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Zoloft Use in Substance Abuse Treatment

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Zoloft (sertraline hydrochloride) is a commonly prescribed antidepressant that belongs to a group of drugs called selective serotonin-reuptake inhibitors (SSRIs). SSRIs work by . Serotonin influences sleep, mood, and emotion, so boosted activity of this neurotransmitter effectively improves mood and decreases anxiety.1

Zoloft is prescribed to treat a number of health issues, such as:1

  • Social anxiety disorder (social phobia).
  • Premenstrual dysphoric disorder (PMDD).
  • Panic disorder.
  • Post-traumatic stress disorder (PTSD).
  • Major depressive disorder.
  • Obsessive-compulsive disorder (OCD).

In addition to treating these health issues, antidepressants such as Zoloft are sometimes integrated into treatment for substance abuse. Mental health issues are commonly found alongside substance addictions. Concurrent treatment of both is referred as dual diagnosis treatment. The use of medications like Zoloft is relatively common in these programs, as underlying mental health conditions may contribute to and perpetuate substance abuse and, in many cases, must themselves be effectively managed to maximize recovery efforts and chances for sustained abstinence.

Zoloft’s efficacy in treatment has been studied and found to have varying levels of success.2,3

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When Is Zoloft Helpful in Substance Abuse Treatment?

Given Zoloft’s efficacy in treating depression, it shows promise in helping people improve their mood as they go through the often very difficult process of drug withdrawal. For instance, when people who have struggled with cocaine abuse go through withdrawal, it is extremely common that they experience depression (or depressive symptoms).3 When symptoms of depression arise during abstinence, it can become increasingly difficult for the user to complete an addiction treatment program, potentially making relapse more likely.3

A meta-analysis of depression treatment as part of drug treatment programs included 4 studies on the effectiveness of sertraline (Zoloft). The meta-analysis found that while SSRIs may be effective in treating depressive symptoms, more studies with bigger sample sizes are needed to make broad recommendations for the inclusion of Zoloft in addiction treatment.4

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Zoloft and Cocaine Addiction Treatment

While research on the use of antidepressants during withdrawal is somewhat limited, some studies have shown that the use of antidepressants like Zoloft can produce positive results (such as a reduction in cravings and a delay in relapse) in recovering cocaine abusers suffering from depression. Still, researchers note that more studies are needed to determine the dose of Zoloft that is needed to have a therapeutic effect, as lower doses (100 mg/day or less) did not produce the same positive results.3

Zoloft and Alcohol Addiction Treatment

A study conducted in 2010 looked at the efficacy of combining Zoloft (an antidepressant) with naltrexone (an opioid antagonist) to treat depressed and alcohol-dependent individuals. The study found that the combination helped to:5

  • Improve depressive symptoms.
  • Decrease adverse events (e.g., anxiety, nausea, sexual problems, etc).
  • Prevent relapse.

These results are promising for those in addiction recovery, especially individuals suffering from co-occurring substance abuse and mental health disorders.5

When Is Zoloft Unhelpful in Substance Abuse Treatment?

Zoloft may not always be appropriate for those in recovery from drug abuse and addiction. For example, one specific study which looked at the effectiveness of using Zoloft during methamphetamine withdrawal produced less-than-encouraging results. People who are going through methamphetamine withdrawal often experience tiredness, depressive symptoms, and a lack of ability to experience pleasure. Given these side effects, researchers were interested in the potential for Zoloft to alleviate these symptoms during treatment.

However, the study found that Zoloft was not effective in reducing depressive symptoms during methamphetamine withdrawal. The group prescribed Zoloft, in fact, did not fare as well as the control group in treatment:2

  • They experienced an array of negative side effects.
  • They did not seem to benefit as much from behavioral therapy.
  • They spent less time in treatment overall.

One possible explanation is that Zoloft is prescribed to treat major depressive disorder, and the mood disorder that meth abusers experience during withdrawal may be different. Researchers suggest that care providers should avoid prescribing Zoloft to users experiencing withdrawal from meth unless a primary depressive disorder has been diagnosed for which the antidepressant is appropriate.

What Are the Possible Side Effects?

Man withdrawaling from Zoloft standing in bedroom corner by window

If you are considering taking Zoloft as part of your treatment regimen for substance abuse, you should first consult with a medical care professional. They will be able to create a protocol for taking the drug and will be able to monitor your progress through treatment.

Zoloft has the potential to produce serious side effects such as suicidal thoughts, so it is imperative to use the drug safely and with medical guidance.

Zoloft side effects can include:6

  • Suicidality.
  • Serotonin syndrome.
  • Neuroleptic malignant syndrome.
  • Hyponatremia (dangerously low levels of sodium in the blood).
  • Abnormal bleeding.
  • Nausea and vomiting.
  • Diarrhea.
  • Insomnia.
  • Drowsiness.
  • Headache.
  • Decreased sex drive.
  • Dry mouth.
  • Anorexia.
  • Anxiety.
  • Nervousness.

In a study of Zoloft use among newly abstinent cocaine-dependent individuals, researchers noted that some study participants experienced sexual dysfunction and suicidal ideation during the study.3

Zoloft may also produce a set of unwanted withdrawal symptoms that may complicate a user’s recovery. Zoloft withdrawal symptoms may include:10

  • Irritability.
  • Insomnia.
  • Restlessness.
  • Panic attacks.
  • Worsening depression.
  • Suicidal thoughts/attempts.

Like many drugs, Zoloft carries a risk of side effects and adverse events. There have been cases of fatalities among people who reported using Zoloft with a monoamine oxidase inhibitor (MAOI). MAOIs such as isocarboxazid (Marplan) are prescribed to treat depression, and combining a MAOI with an antidepressant is extremely dangerous. Zoloft should never be used with an MAOI. In addition, Zoloft is contraindicated in people who have a hypersensitivity to sertraline or any of the inactive ingredients in the drug. Finally, individuals with a seizure disorder or those at risk for suicide should always consult a doctor before using Zoloft.7

Given the seriousness of Zoloft’s possible side effects (both of use and withdrawal), it should only be used when appropriate and under the supervision of a medical professional.

If you’re suffering from addiction and/or a mental health disorder, there is a program that can help you. Don’t wait until it’s too late – give us a call today at to find a treatment center. There are also free drug abuse hotline numbers you can contact.

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Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating him to seek a clinical psychiatry preceptorship at the San Diego VA Hospital’s Inpatient Alcohol and Drug Treatment Program. In his post-graduate clinical work, Dr. Thomas later applied the tenets he learned to help guide his therapeutic approach with many patients in need of substance treatment. In his current capacity as Senior Medical Editor for American Addiction Centers, Dr. Thomas, works to provide accurate, authoritative information to those seeking help for substance abuse and behavioral health issues.
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