Zoloft and Elavil (A Complete Guide)


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Page last updated: 10/11/2022

Zoloft and Elavil (A Complete Guide)

In this blog, we are going to talk about the concomitant use of zoloft and elavil. They both possess antidepressant properties and are prescribed according to the patient’s condition and tolerance. 

This blog will cover the risk-benefit ratio associated with the use of these two antidepressants together. 

Can you take zoloft and elavil together? 

No, it is not safe to take zoloft and elavil together. Both of these drugs are antidepressants in nature. Your doctor will prescribe you either zoloft, or elavil, but not both. 

These drugs treat depression by increasing the amounts of excitatory neurotransmitters in your body, usually serotonin and norepinephrine. The excessive amount of serotonin can result in serotonin syndrome, which is associated with symptoms like:

  • Fever with chills
  • Excessive sweating 
  • Restlessness and fatigue
  • Headache, which often feels like your head is pounding
  • Changes in blood pressure and/or temperature
  • Nausea
  • Vomiting
  • Diarrhoea
  • Bradycardia
  • Tremors
  • Muscle twitching and muscle pain
  • Shivering and goosebumps

Zoloft can also increase the toxic side effects of elavil by increasing its concentration in the body. This combination is not ideal and is not commonly used, but if it is extremely important to use these two agents, your doctor will adjust the dose. However, this condition is pretty rare.

Safety profiles of zoloft and elavil 

Zoloft, brand name for sertraline, belongs to the class of selective serotonin reuptake inhibitors (SSRIs). As the name indicates, these meds inhibit the reuptake of serotonin and make more active serotonin available to bind to its receptors throughout the body. 

This is how it enhances mood, cognition, reward, learning, memory, and various other psychological processes. 

Elavil, on the other hand, is the brand name for amitriptyline. It belongs to the class of Tricyclic antidepressants (TCAs). These agents work by inhibiting serotonin and norepinephrine transports, SERT and NET respectively. 

This way they can help increase the amounts of excitatory neurotransmitters in your system and cure your depression. 

As discussed earlier, it is not safe to use these two meds together. One is enough to tone down depression symptoms. When you talk about safety profiles, zoloft is much safer than elavil. 

Zoloft and other SSRIs are used as a first line of treatment for depression and other psychological illnesses. Elavil, on the other hand, was removed from the list of first line agents because of its adverse side effects. 

TCAs are much more likely to bind to several other receptors in our body. One study suggests that elavil has much more affinity for other receptors including cholinergic receptors. The more if binds to different kinds of active sites, the more side effects occur. 

Zoloft and Elavil (A Complete Guide)

Adverse effects of elavil includes:

  • Painful urination 
  • Dry mouth or xerostomia
  • Gastrointestinal side effects, including nausea and vomiting 
  • Weight gain
  • Vertigo 
  • Drowsiness or extreme fatigue 
  • Constipation 
  • Abdominal pain
  • Enlarged breasts
  • Heartburn
  • Excessive sweating 

In severe conditions it can cause an allergic reaction, associated with painful rash, redness, pus filled blisters, itching, eczema, and burning sensation etc. It can also cause suicidal behavior in people older than 24 years of age. 

The effects of elavil are unpredictable, because of its affinity to bind with multiple receptors. This is one of those drugs which are not that easily tolerated by a majority of the population. 

Elavil can significantly cause QT elongation which can result in deadly arrhythmia. This class of antidepressants is well known for its cardiac toxicity. It can cause sudden cardiac arrest and death upon overdose. 

If, for some reason, you can not tolerate the first line of antidepressants and you have to take elavil or any other TCA, make sure you follow proper adherence. 

A 2004 study gathered all the data from different research studies and revealed 1000+ deaths caused by elavil overdose. The study revealed that cardiac toxicity associated with elavil is dose dependent. People at higher doses are also most likely to suffer from toxic effects. 

Other than depression, elavil is also used to treat other disorders like eating disorder or bulimia nervosa, neuralgia and migraines. Make sure you read the following instructions before taking elavil:

  • Always inform your doctor if you’re allergic to it or any other tricyclic antidepressant. 
  • Carefully read the leaflet or medication guide
  • Don’t take this medication concomitantly with monoaminoxidase inhibitors (MAOIs). 
  • Inform your doctor if you’re pregnant. Breastfeeding is contraindicated with the use of elavil. Make sure you avoid doing that. 
  • Discuss the use of elavil with your doctor if you belong to the geriatric population. It might not be safe for people above 60 years of age. Such people already have multiple underlying health conditions and their immunity and other physiological functions are not that competent. 
  • Avoid drinking too much alcohol with this, as elavil can make you drowsy and so can alcohol. It is advised to limit the use of these two together.
  • If it makes you drowsy, do not take it in the morning. If you have, avoid driving, operating heavy machinery or any task that requires you to have full mental alertness. 

