Zoloft® (sertraline)
Brand
name:
Zoloft®
Generic name:
sertraline (SER
tra leen)
Medication class:
Selective serotonin reuptake inhibitor (SSRI) antidepressant
All FDA black box
warnings are at the end of this fact sheet. Please review
before taking this medication.
What is Zoloft® and what does it treat?
Sertraline is
an antidepressant medication that works to
increase the brain. It is approved to treat adult major depressive disorder (MDD), posttraumatic
stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic
disorder, and social anxiety disorder. It is also approved to treat
obsessive-compulsive disorder (OCD) in adults, children and
adolescents aged 6-17 years.
Symptoms
of depression include:
-
Depressed
mood - feeling sad, empty, or tearful
-
Feeling
worthless, guilty, hopeless, and helpless
-
Loss
of interest or pleasure in your usual activities
-
Sleep
and eat more or less than usual (for most people it is less)
-
Low
energy, trouble concentrating, or thoughts of death (suicidal
thinking)
-
Psychomotor
agitation (‘nervous energy’)
-
Psychomotor
retardation (feeling like you are moving and thinking in slow
motion)
-
Suicidal
thoughts or behaviors
PTSD occurs when a person
experiences a traumatic event (e.g. assault, combat experience) and
then later feels on edge; avoids situations that remind them of the
event; and experiences flashbacks or nightmares.
Premenstrual
dysphoric disorder (PMDD) is a condition where a woman experiences
depression, tension, and irritability for a few days prior to
menstruation that end when menstruation begins. These symptoms are
more severe than those of premenstrual syndrome (PMS).
Panic Disorder occurs
when a person experiences unexpected and repeated episodes of intense
fear. These episodes have physical symptoms including chest pain,
shortness of breath, heart palpitations, sweating, dizziness, and
nausea. Fear of future episodes is also part of panic disorder.
Obsessive
Compulsive Disorder (OCD) occurs when a person experiences the
following symptoms at the same time:
-
Obsessions (unwanted,
recurrent, and disturbing thoughts)
-
Compulsions (repetitive,
ritualized behaviors that the person feels driven to perform in
order to lessen the anxiety produced by the obsessions)
What
is the most important information I should know about Zoloft®?
Do
not stop taking sertraline, even when you feel better. Only your
healthcare provider can determine the length of treatment that is
right for you.
Missing doses of
sertraline may increase your risk for relapse in your symptoms.
Stopping
sertraline abruptly may result in one or more of the following
withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting,
nightmares, headache, and/or paresthesias (prickling, tingling
sensation on the skin).
Depression
is also a part of bipolar illness. People with bipolar disorder who
take antidepressants may be at risk for "switching" from
depression into mania. Symptoms of mania include "high" or
irritable mood, very high self esteem, decreased need for sleep,
pressure to keep talking, racing thoughts, being easily distracted,
frequently involved in activities with a large risk for bad
consequences (for example, excessive buying sprees).
Are
there specific concerns about Zoloft® and pregnancy?
If
you are planning on becoming pregnant, notify your healthcare
provider to best manage your medications. People living with MDD who
wish to become pregnant face important decisions. Untreated MDD has
risks to the fetus, as well as the mother. It is important to
discuss the risks and benefits of treatment with your doctor and
caregivers.
For mothers who have
taken SSRIs during their pregnancy, there appears to be less than a
1% chance of infants developing persistent pulmonary hypertension.
This is a potentially fatal condition that is associated with use of
the antidepressant in the second half of pregnancy. However, women
who discontinued antidepressant therapy were five times more likely
to have a depression relapse than those who continued their
antidepressant. If you are pregnant, please discuss the risks and
benefits of antidepressant use with your healthcare provider.
Caution
is advised with breastfeeding since sertraline
does pass into breast milk.
What
should I discuss with my healthcare provider before taking Zoloft®?
-
Symptoms
of your condition that bother you the most
-
If
you have thoughts of suicide or harming yourself
-
Medications
you have taken in the past for your condition, whether they were
effective or caused any adverse effects
-
If
you experience side effects from your medications, discuss them with
your provider. Some side effects may pass with time, but others may
require changes in the medication.
-
Any
other psychiatric or medical problems you have, including a history
of bipolar disorder
-
All
other medications you are currently taking (including over the
counter products, herbal and nutritional supplements) and any
medication allergies you have
-
Other
non-medication treatment you are receiving, such as talk therapy or
substance abuse treatment. Your provider can explain how these
different treatments work with the medication.
-
If
you are pregnant, plan to become pregnant, or are breast-feeding
-
If
you drink alcohol or use drugs
How should I take
Zoloft®?
Sertraline
is usually taken 1 time per day with or without food.
Typically
patients begin at a low dose of medicine and the dose is increased
slowly over several weeks.
The
dose usually ranges from 50 mg to 200 mg. Only
your healthcare provider can determine the correct dose for you.
