zoloft side effects women

Zoloft Side Effects in Women: What You Need to Know

By Dr. Alex Dimitriu

Sertraline, also called Zoloft, is a drug known mainly as a treatment for depression. First approved in the U.S. in 1991, recently it has been prescribed nearly 40 million times per year.

Although Zoloft can cause side effects in anyone, it can affect women in specific ways. Knowing about the possible side effects of Zoloft in women can help patients know what to expect and play a more informed role in their mental health care.

Understanding Zoloft and Its Uses

Zoloft is the brand name of the drug sertraline. It is a type of selective serotonin reuptake inhibitor (SSRI). These drugs work by increasing the activity of a chemical in the brain called serotonin, which helps regulate your mental state and emotions. Selective serotonin reuptake inhibitors are a common antidepressant medication.

In addition to depression, Zoloft is FDA-approved as a treatment for post-traumatic stress disorder (PTSD), social anxiety disorder, panic attacks, obsessive-compulsive disorder (OCD), and the symptoms of premenstrual dysphoric disorder. In addition to these formally recognized uses, doctors may give Zoloft as an off-label prescription for conditions like generalized anxiety disorder, bulimia, and binge-eating disorder.

Zoloft is taken by mouth as a tablet, capsule, or liquid concentrate solution. It can be prescribed for children, adolescents, and adults.

Common Side Effects of Zoloft in Women

Both men and women can experience side effects from Zoloft. However, certain side effects only affect women or have different risks in women. These include sexual dysfunction, weight changes, menstrual changes, nipple discharge, and bone loss.

In my clinical experience, it is worth noting that depression and anxiety carry significant health risks as well, and these should be weighed against the side effects of medication like SSRIs. Additionally, side effects are often dose dependent, which is why we always aim to “test” the lowest dose that is effective for our patients.

Sexual Dysfunction

It is common for both males and females taking Zoloft to encounter difficulties in their sex life. In females, this sexual dysfunction may affect sex drive and libido, or the desire for sex. In addition, Zoloft can affect a woman’s ability to have an orgasm. In my practice, I often remind patients that untreated depression and anxiety can also negatively impact sex drive.

Studies suggest that 50% or more of patients who take SSRIs like Zoloft experience sexual problems. Sometimes these side effects continue even after someone stops taking these medicines.

Experts aren’t entirely sure why this happens, and in some cases, sexual dysfunction may be linked to the underlying mental health condition that Zoloft is intended to treat.

Weight Changes

Zoloft can induce changes in body weight, and some research has found that women express more concern than men about weight and body image.

Among all people taking Zoloft, the average weight gain is around 1% to 1.5% of their original body weight. This may relate to an increase in appetite and cravings for carb-rich foods. These dietary changes may be linked to improvements in mental health from Zoloft.

Weight gain may also have a genetic component or be a consequence of modified serotonin levels. Although not common, weight gain from long-term Zoloft use may contribute to a person’s risk of diabetes.

At the same time, some people experience weight loss when taking Zoloft. A small percentage of patients report a decrease in appetite. Weight loss could relate to gastrointestinal side effects like nausea, stomach pain, and indigestion.

Menstrual Changes

Zoloft can affect hormones in the body, which may alter the menstrual cycle. When taking Zoloft, a woman’s menstrual periods may stop or become irregular.

These issues are believed to relate to an increase in the production of a hormone called prolactin, which is mostly involved in lactation but affects other bodily processes. Serotonin levels are one of many factors involved in the production of prolactin. Excess prolactin in the body can disrupt the menstrual cycle, interfere with sexual health, and contribute to other side effects of Zoloft in women.

Nipple Discharge

Zoloft can cause the discharge of breast milk in women who are not lactating, a condition known as galactorrhea. This reaction to Zoloft is driven by prolactin levels that are too high.

Bone Loss

Some data indicates that there is an elevated risk of bone loss in people over the age of 50 when taking Zoloft. A lack of bone strength can result in osteoporosis, a condition that makes fractures more likely. Osteoporosis is more common in women than in men.

Doctors cannot fully explain the findings of bone loss in people taking Zoloft. It may be related to elevated prolactin levels or disruptions in the metabolism of cells in the bones. More research is needed to document, confirm, and understand the impact of Zoloft on bone health.

“In my clinical experience, it is worth noting that depression and anxiety carry significant health risks as well, and these should be weighed against the side effects.”

Two pharmacists, one male one female, discussing drug interactions and side effects of Zoloft.

General Zoloft Side Effects

Side effects of Zoloft occur in both males and females. While every patient can have a different reaction to the drug, researchers have identified the most common side effects.

The most frequent side effects, which tend to affect between 10% and 25% of people, include:

  • Gastrointestinal problems like nausea, vomiting, stomach discomfort, diarrhea, and constipation
  • Headaches
  • Dry mouth
  • Feelings of fatigue or physical weakness
  • Dizziness
  • Insomnia or an inability to sleep normally
  • Drowsiness or tiredness

Other side effects that have been found to impact up to 10% of people taking Zoloft include:

  • Excess sweating
  • Mood changes like restlessness, agitation, nervousness, or irritability
  • Tremors
  • Visual problems like blurred vision
  • Fast heart rate

It is important to recognize that not everyone will experience significant side effects. The incidence of these adverse reactions is relatively low, and any given person may have a distinct combination of effects or very few effects at all. In general, Zoloft is well tolerated, and most people find that it provides more benefit than harm.

In addition, initial side effects are not always lasting. Some effects may start to improve after the first weeks of taking Zoloft.

