Does Sertraline affect your muscles severely? (+3 Side effects)

This article will discuss how Sertraline affects your muscles and the potential mechanism of sertraline-induced muscle damage. We will also look at the possible side effects of Sertraline on your muscles and how to prevent and manage sertraline-associated muscle damage.

Does Sertraline affect your muscles severely?

Sertraline can affect your muscles severely, but it is not commonly reported. Side effects like muscle cramps or muscle twitching are common, but they typically subside within a few days of your treatment as your body adjusts to the antidepressant.

However, Sertraline can cause severe muscle damage in rare cases. Rhabdomyolysis and serotonin syndrome are rarely reported with Sertraline which can affect your muscles.

Sertraline (also known as Zoloft) is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of many psychiatric conditions like depression, anxiety disorders, eating disorders, and obsessive-compulsive disorders (1).

Sertraline is associated with several common side effects, some of which are listed below:

• Diarrhea (2)
• Nausea (2)
• Sweating (2)
• Dizziness (2)
• Tremor (2)
• Qt prolongation (2)

If you experience any of these side effects while using Sertraline, it is recommended that you contact your healthcare provider immediately.

What does research suggest?

Rhabdomyolysis is a life-threatening condition that may lead to permanent disability or death. It is characterized by severe muscle damage leading to a release of creatine kinase, myoglobin, and uric acid in the blood. Symptoms of rhabdomyolysis include skeletal muscle injury, dark-colored urine, and renal impairment (1).

Sertraline-induced rhabdomyolysis usually occurs within 1-4 months after starting or increasing the drug dose (1). Below, you can find some of the reported cases of Sertraline-induced muscle damage:

One of the studies reported a case of rhabdomyolysis in a 25-year-old woman who had been taking Sertraline for depression.

The woman was presented to the emergency department with complaints of muscle swelling, soreness, and dark-colored urine. Her blood reports also showed an elevated creatine kinase level (1).

It was observed that six weeks before she visited the Emergency Department, her sertraline dose had been titrated up to 150mg; the patient also reported engaging in strenuous physical activity, such as weight lifting, just one day before this event.

The combination of rigorous exercise and sertraline use was identified as the reason for rhabdomyolysis (1).

Sertraline was discontinued, and symptoms of muscle soreness improved after a few days; however, her creatine kinase levels remained elevated. Sertraline was reinitiated at a low dose of 50mg and gradually increased to 150mg (1).

The patient was closely monitored during the titration period, and during this time, her creatine kinase levels were also normalized. The patient fully recovered and was discharged after 13 days (1).

Another study reported a case of rhabdomyolysis in a 45-year-old lady who had been taking Sertraline for six months. Her dose had been increased up to 150mg three weeks earlier. The muscle damage was attributed to Sertraline; therefore, the medicine was discontinued. Within 3-4 days, the patient became asymptomatic (3)

Another study represents the case of a 13-year-old male who presented to the emergency department complaining of rhabdomyolysis, myositis, and trismus. The patient had a history of taking Sertraline for ADHD and depression.

Six weeks before the onset of these symptoms, his sertraline dose was increased to 100mg. Due to the association of Sertraline with rhabdomyolysis, the drug was discontinued. Two weeks after discontinuing the drug, elevated creatine kinase levels and renal failure resolved (4).

These cases demonstrate a direct link between the use of Sertraline and rhabdomyolysis. A score of 8 was calculated using the Adverse Drug Reaction Probability Scale, also known as the Naranjo Probability Scale, which indicates a possible link between Sertraline and the development of rhabdomyolysis in patients (1).

Potential Mechanisms of Sertraline-induced Muscle Damage

The mechanism of sertraline-associated rhabdomyolysis is not known. However, it is suggested that Sertraline may potentially activate serotonin receptors in skeletal muscles and the peripheral nervous system (1).

Sertraline produces its action by increasing the serotonin levels in the brain, and this elevated serotonin is associated with the prolonged contraction and relaxation of muscles in rhabdomyolysis (1).

Another potential mechanism is that Sertraline may lead to a decrease in the myoplasmic ATP and an increase in the systolic calcium levels, resulting in myositis, which is the inflammation of skeletal muscles (4).

Other possible side effects of Sertraline on muscles

In addition to rhabdomyolysis, Sertraline is also associated with serotonin syndrome. While Sertraline rarely causes serotonin syndrome on its own, when combined with another serotonergic drug or an SSRI, it may induce serotonin syndrome (2).

Symptoms of serotonin syndrome can range from mild to fatal and may include altered mental state, autonomic dysfunction, and neuromuscular excitation (5). Common symptoms associated with serotonin syndrome are as follows:

• Myoclonus (2).
• Excessive sweating (2).
• Muscle rigidity (2).
• Tremors (2).
• Hyperreflexia (2).
• Agitated delirium (2).
• Hyperthermia (2).

Caution should be exercised when co-administering Sertraline with other serotonergic drugs, such as monoamine oxidase inhibitors, linezolid, etc. Your healthcare provider should educate you about the potential side effects associated with such combinations (2).

How is Sertraline-induced muscle damage managed in clinical settings?

In most cases, the rhabdomyolysis associated with Sertraline has been effectively managed by discontinuing the medication. After discontinuing, creatine kinase levels gradually normalize, and symptoms, like muscle swelling, typically resolve within a few weeks.

For cases of mild serotonin syndrome, discontinuing the serotonergic drugs is the primary management. Additionally, supportive care is provided to prevent further complications, including the following measures (5):

• In most cases, sedation may be necessary, which can be achieved using benzodiazepine (5).
• Vital signs are continuously monitored, and if required, they are normalized using IV fluids and cooling measures (5).
• Anti-pyretics such as acetaminophen are typically ineffective in treating hyperthermia associated with serotonin syndromes, as this hyperthermia results from increased muscular activity (5).
• To manage autonomic instability, antihypertensive agents such as esmolol or vasopressors are used (5).
• Hypotension is managed with IV fluids; however, direct-acting sympathomimetics such as phenylephrine, norepinephrine, and epinephrine are utilized in refractory cases (5).
• In some cases of serotonin syndrome, cyproheptadine, a histamine-1 receptor antagonist, can be used as an antidote (5).

In severe cases of serotonin syndrome, patients may require admission to the intensive care unit (ICU) (5).

How do you prevent Sertraline-Associated muscle damage?

The following tips can help you prevent muscle damage associated with Sertraline:

• Avoid engaging in rigorous physical activity, such as weightlifting, while taking Sertraline.
• Suppose your sertraline dose has been recently increased. In that case, it is recommended to immediately report any signs of muscle damage, such as muscle swelling or dark-colored urine, to your healthcare provider.
• Do not start your Sertraline within two weeks after discontinuing the monoamine oxidase inhibitors or other serotonergic drugs, as this may increase the risk of developing serotonin syndrome (2).

Conclusion

This article discusses how Sertraline affects your muscles and the potential mechanism of sertraline-induced muscle damage. We have also looked at the possible side effects of Sertraline on muscles and how to prevent and manage sertraline-associated muscle damage.

References