Zoloft or sertraline remains among the top 20 prescriptions drugs more than 25 years after its introduction. This anti-depressant belongs to the SSRI – selective serotonin reuptake inhibitor – family which includes Prozac, Celexa, Lexapro and Paxil.

Over time, indications expanded beyond depression. Now Zoloft or sertraline is also prescribed for anxiety, panic attacks, PTSD, pre-menstrual dysphoric disorder formerly PMS, obsessive compulsive disorder and social anxiety disorder. Other off-label uses lacking adequate study include alcoholism, migraine prevention, menopausal hot flashes, obesity, eating disorders, Tourette’s syndrome and premature ejaculation.

Studies suggest all of the anti-depressants provide relatively similar results without any one drug obviously superior to its competitors. In spite of aggressive advertising campaigns suggesting unique improvement with specific agents, reality suggests doctors’ habits, drug company marketing and side effect profile decide which product will be prescribed. Therapy seems to be a hit of miss proposition. If this drug fails to help, another is tried.

Among the more bothersome adverse reactions to Zoloft are loss of sexual interest or ability, weight gain, dry mouth and sleep problems. The serotonin syndrome may occur with Zoloft alone but seems more likely when combined with lithium, MAO inhibitors, other SSRIs, tramadol, amphetamines, lithium or tricyclic antidepressants (amitriptyline, nortriptyline). Symptoms include nausea, vomiting, diarrhea, agitation, hallucinations, delirium, seizures, tremor, incoordination, a racing heart rate and elevated body temperature.

Considerable debate surrounds antidepressants like Zoloft. Prescriptions for these drugs frequently originate from brief interactions with a family physician, nurse practitioner or physician’s assistant rather than a trained mental healthcare expert following more in depth assessment. As a result therapy often seems misdirected.

A significant number of people experience difficulty discontinuing treatment. Symptoms often are mistakenly confused with relapse of depression. Among the common complaints are dizziness, fatigue, tingling, blurred vision, sleeplessness, electric shock like sensations, agitation and crying spells.

Experts continue to debate whether these drugs offer significant advantages compared to placebo therapy. The vast majority of people treated with Zoloft improve at least somewhat. However relatively few achieve complete resolution of their symptoms. Weighing the benefits against the risks seems appropriate prior to beginning treatment.