Why Zoloft (Sertraline) Causes Insomnia and How to Fix It

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Zoloft is a commonly prescribed medication to treat depression, anxiety disorders, obsessive compulsive disorders and other emotionally induced stress disorders. However, it is also known to cause insomnia in some people. Learn about Zoloft insomnia and how to treat it.

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What is Zoloft?

Zoloft, with the generic name of Sertraline, is a commonly prescribed medication to treat depression, anxiety disorders, obsessive compulsive disorders and other emotionally induced stress disorders. Zoloft belongs to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are thought to work by preventing the reuptake of serotonin by nerves, leading to an increase in serotonin concentrations within the nerve synapse (space between two nerves) (Yoham and Casadesus, 2022). It is this blocking of certain reuptake pathways, which helps to rebalance chemicals in the brain. It is believed that this rebalancing is the main action by which Zoloft helps people with anxiety, depression, and other disorders. Zoloft is an effective antidepressant with less potential for drowsiness than many other antidepressants, but it is not without its side effects (Turner, and Phelon, 2022; Ahmadpanah et al., 2019).

Does Zoloft Cause Insomnia?

According to British National Formula, the most commonly reported side effects are headache, nausea, diarrhoea, weight loss, insomnia, and sexual dysfunction. Unlike some other therapies for mental health disorders, Zoloft is not a sedative, it is a SSRI, which does not cause drowsiness, however it does have an effect on sleep, with many patients reporting fatigue as a common side effect (Wichniak, et al., 2017). Many patients who are prescribed Zoloft and other related drug compounds of this class reported reduced symptoms of depression but worsening insomnia.

Studies by Wilson & colleagues in 2014, demonstrate in animal models the effect Zoloft can have in changing the levels of other neurotransmitters in the brain, such as the reuptake of serotonin. These changes in brain chemistry are hypothesised to be the cause of antidepressant induced insomnia in some patients. Various clinical studies have also shown that SSRIs like Zoloft increase the amount of time it takes to fall asleep, leading to interrupted sleep patterns and reduced time spent in rapid eye movement (REM) sleep. This results in poor overall recovery and feelings of chronic fatigue (Lewis, et al., 2019). For some patients, Zoloft-related insomnia is temporary, while for others it can be ongoing and require further assessment and treatment (Wilson, and Argyropoulos 2005).

When is the Best Time to Take Zoloft for Sleep?

Insomnia is the most common sleep disorder in America, with an estimated 70% of all Americans suffering from this condition each year. Transient insomnia (lasting days or even weeks) as well as chronic insomnia (lasting years) have both been linked to antidepressant use such as Zoloft in recent studies (Holshoe, 2009). Other studies have directly implicated antidepressants in patients with induced insomnia, due to the effect the drug has with sleep physiology (Wilson, and Argyropoulos, 2005).

In order to limit the effect Zoloft has on your sleep patterns, you should take your dose of Zoloft at the same time each day, either in the morning or evening. Taking Zoloft in the morning or evening will depend on if the drug makes you feel drowsy or not (Wang et al., 2019). Most patients who are suffering from Insomnia find that taking Zoloft in the morning helps to reduce the drug’s effect on sleep. You should avoid caffeinated drinks, entirely or limit them only to the morning, as caffeine has a 12-hour half-life (Schutte-Rodin et al., 2008). Many patients also report a very strong positive effect of physical activity on getting better, deeper sleep as well as battling the root cause of the initial disorder that requires treatment with Zoloft.

What are the Side Effects of Zoloft?

Including insomnia, Zoloft also has a number of other reported side effects by the Mayo Clinic (2022), such as:

  • Nausea/ feeling sick
  • Heartburn/ acid reflect
  • Diarrhoea
  • Constipation
  • Lack of appetite
  • Weight fluctuations
  • Dry mouth
  • Fatigue
  • Dizziness
  • Specific sexual dysfunctions in men and women

 

In men, Zoloft can cause erectile dysfunction and difficulty in ejaculation, while in women it can limit or cause difficulty in achieving an orgasm (Rosen Marin, 2003). Zoloft is contraindicated in pregnant women as it has been linked to increased risk of birth defects (Anderson et al., 2020).

Many of the side effects will be immediately apparent within the first week of taking the medication, with side effects such as nausea and fatigue/ drowsiness appearing early on in treatment. There is a strong dose relationship with these side effects, often increasing in severity as the dosage increases.