Managing and Minimizing Zoloft Side Effects in Women

The first step in addressing any side effects of Zoloft is to talk with your doctor or psychiatrist. They can recommend an adjustment to your dosage, a change in medication, or other specific actions and tips that are most appropriate in your situation.

“In my practice, I often remind patients that untreated depression and anxiety can also negatively impact sex drive.”

Other things that may help manage or minimize the side effects of Zoloft in women can vary based on the nature of those effects.

  • Sexual Dysfunction: If Zoloft is providing benefits in treating depression but also causing sexual problems, doctors may prescribe additional medications, which studies have shown may help with a low libido or difficulty having orgasms. Consulting with a sex therapist for advice may be effective for some individuals.
  • Weight Changes: For weight gain, a number of steps may help, including making adjustments to your diet and exercise habits.
  • Menstrual changes: When menstrual changes occur, your doctor may check for other potential causes and consider changing your medication or daily doses. If high prolactin levels are detected, you may be prescribed additional medication or hormone therapy.
  • Nipple discharge: If this symptom is significant and affecting your daily life and activities, medication may be suggested to address elevated prolactin levels.
  • Bone loss: Some steps to minimize bone loss can include taking supplements of vitamin D and calcium and avoiding cigarette smoking. If you have other risk factors for osteoporosis, your doctor may order a bone mineral density test. To prevent fractures, you can decrease the risk of falls by improving your balance and eliminating tripping hazards in your home.

Warnings and Potential Serious Side Effects of Zoloft

Although serious side effects are rare, anyone taking Zoloft should be aware of the potential risks so that they can take precautions and watch for possible warning signs.

  • Worsening of mental health: Some people have a sudden exacerbation of their mental health problems after taking Zoloft. This may result in deep sadness and suicidal thoughts and behaviors. In people with a diagnosis of bipolar disorder, Zoloft may lead to swings between mania and depression. Bipolar disorder is relatively rare, but it is important that a provider screen for the condition to prevent adverse reactions from SSRIs. People with thoughts of suicide should seek help immediately.
  • Low sodium levels: Zoloft can lower the amount of sodium in the blood, a condition known as hyponatremia. Some signs of hyponatremia include memory problems, confusion, headache, and physical weakness. The risk of this side effect is higher in older patients.
  • Bleeding: Taking Zoloft makes people more susceptible to bleeding. This is more likely in people who also take blood thinners like warfarin or other drugs that thin the blood, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
  • Angle-Closure Glaucoma: Glaucoma occurs when fluid can’t drain from the eyes, raising pressure that leads to eye damage. Pain, vision changes, and redness of the eyes are symptoms of glaucoma.
  • Serotonin syndrome: This condition can occur if serotonin levels get too high. It may result in confusion, changes to heart rate or blood pressure, tremor, seizures, and other symptoms. A risk factor is when Zoloft is taken with other substances that can increase serotonin, including amphetamines, other antidepressants like serotonin and norepinephrine reuptake inhibitors (SNRIs), tramadol, tryptophan, and St. John’s wort.
  • Drug interactions: Although major drug interactions are limited, it is best to inform a pharmacist about all prescriptions, supplements, and over-the-counter medicine and ask questions about any potential interactions with Zoloft.
  • Coexisting conditions: People with liver problems or a diagnosis of a seizure disorder may require more caution than others when planning the dosage and administration of Zoloft.
  • Allergic reactions: As with any medication, allergic reactions are uncommon but may occur. Signs of allergies when first taking Zoloft can include hives or skin rash, fever, unexplained swelling, or trouble breathing.
  • Withdrawal: Abruptly stopping the use of Zoloft may cause headache, mood and behavior changes, irritability, seizure, and confusion.

If any indications of severe reactions or complications arise, patients should seek prompt attention from a healthcare professional.

To reduce the risks of adverse effects, Zoloft should always be used according to the package directions. A regular dose should be taken as stipulated by the doctor and pharmacist, and patients should avoid suddenly stopping taking Zoloft.

Zoloft When Pregnant or Breastfeeding

Taking Zoloft and other SSRIs during pregnancy can affect a fetus. The risks of exposure during the first trimester are not clearly established. A baby who was exposed to Zoloft during the third trimester, though, is at risk of certain issues, some of which can be serious.

That said, untreated mental health conditions during pregnancy may also pose health risks for newborns. As a result, many pregnant women continue taking Zoloft with extra care devoted to watching for effects on the fetus. Consulting with a health care team can help women weigh the pros and cons of using Zoloft while pregnant.

In most situations, Zoloft is considered to be safe to use while breastfeeding. Only a small amount of Zoloft passes into breast milk, so it poses very low risk to infants. Zoloft is considered one of the best of the SSRIs for women who are lactating.

FAQs About Zoloft Side Effects

How long does it take for side effects to start?

Some side effects may begin within days of starting to take Zoloft, and others become more likely with long-term use. For example, stomach problems may arise initially. But when issues like weight gain or bone loss occur, it is normally only after many months or years of taking Zoloft.

Do women have more side effects from Zoloft?

Many reactions to Zoloft are similar for both men and women. However, some side effects, such as nipple discharge and menstrual changes, only affect women.

Does Zoloft have more side effects than other SSRIs?

With an extensive history of use, Zoloft has been found to be well tolerated overall. Within the SSRI group of antidepressant medications, most drugs have a similar side effect profile. But there can be some variation in the frequency or severity of certain side effects.

Other types of SSRIs include:

  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)

A doctor or psychiatrist can review the comparative benefits and drawbacks of each of these drugs based on your diagnosis, health history, and personal concerns about specific side effects.

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