Does sertraline work right away? (7+ early side effects)

In this article, we will discuss whether sertraline starts to work right away. We will also discuss some research studies and the main reason why sertraline can take some time to kick in. We will also discuss what one should do if sertraline fails to help their symptoms.

Does sertraline work right away?

No, sertraline does not work right away. This serotonin reuptake inhibitor (SSRI) can take 4-6 weeks to work and make positive changes in your symptoms. (1,2)

Sertraline is primarily used as an antidepressant for the management and treatment of depression, anxiety, and several other conditions. These conditions do not typically progress overnight. Similarly, it is impossible to treat them overnight, and these medications take time to work. 

It also takes your body some time to adjust to antidepressants like sertraline. It is also important to note that each individual is unique and can respond differently to sertraline. 

People with mild symptoms of anxiety or depression may start to respond earlier compared to people with more complex symptoms. Additionally, sertraline might not help everyone.

Determining the most suitable antidepressant for your symptoms could be a trial-and-error process, and people may try multiple antidepressants before they find the one that works best for them.

What does research suggest?

Research studies have indicated that sertraline can take time, almost 4-6 weeks, to work in some individuals. One study monitored the beneficial effects of sertraline in depressed individuals. (3)

The study did not observe any clinically significant improvement in 4-6 weeks of treatment and concluded that sertraline can take more than 6 weeks to provide noticeable antidepressant effects. (3)

However, the study showed that sertraline did help with anxiety and physical symptoms of depression at week 6, but there were no meaningful antidepressant effects. (3)

Another research study investigated the effects of sertraline and fluoxetine, another SSRI, on depression (4). 

During the trial, 50 mg of sertraline showed no antidepressant effects after 4 weeks of treatment. After week 6, the response rate was seen to be 21% with 50 mg of sertraline, but it was still not enough to be clinically significant. (4)

The study, however, showed that a higher dose of sertraline can show some response rate in 4 weeks compared to 50 mg of sertraline – which is considered the standard therapeutic dose for most patients (4). However, higher doses of sertraline are not tolerable for everyone. 

Even if the medication shows some effects, the side effects associated with higher doses may make it difficult for people to continue with it, affecting the outcomes of this treatment strategy. 

These studies indicate that sertraline does not work right away and can take more than 6 weeks to help make a noticeable change in your symptoms.

Why does sertraline take time to work?

Sertraline takes time to work because it balances the amount of serotonin, an excitatory monoamine neurotransmitter in your brain. Serotonin plays a major role in the pathophysiology of depression and related symptoms (1). 

Sertraline, being an SSRI, actively inhibits the reuptake of serotonin by blocking serotonin transporters (SERT). This increases the availability of serotonin to bind to its respective receptors, which, in turn, makes up for the serotonin deficiency linked with depression (1). 

This process takes time, and the antidepressant cannot balance serotonin levels adequately in a short period.

What factors affect the time taken by sertraline to work?

Several factors can affect the time taken by sertraline to work, including:

Dosage strength

Taking a lower dose of sertraline may mean it needs more time to build up in your system and start making a noticeable impact on your mood. Your healthcare provider may adjust the dosage based on how you respond to the antidepressant.

The typical adult dosage recommendations for sertraline are: (2)

Condition	Initial dose	Frequency	Maximum daily dose
Depression	50 mg	Once daily	200 mg per day
Obsessive-Compulsive Disorder (OCD)	50 mg	Once daily	200 mg per day
Panic Disorder, Post-Traumatic Stress Disorder (PTSD), Social Anxiety Disorder (SAD)	25 mg	Once daily	200 mg per day
Premenstrual Dysphoric Disorder (PMDD)	50 mg	Once daily	150 mg per day during the luteal phase of the menstrual cycle

Age 

Older individuals may find that the effects of sertraline take a bit longer to kick in. This doesn’t mean it’s not working; it might just require some patience. Younger individuals, on the other hand, might be able to notice a difference earlier.

The severity of symptoms:

When dealing with severe symptoms, the road to improvement might be longer. In cases of Major Depressive Disorder (MDD), sertraline monotherapy might not even work.

