Zoloft For Kids: Safety, Side Effects, Dosage, And Precautions

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The brand Zoloft is the name of a generic drug, sertraline hydrochloride. The drug belongs to the selective serotonin reuptake inhibitors (SSRIs) family and is prescribed as an antidepressant (1). While administering Zoloft for kids with depressive symptoms, weighing its benefits against risks is important.

Serotonin is a neurotransmitter that transfers messages between nerve cells and induces wellbeing and stabilizes the mood. The drug increases the amount of serotonin in the brain. As a result, doctors prescribe Zoloft for treating severe depression, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), premenstrual dysphoric disorderⁱXA severe type of premenstrual syndrome due to an overreaction to hormonal changes leading to irritation and anxiety , and anxiety issues.

Read on to know about the safety guidelines of Zoloft for children.

In This Article

Is Zoloft Safe For Kids?

Zoloft for kids should be used only under a doctor's advice

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The US Food and Drug Administration (FDA) approves the use of Zoloft for treating obsessive-compulsive disorder (OCD) in children and adolescents aged 6 to 17 years (2). Children should take Zoloft only when prescribed by a doctor.

OCD is a long-term psychological disorder characterized by unwanted thoughts or images that repetitively come to the mind and cause anxiety (obsessions) along with recurrent, irresistible behavior (compulsions). For example, a child with OCD may have a constant fear of germs, leading to excessive hand-washing (3).

Expert says

According to the National Alliance On Mental Illness (NAMI), there are no known problems linked to the long-term use of Zoloft on use as directed by the doctor (9).

What Is The Dosage Of Zoloft For Children?

Zoloft is available only upon prescription from a doctor, who decides the optimum dose for your child and may gradually increase or decrease it if necessary.

This psychiatric medication is started at a minimum dose, and based on the tolerability, the dosage may be increased weekly. It is given once daily, either in the morning or evening.

Zoloft is available as tablets containing 25mg, 50mg, and 100mg of Sertraline hydrochloride and an oral solution containing 20mg drug per mL of solution. The dosage for children and adolescents is as follows (2):

Indication	Age	Starting dose (mg/day)	Maximum dose (mg/day)
OCD	6-12 years	25	200
OCD	13-17 years	50	200

Point to consider

Zoloft is usually prescribed for children six years and above after a confirmed diagnosis of OCD, PTSD, and various other psychiatric conditions (10).

You may dilute Zoloft oral concentrate by taking the required amount and adding it to half a cup of water, ginger ale, lemon soda, lemonade, or orange juice before offering it to your child.

Dilute Zoloft for kids by adding it to orange juice

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What Are The Side Effects Of Zoloft In Children?

The common side effects of Zoloft include (4)

Nausea
Vomiting
Dryness of mouth
Stomach pain

Zoloft may cause stomachache in children

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Indigestion
Constipation
Diarrhea
Dizziness
Weight loss
Sleep disturbance
Shaking of body
Headache
Anxiety
Drowsiness
Excessive tiredness (fatigue)
Feeling nervous or agitated
Excess sweating
Decreased appetite

Contact your child’s doctor if any of these symptoms worsen.

Zoloft can also cause some serious adverse reactions. Contact your healthcare provider immediately if you notice any of these side effects in your child.

Epileptic fitsⁱXA Neurological condition resulting in sudden, recurrent seizures and unconsciousness
Breathing problems
Abnormal bleeding, such as nose bleeds

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Increased heartbeat
Allergic reactions such as hives and rashes
Fever, hallucination, and weakness
Confusion

In a study conducted on children and adolescents taking sertraline (Zoloft), several adverse reactions were observed. As shown in the graph below, the most commonly reported adverse effects were headaches, appetite loss, and sweating, recorded seven, six, and five times, respectively. However, the study found no association between side effects and the dosage or concentration of the medicine.

Commonly reported adverse effects of Zoloft

Source: Therapeutic drug monitoring of sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of obsessive-compulsive disorder; Comprehensive Psychiatry

What Are The Contraindications Of Zoloft?

Zoloft should not be taken if the child is allergic to Sertraline. Some other drugs that are contraindicated to be used concomitantly with Zoloft include (2)

SSRIs, SNRIs (serotonin-noradrenaline reuptake inhibitors), triptans, tricyclic antidepressants, fentanyl, buspirone, tryptophan precursors, and St. John’s Wort. These drugs may increase the risk of serotonin syndrome (excess serotonin in the body) and cause agitated mental states with hallucinations or coma, muscle rigidity, seizures, flushing, and changes in heart rate and blood pressure.

Allergy to Zoloft may lead to a flushed appearance in kids

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Monoamine oxidase inhibitors (MAOIs) such as selegiline, phenelzine, tranylcypromine, linezolid, and intravenous methylene blue. A switch, if necessary, from Zoloft to MAOIs should be done after a minimum of two weeks.

