Zoloft (sertraline) is an antidepressant prescribed for depressive disorders, obsessive-compulsive disorders, panic disorders, and anxiety. It is the most common psychiatric drug used in United Stated even though it has serious side effects in long-term therapy[1]. It is associated with psychiatric side effects more than other selective serotonin reuptake inhibitors, as it causes anxiety, insomnia, emotional changes, tremor, psychosis and it disturbs psychomotor coordination.
Insomnia is a sleep disorder often caused by long-term therapy with antidepressants. Affected patients have trouble sleeping and feel irritated, depressed and sleepy. Insomnia can also be one of the many withdrawal symptoms of Zoloft and it can lead to complications such as slowed reaction time, which can affect your driving habits, and lead to high blood pressure, obesity, and poor immune system function[2].
Anxiety is the common term for psychomotor agitation, which includes mental tension and emotional distress. Anxiety is found in major depressive disorders and it is sometimes linked to bipolar disorder. It is often treated with antipsychotics which decrease the length of agitation. Another long-term side effect of Zoloft is fatigue, which can be mental, physical, or both mental and physical. Even though it is a non specific symptom, it is associated with mental stress, overstimulation, depression and lack of sleep. Long-term therapy with sertraline can affect short term memory and verbal fluency.
Additionally, there are serious sexual side effects which can appear during treatment, such as ejaculation difficulties and lack of sexual arousal. Sexual arousal disorder includes inadequate lubrication for women and erectile dysfunction for men. Studies showed that long-term therapy with sertraline caused ejaculation difficulties in 67% of men and difficulties achieving orgasm in 41% of women who initially didn't have such problems[3]. Sexual desire disorder is characterized by decreased libido for some period of time, while sexual arousal disorder describes women suffering from frigidity and men with impotence. Frigidity is the lack or absence of sexual desire or response to sexual stimulus. Other common sexual problems related to long-term use of Zoloft are painful intercourse, vaginal dryness, vaginal irritation and involuntary spasms of the vagina; a medical condition known as vaginismus.
One of the many paradoxical reactions of Zoloft is the increased risk of suicide following extended therapy. This is a major concern as it may increase the risk of suicide in patients under 25 years old, by doubling its rate from 2 in 1000 to 4 in 1000 adolescents[4]. Although this is an antidepressant meant to prevent such incidents, it can end up increasing its likelihood. Early indicators of suicide in children and adolescents are loss of interest in school and family, alcohol and substance abuse, as well as excessive sleeping.