Zoloft for Anxiety: Uses, Side Effects, Precautions

Key Takeaways

• Zoloft is an FDA-approved medication for treating social anxiety disorder.
• Common side effects of taking Zoloft include diarrhea, dry mouth, and fatigue.
• People under 18 should not take Zoloft for social anxiety due to increased risks.

Zoloft (sertraline hydrochloride) is a prescription medication typically used to treat depression. However, the U.S. Food and Drug Administration (FDA) has also approved this drug for the treatment of social anxiety disorder, a mental health condition marked by an irrational fear of being watched or judged, or of embarrassing or humiliating oneself.

It’s important for individuals who have been prescribed Zoloft for anxiety to understand how to use this drug safely and to be aware of its potential side effects. We also share some precautions to know before taking this drug, along with warnings and potential interactions.

The Most Important Things to Know About Zoloft

• This drug is not approved for treating social anxiety in pediatric patients.
• It is not safe to take Zoloft with many other substances, including some prescription and over-the-counter medications, as well as certain herbal supplements.
• If severe side effects are experienced when taking Zoloft, it’s important to seek immediate medical attention.

How Zoloft Works for Anxiety

Zoloft is a type of medication called a selective serotonin reuptake inhibitor (SSRI). SSRIs work by slowing down the reabsorption of serotonin, a neurotransmitter that plays a role in regulating mood and controlling anxiety.

SSRIs are also used to treat several other mental health conditions, such as major depressive disorder, obsessive-compulsive disorder, premenstrual dysphoric disorder, panic disorder, and post-traumatic stress disorder.

Precautions When Taking Zoloft for Anxiety

People should be cautious when taking Zoloft in the following situations:

• They are allergic to sertraline, the active ingredient in Zoloft.
• They are taking medication to treat alcohol use disorder.
• They are breastfeeding, pregnant (especially in the third trimester), or planning to become pregnant.
• They have bipolar disorder or a family history of bipolar disorder
• They have impaired liver or kidney function, heart disease, diabetes, or a history of seizures.

Zoloft is not approved by the FDA for treating social anxiety disorder in individuals under 18. There is evidence of an increased risk of suicidal thoughts and behaviors in children and adolescents taking Zoloft.

Zoloft Dosage for Anxiety

Zoloft is available in 25 mg, 50 mg, and 100 mg tablets, as well as a 20 mg/ml oral solution. Those prescribed Zoloft should confirm the correct dosage with their healthcare provider.

For social anxiety disorder, the usual starting dose is 25 mg, increasing to 50 mg after one week. Increases can be made weekly up to a maximum of 200 mg for those who don’t respond to lower doses.

Modifications

Certain populations may require an adjusted dosage when taking Zoloft for anxiety, and/or close monitoring by their healthcare provider.

• People who are pregnant or nursing must discuss the risks and benefits of taking Zoloft because it may pose a risk to the fetus during the third trimester as well as to a newborn while breastfeeding.
• Older patients should begin with lower dosages so prescribers can monitor for adverse reactions before increasing dosages if needed.

Illustration by Alexandra Gordon, Verywell

How to Take and Store

Generally, Zoloft is taken once daily, with or without food, within the following guidelines.

• Swallow the tablets whole, not chewed or crushed.
• If taking the liquid form, combine the prescribed amount of medication with one-half cup of liquid (water, ginger ale, lemon-lime soda, lemonade, or orange juice). Prepare each dose immediately before taking it, not in advance.
• If a daily dose is forgotten, take it once remembered. However, if it is close to the time of the next dose, skip the missed dose and take it at the regular time. Never take two doses of Zoloft at the same time.
• When traveling, store Zoloft in a carry-on bag in case checked luggage gets lost.
• It’s important for people to continue taking Zoloft as long as a care provider instructs, even if they start to feel better. Abruptly stopping Zoloft can lead to sertraline withdrawal symptoms such as nausea, tremors, lightheadedness, muscle pains, weakness, insomnia, and anxiety.

Zoloft Overdose

The risk of a fatal Zoloft overdose is low. Nevertheless, if too much Zoloft is taken, get help right away before the drug has a chance to cause unpleasant or dangerous symptoms. Symptoms of an overdose include dizziness, drowsiness, nausea, vomiting, increased or slow heart rate, and coma.

Zoloft Side Effects

Side effects of Zoloft can range from mild to more serious. Side effects should ease and disappear as the body grows accustomed to the medication. If they don’t, contact a healthcare professional for advice. Don’t stop taking Zoloft unless a care provider says to.

