Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Sertraline, sometimes referred to by its full chemical name sertraline hydrochloride or sertraline HCL for short, is an antidepressant drug taken by millions of Americans annually. It’s the generic version of a medication called Zoloft, and is a member of a drug class called SSRI which is the most common type of antidepressant.
But is sertraline proven to be effective for reducing depression scores in real patients? Does the drug have any concerning side effects? What about sexual side effects? Does it cause weight gain? And how do real users respond to its treatment?
In this article we’ll answer all of these questions and more as we review clinical studies on sertraline, document its side effects, explain whether it causes weight gain and more. We'll also share real, unsponsored user reviews of the medication.
Does Sertraline Reduce Depression?
Sertraline is well-studied for treating major depressive disorder (MDD).
Sertraline was approved by the FDA decades ago, and a medical review published in 2001 found the drug to be one of the most effective pharmaceutical treatments for depression. The study authors documented how sertraline was as effective as the other leading antidepressants at the time, but caused fewer side effects on average.
A 2019 clinical trial on sertraline for depression was funded by the National Institute for Health Research in the U.K. After 12 weeks, 73% of patients on sertraline experienced remission, which refers to a full or partial reduction in depression symptoms.
Only slightly fewer patients by percentage (65%) experienced remission taking placebo pills, so the researchers concluded that sertraline was not definitively more effective than placebo.
Another recent clinical trial on sertraline had more favorable results. This trial, published in the Journal of Clinical Psychopharmacology, found 72% of patients to respond favorably to sertraline compared with only 32% of patients taking placebo pills. The researchers did note that sertraline took a relatively long time to start working.
We will conclude from the available research that sertraline is effective for treating major depression, although it was found to be no more effective than placebo in one study.
Sertraline Side Effects
The most common side effects of sertraline are somewhat mild. StatPearls, which is one of the largest freely-accessible medical databases, describes the following side effects as the most commonly experienced by sertraline patients: fainting, lightheadedness, diarrhea and nausea.
A meta-review published in 2018 compared antidepressant side effects across a wide range of medications, and found that sertraline had the highest rates of seizure and sexual dysfunction as side effects.
The most concerning potential side effect of sertraline is the increased risk of suicidality. Like many SSRIs, sertraline’s FDA label has a “black box” warning detailing that the medication may increase suicidal throughts and actions in young adults, adolescents and children.
Given this risk, it seems rational for young adults or guardians of adolescents to speak with their doctor about alternative antidepressant medications that may not increase the risk of suicidal thoughts.
Real, Unsponsored User Review of Sertraline
One of the most popular YouTube reviews of sertraline is published by a creator named Sarah Rocksdale. She explains why she chose sertraline instead of other medications, side effects she experienced and whether the drug benefited her mental state.
The review is unsponsored:
Does Sertraline Cause Weight Gain?
Patients are often concerned about whether sertraline causes weight gain, which is a rational concern given that many prescription antidepressants we've reviewed on Illuminate Health have weight gain as a documented side effect.
We have not come across any medical research suggesting that sertraline causes weight gain in humans. One animal study found that sertraline inhibited appetite, food intake and body weight in both lean and obese animals. This suggests that sertraline may have a weight loss effect.
A medical review published in the Obesity Reviews journal compared the effects of various antidepressants on weight. The study authors did not conclude that sertraline causes weight gain.
It seems that sertraline does not cause weight gain based on early results. This may make the drug a better option for overweight and obese patients when compared with other antidepressants that are proven to cause weight gain on average.
Is the Brand Name Version of Sertraline Safer?
Generally, we recommend that patients speak with their doctor about generic medications over branded ones, because they contain the same active chemical compound and the generic version is often cheaper.
However, in the case of sertraline, the branded version called Zoloft may be the more sensible choice. A medical review compared safety and efficacy data between generic and brand-name drugs from millions of patients.
Patients taking sertraline experienced higher rates of psychiatric hospitalizations compared with patients taking Zoloft. This suggests that Zoloft may be safer.
Branded and generic medications are not always manufactured by the same company, so quality control issues could theoretically lead to discrepancies in effectiveness and safety even if the active ingredient is the same.
Does Sertraline Cause Withdrawals?
We can’t locate any medical studies suggesting that sertraline causes withdrawals. The drug’s FDA label mentions that newborns may experience withdrawals if their mother was using sertraline, but no mention on the FDA label of adult patients being at risk of withdrawals.
A medical review on SSRI withdrawals found that this class of drugs does cause withdrawals in some cases, but just because the drug class confers this risk does not mean that sertraline specifically confers this risk.
We do not believe that patients need to concern themselves with sertraline withdrawals, because there doesn’t appear to be any medical evidence of this side effect, and the drug's FDA label doesn’t reference it.
However, any patient may have an individual negative reaction to a drug.
