When Should You Increase Your Zoloft Dosage To Treat Anxiety?

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When Should You Increase Your Zoloft Dosage To Treat Anxiety?

Updated at

May 3, 2022

Medically reviewed by

Dr. Carolina Estevez, Psy.D

Written by

HealthMatch staff

Content

• Overview
• What is Zoloft?
• What is the proper Zoloft dosage for anxiety?
• When to increase your Zoloft dose for anxiety?
• Talk to your doctor first
• Factors that could impact whether you need a higher dose
• Zoloft’s effects on anxiety
• The lowdown

If you’ve been prescribed Zoloft to treat your anxiety, but it’s not quite doing the job, you might find it tempting to increase your dosage. 

However, Zoloft is a psychiatric medicine, so it’s crucial you don’t take more or less than the dosage prescribed. However, your doctor may be able to prescribe a stronger dose if needed, if they determine that this is the right course of action.

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What is Zoloft?

Zoloft, or sertraline as it is known under its generic name, is a psychiatric medicine used largely in the treatment of depression and anxiety. 

Taken orally, Zoloft belongs to a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. SSRIs are a commonly prescribed antidepressant that improves mood by blocking the mechanisms that absorb serotonin, allowing it to be available to the brain for longer. 

This is important because serotonin is known for its ability to induce feelings of happiness. In fact, serotonin is often referred to as the “happy hormone.” 

What is the proper Zoloft dosage for anxiety?

Starting Zoloft

The appropriate dosage of Zoloft will be determined by a doctor and is likely to differ depending on the patient and their individual needs. 

Typically, 50 milligrams once a day is a standard starting dosage for adults with depression, obsessive-compulsive disorder, and premenstrual dysphoric disorder. Some conditions tend to start with a lower dose of 25 milligrams once a day, like panic disorder. 

Maximum dose

Your Zoloft dose must stay within a safe range, so you’re unlikely to be prescribed anything higher than 150-200 milligrams per day. In the end, your dosage will depend on the condition being treated and your individual needs. 

Children

Children can also benefit from Zoloft but will follow a different dosage regimen. This dose will be at the discretion of your doctor and is based on your child’s age, size, and therapeutic need. For instance, for children aged 6 to 12 years of age with obsessive-compulsive disorder, a standard starting dose is 25 milligrams once a day. 

If you have concerns or questions about your dosing, make sure to discuss it with your doctor before making any changes to your medication regimen. 

When to increase your Zoloft dose for anxiety?

If you’re taking Zoloft, but aren’t feeling any improvement in your anxiety levels, it can be tempting to simply up your dose – but it’s important not to. 

Zoloft is not an instant relief medication. SSRIs do not exert instant effects like, pain relief does. Zoloft (and other SSRIs) is a little more complicated and it takes longer for its full effects to be felt. 

These medications take time for their effectiveness to peak. Zoloft works by blocking the reuptake of serotonin and it takes repetitive dosing and time for the medication to be able to exert its effects on your system. It can take around two to six weeks before you start to experience a reduction in your anxiety symptoms. 

If after this period you still haven’t seen any benefits then you may want to talk to your doctor about altering your Zoloft dose. 

Talk to your doctor first

While Zoloft can have a positive impact on anxiety, it can also come with some minor side effects. Zoloft can also increase your risk of serious side effects if you have an existing medical condition or are taking other medication. 

Therefore, increasing your Zoloft dose without approval from your doctor should not be done under any circumstances. This can have serious detrimental effects on your health and wellbeing and can result in coma and seizures.

Zoloft side effects and drug interactions 

The following side effects¹ and potential drug interactions² highlight why it’s important to follow your Zoloft prescription and avoid increasing your dosage without your doctor's approval.

Potential side effects of Zoloft include:

• Nausea 

• Loss of appetite or indigestion 

• Diarrhea

• Excessive sweating 

• Tiredness or fatigue 

• Sexual performance issues, e.g. reduced sex drive, failure to ejaculate 

• Sleep disturbances, e.g. sleepiness or insomnia 

• Shaking hands

• Increased agitation and irritability

• Suicidal ideations 

• Impulsive and dangerous behavior 

• Worsening of depression and/or anxiety symptoms

• Violent behavior 

• Seizures 

• Manic behavior, e.g. fast-paced and racing thoughts, extreme high and low emotions, excessive energy, and talking grandiose thinking.

