Zoloft for anxiety explained: How it helps and what to know

How Does Zoloft Help Anxiety?

Zoloft is the brand name for sertraline, a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). The FDA has approved Zoloft for social anxiety disorder and panic disorder, and it’s also commonly prescribed off-label for generalized anxiety disorder (GAD). Zoloft can be taken as a standalone treatment or combined with other medications or therapy.

While the exact way it eases anxiety isn’t fully understood, SSRIs like Zoloft help regulate serotonin—a natural chemical that plays a role in mood, energy, and sleep. By helping serotonin stay active longer, Zoloft may reduce the intensity of anxious thoughts and the physical symptoms that come with them.

Kate Hanselman, a psychiatric mental health nurse practitioner at Thriveworks, notes that while everyone’s experience is different, Zoloft tends to help with symptoms like worry, rumination, fear, and sleep difficulties.

How Quickly Does Zoloft Work for Anxiety?

Zoloft is helpful for many people, but it isn’t a quick fix for anxiety. While some people may start to feel better in one to two weeks, it usually takes up to six weeks to start seeing significant improvement. You may even continue to see improvement for up to 12 weeks.

This mirrors what Leslie Lugo, RPh, BCPP, a psychiatric pharmacist with Experts Ink, has seen in her practice. “While I have seen many people improve in the first one to two weeks, it’s important to take the medication for at least four to six weeks to see if it will work. At this point, you should start feeling a lot better. You may gradually feel even better up to 12 weeks after starting.”

Why does it take so long? Zoloft works gradually by shifting your brain chemistry, and those changes take time. The first few weeks can feel frustrating, especially if you’re hoping for immediate relief, but sticking with the medication is key to giving it a fair shot.

What improves first? From Lugo’s experience, “physical symptoms of anxiety, like a racing heart or sleeping problems, usually go away first, while psychological symptoms like worrying can take more time.”

When to check in: If you haven’t noticed much of a change by week six, check with your prescriber. They may recommend a dosage adjustment or trying an alternative medication, depending on how well Zoloft worked and what side effects you experienced.

Follow-up schedule: “You should expect to have more follow-up appointments during the early stages of treatment, usually every two to four weeks,” Lugo explains. “Once you’ve found an effective medication and you are starting to feel better, visits can be extended to every one to three months. Once treatment is successful and you are stable, you may be able to be seen less often—every six months or even longer,” she adds.

Hanselman agrees: “I usually ask my patients to come back after two to four weeks to see how they’re feeling and provide encouragement.”

What’s the Typical Zoloft Dosage for Anxiety?

The usual starting dosage for Zoloft for anxiety is 25 mg once daily. From there, your provider may gradually increase the dosage, up to a maximum of 200 mg per day.

There’s no one-size-fits-all dosage when it comes to Zoloft. Your provider will work with you to find the right dosage for you. If you have liver problems, you may need a lower dosage. Zoloft is not recommended if you have severe liver problems or if you have been diagnosed with bipolar disorder.

Common Side Effects of Zoloft

Like all medications, Zoloft can cause side effects. Most are mild and tend to get better over time as your body gets used to the medication.

In Zoloft clinical trials, the most common side effects included:

• Nausea or diarrhea
• Insomnia or drowsiness
• Dry mouth
• Dizziness
• Fatigue
• Tremor or restlessness
• Decreased appetite
• Increased sweating
• Constipation
• Sexual side effects (such as lower sex drive or trouble with erections or ejaculation)

Hanselman cautions that “initially, Zoloft can cause gastrointestinal problems, headaches, and other symptoms that may feel like physical symptoms of anxiety, even though they aren’t. That’s one reason it’s best to start with a low dosage and gradually increase it.”

This is what Lugo has seen in her practice as well. “Your doctor may start you on a low dose and gradually increase it to prevent you from feeling jittery or overstimulated. Feeling this way sometimes happens and should get better over time.”

If side effects are disruptive or don’t improve after a few weeks, talk to your provider. They may recommend adjusting the dosage or trying a different medication.

Can Zoloft Make Anxiety Worse at First?

Yes, Zoloft can make anxiety worse at first, but the effects are usually temporary.

A 2017 study found that about one in four people started on an antidepressant for either anxiety or depression experienced worsened anxiety in the first six weeks. The risk was higher for people taking a higher antidepressant dosage.

This early effect may be due to your brain adjusting to higher levels of serotonin. Like many other side effects, these symptoms usually get better over time. Starting at a low dosage and increasing it slowly can help reduce the risk of side effects, including worsening anxiety.

If anxiety becomes severe or feels overwhelming, speak with your provider. In some cases, they may recommend short-term treatment with a fast-acting anxiety medication like a benzodiazepine or beta blocker.

Is Zoloft a Good Choice for My Anxiety?

It depends. There isn’t any single “best” anxiety medication. Everyone is different. Zoloft is considered a first-line treatment for many types of anxiety, including social anxiety disorder, panic disorder, and generalized anxiety disorder.