A YouTube creator named "Calamity xo" published a video sharing their experience with sertraline withdrawals:
What Dosage of Sertraline is Typically Prescribed?
StatPearls lists the effective dosage range for sertraline to treat depression to be between 50 milligrams (mg) and 200 mg daily. There are certain patient populations such as breastfeeding women and patients with kidney disease that may require individualized dosage recommendations; this is just the general recommendation.
StatPearls describes the dosing range of sertraline for anxiety disorders such as obsessive-compulsive disorder and panic disorder as between 25 mg and 200 mg. Sertraline is approved by the FDA for the treatment of these conditions.
Doctors will typically prescribe sertraline at a starting dose of 50 mg, because lower doses will confer lower risk of side effects. If the patient responds positively to this low dose, they can remain at this dosage indefinitely. If the patient fails to respond, the doctor will titrate the dose up slowly over the course of weeks until the patient experiences relief.
Can I Use Alcohol While Taking Sertraline?
Since many medications interact negatively with alcohol, patients are often curious about whether sertraline does as well.
Sertraline’s FDA label indicates that while the drug does not potentiate the effects of alcohol (meaning it does not make the effects of alcohol stronger) it is inadvisable to drink alcohol while taking sertraline because both are sedatives. This may cause health risks and also means patients on sertraline should not drive while using alcohol.
Given the negative interaction between sertraline and alcohol, it's important that patients are honest with their doctor about their alcohol intake. If a patient is unable to refrain from drinking alcohol, their doctor may be able to prescribe them an antidepressant that does not have a negative interaction with alcohol.
Sertraline Vs. Lexapro
Lexapro is one of the most commonly-prescribed prescription antidepressants, so patients are often curious about whether sertraline or Lexapro is more effective. As we documented in our Lexapro Vs. Zoloft article, there have been medical studies directly comparing the safety and efficacy of the two drugs.
A comparative study published in the Indian Journal of Psychiatry reported that the two drugs had similar efficacy, but the side effect rate of sertraline was 56%, while the side effect rate for Lexapro was only 45%. This suggests that Lexapro may be better tolerated than sertraline.
In light of this data, we would recommend that patients speak with their doctor about Lexapro rather than sertraline, as the two drugs appear similarly effective but Lexapro may be cause less side effects.
Can Sertraline Make it Hard to Ejaculate?
Male patients often report that sertraline makes it more difficult to ejaculate, and at least one clinical trial provides research backing for this claim. The linked study, published in 1995, found that sertraline was an effective treatment for premature ejaculation. The drug caused a “significant prolongation of time to ejaculation.”
If sertraline is effective at delaying ejaculation in patients with clinically-diagnosed premature ejaculation, it logically follows that the drug may unfavorably delay ejaculation in patients with typical ejaculation patterns.
This sexual side effect appears common amongst SSRI drugs. A medical review of the sexual side effects of antidepressants, published in the Journal of Clinical Psychopharmacology, found that all four medications studied caused a delay in ejaculation.
How Does Sertraline Work?
As referenced previously, sertraline is a selective serotonin reuptake inhibitor (SSRI). This means that it delays processing and clearance of serotonin in the brain, leading to artificially increased levels of this neurotransmitter. Serotonin influences mood and emotions, so increasing its levels allows the drug to theoretically influence a more positive and relaxed mood.
Researchers still aren’t exactly sure how SSRI medications work, because it hasn’t been conclusively proven that depressed patients have lower serotonin levels than patients without depression.
Depression is likely multifactorial in most cases, so researchers don’t need to understand exactly how a drug works on an individual to conclude that it works on average. If a drug is proven to be safe and can reduce depression scores across a large population of depressed patients, it may be approved for use even if the exact mechanism of action isn’t fully understood.
Our Mental Wellness Recommendation
We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
Sertraline User Reviews
Sertraline has been reviewed over 4,000 times on Drugs.com, which is an online resource where patients can publish personal reviews of prescription medication.
Sertraline has a rating of 6.8 out of 10 for treating depression which is a relatively average score.
The top positive review is written by a user named "lil" who claims the drug improved their quality of life:
"This pill has changed my life and honestly saved my life. I am so much more productive and energetic, I no longer have racing thoughts and cry for hours every night. I feel like myself again, and I feel like my best self."
The top negative review comes from an anonymous user who gave sertraline a 2/10 rating and claims the drug caused serotonin syndrome:
"On day 3, I experienced serotonin shock syndrome. I woke up suddenly in the middle of the night with my entire body shaking, my heart rate extremely high, and extremely confused. My parents took me to the ER after I told them I felt like my life was ending. The physicians assistant in the ER dismissed me as a panic attack, even tho I’ve had anxiety my entire life and I have never felt close to way I did that night. My experience left me completely traumatized."