If
you are taking it for PMDD, sertraline can be taken once daily
(everyday) or intermittently (usually starting 14 days prior to
menstruation through the first full day of menses of each cycle).
The
liquid should be measured with an oral syringe or dropper which you
can get from your pharmacy. It should be added to 4 ounces of water,
ginger ale, lemon/lime soda, lemonade, or orange juice immediately
prior to taking the medication. It should not be mixed in advance.
Consider
using a calendar, pillbox, alarm clock, or cell phone alert to help
you remember to take your medication. You may also ask a family
member or friend to remind you or check in with you to be sure you
are taking your medication.
What happens if I miss
a dose of Zoloft®?
If
you miss a dose of sertraline, take it as soon as you remember,
unless it is closer to the time of your next dose. Discuss this with
your healthcare provider. Do not double your next dose or take more
than what is prescribed.
What should I avoid
while taking Zoloft®?
Avoid
drinking alcohol or using illegal drugs while you are taking
antidepressant medications.
They may decrease the benefits (e.g., worsen your condition) and
increase adverse effects (e.g., sedation) of the medication.
What happens if I
overdose with Zoloft®?
If
an overdose occurs, call your doctor or 911. You may need urgent
medical care. You may also contact the poison control center at
1-800-222-1222.
A
specific treatment to reverse the effects of sertraline does not
exist.
What are the possible
side effects of Zoloft®?
Common
Side Effects
-
Headache,
nausea, diarrhea, dry mouth, increased sweating
-
Feeling
nervous, restless, fatigued, sleepy or having trouble sleeping
(insomnia)
These
will often improve over the first week or two as you continue to take
the medication.
Sexual
side effects, such as problems with orgasm or ejaculatory delay often
do not diminish over time.
Rare Side Effects
Increased
bleeding (e.g., gums may bleed more easily), low sodium blood levels
(signs of low sodium levels may include headache, weakness,
difficulty concentrating and remembering), teeth grinding
Serious Side Effects
Seizure
Are there any risks of
taking Zoloft® for long periods of time?
To
date, there are no known problems associated with long term use of
sertraline. It is a safe and effective medication when used as
directed.
What other medications
may interact with Zoloft®?
Sertraline
should not be taken with or within two weeks of taking monoamine
oxidase inhibitors (MAOIs). These include phenelzine (Nardil®),
tranycypromine (Parnate®),
isocarboxazid (Marplan®),
rasagiline (Azilect®),
and selegeline (Emsam®).
Although
rare, there is an increased risk of serotonin syndrome when
sertraline is used with other medications that increase serotonin,
such as other antidepressants, migraine medications called “triptans”
(e.g., Imitrex®),
some pain medications
(e.g., tramadol (Ultram®)),
and the antibiotic linezolid (Zyvox®).
Symptoms associated with serotonin syndrome include nausea,
vomiting, shivering, heavy sweating, rapid heart rate, and headache.
Sertraline
should not be taken with pimozide (Orap®).
Sertraline
may increase the
effects of other medications that can cause bleeding (e.g., ibuprofen
(Advil®,
Motrin®),
warfarin (Coumadin®)
and aspirin).
Sertraline liquid should NOT be taken in combination with disulfiram (Antabuse®)
due to the alcohol content of the concentrate.
How long does it take
for Zoloft® to work?
Sleep,
energy, or appetite may show some improvement within the first 1-2
weeks. Improvement in these physical symptoms can be an important
early signal that the medication is working. Depressed mood and lack
of interest in activities may need up to 6-8 weeks to fully improve.
Provided
by the College of Psychiatric and Neurologic Pharmacists
(January
2013)
Summary
of Black Box Warnings
Suicidal
Thoughts or Actions in Children and Adults
-
Depression
and certain other psychiatric disorders are themselves associated
with increases in the risk of suicide.
-
Patients
with major depressive disorder (MDD), both adult and pediatric, may
experience worsening of their depression and/or the emergence of
suicidal ideation and behavior (suicidality) or unusual changes in
behavior, whether or not they are taking antidepressant medications.
This risk may persist until significant remission occurs.
-
In
short-term studies, antidepressants increased the risk of
suicidality in children, adolescents, and young adults when compared
to placebo. Short-term studies did not show an increase in the risk of suicidality with antidepressants
compared to placebo in adults beyond age 24. Adults age 65 and
older taking antidepressants have a decreased risk of suicidality.
-
Patients,
their families, and caregivers should be alert to the emergence of
anxiety, restlessness, irritability, aggressiveness and insomnia.
If these symptoms emerge, they should be reported to the patient’s
prescriber or healthcare professional.
-
All
patients being treated with antidepressants for any indication
should watch for and notify their healthcare provider for worsening
symptoms, suicidality and unusual changes in behavior, especially
during the first few months of treatment.
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