Common Side Effects

The most common side effects of Zoloft include:

• Diarrhea
• Dry mouth
• Fatigue
• Headache
• Increased sweating
• Nausea
• Nervousness
• Restlessness
• Sleep disturbances

Severe Side Effects

When first starting Zoloft or after changing the dosage, report any of the following side effects to a healthcare provider immediately:

• Allergic reaction symptoms such as hives, rash, difficulty swallowing or breathing, severe dizziness, and swelling of the face, mouth, throat, or tongue
• Changes in urine or stools (dark or increased urine, black stools)
• Nervousness
• Persistent vomiting or nausea
• Seizures
• Severe abdominal pain
• Suicidal thoughts and behaviors
• Tremors
• Yellowing of the eyes or skin
• Symptoms of serotonin syndrome, including agitation, confusion, sweating, hallucinations, abnormal reflexes, muscle spasms, and rapid heartbeat

When to Go to the ER

If a care provider is unavailable and severe symptoms are occurring, go to the emergency room immediately. Tell the medical personnel about the medication, the dosage prescribed, and when symptoms began.

Warnings and Interactions for Zoloft

Take Zoloft as directed by a healthcare provider. To ensure Zoloft is safe to take, it’s important for patients to disclose their mental health and family history; all current or past prescription and over-the-counter medications; and any other substances that they are taking or plan to take.

Warnings and interactions when taking Zoloft include:

• Zoloft is not approved for treating anxiety in pediatric patients.
• Don’t take this drug in combination with, or within weeks of taking, monoamine oxidase inhibitors (MAOIs), pimozide, and disulfiram (in the case of liquid Zoloft).
• Don’t take Zoloft with supplements such as St. John’s Wort, 5-HTP, or SAMe due to the risk of serotonin syndrome.
• Don’t take it with aspirin, anticoagulants, or nonsteroidal anti-inflammatory drugs, which may increase the risk of bleeding.
• Consumption of illegal drugs and alcohol is not advised while taking Zoloft.
• Avoid grapefruit and grapefruit juice as they can interfere with how the body metabolizes this medication.
• Zoloft may cause drowsiness and reduced alertness. Don’t drive, operate dangerous machinery, or participate in hazardous activities unless sure that Zoloft does not cause these effects. This can be avoided by working out the best time of day to take Zoloft.
• Be mindful of any unusual changes in behavior or mood six to eight weeks after beginning Zoloft. If symptoms worsen, contact a physician immediately.

Black-Box Warning

The black-box warning for Zoloft indicates that it may cause or increase thoughts of suicide in children and young adults (under 25), especially in the first few weeks after starting the drug or changing the dosage.

The information provided does not include every possible outcome of taking Zoloft. Always follow a care provider’s guidelines, and consult them or a pharmacist right away with any questions or concerns.

Frequently Asked Questions

• Does Zoloft help with anxiety?

  Although clinicians most often prescribe Zoloft to treat depression, the FDA has approved it to treat social anxiety disorder, too.

• Is 25mg of Zoloft enough for anxiety?

  Pfizer, the manufacturer of Zoloft, lists the starting dosage for anxiety at 25 mg per day. A care provider may increase the dosage, typically by 25 mg per week, up to a maximum of 200 mg per day. The optimum dosage for anxiety depends on the individual; a physician will weigh the benefits of increasing the dosage against the side effects experienced.

• How long does Zoloft take to work for anxiety?

  Research indicates that many people find some relief from anxiety symptoms within the first six weeks of starting Zoloft.

• When should you increase your Zoloft dosage for anxiety?

  A care provider is likely to increase a patient’s Zoloft dosage if their anxiety symptoms fail to improve within the first few weeks of beginning treatment with the drug.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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2. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systemic review and meta-analyses based on clinical study reports. BMJ. 2016;352:i65, doi:10.1136/bmj.i65

3. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991

4. Foong AL, Grindrod KA, Patel T, Kellar J. Demystifying serotonin syndrome. Can Fam Physician. 2018;64(10):720-727.

5. National Alliance on Mental Illness. Sertraline (Zoloft).

6. Ellingrod VL. Grapefruit juice and psychotropics: How to avoid potential interactions. Current Psychiatry.

7. Pfizer. Zoloft – sertraline hydrochloride tablet, film coated.

8. Lewis G, Duffy L, Ades A, et al. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (Panda): A pragmatic, double-blind, placebo-controlled randomised trial. Lancet Psychiatry. 2019;6(11):903-914. doi:10.1016/S2215-0366(19)30366-9

Additional Reading

• Pfizer. Zoloft (setraline hydrochloride): tablets and oral concentrate.

By Arlin Cuncic, MA

Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master’s degree in clinical psychology.

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