Medication guide

Sertraline (Zoloft / J Zoloft)

What is sertraline?

Sertraline is known as Zoloft in the United States and many other countries, Lustral in the UK, and J Zoloft in Japan (ジェイゾロフト on Japanese packaging); it's all the same medicine. It belongs to the SSRI group of antidepressants. It works on serotonin, a chemical messenger in the brain linked to mood and anxiety, and it is widely used around the world.

How is it different from other antidepressants?

In large published comparisons of antidepressants, sertraline stands out as one of the best balanced between effectiveness and tolerability; a well-known comparison even suggested it as a sensible first choice for depression. In practice:

Works on low mood, panic, and trauma-related anxiety: it is approved in Japan for panic disorder and PTSD as well as depression, which few antidepressants here are
Once a day, at any time: the Japanese label sets no time of day and no link to meals, so it fits any routine
Flexible dosing: treatment starts low and is stepped up gradually, so it can be tuned to you
Some of the most reassuring breastfeeding data of any antidepressant

What is it used for in Japan?

Depression
Panic disorder
Post-traumatic stress disorder (PTSD)

How does it help?

By gradually increasing serotonin in the brain, it eases low mood, panic, and anxiety over time. The full effect often takes a few weeks. If you don't feel better right away, that's normal; keep taking it as prescribed.

What should I tell my doctor before starting?

Sertraline suits most people, but a few situations rule it out entirely; your doctor will choose something else if any of these apply:

A past allergic reaction to sertraline
Taking, or recently stopping, an MAO inhibitor (a medicine for depression or Parkinson's); these can't overlap
The medicine pimozide; the combination isn't allowed

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

Other antidepressants, tramadol (a painkiller), migraine triptans, or lithium
Blood thinners, or regular painkillers like ibuprofen
A heart rhythm problem (including long QT), or medicines that affect heart rhythm
Liver problems
Glaucoma
A history of seizures, or bipolar disorder
Past suicidal thoughts, or strong impulsivity: the label asks for closer monitoring
Being older
St John's Wort supplements
Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it, and what if I miss a dose?

Sertraline is taken once a day, morning or evening, with or without food; pick a time you can keep. Treatment starts at a low dose and is stepped up gradually.

If you miss a dose: take it when you remember, unless the next dose is close; in that case just skip. Never take a double dose to catch up
Early on: nausea can appear when you start, and it often eases as your body adjusts. Some side effects can continue, so tell your doctor if they do
Agitation: if you notice unusual agitation, irritability, or feeling wired, contact your doctor promptly rather than waiting it out
Alcohol: avoid it while taking sertraline; the Japanese label advises against drinking

What side effects should I expect?

Many are mild and ease as your body adjusts, and many can be eased with a counter-medicine (for nausea, for example). Not everyone gets them; the rough figures below just give a sense of how common each one is.

Nausea (around 20%): mostly when you start, and it often eases as your body adjusts; if it bothers you, tell your doctor, as a counter-medicine can help
Drowsiness (around 15%), or trouble sleeping
Diarrhea or loose stools
Headache
Dizziness
Dry mouth
Feeling more anxious or restless at first
Sexual side effects (less common)
Weight changes, up or down (less common)

If anything is bothering you, tell your doctor; there's often a way to adjust. And if you ever feel worse instead of better, tell us straight away; it's easily managed, and that's what we're here for.

Will I become dependent? How do I stop safely?

No; sertraline isn't addictive, but it does need a planned, gradual stop. There's no craving and no urge to take more the way some sleep or anti-anxiety medications cause. Your body does get used to it, though, and stopping suddenly can cause withdrawal-like symptoms: dizziness, nausea, tingling, brief electric-shock-like sensations, irritability, anxiety, headache, or trouble sleeping, usually starting a few days after stopping and settling over days to a couple of weeks. So never stop suddenly on your own.

Tapering makes this manageable for most people: the dose comes down in small steps, moving to the next step once any symptoms have settled, with a gentler pace near the end. If symptoms do appear along the way, stepping back up briefly and slowing down helps, though they may take a few days to settle. Many people continue for some months after they feel better, and coming off is planned together.

Can I drive while taking it?

Yes, with care, especially at the start. Sertraline can cause drowsiness or dizziness, so see how it affects you before driving, particularly when starting or changing the dose. The Japanese label asks for caution here, not a ban.

What about pregnancy and breastfeeding?

Treatment can continue in pregnancy when the benefit is judged to outweigh the risk; the decision is individual. Sertraline is one of the antidepressants often preferred during breastfeeding. Very little of it passes into breast milk, giving it some of the most reassuring breastfeeding data of any antidepressant. In pregnancy, the decision is made with your doctor, weighing the real risks of untreated depression. Never stop on your own on learning you're pregnant. Our guides to medication in pregnancy and medication while breastfeeding cover the details.