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Zoloft Side Effects: Can Sertraline Cause Insomnia, Nausea or Pain?

zoloft side effects

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Sertraline by leading to serotonin accumulation in the synaptic clefts. It leads to increased neuronal activity and subsequent improvement in mood. SSRIs are selective and only work on serotonin receptors. They produce mood elevation and brain stimulatory effects. SSRI drugs like sertraline (Zoloft) are likely to produce many adverse side effects, so Zoloft initial side effects should always be kept in mind. Data from premarketing assessment shows that taking the drug may elicit several troublesome side effects of Zoloft. The study by Joel Kauffman from the University of Sciences in Philadelphia found that adverse effects may occur in up to 75% of individuals treated with SSRIs such as sertraline.

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Table of Contents

Short-Term Side Effects of Zoloft (Sertraline)

What are the side effects of Zoloft? The common side effects of the drug can be classified based on the body system in which they occur.

Gastrointestinal Adverse effects

  • Abdominal Pain
  • Constipation
  • Diarrhea
  • Nausea
  • Dyspepsia
  • Dry mouth

Serotonin plays various functions within the digestive system. As a matter, over 90% of the total serotonin that’s produced by the body goes into the gut. By looking at the various functions that serotonin plays within the digestive system, we can easily understand how sertraline might cause some of the Zoloft common side effects in the GI tract.
Serotonin increases intestinal peristalsis and secretion. Thus, an increase in serotonin caused by sertraline might lead to Zoloft diarrhea.
Dyspepsia(problems with swallowing) may be a manifestation of serotonin’s effect on peristalsis in the esophagus.Woman has an abdominal pain
Serotonin regulates both gastric emptying and colonic tone. Sertraline might, therefore, cause constipation by altering the amount of serotonin in the body.
Zoloft side effects first week often include nausea. It results from the activation of receptors found on nerves that go to the brain’s vomit centers.
Abdominal pain might be a result of serotonin-mediated modulation of gut motility and enzyme secretion.
Serotonin’s activity on the autonomic nervous system leads to dry mucous membranes which may be associated with dryness of the mouth and Zoloft a sore throat.

Metabolic and Endocrine Symptoms

  • Weight gain or loss
  • Increased appetite
  • Increased risk of bone fracturing

Serotonin affects various mechanisms that are involved in body energy control. It has a role in setting the body’s overall metabolic rate. It may also lead to an increase in appetite and consequent Zoloft weight gain.
On the other hand, weight loss may occur when the increased levels of serotonin lead to a loss of the body’s adipose tissue.
Serotonin causes a reduction in bone mass hence administrating high doses of sertraline may predispose one to frequent bone fractures.
By interfering with the actions of the hypothalamic-pituitary-adrenal axis, excessive serotonin may alter numerous processes in the body. A common manifestation of this effect is usually unusual sweating. Zoloft night sweats are thus common in people on sertraline.

Nervous System Disorders

  • Tremors
  • Dizziness
  • lethargy
  • Muscle spasms
  • Headache
  • Movement disorders, e.g., hyperkinesia

Tremors, movement disorders, and muscle spasms may occur due to the serotonin’s influence on the brain’s motor activity. Does Zoloft make you tired? Yes, it does. Lethargy is also a common side effect.
Taking sertraline may lead to a spike in serotonin such that the brain stem’s activity is impaired leading to dizziness and, on infrequent occasions, coma and convulsions.

Behavioral Side Effects

  • Sleep disturbances
  • Agitation
  • Zoloft memory loss
  • Suicidal ideation

Taking Sertraline may lead to serotonin’s overstimulation of wakefulness centers of the brainstem. It may cause changes in a person’s sleep tendencies such as insomnia. Does Zoloft make you sleepy? Yes, it may also lead to somnolence (excessive sleepiness).
By acting on various receptors in the hippocampus, serotonin may affect learning and memory. Though quite rare, sertraline memory loss has been documented.
Serotonin’s modulation of various behavioral centers in the brain may culminate in diverse behavioral side effects. Some of the people who take sertraline may, for instance, display increased agitation. Can Zoloft cause hallucinations? Yes, hallucination, feeling of euphoria known as sertraline high, anxiety, nightmares, and psychosis are also potential behavioral side effects of sertraline.
Suicidal thoughts has also been witnessed in patients on SSRI such as sertraline.

Renal and Urinary Disorders

  • Enuresis
  • Urinary Incontinence
  • Urinary Retention

Serotonin’s modulation of the urinary system includes the regulation of contractions in the bladder and the external urinary sphincter. Sertraline may, therefore, cause problems with urination such as retention or incontinence, Zoloft frequent urination, and enuresis.

Sexual dysfunction and reproductive side effects

  • Loss of libido
  • Anorgasmia
  • Delayed ejaculation
  • Erectile dysfunction

Sexual dysfunction is one of the more prominent sexual side effects of sertraline therapy. Delayed orgasm and anorgasmia often occur due to serotonin’s effect of delaying and possibly inhibiting ejaculatory latency.
Since serotonin is involved in controlling penile flaccidity and detumescence, taking Zoloft may cause erectile dysfunction in men.