Zoloft, although it is safer than elavil in comparison, also has side effects. These include:

  • Loss of appetite
  • Tiredness
  • Feeling angry or agitated
  • Weight gain
  • Inability to digest food
  • Nausea
  • Diarrhoea
  • Loss of libido
  • Sweating/Night sweats
  • Tremors or shaking
  • Insomnia
  • Decreased sex drive
  • Impotence
  • Inability to ejaculate

Serious side effects of zoloft include:

  • Seizure/convulsions
  • Eye pain with vision problems
  • Migraine 
  • Confusion
  • Agitation
  • Memory problems/Dementia 
  • Severe weakness and inability to move
  • The inability to have an erection
  • Hypothyroidism (low thyroid gland function)
  • Bone marrow failure associated with low blood counts
  • Thrombocytopenia
  • Neutropenia 
  • Abnormal behaviour/mania 
  • Suicidal thoughts
  • Feeling guilty all the time
  • Extrapyramidal symptoms

If your doctor has prescribed zoloft, give the following points a quick read:

  • Make sure you take zoloft once daily, as recommended by your healthcare provider.
  • Consult your doctor if your mood worsens or you experience a serious side effect. 
  • Zoloft tends to induce suicidal behavior in users younger than 24 years of age. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 
  • Do not stop zoloft abruptly. If it’s time for you to stop zoloft, your doctor will simply make a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 
  • Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

As discussed earlier, zoloft is much safer than elavil because of lesser attraction to other receptors. This is why it is preferred over elavil. 

For people who can not tolerate zoloft and other SSRIs, the doctor starts going through other classes of antidepressants and that’s where you might end up with elavil. 


In this blog, we discussed the concomitant use of zoloft and elavil. They both are antidepressants, but belong to two different classes. Zoloft belongs to selective serotonin reuptake inhibitors (SSRIs) and elavil belongs to tricyclic antidepressants (TCAs). 

Zoloft inhibits the reuptake of serotonin, whereas elavil inhibits the reuptake of both serotonin and norepinephrine. It is not recommended to use these two agents together. 

The concomitant use can increase the risk of serotonin syndrome, which occurs with dangerously high amounts of serotonin in your body. This is why your doctor will either recommend zoloft or elavil, but never both. In terms of safety, zoloft is considered much safer than elavil. 

Elvail and other TCAs have higher affinity to bind with several other types of receptors in the body which is the root cause of more side effects. Make sure you never start taking medications without your doctor’s approval.

Self-medication for the treatment of psychological illnesses can wreak havoc on your body. It is not even recommended to change your timing or dose without discussing with your healthcare provider first. 

FAQs: zoloft and elavil

Can you take Zoloft with Elavil?

It is not advised to take these two drugs together. Usually one antidepressant with appropriate dose is enough to provide relief from depression. Zoloft and other SSRIs are used as the first line of agents for the treatment of depression because of their better safety profile. 

Elavil on the other hand can bind to several other receptors in your body and produces more side effects. If it is extremely necessary to combine these two drugs together, your doctor will carefully adjust the dose. However, this condition is pretty rare.

Does amitriptyline react with sertraline?

Sertraline can enhance the toxic effects of amitriptyline by increasing its concentration in the body. The two together can cause much pronounced side effects. 

The excess amounts of serotonin can also give rise to serotonin syndrome which is associated with symptoms like fever with chills, confusion, tremors, brain fog, agitation, convulsions etc.

Which is better for anxiety, zoloft or amitriptyline?

Zoloft has a better safety profile. It can tone down the symptoms of anxiety and stabilise mood. Elavil, on the other hand, has more side effects because of its ability to bind with other receptors. 

It’s best to consult your healthcare provider to determine which medicine is best to treat your anxiety. 

What is Elavil classified as?

Elavil belongs to the class of Tricyclic antidepressants (TCAs). These agents work by inhibiting serotonin and norepinephrine transports, SERT and NET respectively. This way they can help increase the amounts of excitatory neurotransmitters in your system and cure your depression. 

Can you drink caffeine with Zoloft?

The interaction between zoloft and caffeine depends on how much you take it. Some studies suggest that antidepressants can inhibit the metabolism of caffeine. 

When the metabolism is affected, the chemical stays longer in your body as it normally should, hence it produces prolonged effects. 

A 2017 study found that low dose caffeine can enhance the efficacy of antidepressants in the treatment of major depression. A cup of coffee in the morning will not harm you as much as larger quantities will. 

What can you not take with sertraline?

You should avoid taking the following with zoloft:

  • Monoaminoxidase inhibitors. The concomitant use increases the risk of serotonin syndrome. 
  • Tryptophan rich foods. 
  • Non-steroidal anti-inflammatory drugs (NSAIDS). The combination can increase the risk of bleeding 
  • Pimozide