How Zoloft (Sertraline) Is Used to Treat Social Anxiety Disorder

Sertraline: Generic, Uses, Side Effects, Dosages, Interactions & Warnings

How Zoloft (Sertraline) Is Used to Treat Social Anxiety Disorder

In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (younger than 24 years) taking antidepressants for major depressive disorders and other psychiatric diseases.

This increase was not seen in patients over age 24 years; a slight decrease in suicidal thinking was seen in adults over age 65 years.

In children and young adults, risks must be weighed against the benefits of taking antidepressant medicines.

Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during the initial 1-2 months of therapy and dosage adjustments.

The patient's family should communicate any abrupt changes in behavior to the healthcare provider.

Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy.

This drug is not approved for use in pediatric patients for the major depressive disorder but it is approved for obsessive-compulsive disorder in children older than 6 years.

Not approved for the treatment of bipolar depression.

This medication contains sertraline. Do not take Zoloft if you are allergic to sertraline or any ingredients contained in this drug.

Keep reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.



Do not use disulfiram concomitantly with the oral solution due to alcohol in preparation

Concomitant pimozide: Risk of long QT syndrome

Coadministration with serotonergic drugs

  • Do not use MAOIs concomitantly or within 14 days before initiating sertraline or within 14 days after discontinuing sertraline
  • Reactions to concomitant administration with MAO inhibitors include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma
  • Starting sertraline in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
  • If linezolid or IV methylene blue must be administered, discontinue SSRI immediately and monitor for CNS toxicity; may resume 24 hours after last linezolid or methylene blue dose, or after 2 weeks of monitoring (5 weeks for fluoxetine), whichever comes first

Short-term Effects

In short-term studies, antidepressant medicines increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (younger than 24 years) taking antidepressants for major depressive disorders and other psychiatric diseases.

See “What Are Side Effects Associated with Using Sertraline?”

Long-term Effects

See “What Are Side Effects Associated with Using Sertraline?”


Clinical worsening and suicide ideation may occur despite medication.

Use caution in patients with seizure disorders.

May worsen mania symptoms or precipitate mania in patients with bipolar disorder.

Increases risk of hyponatremia and impairment of cognitive/motor functions in the elderly.

Increases risk of bleeding in patients taking anticoagulants/antiplatelets concomitantly.

Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy

Pregnancy: Conflicting evidence regarding the use of SSRIs during pregnancy and increased risk of persistent pulmonary hypertension of the newborn.

In neonates exposed to SNRIs/SSRIs late in the third trimester: Risk of complications such as feeding difficulties, irritability, and respiratory problems.

Avoid abrupt withdrawal.

Bone fractures are reported with antidepressant therapy; consider the possibility of a patient presents with bone pain, bruising, or point of tenderness.

Coadministration of this medicine with other drugs that enhance the effects of serotonergic neurotransmission (e.g., tryptophan, fenfluramine, fentanyl, 5-HT agonists, St. John's wort) should be undertaken with caution and avoided whenever possible due to the potential for pharmacodynamic interaction.

May cause false-positive urine immunoassay screening tests for benzodiazepines.

SSRIs and SNRIs are associated with the development of SIADH; hyponatremia was reported.

Pregnancy and Lactation

Use sertraline with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

Use of sertraline late in the third trimester is associated with complications in newborns and may require prolonged hospitalization, respiratory support, and tube feeding.

Persistent pulmonary hypertension of the newborn

  • The potential risk of persistent pulmonary hypertension of the newborn (PPHN) when used during pregnancy
  • Initial public health advisory in 2006 was a single published study; since then, there have been conflicting findings from new studies, making it unclear whether the use of SSRIs during pregnancy can cause PPHN
  • FDA has reviewed the additional new study results and has concluded that, given the conflicting results from different studies, it is premature to reach any conclusion about a possible link between SSRI use in pregnancy and PPHN
  • FDA recommendation: FDA advises healthcare professionals not to alter their current clinical practice of treating depression during pregnancy and to report any adverse events to the FDA MedWatch program
  • A meta-analysis of 7 observational studies, found exposure to SSRIs in late pregnancy (i.e., greater than 20 weeks gestation) more than doubled the risk of PPHN that could not be explained by other etiologies (e.g., congenital malformations, meconium aspiration) (BMJ 2014;348:f6932)

Sertraline is distributed into breast milk; use caution when breastfeeding (American Academy of Pediatrics states effect on nursing infants is unknown but may be of concern).


Zoloft (sertraline) vs. Paxil (paroxetine): Uses, Side Effects

How Zoloft (Sertraline) Is Used to Treat Social Anxiety Disorder

All SSRIs, including Zoloft, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example

  • isocarboxazid (Marplan),
  • phenelzine (Nardil),
  • tranylcypromine (Parnate),
  • selegiline (Eldepryl, Emsam, Elazar), and
  • procarbazine (Matulane).

Other drugs that inhibit monoamine oxidase include

  • linezolid (Zyvox) and
  • intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between Zoloft and MAOIs.

) Similar reactions occur when Zoloft is combined with other drugs — for example, tryptophan, St.

John's wort, meperidine (Demerol, Meperitab), tramadol (ConZip, Synapryn FusePaq, Ultram) — that increase serotonin in the brain.