• An allergic reaction (typical symptoms include trouble breathing, a rash or hives, and swelling).

• Eye problems, e.g. blurred vision, red eyes, pain in the eyes.

• Serotonin syndrome includes symptoms such as hallucinations, agitated behavior, loss of consciousness/coma, increased heart rate, vomiting, and rigid muscles

There are also specific side effects that can affect children taking Zoloft:

• Nose bleeds

• Urine problems, e.g. frequently needing to urinate or leaking urine 

• Changes to menstruation, specifically heavier periods 

• Agitation or fidgeting 

• Aggressive or irritable behavior that is out of the norm 

• Changes to physical development. You may see your child’s growth rate start to slow down and/or weight gain.

 Conditions that can increase your risk of Zoloft side effects:

• Glaucoma: People with glaucoma can experience an increase in glaucoma attacks if they take Zoloft and should therefore talk to their doctor to determine if the SSRI is appropriate. 

• Seizure conditions: Since seizures are already a potential side effect of Zoloft, the medication should be considered carefully in people with a seizure condition lest it increases their frequency or severity³. 

• Liver issues: Patients with liver problems should take care when starting Zoloft as they can experience stronger effects than normal, due to their liver’s inability to break down the medication. 

• Bipolar disorder: Bipolar disorder is a possible contraindication for Zoloft as you may experience a higher risk of manic symptoms. 

• Kidney issues: Much like the liver, if your kidneys aren’t functioning well then you may not be able to filter medications properly, resulting in higher levels of Zoloft in your system. 

Side effects that can occur when Zoloft is taken alongside certain medications: 

• Increased risk of serotonin syndrome can occur when Zoloft is taken withmonoamine oxidase inhibitors, linezolid, intravenous methylene blue, triptans, lithium, fentanyl, tramadol, and St John’s wort.

• Heart problems can occur when Zoloft is taken with pimozide.

• Bruising and bleeding can occur when taken with nonsteroidal anti-inflammatory medications, e.g. aspirin.

• A build-up of medications (including Zoloft) can occur in your system when taken with cimetidine, tricyclic antidepressants.

Factors that could impact whether you need a higher dose

While it’s important to stick to the dose recommended by your doctor, there are legitimate and safe reasons why your doctor may increase your Zoloft dose. 

For instance, your doctor may increase your Zoloft dose if you aren’t seeing a significant reduction in your anxiety symptoms, so long as it is safe. 

Zoloft’s effects on anxiety

The risks of altering your Zoloft dosage without medical approval are substantial. However, with a prescribed dosage and professional advice, Zoloft can have a positive impact on your anxiety and improve your quality of life. 

Research tells us that Zoloft can effectively reduce anxiety scores. One study⁴ found that Zoloft managed to significantly improve anxiety, worry, and depressive symptoms in patients (60 years and older), with an anxiety diagnosis (generalized anxiety disorder, panic disorder, agoraphobia, or social phobia). 

Zoloft is also an effective treatment option for children suffering from anxiety. A 2018 study found that SSRIs significantly reduced anxiety symptoms⁵ in children. The study also found that a combination of Zoloft and cognitive behavioral therapy was a particularly effective treatment option. 

What To Expect When You Take Anxiety Medication

The lowdown

Zoloft is an effective treatment for managing anxiety. Your doctor will prescribe Zoloft if they believe it is a good fit, and may gradually increase your dose until you start to see results or reach a maximum dose. 

However, since Zoloft can have some serious side effects and can interact negatively with other drugs, do not increase your dosage until you have consulted a medical professional.

Sources

1. SSRI Antidepressant Medications: Adverse Effects and Tolerability (2001)

2. A review of significant pharmacokinetic drug interactions with antidepressants and their management (2016)

3. Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database (2015)

4. A randomized, controlled trial of the effectiveness of cognitive-behavioral therapy and sertraline versus a waitlist control group for anxiety disorders in older adults (2006)

5. Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis (2017)

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