Over time, more mild side effects of Zoloft fade away as the body adjusts to the new medication. In very rarely reported side effects, Zoloft can cause hallucinations, partial or full body seizures, skin rashes and in around 22% of patients- night sweats (Brim, 2022). It is important a patient monitor their own mood and mental health during the first few months of therapy and contact their doctor is symptoms become more severe or if they start to experience suicidal thoughts or feelings. A patient should not suddenly stop taking an SSRI, instead when a therapy needs to be terminated it requires a tapering off phase to ensure side effects are manageable.

Zoloft Recommended Dosage

Before prescribing Zoloft, or any other antidepressant, patients need to be screened for bipolar disorder, mania, or hypomania taking into account family history and the mini-mental health assessment screening tool. The initial therapeutic dosage in both adult and paediatric cases is between 25 mg or 50 mg per day. Depending on the extent of the condition, fine tuning the dose is required in conjunction with the patient and can in some extreme cases have doses as high as 200mg.

Zoloft should be administered only once a day, either in the morning or evening, depending on the drug’s impact on the patient’s sleep patterns and mood. If Zoloft makes the patient drowsy, then the patient is recommended to take it before bed. Otherwise if it interferes with sleep and causes insomnia, then the patient may benefit from taking Zoloft in the morning (Wichniak, et al., 2017). Zoloft can be taken with or without food, however consistency is key, taking it in the same manner, either with or without food every day at the same time. This will help your body and brain adjust and rebalance those neurotransmitters in the brain that are thought to regulate your mood.

References

  • Ahmadpanah, M., Ramezanshams, F., Ghaleiha, A., Akhondzadeh, S., Bahmani, D.S. and Brand, S., 2019. Crocus Sativus L.(saffron) versus sertraline on symptoms of depression among older people with major depressive disorders–a double-blind, randomized intervention study. Psychiatry research, 282, p.112613.

  • Anderson, K.N., Lind, J.N., Simeone, R.M., Bobo, W.V., Mitchell, A.A., Riehle-Colarusso, T., Polen, K.N. and Reefhuis, J., 2020. Maternal use of specific antidepressant medications during early pregnancy and the risk of selected birth defects. JAMA psychiatry, 77(12), pp.1246-1255.

  • Brim, W. (2022). Staff Perspective: Night Sweats – About Nocturnal Hyperhidrosis. Uniformed Services University. https://deploymentpsych.org/blog/staff-perspective-night-sweats-about-nocturnal-hyperhidrosis0

  • Holshoe, J.M., 2009. Antidepressants and sleep: a review. Perspectives in psychiatric care, 45(3), pp.191-197.

  • Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., Button, K.S., Churchill, R., Derrick, C., Dowrick, C. and Gilbody, S., 2019. 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. The Lancet Psychiatry, 6(11), pp.903-914.

  • Mayo Clinic (2022). Antidepressants: Get tips to cope with side effects [internet source]. Cited: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20049305 [accessed 10/07/2022].

  • Rosen, R.C. and Marin, H., 2003. Prevalence of antidepressant-associated erectile dysfunction. Journal of Clinical Psychiatry, 64, pp.5-10.

  • Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C. and Sateia, M., 2008. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine, 4(5), pp.487-504.

  • Turner, B. and Shonda Phelon, D.N.P., (2022) SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN ADOLESCENTS AND YOUNG ADULTS, [presentation].

  • Wang, X., Li, P., Pan, C., Dai, L., Wu, Y. and Deng, Y., 2019. The effect of mind-body therapies on insomnia: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2019.

  • Wichniak, A., Wierzbicka, A., Walęcka, M. and Jernajczyk, W., 2017. Effects of antidepressants on sleep. Current psychiatry reports, 19(9), pp.1-7.

  • Wilson, C.B., McLaughlin, L.D., Ebenezer, P.J., Nair, A.R., Dange, R., Harre, J.G., Shaak, T.L., Diamond, D.M. and Francis, J., 2014. Differential effects of sertraline in a predator exposure animal model of post-traumatic stress disorder. Frontiers in behavioral neuroscience, 8, p.256.

  • Wilson, S. and Argyropoulos, S., 2005. Antidepressants and sleep. Drugs, 65(7), pp.927-947.

  • Yoham, A.L. and Casadesus, D., 2022. Tretinoin. In StatPearls [Internet]. StatPearls Publishing. Cited: https://www.ncbi.nlm.nih.gov/books/NBK557478/ [accessed 10/07/2022]

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