Cimetidine (Cimetidine Acid Reducer, Tagamet HB ) may increase the levels in blood of Zoloft by reducing the elimination of Zoloft by the liver. Increased levels of Zoloft may lead to more side effects.

Zoloft increases the blood level of pimozide (Orap) by 40%. High levels of pimozide can affect electrical conduction in the heart and lead to sudden death. Therefore, patients should not receive treatment with both pimozide and Zoloft.

Through unknown mechanisms, Zoloft may increase the blood thinning action of warfarin (Coumadin, Jantoven). The effect of warfarin should be monitored when Zoloft is started or stopped.


All SSRIs, including Paxil, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants — for example, isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl, Carbex), and procarbazine (Matulane) — or other drugs that inhibit monoamine oxidase such as linezolid (Zyvox) and intravenous methylene blue.

Such combinations may lead to confusion, high blood pressure, tremor, hyperactivity, coma, and death. (A period of 14 days without treatment should lapse when switching between Paxil and MAOIs.) Similar reactions occur when Paxil is combined with other drugs — for example, tryptophan, St. John's wort, meperidine (Demerol), tramadol (Ultram) — that increase serotonin in the brain.

Paxil may increase the effect of the blood thinner, warfarin (Coumadin), leading to excessive bleeding. Therefore, warfarin therapy should be monitored more frequently in patients who are also taking Paxil.

Combining SSRIs such as Paxil with aspirin, nonsteroidal anti-inflammatory drugs or other drugs that affect bleeding may increase the lihood of upper gastrointestinal bleeding.

Phenytoin (Dilantin) and phenobarbital may decrease the amount of Paxil in the body and possibly reduce its effectiveness.

Insomnia by definition is a condition characterized by difficulty falling or staying asleep. There is no set definition of insomnia in terms of hours of sleep, and insomnia can have many forms.

Some people with insomnia may have no trouble falling asleep, but wake up too soon. Other people may have the opposite problem, or they have problems with falling asleep as well as staying asleep.

The common factor is poor-quality sleep that doesn't leave you feeling refreshed when you wake up.

Temporary insomnia lasts anywhere from one night to a few weeks. This can involve a single episode of poor-quality or unrefreshing sleep or recurring episodes of insomnia separated by periods of normal sleep.

On the following slides, we offer some suggestions and tips intended to help overcome temporary insomnia and maximize your chance for getting a healthy night's sleep:

What is the best sleep environment when you have insomnia? Keep the room pleasant, comfortable and get rid of clutter and distractions. Be sure to select the right bed and mattress for your needs. An old mattress or the wrong mattress for you can contribute to musculoskeletal problems and sleep disturbances. Experts suggest a cold bedroom is best for insomnia.

Sleep experts who offer sleep hygiene tips advise avoiding use of the bed for TV, working, eating or any other activities. Use the bed only for sleeping and sex. If you to use the bed for a bit of nighttime reading, read only books in bed that promote relaxation and enjoyment.

«Reconditioning» is often recommended as part of the treatment plan for insomnia. This means that you are «reconditioned» to associate the bed with sleep. If you are not able to sleep at all, get bed and move to another room, so that you do not associate the bed with wakefulness.

Typically, if you are not sleeping after 20 to 30 minutes in bed, you should get bed and return when you are tired. During the time bed, you should not do anything that may stimulate or increase your wakefulness and you should avoid turning on the TV, computer, cell phone or bright lights and avoid looking at the clock.

Return to bed when you feel drowsy.

Establishing a regular sleep-wake cycle can help people who suffer from insomnia.

By doing so, the body will learn to set its internal clock to your schedule, eventually responding to internal cues to become sleepy at a given time and to awaken at a given time.

Getting up at the same time every morning, even on weekends, is a good way to establish this regular cycle. Melatonin is a sleep-wake cycle hormone naturally produced by the body that is important for regulating sleep and wakefulness.

An afternoon nap can make falling asleep at night even harder, no matter how tired you may be. «Extra» sleep on weekends can also throw off your sleep schedule and make midweek insomnia even worse. Naps in the afternoon should be limited and short (around 20 minutes).

Limit your consumption of caffeine in the afternoon and evening. Don't forget that chocolate, hot cocoa and colas also are sources of caffeine.

Excessive consumption of of alcohol at any time in the day can also disrupt sleep patterns and lead to unsatisfying sleep. Don't drink any alcoholic beverages in the few hours prior to going to bed. Cigarette smoking can also worsen insomnia.

Try to fit in some exercise during the day, but avoid strenuous exercise right before bedtime. Exercising at least four to five hours before bedtime is preferred.

If you have insomnia, foods to avoid include fried, fatty heavy foods French fries and spicy foods hot wings that may give you heartburn and make it hard to sleep. Eating heavy or spicy foods in the evening or eating just prior to bedtime can disrupt your sleep.

If you have insomnia, establishing a sleep ritual for relaxation can be helpful. Try this «winding down» ritual just prior to bedtime. Take a warm bath while listening to relaxing music.

Enjoy a cup of chamomile tea. Then, read a lighthearted book.

The goal is to free your mind of distracting or troublesome thoughts and engage in a relaxing, enjoyable activity reading, watching a pleasant film or listening to music.


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