Does Sertraline cause postural hypotension? (3+ management tips)

In this article, we will discuss postural hypotension associated with Sertraline – an antidepressant. We will explore research studies and what you should do if this side effect occurs.

Does Sertraline cause postural hypotension?

Yes, Sertraline may cause postural hypotension in some individuals. It is not considered a common side effect, but Sertraline may trigger postural hypotension, especially in patients with comorbid conditions such as hypertension, diabetes and Addison’s disease (1,3).

Sertraline, brand name Zoloft, is an FDA-approved medication used in the management of major depressive disorders (MDD), obsessive-compulsive disorders (OCD), panic disorders and eating disorders (4).

Postural hypotension, also known as orthostatic hypotension, refers to a sudden decrease in blood pressure when an individual stands from a sitting or lying position. It is defined as a systolic blood pressure drop of 20mmHg or more and a diastolic blood pressure drop of 10mmHg or more within 3 minutes of standing (5).

In some cases, postural hypotension may not be directly related to antidepressant use and may be caused by other individual-specific factors. If you experience postural hypotension while taking this medication, it is important to consult your healthcare provider.

What does research suggest?

Several research studies on postural hypotension associated with antidepressants have linked the use of Sertraline to postural hypotension. Although the exact mechanisms remain unclear, several hypotheses have been proposed regarding how Sertraline may cause postural hypotension.

Sertraline is a selective serotonin reuptake inhibitor (SSRI), which exerts its effects by increasing serotonin levels in the brain (4). Serotonin plays a role in the central regulation of blood pressure. Studies have shown that serotonin can reduce cardiac output, leading to a decrease in blood pressure (2,6).

Sertraline can also influence the autonomic nervous system, which controls involuntary physiologic functions such as blood pressure and heart rate. This medication may suppress the sympathetic nervous system in individuals, potentially leading to changes in blood pressure when one stands from a sitting or lying position (2,3,6).

Additionally, Sertraline is associated with arterial vasodilation, which can result in a drop in blood pressure. This vasodilation may become more pronounced when a person stands up, leading to postural hypotension (6).

A research study on the effect of antidepressant medication on blood pressure suggested that medications like Escitalopram, Fluoxetine and Sertraline affect fluid balance, potentially causing changes in blood pressure and leading to postural hypotension (2,3).

What factors can contribute to Sertraline-induced postural hypotension?

Sertraline-induced postural hypotension can be influenced by several factors, primarily patient-specific factors. Every individual reacts differently to medications, including Sertraline.

Individuals with underlying conditions that can cause postural hypotension on their own, such as adrenal insufficiency and hypoglycemia, may experience exacerbated symptoms when taking Sertraline (3).

High doses of Sertraline may also precipitate postural hypotension in some individuals. 

Additionally, the use of other medications alongside Sertraline may augment its side effects, including postural hypotension. Your healthcare provider should consider these individual factors when prescribing Sertraline to reduce incidences of postural hypotension

What to do if Sertraline causes postural hypotension?

If Sertraline causes postural hypotension, it is important to discuss it with your healthcare provider. Your doctor may consider adjusting your dose to see if it might help alleviate this side effect.

If postural hypotension persists or worsens, your primary healthcare provider may advise discontinuing the medication. It is important to emphasize that discontinuing the medication should only be done under your doctor’s guidance; you should not attempt it on your own.

If postural hypotension symptoms persist, your doctor may recommend switching to other antidepressants such as Escitalopram under their supervision to reduce the risk of postural hypotension.

Lifestyle modifications such as monitoring your blood pressure, staying well-hydrated, regularly exercising, and limiting your alcohol intake can be effective in managing postural hypotension symptoms.

Conclusion:

In this article, we have explored Sertraline-induced postural hypotension, including research findings and factors that may increase susceptibility to postural hypotension. We have also provided recommendations on how to manage its effects. 

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