Zoloft During Pregnancy: What to Expect

By Frank DiVincenzo, MD
Medically reviewed checkmarkMedically reviewed
May 25, 2022

Zoloft, the brand name of the generic medication sertraline, is a commonly prescribed antidepressant medication.

While many medications used for treating major depressive disorder are not safe for pregnancy, Zoloft is one of the few that may be continued under certain circumstances.

It is also one of the safest options for breastfeeding.

Zoloft is a selective serotonin reuptake inhibitor (SSRI) that works by preventing the brain from clearing serotonin, which helps to stabilize levels and alleviate symptoms of depression.

In this article we’ll explore Zoloft use during pregnancy and how to know what to expect.

While not every doctor will recommend Zoloft use during pregnancy, in some cases the benefits outweigh the potential risks.

This article will explain common dosages, potential side effects, drug interactions, and how to know when you should see a doctor. 

Is It Safe To Take Zoloft During Pregnancy?

Taking an antidepressant like Zoloft during pregnancy is not fully risk-free.

However, the American College of Obstetricians and Gynecologists (ACOG) considers untreated depression during pregnancy to be risky for both the pregnant person and the baby.

Untreated depression during pregnancy can cause complications, such as:

  • Fetal growth problems
  • Premature birth
  • Low birth weight
  • Postpartum complications in the parent
  • Post-birth complications such as developmental delays in the baby

Among antidepressant options, Zoloft (sertraline) is considered to be one of the safest for pregnancy.

But there are still potential risks, and a patient should make the decision to continue Zoloft during pregnancy after considering risks versus benefits with their healthcare team.

Zoloft use in the first trimester was associated with an increased risk for cardiovascular malformations in the infant.

Other congenital anomalies were not significantly associated with Zoloft.

A Centers for Disease Control and Prevention (CDC) study did not find any link between birth defects and taking sertraline during pregnancy.

A slightly increased risk was observed with other types of selective serotonin reuptake inhibitors, such as paroxetine and fluoxetine.

There are other risks when it comes to taking Zoloft or any other SSRI during pregnancy.

Third trimester use may include a higher level of post-birth symptoms such as:

  • Low blood sugar
  • Jittering and irritability
  • Delayed feeding ability
  • Hyperactive reflexes
  • Vomiting
  • Seizures
  • Respiratory distress

Only your healthcare provider and you can determine whether Zoloft is safe to continue for your pregnancy.

Do not suddenly stop taking Zoloft without first discussing this with your healthcare provider.

Should you stop taking Zoloft if you find out you’re pregnant? 

If you find out that you are pregnant and you are currently taking Zoloft or any other antidepressant medication, let your healthcare provider know immediately.

Zoloft should not be suddenly discontinued due to fear of miscarriage.

A study that compared people taking SSRIs during early pregnancy to those who stopped taking SSRIs before pregnancy found that both groups had a similar miscarriage risk.

Discontinuing Zoloft if you find out you are pregnant will not impact miscarriage risk.

If you take Zoloft and want to discontinue use during pregnancy, work with your healthcare provider to taper your dose.

Antidepressants should not be suddenly stopped.

This can lead to serious adverse effects or withdrawal symptoms.

A medical provider can help you understand the risks versus benefits of discontinuing or taking Zoloft during pregnancy.

Pregnancy can increase the risk of anxiety or depression, and a pregnant person’s mental health can play a major role in pregnancy outcomes.

Common Dosage

Zoloft is available in 25, 50, and 100 mg tablets.

It is also available as an oral solution, though this form of the medication contains 12% alcohol and should not be used during pregnancy.

For pregnancy, the lowest effective dose of Zoloft should be used.

Dosages may start at 25-50 mg per day.

Is It Safe to Take Zoloft While Breastfeeding?

It is generally considered to be safe to take or continue taking Zoloft while breastfeeding.

A small amount of Zoloft may be able to pass into breast milk, but the risk for this SSRI is minimal compared to other antidepressants.

Because of this low risk, Zoloft is often a first choice for medical providers who are treating depression in postpartum people.

Side Effects

Zoloft may cause some common side effects.

Any symptoms associated with taking Zoloft should be reported to a medical provider.

Common Side Effects

Common side effects associated with Zoloft can include:

More Serious Side Effects

Less commonly, Zoloft may cause more serious side effects.

These can include confusion, hallucinations, and tremors.

Also, Zoloft carries a “black box warning” due to the increased suicide risk it may cause in children, adolescents, and young adults with major depression or other psychiatric disorders who take this medication.

If you notice any of the following symptoms, let a healthcare provider know immediately:

  • Increased or worsening anxiety or agitation
  • Aggression or hostility
  • Panic attacks
  • Insomnia
  • Unusual changes in behavior or impulse control
  • Restlessness or manic behavior
  • Thoughts of suicide or self-harm

Drug Interactions

Zoloft can interact with many medications.

These interactions may increase the risk of serious side effects while taking Zoloft.

It’s important that you  let your healthcare provider know if you take any other prescription medications, OTC medications, vitamins, herbal supplements, or anything else before starting Zoloft.

What to Avoid

You should not take Zoloft if you also take, or have recently taken:

  • Monoamine oxidase inhibitors (MAOIs)
  • St. John’s wort
  • Eliglustat
  • Flibanserin
  • Isocarboxazid
  • Lomitapide
  • Phenelzine
  • Pimozide
  • Procarbazine
  • Selegiline
  • Thioridazine
  • Tranylcypromine

Other Antidepressants That Are Safe for Pregnancy

Sertraline (Zoloft) is considered to be one of the safest options for use during pregnancy.

Certain other antidepressants may be prescribed during or after pregnancy, including:

There are risks associated with many medications during pregnancy.

However, your healthcare provider will discuss risks, benefits, and the effects of different medications.

You and your provider will work together to make the safest choice for you and your baby.

When to See a Doctor

IIf you take Zoloft or other antidepressant medications, see your doctor if you are thinking of becoming pregnant or find out that you are pregnant.

Some antidepressants carry a much higher risk during pregnancy than others.

Your healthcare provider may recommend switching medications or decreasing dosage.

You should never decrease your dose or stop taking any antidepressants suddenly without talking to your provider, since this could lead to serious side effects or withdrawal.

If you are pregnant and experiencing symptoms of depression, speak to a healthcare provider.

Treating depression during pregnancy can help to avoid certain complications before and after birth.

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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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Frank DiVincenzo, MD

Dr. Frank DiVincenzo has been a physician with K Health since 2020. He grew up near Chicago, Illinois, but left the big city to go to college and then attend graduate school in Missouri. He received a Bachelor of Science in Mathematics and a Master of Science in Microbiology before graduating from the University of Missouri–Columbia School of Medicine.