But it may not be the best choice for other types of anxiety. Examples include phobias, health anxiety (illness anxiety disorder or somatic symptom disorder), and performance anxiety. In these cases, either another anxiety medication or talk therapy may be more effective.

Other Medications Commonly Prescribed for Anxiety

Other commonly prescribed anxiety medications include:

Other SSRIs: Examples include Lexapro (escitalopram), Paxil (paroxetine), and Prozac (fluoxetine)

Serotonin–norepinephrine reuptake inhibitors (SNRIs): These include Effexor XR (venlafaxine) and Cymbalta (duloxetine)

Other options: Buspirone (Buspar), benzodiazepines, beta blockers, hydroxyzine (Atarax, Vistaril)

How to Know What’s Right for You

It may take time to find the right treatment for you. Starting with Zoloft doesn’t mean you’re locked in forever. It’s just a starting point on your journey toward feeling better.

Here are three things to consider when choosing anxiety treatment:

1. Your Symptoms

A good first place to start is with your symptoms. Speaking with your provider and getting an accurate diagnosis is the most important step to finding the right treatment. Why? Because misdiagnosis is common.

Common misdiagnoses include:

• Anxiety when it’s actually obsessive-compulsive disorder (OCD)
• Anxiety alone when there’s also depression, bipolar disorder, or OCD
• Treating anxiety as one condition when it’s actually multiple anxiety disorders

This is important because each of these conditions requires different treatment.

You can help your provider get an accurate diagnosis by tracking and recording your symptoms, triggers, and any major life changes or stressors. Bringing medical records to your appointment will also help your provider. When you discuss your symptom tracker, “talk to your prescriber about specific symptoms that bother you so they know what matters most,” Hanselman says.

2. Side Effects

The next thing to think about is side effects. Different medications have different side effects, and this includes SSRIs like Zoloft.

An important part of finding the right medication is thinking about which side effects are more important to you.

Here are some common side effects and the anxiety medications more likely to cause them:

• Weight gain: SNRIs are less likely to cause weight gain and may even lead to slight weight loss
• Sexual side effects: Can happen with any SSRI or SNRI, but more common with Paxil, Zoloft, Prozac, Lexapro, Celexa, and Effexor XR
• Drowsiness: Common with Vistaril and benzodiazepines; SNRIs least likely to cause this
• Insomnia: More likely with Prozac, Zoloft, and SNRIs

3. Your Other Medical Conditions and Medications

Another important consideration is your other medical conditions. For example, antidepressants like Zoloft are not recommended if you are living with bipolar disorder. But if you are living with anxiety and depression, then an antidepressant may help with both. And some anxiety medications may not be right for you if you have liver or kidney problems.

Medications that can interact with anxiety medications include:

• Tamoxifen: Not recommended with many anxiety medications, including Paxil (paroxetine), Prozac (fluoxetine), and Cymbalta (duloxetine)
• Monoamine oxidase inhibitors (MAOIs): Examples include Zelapar (selegiline) and Azilect (rasagiline). Not recommended within at least 14 days of all SSRIs or SNRIs except Paxil, which must be stopped five weeks before an MAOI
• Blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs): Antidepressants can increase the risk of bleeding. This risk is higher if you are taking blood thinners or NSAIDs
• Other medications that affect serotonin: There is a small risk of developing serotonin syndrome with SSRIs and SNRIs. The risk is higher with other medications that affect serotonin, like Ultram (tramadol). It’s also higher if you are using St. John’s Wort

That’s why it’s important to have a complete medication list. “Be sure to tell your psychiatric provider about all medications you are taking, including vitamins and herbal supplements,” Lugo says.

It’s also important to let your provider know what you’ve already tried. “Think about what medications have worked before and what medications have worked for family members. If you’ve tried medications that haven’t worked, that’s important too,” Hanselman says.

Lugo also notes that pharmacogenomic testing may be available to individualize your therapy. Pharmacogenomic testing can help your psychiatric provider choose a medication that works best for your genetics.

The Bottom Line

Zoloft (sertraline) is an antidepressant and a first-choice medication for some types of anxiety. Some people start to feel better in the first couple of weeks, but it can take up to six weeks to get the full benefits of the medication.

Whether it’s right for you will depend on your symptoms, what side effects are most important to you, and your other medical conditions and medications. Thriveworks can connect you with a licensed clinician who can help find the right treatment option for you.

Frequently Asked Questions

What does Zoloft feel like when it starts working?

When Zoloft starts working, you’ll likely notice anxiety feels less overwhelming and daily life becomes more manageable. Intrusive thoughts don’t disappear completely, but they’re not in control anymore. You might also experience fewer physical symptoms like tension or restlessness, along with increased energy and motivation.

Will I have to take Zoloft forever?

No, you don’t have to take Zoloft forever. Some people take it temporarily while learning anxiety management skills in therapy, others use it during difficult life periods, and some find long-term use most helpful. Your provider will work with you to determine the best approach for your situation.

Will Zoloft change my personality?

No, Zoloft won’t change who you are. The goal is to manage anxiety so you can feel more like yourself again. If anything, you may feel more grounded, motivated, and emotionally stable once your symptoms improve.