Starting treatment simultaneously with sertraline and clonazepam, with subsequent gradual discontinuation of clonazepam, may accelerate the response. The authors of the study argued that the improvement achieved with sertraline is different and of a better quality than the improvement achieved with a placebo. Cognitive behavioral therapy alone is not more effective than sertraline in adolescents and children; however, a combination of these treatments is effective.

Zoloft Drug Interactions

Although antidepressants may not cure depression, they can reduce symptoms. If your healthcare provider prescribes a triptan with sertraline, you will be carefully monitored for serotonin syndrome. Additionally, at least 14 days should pass between stopping an MAOI and starting sertraline (and vice versa) to prevent serious complications like serotonin syndrome.

In the treatment of depression accompanied by OCD, sertraline performs significantly better than desipramine on the measures of both OCD and depression. Sertraline appears to work better in melancholic depression than fluoxetine, paroxetine, and mianserin and is similar to the tricyclic antidepressants such as amitriptyline and clomipramine. In several double-blind studies, sertraline was consistently more effective than placebo for dysthymia, a more chronic variety of depression, and comparable to imipramine in that respect. Sertraline’s effectiveness is similar to that of other antidepressants in its class, such as fluoxetine and paroxetine, which are also considered first-line treatments and are better tolerated than the older tricyclic antidepressants. It was also the eleventh most commonly prescribed medication in the United States, with more than 42 million prescriptions in 2023, and sertraline ranks among the top 10 most prescribed medications in Australia between 2017 and 2023.

Both triptans and sertraline increase serotonin. St. John’s wort is an herbal dietary supplement that many people take for mild to moderate symptoms of depression, as well as various other conditions. Nonsteroidal anti-inflammatory drugs are commonly used to help relieve pain, inflammation, and fever. They are not as commonly prescribed due to their side effects and drug and food interactions. Monoamine oxidase inhibitors are an older class of drugs used to treat depression.

It can also increase the risk of long QT syndrome, although the risk is considered low. While specific antipsychotics can cause this risk, other drugs can also have this same effect. People taking NTI drugs must be carefully monitored to ensure the drug is at appropriate levels in the body at which it is effective but not toxic. Serotonin syndrome is a rare but serious condition caused by too much serotonin in the body, often from combining multiple serotonin-boosting medications or supplements. These interactions may raise serotonin levels or cause other effects, some manageable, others best avoided. Sertraline (brand name Zoloft)—an SSRI used to treat depression and anxiety—can interact with other medications and affect how they work.

In addition, sertraline appears to be more effective than fluoxetine or nortriptyline in the older-than-70 subgroup. Limited pediatric data also demonstrates a reduction in depressive symptoms in the pediatric population though remains a second-line therapy after fluoxetine. It is on the World Health Organization’s List of Essential Medicines and available as a generic medication. If you stop taking Zoloft, it is also possible that you may experience a return of symptoms.

Nausea is often the greatest when you first begin taking this medication or if your physician increases your dose. Nausea, diarrhea, and insomnia are the most common Zoloft side effects. As with all medications, Zoloft may cause certain unwanted side effects. While severe side effects are less common, they can occur in some individuals.

  • If you are currently breastfeeding or pregnant, or if you plan to become pregnant, discuss the risks and benefits of treatment with your physician.
  • To cope with Zoloft-related nausea, you may find it helpful to take the medication with food.
  • Because Zoloft affects serotonin levels in the brain, it also has the potential to cause serotonin syndrome.
  • The improvement began during the first week of treatment, and in addition to mood, irritability, and anxiety, improvement was reflected in better family functioning, social activity, and general quality of life.

For example, Orap and other brands of pimozide zoloft and pepcid should not be taken with sertraline, as the combination can cause serious heart rhythm problems. Watch for symptoms such as agitation, confusion, rapid heartbeat, flushed skin, sweating, tremors, muscle stiffness, or restlessness. By Nancy SchimelpfeningNancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. This involves taking smaller and smaller doses over time until you eventually stop taking this medication altogether. The important thing to avoid is stopping or changing treatment without input from your physician. There may be strategies they can offer (including a dose adjustment or adjunctive therapies) to help you better adjust to the prescribed treatment.

Because Zoloft affects serotonin levels in the brain, it also has the potential to cause serotonin syndrome. The pandemic has led to an increase in searches for antidepressants, with sertraline, fluoxetine, duloxetine, and venlafaxine showing the highest search volumes, whereas searches of citalopram decreased during the pandemic. In a placebo-controlled study, the concomitant administration of sertraline and methadone caused a 40% increase in blood levels of the latter, which is primarily metabolized by CYP2B6.

Medical Professionals

Accordingly, a meta-analysis of antidepressants in older adults found that sertraline, paroxetine and duloxetine were better than placebo. In meta-analyses, sertraline efficacy is similar to that of other SSRI antidepressants, with an odds ratio for response in clinical depression of between 1.44 and 1.67. If serotonin levels become too high, you may experience serotonin syndrome. Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood. Most antidepressants help relieve depression by affecting these neurotransmitters, sometimes called chemical messengers, which aid in communication between brain cells. There are many types of antidepressants available that work in slightly different ways and have different side effects.

Serotonin syndrome is a potentially life-threatening condition in which serotonin levels become too high. Zoloft belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRIs). Nausea is the most common side effect of Zoloft, affecting around one in four people who take sertraline. In 2005, the FDA added a boxed warning concerning pediatric suicidal behavior to all antidepressants, including sertraline. In 2003, the UK Medicines and Healthcare products Regulatory Agency issued guidance that, apart from fluoxetine (Prozac), SSRIs are not suitable for the treatment of depression in patients under 18. Other experts emphasized that the drug’s effect on inpatients had not differed from placebo and criticized the poor design of the clinical trials by Pfizer.