Zoloft (sertraline HCl) is the fourteenth most prescribed medication in the United States. Nearly forty million Americans use Zoloft to relieve depression, improve their mood and energy, and increase their comfort in social situations. It also works to reduce panic attacks and the urge to perform repetitive compulsive tasks.

What Is Zoloft?

Zoloft is a prescription-only antidepressant medication that belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs). It works by blocking the removal of serotonin from the brain which then increases serotonin levels and helps balance chemicals in the brain that can affect our mood.

Zoloft Generic Name

Zoloft is a brand name for the generic drug called sertraline hydrochloride (HCl). It was first approved for medical use in 1991 by the U.S. Food and Drug Administration (FDA). The generic version of the drug became available in 2006 and is offered in both a tablet and liquid form.

Sertraline Uses

Sertraline is approved by the FDA for the treatment of:

• Major depressive disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder
• Social anxiety disorder
• Premenstrual dysphoric disorder

Major depressive disorder

Major depressive disorder (MDD), also known as clinical depression, is a common and serious mood disorder that usually affects young adults, especially women, between the ages of 18-25. If you experience MDD, you continually feel sad and lose interest in daily activities that you used to enjoy. You may find it difficult to carry out everyday tasks and have the feeling that life is no longer worth living. You may also have physical symptoms such as chronic pain or digestive issues.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), to be diagnosed with major depressive disorder, you will have at least five of the following symptoms (including at least one of the first two symptoms listed) persistently almost every day for a minimum of two weeks:

• Depressed mood
• Noticeable loss of interest or pleasure in your usual activities
• Significant/noticable change in weight and/or appetite
• Slower thoughts and movements, and physical and emotional reactions (psychomotor retardation)
• Fatigue or lack of energy
• Feelings of excessive or inappropriate guilt or worthlessness
• Difficulty thinking and concentrating, or indecisiveness
• Suicidal thoughts, recurrent suicidal ideation, or a suicide plan or attempt

Over 7% of American adults have at least one major depressive episode a year.

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is a condition where you become entangled in a cycle of obsessions and compulsions.

Obsessions are defined as repetitive, unwanted, and uncontrollable intrusive thoughts, images, or urges that trigger intensely distressing feelings, including the feeling that things need to be done ‘correctly’. Obsessions seen with OCD include obsessions related to contamination, losing control, fear of harm, perfectionism, religion, unwanted sexual thoughts, and more.

Compulsions are defined as behaviors you engage in to try and escape or abolish the obsessions and feel less distressed. Common compulsions include excessive washing and cleaning, checking, and repeating, as well as mental compulsions including mental reviewing, counting, praying, and others.

To be diagnosed with OCD, this cycle of obsessions and compulsions becomes so extreme that it takes up much of your time and prevents you from carrying out other activities you value and would like to do.

The FDA has approved the use of sertraline to treat OCD in adults and children aged 6-17 years.

Panic disorder

According to the DSM-5, panic disorder is considered to be an anxiety disorder where diagnosis is based on the following:

• You experience unexpected panic attacks on a regular basis
• At least one attack is followed by at least one month or feeling fearful of further attacks and accordingly trying to avoid situations that might induce an attack
• The attacks are not due to the direct physiological effects of a drug, medication, or medical condition
• The attacks are not better accounted for by another mental disorder

Panic attacks are categorized as expected and unexpected. Expected panic attacks are typically linked to a specific fear such as being afraid of heights, whereas unexpected panic attacks have no known triggers and appear to occur out of the blue.

Post-traumatic stress disorder

Post-traumatic stress disorder is caused by the experience of a traumatic situation or event such as an accident; being a victim or witness to a violent crime, war or terrorism, serious disease or natural disaster; or being a victim of physical or sexual abuse. Such a traumatic experience can cause you to feel intense fear, pain, or sorrow to the extent that you are fearful of serious harm or death. Afterwards you can relive these feelings to the extent that they may affect your daily activities and relationships.

