Sertraline (Zoloft) is a commonly prescribed antidepressant. It is part of a class of drugs known as selective serotonin-reuptake inhibitors (SSRIs). It is used to treat major depression, anxiety disorders, post-traumatic stress disorder (PTSD), panic disorders, and eating disorders. It is also used to treat severe premenstrual symptoms caused by premenstrual dysphoric disorder (PMDD) and obsessive-compulsive disorder (OCD). More than half (56%) of people quitting antidepressants experience withdrawal symptoms. The experience is different for everyone. Some people experience mild symptoms, while others have symptoms severe enough to interfere with daily life.
Causes of Sertraline Withdrawal
Sertraline works by preventing the reabsorption (reuptake) of serotonin, thereby increasing the serotonin available in the brain. Serotonin, a neurotransmitter, plays an important role in moods and emotions. When you stop or reduce your dose of sertraline, these serotonin levels will drop, eventually reaching pretreatment levels. Withdrawal symptoms happen as your mind and body adapt to this change. Sertraline has a relatively short half-life compared to other SSRIs—about one day. This means that within a few days you will have very little sertraline in your bloodstream. Short-acting antidepressants like sertraline can cause withdrawal symptoms, as your body is essentially shocked by the absence of the drug and is trying to adapt to the change in serotonin levels. It’s important to know that discontinuing your antidepressants may lead to a relapse of your original symptoms and even to the emergence of suicidal thoughts.
Signs & Symptoms of Sertraline Withdrawal
The most common symptoms that develop during sertraline withdrawal include:
Flu-like symptomsInsomniaNauseaImbalanceSensory disturbancesAnxiety or agitation
While these may be the most common symptoms, SSRI withdrawal affects many of the body’s systems. The full range of potential withdrawal symptoms include:
Digestive: Nausea, vomiting, cramps, diarrhea, or appetite lossBalance: Dizziness or lightheadedness, sometimes making it difficult to walkSleep problems: Nightmares, unusual dreams, excessive/vivid dreams, or insomniaOverall: Flu-like symptoms including headache, muscle pain, weakness, and tiredness.Mood: Anxiety, agitation, panic, suicidal ideation, depression, irritability, anger, mania, or mood swingsBizarre sensations: Brain zaps (like an electrical shock or shiver in your brain), pins and needles, ringing in the ears, strange tastes, or hypersensitivity to soundHeat intolerance: Excessive sweating, flushing, or an intolerance to high temperaturesMotor control: Tremors, muscle tension, restless legs, unsteady gait, or difficulty controlling speech and chewing movements
For most people, sertraline withdrawal begins within three to four days of your last dose. The duration of SSRI withdrawal can vary, but you can expect it to last anywhere from a few days to a few weeks, however, sometimes it can last much longer. Withdrawal symptoms vary from person to person. Some people have no symptoms at all, whereas others have symptoms severe enough to interfere with their responsibilities at home, work, or school. If you do have severe withdrawal symptoms, it does not mean that you are addicted to sertraline. Addiction is characterized by the pattern of the use of substances in the face of adverse consequences. Withdrawal can happen to anyone taking sertraline for a few months or longer. To get a better idea of the range of symptoms and symptom severity, you may want to check out the Discontinuation-Emergent Signs and Symptoms Scale (DESS), which is sometimes used by clinicians to measure the severity of SSRI withdrawal symptoms.
Coping & Relief
One method that people use to quit SSRIs is a medication taper. This means gradually reducing your dose over the course of several weeks or months. While this is an option, some doctors prefer to switch their patients to a longer-acting SSRI before beginning a taper. Because sertraline has such a short half-life, the amount of drug in your system can drop off quickly. Switching to a longer-acting SSRI, like Prozac, may help you avoid these peaks and valleys. In the past, doctors weren’t sure whether tapering SSRIs was an effective treatment for withdrawal. However, new research suggests that a slow taper stretched out over the course of several months may be more effective than traditional tapering schedules. The researchers recommend continuing the taper until your dose is nearly zero—well past therapeutic levels. This means that by the end of the taper you may be breaking pills into tiny pieces or switching to a liquid dose. If you are still experiencing withdrawal symptoms, these remedies may help.
Psychotherapy
Psychotherapy can improve mood, reduce anxiety, and help you better cope with your symptoms.
OTC Medications
You can treat aches and flu-like symptoms with over-the-counter pain relievers and anti-nausea medications.
Lifestyle
There are also steps you can take that might decrease your withdrawal symptoms, or at least make them easier to manage. These include:
Exercise. Getting at least 45 minutes of moderate activity three times a week can improve mood and reduce stress.Sleep. Make sure that you are getting adequate rest each night. Focus on going to bed and waking up at the same time each day.Eat well. Eat nutritious meals on a regular schedule, and stay hydrated. Try to avoid foods that may increase your anxiety, such as caffeinated beverages.
Natural Remedies
Vitamins, minerals, and herbal supplements may be helpful. However, you should always review all of these with your doctor before taking any natural supplements or home remedies.
Social Support
One of the most important factors in SSRI withdrawal management is the presence of a social support system. Having people around who can help and support you through a difficult time can reduce stress and anxiety, both of which can make withdrawal symptoms even worse. When your friends and family understand that you are in withdrawal, they will be more forgiving of irritability and mood swings. By preventing interpersonal conflict at home, you will avoid some of the negative social effects of withdrawal.
Warnings
Sertraline, like other SSRIs, comes with a warning from the FDA about the potential for an increase in suicidal ideation and behaviors in children and young adults, particularly when medication is initiated or dosages are changed. Recognizing the signs of suicidal ideation in yourself or someone else can help save your life or the life of a loved one. Call for help right away if you or a loved one shows any of the following symptoms:
Planning how you would commit suicide if you were going to do itTalking or thinking about suicide more than normal, for example, “I wish I were dead”Gathering the means to commit suicide, such as bullets or pillsFeeling hopeless or trappedHaving intense mood swingsEngaging in risky or self-destructive activities, such as driving drunkBecoming preoccupied with death, dying, or violenceGetting affairs in order or giving away belongingsSaying goodbye to people as if it were the last time
If you are pregnant or planning to become pregnant, talk to your obstetrician/gynecologist or psychiatrist about the risks and benefits of continuing and discontinuing sertraline. There is a small risk of giving birth too early if you take antidepressants during your second and third trimesters. On the other hand, if you do discontinue sertraline while you’re pregnant, you are more likely to relapse. For more mental health resources, see our National Helpline Database.
Long-Term Treatment for Sertraline Withdrawal
You may require additional treatment after the withdrawal period has ended. If you are still experiencing mental illness such as depression or anxiety, you may require continued care. About 50% of people who recover from depression experience another depressive episode in their lifetimes. Some people stay on antidepressants indefinitely to prevent such an outcome, whereas others choose different modalities of treatment, such as psychotherapy. Researchers have found that psychotherapy reduces the risk of relapse in people discontinuing antidepressants.
Resources
The National Suicide Prevention Lifeline will connect you with staff or volunteers at a crisis center near you. The people on the other end of the line can help you calm down and figure out what to do next. It is available 24/7, 365 days per year. If you are hesitant to call, you may prefer to chat with a counselor. The chat services are also open 24/7. If you have health insurance, you can also search the company’s list of local providers who accept your insurance. Most insurance companies have at least some mental health coverage, including state and federal plans.
A Word From Verywell
Sertraline withdrawal symptoms are real, and discontinuing this medicine is a real challenge for lots of people. Don’t hesitate to talk to your doctor or other members of your support system about the way it’s affecting your life. And remember: Withdrawal symptoms are only temporary.