Cardiovascular Effects

  • Palpitations
  • Bradycardia
  • Tachycardia
  • Torsades de Pointes
  • QT prolongation
  • Thrombocytopenia
  • Peripheral Ischemia
  • Leucopenia
  • Abnormal bleeding tendencies

Serotonin regulates the heart-pump mechanism by affecting the activity of the sinus and AV nodes. Taking medication that increases serotonin levels in the brain may, therefore, cause cardiac problems such as palpitations, bradycardia, tachycardia, as well as other rare side effects, e.g., QT prolongation on an ECG and Torsade de Pointes.
Zoloft may alter the effects of serotonin on platelet function leading to thrombocytopenia. It may also lead to leukopenia.
Serotonin’s influence on vascular dilatation and constriction may be the basis for vascular adverse effects such as peripheral ischemia due to vasoconstriction, and hot flushes due to vasodilation.
The disorders of platelet function and the vascular side effects of sertraline may further lead to abnormal bleeding tendencies that may present in the form of frequent Zoloft nosebleed, Purpura, vaginal bleeding, etc.

Severe Long-Term Syndromes Associated with Zoloft

Serotonin Syndrome

The man is complaining about side effectsSerotonin Syndrome is a condition that may occur in patients on Zoloft medication. The condition is greatly influenced by interactions like sertraline and marijuana. Its presentation varies in severity from mild, barely-perceptible symptoms to very severe, life-threatening symptoms.
Serotonin syndrome occurs due to excessive serotonin in the body which causes autonomic instability, altered mental status, and neuromuscular dysfunction. Symptoms of serotonin toxicity may include confusion, coma, agitation, delirium, hypertension, tachycardia, flushing, vomiting, diarrhea, tremor, Zoloft neck pain, convulsion. Severe serotonin syndrome may cause acute kidney injury, acute liver failure, metabolic acidosis, diffuse intravascular coagulation and eventually death.

Serotonin Discontinuation Syndrome

Discontinuation from Zoloft therapy might cause discontinuation symptoms if it’s done abruptly in a person who’s been on sertraline for a long time. The discontinuation symptoms may include a headache, Zoloft muscle aches, malaise, nausea, chills, flu-like symptoms, paresthesia (feeling of pins and needles in hands and feet), electric-shock-like sensations, agitation, anxiety, and insomnia.

Hypersensitivity to Zoloft

Developing an allergic reaction to Zoloft is possible. Severe hypersensitivity may cause anaphylactoid reactions and shock, but this is quite rare.

Special Side Effects of Zoloft (Sertraline) In Children

Antidepressant therapy using sertraline should be closely monitored in children and teenagers. About 1 in 50 children adopt suicidal tendencies when on SSRI treatment. SSRIs including Zoloft may also worsen depression in children.
Other common adverse effects of Zoloft in children include urinary incontinence and enuresis, Zoloft chest pain, diarrhea, vomiting, agitation, tremors, hyperkinesia, and anorexia.

Why Does Zoloft (Sertraline) Cause Side Effects?

Sertraline works by increasing the level of serotonin. Serotonin is produced by enterochromaffin cells in the gut as well as other serotogenetic neurons of the brain. It is transported in blood and stored in blood platelets. Serotonin has different functions in the body such as regulating mood, sleep, and appetite, modulating gastrointestinal tract motility, regulating blood clotting, influencing the dilation and constriction of blood vessels and many other functions.

Zoloft effects by preventing the reuptake of serotonin on many presynaptic neurons in the brain. It leads to an accumulation of serotonin in the brain and the rest of the body as well.

The increased levels of serotonin may inadvertently affect other body systems besides the brain. Serious side effects of Zoloft are therefore a manifestation of the elevated levels of serotonin exerting undesirable effects on different body systems. Using Zoloft during pregnancy may also cause side effects in the fetus hence expectant mothers should take the drug under strict professional guidance.

How to Reduce the Incidence of Zoloft (Sertraline) Side Effects

In addition, to avoid such problems as overdose on Zoloft, patients on sertraline medication are also advised to be on the lookout for possible treatment-emergent adverse effects. The following are generally good practices to prevent the development or worsening of Zoloft side effects.

  • Report any suspected side effect or allergic reaction to sertraline to the doctor as soon as it’s noticed. If Zoloft causes allergic reactions ask the doctor about Zoloft natural alternatives.
  • Avoid unprescribed polypharmacy. Do not take Zoloft with another drug unless prescribed by a health professional.
  • Use of alcohol is strongly prohibited. Drinking on Zoloft can increase the risk of side effects
  • Avoid taking more than prescribed.
  • Ask your health care provider about the viability of using such drugs as sildenafil (Viagra), vardenafil or tadalafil (Cialis) to treat sertraline-induced sexual dysfunction.
  • Wean off Zoloft: treatment should not be stopped abruptly.
  • Tapering off sertraline may take several weeks to avoid the development of Serotonin Discontinuation Syndrome.
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View Sources
Medically Reviewed By Michael Espelin APRN
Nena Messina

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.


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