Does Sertraline make you sad? (+3 tips)

In this brief article we shall answer the question, “Does sertraline make you sad?” We shall also discuss how Sertraline can negatively affect your emotions and when to seek help.

Does Sertraline make you sad?

Yes, Sertraline can make you sad. Chronic use of serotonin reuptake inhibitors (SSRIs) including sertraline has been reported to cause emotional blunting or sadness in about half of the patients taking the drugs (1).

Sertraline is a widely used antidepressant which belongs to the SSRI class (2). It is used to manage major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder and social anxiety disorder (2).

It works by inhibiting the reuptake of serotonin resulting in the accumulation of the neurotransmitter in the brain synapses. This leads to improvement of depressive symptoms since serotonin regulates mood, personality and wakefulness (2).

Despite its indication for the management of depression, the drug has been reported to cause emotional blunting or sadness in up to 40-60% of its users upon chronic use (1,3). Some of its listed adverse effects include suicidal ideation in children and young adults. It should also be monitored for unusual changes in behaviour, depression, anxiety, suicidal ideation and worsening illness (2).

It is therefore paramount to be watchful for these paradoxical symptoms if you are taking the drug or have a close relative or friend who is on the drug. You should immediately contact your doctor if you notice any of these symptoms.

How does Sertraline make you sad?

The exact mechanism through which Sertraline and other SSRIs produce this paradoxical effect has not been well understood. Some researchers have suggested that there is a latent period before the drug begins to work which is sometimes characterised by an increased risk for harmful behaviours (3,4). During this period, the patient may have a sudden surge of energy, so that if somebody is suicidal for example, they will accomplish their feelings (3,4).

Some other researchers have attributed this to the effect of two neurotransmitters glutamate and serotonin that are associated with SSRIs. According to their findings, SSRIs cause the serotonin receptors in the brain to release serotonin and glutamate at different times, and the two have some behaviorally distinctive effects (4). Serotonin is released immediately after taking the drugs but does not improve the depressive symptoms until after a couple of weeks. Glutamate is released after some days, thus causing dual signals and a delay in drug action (4).

It is important to know therefore that Sertraline will take a couple of weeks to act, and that the delay may precipitate some harmful ideations. Please contact your doctor immediately if you start experiencing negative thoughts or behaviours after initiating Sertraline treatment.

What does research suggest?

Sertraline and other SSRIs have been reported to cause emotional blunting or sadness in 40 to 60% of patients on chronic use (1,3). This suggests that about half of the patients who use sertraline will experience this side effect.

The emotional blunting occurs during that latent period before the drug begins to work. The duration varies for different people. It may last for a few days in some individuals or even delayed to six weeks in others (3,5).

You should therefore be aware of this latent period whereby the disease may worsen before the recovery starts. Please contact your doctor immediately when you feel that the symptoms are becoming bothersome.

What factors contribute to sadness when taking Sertraline?

Several factors may contribute to sadness when one is taking Sertraline. These include the patient characteristics, drug interactions and lifestyle (6). Some people are more likely to experience this adverse effect because they are genetically predisposed.

Sertraline also interacts with several drugs which may increase the risk of developing sadness (1,6). Please inform your doctor or pharmacist about the drugs that you are on before you start taking sertraline.

The overall health is also an important determinant. Patients with preexisting diseases such as liver problems are more vulnerable (6). Lifestyle is also key. Excessive alcohol or smoking may increase the risk of emotional blunting or sadness (6). You should therefore reduce your alcohol intake and smoking when you are taking Sertraline if you drink or smoke.

Is Sertraline-induced emotional blunting reversible?

The emotional blunting should ordinarily last for a few days to weeks until the drug starts working depending on an individual’s response to the drug. However, as we discussed earlier, this is a dangerous period, and a lot of care should be taken to prevent risky or harmful behaviours (3,4).

If the Sertraline continues to impact negatively on your mental health during this period, then it is best to contact your doctor who will assess your condition and may switch you to another antidepressant.

Conclusion

It is important to understand the complex relationship between Sertraline and your emotions. Sertraline can initially cause you to feel sad and worsen your depression for a few days to weeks before it starts acting. This is considered a dangerous time as it may impact negatively on your mental health and cause you to develop some harmful ideations. This has been reported to occur in about half of the people who take the drug.

It is therefore very important to be alert during this period. My advice is that you should immediately contact your doctor as soon as you notice that Sertraline is negatively impacting your mental health.

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