Why does sertraline give me heartburn? (3+ tips)

In this article, we shall answer the question, “Why does sertraline give me heartburn?” The article will also explore the role of sertraline in the management of anxiety and depression. 

Why does sertraline give me heartburn? 

Sertraline gives you heartburn because it belongs to the selective serotonin reuptake inhibitor class (SSRIs) that is known to increase gastric acid secretion (1). An increase in gastric acid secretion causes heartburn. 

Sertraline is a prescribed medication used for managing depression and anxiety. It exerts its effects by increasing the central nervous system (CNS) concentration of serotonin (2). This helps to enhance mood and help to recover from depression and anxiety (3). Even though sertraline is one of the safest antidepressants, it is associated with multiple side effects, including gastrointestinal (GI) side effects such as heartburn (2).

The mechanisms behind heartburn upon sertraline ingestion are not known considering that it is a basic drug and serotonin itself decreases stomach acid secretion (1). 

What is the connection between sertraline and heartburn?

Individuals who use sertraline, especially for extended periods may experience symptoms of hyperacidity and heartburn (3). The exact mechanisms through which sertraline causes heartburn are not known. However, when taken orally, it may lead to irritation of gastric mucosa and the resultant GERD which may manifest as heartburn and other symptoms. Heartburn may also be a result of the oesophagal sphincter relaxation effect caused by sertraline (4). 

The prevalence of heartburn in patients using sertraline is approximately 22.2% while the incidence is about 14.2 per 1000 individuals (5). This means that the probability of developing GERD due to sertraline use is quite high. 

Patients using sertraline to treat depression and anxiety should follow appropriate strategies to prevent heartburn. Individuals experiencing heartburn symptoms should consider switching to other antidepressant medications that are well tolerated. Other SSRIs such as citalopram or SNRIs such as duloxetine have a safer GI side effect profile and hence can be used as alternative options (5).

What favours experiencing heartburn when taking sertraline? 

• Dosage: A high dose of sertraline predisposes an individual to the risk of experiencing heartburn when taking sertraline. Normally, sertraline is initiated at between 25mg and 50 mg. Instances where dosage adjustments have to be made may increase the likelihood of experiencing heartburn before the body adjusts to the new dosage. 
• Prolonged use: Prolonged use of the medication may also increase the risk of heartburn. Research shows that sertraline changes the composition of specific taxa of the gut microbiota (6). Gut dysbiosis may induce hyperacidity. 
• Food factors: Taking sertraline with acidic foods like caffeine, alcohol and citrus fruits also increases the risk of experiencing heartburn. 
• Genetics: Some people are also genetically predisposed to Gastro oesophagal reflux due to structural problems in the oesophagus, acid secretion or the control of inflammation. 
• Gastrointestinal factors: It is advisable to take sertraline with food. Food, not only increases the absorption of sertraline, but it also minimizes acid reflux. 

What are the tips for alleviating heartburn caused by sertraline?

Sertraline can lead to multiple side effects when taken in large doses as well as when taken for a prolonged period. One of the most common gastrointestinal (GI) side effects is heartburn (2, 3). The following strategies can help to prevent heartburn.

• Sertraline should be taken with adequate water or fluids
• Avoid taking sertraline on an empty stomach (5).
• Sertraline should be taken after feeding or together with food.
• Patients are encouraged to rest after taking sertraline to prevent heartburn symptoms
• Avoid taking sertraline without a doctor’s prescription.

Are there over-the-counter remedies for heartburn relief?

Several over-the-counter medications can be used for heartburn relief. They include:

Antacids: Antacids work locally by neutralizing stomach acid. They include calcium carbonate, magnesium and aluminium compounds. 

Histamine 2 receptor blockers: These medications work by binding reversibly to H2 receptors in the gastric parietal cells to decrease the production of gastric acid. They include cimetidine, ranitidine and famotidine. 

Proton pump inhibitors: These medications work by inhibiting proton pumps in the stomach lining to decrease H+ ion secretion. This reduces stomach acidity. They include omeprqzole, esomeprazole, rabeprazole and pantoprazole.  

When you use these medications to manage acidity caused by sertraline, always inform your healthcare provider. Although stomach acid may cause discomfort when produced in excess, an acidic environment is important for the absorption of some medications. 

Are there alternative medications without heartburn side effects?

Patients at risk of GERD due to sertraline use can use alternative medications to manage their anxiety and depression. Tell your doctor if you are experiencing heartburn after taking sertraline. You may be switched to antidepressants of different pharmacological classes including SNRIs such as duloxetine (5). Some SSRIs have proven to reduce oesophagal reflux symptoms like hyperacidity like citalopram (7). 

Conclusion

Sertraline can cause GERD through relaxation of the oesophagal sphincter when taken for a long period to manage anxiety and depression. In my opinion, all patients on long-term sertraline use should get advice from their healthcare providers and appropriate alternatives and prevention tips. 

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