Pimozide, which is used to treat Tourette syndrome, as it could increase blood levels and risk of arrhythmias (changes in heart rhythms).

Antabuse (disulfiram) used to treat alcohol addiction. Zoloft oral concentrate contains 12% alcohol, which may react with the drug.

Be watchful

Children taking Zoloft (sertraline) should avoid consuming grapefruit, its juices, or grapefruit extract since it may interact and causes adverse effects (11)

Precautions To Take When Using Zoloft

Besides the brain, Serotonin affects various other tissues and cells, such as the gastrointestinal tissues, blood cells, and platelets (5). As Zoloft acts by modulating serotonin levels, certain precautions need to be exercised (2) (4).

Inform your doctor if your child has any heart complications, bleeding disorders, or epilepsy.

Sertraline is metabolized by the liver; thus, blood concentration may increase in the cases of liver disease. So, ensure the dose of the medication is adjusted by the doctor every week.

The FDA suggests screening for bipolar illness or manic disorder and taking the family history for suicides, mood disorders such as depression and bipolar disorderⁱXThe psychological condition that makes the person experience severe mood swings and behavioral changes and psychiatric disorders before administering Zoloft. Zoloft may cause manic or depressive episodes or suicidal tendencies.

At the start of treatment, Zoloft may slow down reactions and cause sleepiness. So, be cautious when the child is riding a bicycle or doing tasks that require alertness.

This medication should not be administered with drugs that reduce blood clotting as it increases the risk of bleeding. These drugs may include aspirin, warfarin, heparin, and non-steroidal anti-inflammatory drugs (NSAIDs such as diclofenac, ibuprofen).

Consult a healthcare provider before the child uses any over-the-counter medication, herbal preparation, or health supplement.

All medications should be kept out of children’s reach.

In case a dose is missed, do not give a double dose the next day. The symptoms of overdose can be severe.

The dropper dispenser of Zoloft oral concentrate is made of dry rubber. Make sure your child is not allergic to it.

Zoloft is an effective drug for OCD in pediatric patients. When coupled with mental health therapies like cognitive behavioral therapy, it helps improve the quality of life. However, it may take a few weeks before the full effects show; thus, do not stop the medication abruptly if no improvement is seen. Always consult with your doctor before making any dose changes.

Frequently Asked Questions

1. Can Zoloft cause aggression in children?

A study indicates that SSRIs may lead to an increase in aggression. However, increased aggressiveness is not seen in all individuals but may happen for a few. If you notice such symptoms in your children, you should contact your child’s doctor promptly (6).

2. Does Zoloft help with attention?

Zoloft is not found to affect attention negatively; however, it may improve one’s ability to process more than one piece of information at a time (7).

3. Does Zoloft cause hyperactivity?

Zoloft (sertraline) is less likely to cause hyperactivity in children when compared to other SSRIs, such as fluoxetine (8).

4. Can Zoloft be used to treat ADHD in children?

According to New York-based physician and psychotherapist, Dr. Ryan Sultan, “Zoloft (sertraline) is not specifically used for the treatment of ADHD. However, it can be beneficial for children with ADHD, particularly those with comorbid conditions like anxiety or depression, which can exacerbate ADHD symptoms. Hence, treating these coexisting conditions can improve ADHD symptoms as well.”

Zoloft for kids is usually prescribed when they exhibit certain signs of depression or stress disorders. If you notice signs of epileptic fits, hallucinations, or breathing problems in your child, contact the doctor immediately. The doctor prescribes the dosage based on the symptoms and reduces it if there is an improvement in the condition. It should be noted that depression usually leads to suicidal and other self-harming thoughts. Therefore, you should always watch your child’s activities and talk to them about their feelings.

Infographic: Are Other Medications Available For Treating OCD in Children?

OCD in children needs to be carefully assessed by a pediatric psychiatrist before any intervention begins. The doctor may prescribe drugs or a combination of medications and cognitive behavioral therapy (CBT) depending on the severity of the disorder. The infographic below lists the FDA-approved medications for pediatric OCD.

alternatives to zoloft for pediatric ocd (infographic)

Get the high-quality PDF version of this infographic.

Key Pointers

Zoloft or Sertraline is FDA approved to treat OCD in children above six years.
You should give Zoloft to your child only if a doctor prescribes it.
Dryness of mouth, gastrointestinal disturbances, anxiety, and sleep disturbances are some of the common side effects of Zoloft.
Avoid using any OTC preparations or herbal drugs when your child is on Zoloft without consulting a healthcare professional.

Struggling with a child who’s on Zoloft for anxiety but now only sleeps 2 hours a night? Get tips on what you can do to help in this video.

References

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