Lifestyle factors

A hectic or stressful lifestyle can impact how well sertraline works. Persistent stress may affect the effectiveness of sertraline in achieving treatment goals. Incorporating stress-reducing activities, like regular exercises, can enhance the effects of sertraline.

Use of other medications

Some medications may interact with sertraline, affecting how quickly or slowly it gets absorbed and utilised by the body. Discussing all the medications you’re taking, including over-the-counter ones, is important to avoid potential drug-drug interactions.

What sertraline-induced side effects can affect the early course of treatment?

Some sertraline-induced side effects can affect the early course of treatment, including: (5)

• headache
• dizziness
• excessive tiredness
• nervousness
• uncontrollable shaking of a part of the body
• dry mouth
• heartburn
• difficulty falling asleep or staying asleep
• constipation
• diarrhoea
• nausea
• vomiting
• loss of appetite
• weight changes
• Excessive sweating
• Sexual side effects

These side effects can vary from person to person and can affect people differently. Sertraline may also cause some serious side effects which may require immediate medical attention.

What to do if sertraline does not help your symptoms adequately?

If sertraline fails to manage your symptoms adequately or causes side effects, please reach out to your healthcare provider. As discussed earlier, sertraline and similar antidepressants can take 4-6 weeks to kick in. 

So, if you’re new to sertraline, give this medication some time to work. Some people might take longer than 6 weeks to see a noticeable difference. 

However, if you think that your mental health is getting worse while waiting for the antidepressant to kick in or if sertraline is causing unbearable side effects, your doctor might consider adjusting your treatment strategy.

If sertraline-induced side effects are minimal but the drug isn’t working well enough, your doctor might increase your dose and see if it makes a difference. Higher doses generally generate a more prominent response compared to lower doses, but they come with tolerability issues. 

If your body can handle a higher dose without experiencing enhanced side effects, dose escalation could be a good and effective option for you. However, if low doses are not helping and high doses are intolerable, your doctor might add another antidepressant to your regimen or switch you entirely to a different medication. 

There are plenty of antidepressants that can replace sertraline, including other SSRIs. However, the choice of antidepressants should be made by a qualified healthcare provider. 

As a pharmacist, I always help my patients understand why they should closely follow their prescriber’s directions when it comes to antidepressants. Some of the people I know are doing well on sertraline, as it’s one of the most commonly prescribed antidepressants worldwide, with a lot of success stories. 

Now, I know that the initial phase of sertraline treatment can be irritating on so many levels – you might not feel a difference or may experience side effects like nausea, dizziness, sleep disturbances, etc. It might feel like the drug is making you feel even worse, but try and give it some time. 

It does kick in and starts making positive changes in your mental health. However, not everyone does well on sertraline. If this antidepressant is not the right choice for you, your doctor will safely switch you to a different one. Just make sure you do not make any changes to your prescription on your own.

References 

1. Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689

2. The Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. ZOLOFT (sertraline hydrochloride) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839s74s86s87_20990s35s44s45lbl.pdf

3. Lewis G, Duffy L, Ades A, Amos R, Araya R, Brabyn S, Button KS, Churchill R, Derrick C, Dowrick C, Gilbody S, Fawsitt C, Hollingworth W, Jones V, Kendrick T, Kessler D, Kounali D, Khan N, Lanham P, Pervin J, Peters TJ, Riozzie D, Salaminios G, Thomas L, Welton NJ, Wiles N, Woodhouse R, Lewis G. 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 Nov;6(11):903-914. doi: 10.1016/S2215-0366(19)30366-9. Epub 2019 Sep 19. PMID: 31543474; PMCID: PMC7029306. https://pubmed.ncbi.nlm.nih.gov/31543474/

4. Suri RA, Altshuler LL, Rasgon NL, Calcagno JL, Frye MA, Gitlin MJ, Hwang S, Zuckerbrow-Miller J. Efficacy and response time to sertraline versus fluoxetine in the treatment of unipolar major depressive disorder. J Clin Psychiatry. 2000 Dec;61(12):942-6. doi: 10.4088/jcp.v61n1209. PMID: 11206600. https://pubmed.ncbi.nlm.nih.gov/11206600/ 

5. National Library of Medicine. Sertraline: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a697048.html