Answer

Zoloft (sertraline) can be taken in the morning or in the evening according to the prescribing information for the drug.

Most clinical studies evaluating Zoloft dosed it once daily, but the exact administration time was varied. Whether or not you decide to take Zoloft in the morning or evening, there doesn't appear to be any difference in how effective the medication is.

Most often, the best time to Zoloft is at a time that helps to mitigate the side effects you may experience.

For example, drowsiness and dizziness are two of the most common side effects, with over a 10% incidence rate. If you experience one of those side effects, evening dosing may be preferred.

Below, we answer some other commonly asked questions about Zoloft.


Eat Before Taking Zoloft?

Zoloft can be taken with or without food so no, you don't have to eat before taking it. However, if it causes nausea or other similar gastrointestinal side effects, food may help to minimize them.

The prescribing information does note that food has a slight influence on absorption, however:

"Administration with food causes a small increase in Cmax [maximum concentrations] and AUC [area under the curve]."

Nevertheless, these small increases in concentration aren't thought to change how effective it is.


Can Zoloft Be Used To Treat Anxiety?

Zoloft is perhaps most well-known for its role in treating depression, but it is also FDA-approved for a variety of other conditions, including:

  • Social phobia (social anxiety disorder)

  • PTSD (post-traumatic stress disorder)

  • Panic disorder

It is not FDA approved for the treatment of other anxiety conditions, such as generalized anxiety disorder but is often used off-label for this purpose and a variety of studies have shown modest benefit.

In fact, United Kingdom guidelines for the treatment of generalized anxiety disorder recommend Zoloft as the first-line drug for treatment.

How Long Does Zoloft Take To Work?

Zoloft is an SSRI (selective serotonin reuptake inhibitor), which generally takes 4 to 6 weeks to realize maximum effects.

However, you may notice an improvement in many symptoms (such as lack of energy or appetite) before 4 to 6 weeks. Initial improvement can be seen in as little as 1-2 weeks.

The following is an excerpt from the Guidelines For The Treatment Of Major Depressive Disorder:

"Improvement with pharmacotherapy can be observed as early as the first 1–2 weeks of treatment, and improvement continues up to 12 weeks. Many patients may show partial improvement as early as the end of the first week. Others achieve improvement within the first 2–4 weeks. In short-term efficacy trials, all antidepressant medications appear to require at least 4–6 weeks to achieve maximum therapeutic effects. There is also evidence for continued accrual of benefit for an additional 4–6 weeks."

What Are Common Side Effects?

The most common side effects of Zoloft include:

  • Change in appetite or weight
  • Change in sex drive or performance
  • Diarrhea
  • Increased sweating
  • Indigestion
  • Nausea
  • Tremors
  • Dizziness
  • Sedation

The Guidelines For The Treatment Of Major Depressive Disorder lists the most common side effects into several categories:

  • Gastrointestinal
  • Activation/Insomnia
  • Sexual
  • Neurologic
  • Weight

Gastrointestinal

Gastrointestinal side effects including nausea, diarrhea and vomiting. These side effects are thought to be more prevalent at higher doses but tend to go away after the first few weeks of treatment.

Activation/Insomnia

Zoloft can sometimes make symptoms of insomnia, sleep disturbances and restlessness (akathisia) worse. If these side effects do occur, they may go away over time. Adding on additional medications (e.g. melatonin, beta-blockers) may help.

Sexual

All SSRI drugs are associated with sexual dysfunction, including decreased sex drive and decreased performance. There are a variety of treatments available to lessen these effects.

Neurologic

Neurologic effects from Zoloft can include dizziness, headaches and less commonly, movement disorders. It has been reported that there may also be an increased risk of falls, especially among the elderly, most likely due to the increased risk of dizziness.

Weight

Zoloft has been associated with both weight loss and weight gain. However, the prescribing information points out that children and adolescents more commonly experience decreased appetite and weight loss, and therefore recommends to monitor both height and weight.


Summary

Zoloft (sertraline) can be taken in the morning or the evening, whichever is most convenient for you. Administration time does not alter how well the drug works.

References
  1. Guidelines for the Treatment of Major Depressive Disorder. Psychiatry Online
  2. Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. PubMed
  3. Management of generalized anxiety disorder in adults: summary of NICE guidance. BMJ
  4. Zoloft Prescribing Information. Pfizer