Signs and symptoms of PTSD include:

• Nightmares, flashbacks, bad memories, hallucinations
• Feeling anxious, restless, or on edge
• Trouble sleeping, feeling depressed
• Feeling afraid, helpless, numb, or detached from others
• Angry or violent outbursts
• Avoiding things or people that remind you of the trauma
• Negative feelings about yourself, feeling guilty

It is estimated that nearly 3% of U.S. adults had panic disorder in the past year.

Social anxiety disorder

Social anxiety disorder, or social phobia, is the feeling of intense anxiety or fear of being judged, negatively evaluated or rejected in a social or performance situation. You may be concerned about acting or appearing visibly anxious, or being viewed as stupid, awkward, or boring. These worries can cause you to avoid social situations. You may also have physical symptoms, such as a rapid heart rate, nausea, sweating, and even full-blown anxiety attacks. You understand that your anxiety and fear is excessive, yet you can feel powerless to prevent it and it can cause you to lose out on forming social and romantic relationships, completing your studies, and gaining a career.

If you think you may have social anxiety disorder, make sure you get professional medical advice. You can be treated with an effective medication, such as sertraline, and avoid possible alcoholism as a result of your social phobia. Unfortunately, fewer than 5% of the ~15 million American adults who have this disorder seek an available and effective medical treatment.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder is when you can have serious depression, irritability, and tension before menstruation. PMDD is a more severe form of premenstrual syndrome (PMS) and can prevent you from carrying out your normal activities and social interactions. In both PMDD and PMS, about five to eleven days before menstruation, you may experience a wide range of physical or emotional symptoms which will then cease once your period starts. It is clear that hormonal fluctuations are involved in these conditions but the specific causes are not yet known.

How Does Sertraline Work?

Sertraline is one of a group of antidepressants called selective serotonin reuptake inhibitors or SSRIs. These drugs work to relieve depression by acting in the brain to increase the levels of a mood-enhancing neurotransmitter or chemical called serotonin. More specifically, SSRIs prevent the reuptake or absorption of serotonin by neurons (brain nerve cells) so that serotonin levels are increased.

Before You Take Sertraline

Sertraline should not be taken for any of its FDA approved uses without consultation with a doctor. You cannot take sertraline if you have an allergy or hypersensitivity to sertraline.

Other medical conditions

Before you take sertraline, your doctor will talk to you about your medical history and make sure that no other existing medical conditions or medications you have used or are using will affect your suitability for this medication. For instance, you cannot be prescribed sertraline, or your doctor will have you very carefully monitored, if you have or are at risk of:

• Hyponatremia or a very low concentration of sodium in your blood
• SIADH or the syndrome of inappropriate secretion of antidiuretic hormone
• Bipolar depression or bipolar mania
• A seizure disorder
• Angle closure glaucoma since sertraline can have an effect on your pupil size causing it to dilate more and potentially increase the pressure inside your eye
• Kidney or liver disease since this can affect how well you can break down and eliminate sertraline from your body
• Severe active bleeding or problems with your blood platelets working properly

Pregnancy and Zoloft

If you are pregnant let your healthcare provider know immediately. There are certain circumstances in which Zoloft may be continued during pregnancy. Zoloft is considered one of the safest options for depression for breastfeeding women.

Sertraline interactions

Sertraline can interact with various medications. These drug interactions can affect how well sertraline works for you and potentially cause serious but preventable side-effects.

You need to let your doctor know what other medications you are currently taking or have taken recently before you are prescribed sertraline. This is also true of over-the-counter (OTC) medications or off-the-counter supplements.

Do not use sertraline if you have taken a monoamine oxidase inhibitor (MAOI) in the last 14 days or are about to take an MAOI within the next 14 days because this can result in dangerously increased blood pressure and serotonin syndrome.

St. John’s wort is an herbal supplement used to treat depression and it should not be combined with sertraline or any other depression or anxiety medications. Other medications that can interact with sertraline and cause serious problems include:

• Eliglustat
• Flibanserin
• Isocarboxazid
• Lomitapide
• Phenelzine
• Pimozide
• Procarbazine
• Selegiline
• Thioridazine
• Tranylcypromine

Zoloft and alcohol

Avoid drinking alcohol with sertraline as this can also cause unpleasant but preventable side effects. Sertraline may impair your thinking and reactions so take extra care when driving or carrying out other activities where you need to be alert.