Does Sertraline affect vitamin D? (+3 interactions)

In this brief article we shall answer the question, “Does Sertraline affect vitamin D?” We shall also discuss the relationships between Sertraline and vitamin D, whether you can take Sertraline if you have vitamin D deficiency and how to safely use the drug if you have the deficiency.

Does Sertraline affect vitamin D?

Yes, Sertraline affects vitamin D. Sertraline has been reported to statistically lower the levels of vitamin D. The relationship between Sertraline and vitamin D is fairly complex, but its use is recommended when using Sertraline, as the drug can cause bone loss in some individuals, a condition which may be ameliorated by vitamin D (1,2,3,4).

You should not however be worried as these interactions affect a few people, especially those with vitamin D deficiency.

Sertraline (Zoloft) is a widely used antidepressant classified as a serotonin reuptake inhibitor (SSRI) which acts by inhibiting the reuptake of serotonin in the brain (1). It is used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and social anxiety disorder (1).

Its use along with the other SSRIs has however been shown to cause bone loss in some individuals, a condition which may be ameliorated by the concomitant use together with vitamin D (2,3,4).

Vitamin D is an essential vitamin for the body. It plays a major role in the development of bones through the regulation of the absorption and metabolism of both calcium and phosphorous minerals (3,5). Additionally, it has been demonstrated to improve depressive symptoms when used adjunctively with antidepressants, including Sertraline (3,4,5).

Vitamin D is mainly obtained from exposure to the sun’s UV rays and dietary intake (5).

How does Sertraline affect vitamin D levels?

The prolonged use of antidepressants including Sertraline and other SSRIs has been reported to statistically lower the levels of vitamin D (4,7). The exact mechanism is unknown. Several drugs are known to interfere with the metabolism of vitamin D through the activation of the pregnane X receptor and thereby deplete the levels of vitamin D, but Sertraline is not included in this list (3,5).

What does research involving Sertraline and vitamin D suggest?

The relationship between Sertraline and vitamin D is fairly complicated and is centred around the influence on brain neurotransmitters (3,5,6). Research has linked depression to vitamin D deficiency (3,4,5). Vitamin D is thought to play a role in the regulation of the levels of serotonin, dopamine and norepinephrine neurotransmitters, which are the key drivers of depression (3,5,6). Low levels of vitamin D would therefore potentially lead to depression, and several studies have reported as such (3,4,5,6).

Indeed, several studies have reported a significant correlation between low vitamin D levels and depression, sometimes manifesting in suicide attempts, even in patients (3,6). This is of concern since depression is thought to account for up to 60% of suicides (6).

Both Sertraline and vitamin D raise the levels of these neurotransmitters, especially serotonin, and therefore augment each other in the treatment of depression (3,5). The concomitant use of both Sertraline and vitamin D has indeed been reported to improve the symptoms of depression, even though Sertraline may reduce the levels of vitamin D (3,5,6).

It is also noteworthy that Sertraline and other SSRIs have been reported to cause bone loss, a condition that is ameliorated by vitamin D (2,3).

The interplay between Sertraline and vitamin D is therefore peculiar. Sertraline can potentially cause or worsen vitamin D deficiency in those who are already deficient, thereby exacerbating the Sertraline-induced bone loss leading to osteoporosis, fractures and other related bone disorders (2,3). Please contact your healthcare practitioner or pharmacist before starting your Sertraline dose.

What are the risks of lower vitamin D levels?

Vitamin D deficiency can cause a reduction in bone density which may result in osteoporosis and fractures (2,3). It may also lead to a lowering of immunity, and therefore risk of contracting diseases. Low vitamin D levels can also predispose a person to a higher risk of depression and possible negative consequences (3,6).

Lifestyle and dietary habits influence the levels of vitamin D as well (5). It is recommended that you reduce your alcohol intake and smoking if you are a smoker or drink alcohol as they may exacerbate vitamin D deficiency. A balanced diet is also important

Can you take Sertraline if you have vitamin D Deficiency?

You can take Sertraline if you have vitamin D deficiency, but your vitamin D deficiency must be corrected to prevent bone disorders (2,3). This is achieved by the use of vitamin D supplements (3,4,6). Vitamin D is also obtained from exposure to the sun, and dietary intake (5).

Regular monitoring of your vitamin D levels is crucial when you are taking Sertraline if you have been told that you have vitamin D deficiency. The concomitant use of  Sertraline and vitamin D has an extra benefit in the treatment of depression owing to their synergistic action (3,4,6).

Contact your doctor before initiating Sertraline therapy, especially if you have vitamin D deficiency.

Can you take vitamin D supplements when taking Sertraline?

Yes, you can take vitamin D supplements together with Sertraline, as they augment each other in the treatment of depression (3,5). Additionally, the supplements can correct the lowering of the vitamin D levels by Sertraline (3,5,6).

However, it is important for you to first contact your doctor to assess you and determine your vitamin D levels before taking the supplements if you are on Sertraline therapy. The major risk is vitamin D toxicity which causes nausea, vomiting and frequent urination. It may even progress to bone pain and the formation of renal stones. You may not require the supplements if your vitamin D levels are normal.

Conclusion

Sertraline may deplete the levels of vitamin D in a few individuals, especially in persons with vitamin D deficiency. The relationship between Sertraline and vitamin D is peculiar. Both Sertraline and vitamin D act synergistically to treat depression, but Sertraline can cause bone loss thereby predisposing you to fractures and other bone disorders which are managed by supplementation with vitamin D. This however occurs in a few people.

You can still take Sertraline if you have vitamin D deficiency, but this has to be treated by the use of vitamin D supplements. Exposure to sunlight can also correct the disorder. I would strongly recommend that you notify your doctor before initiating Sertraline therapy if you have been diagnosed with vitamin D deficiency before, to prevent bone disorders.

References