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There are times in life when it seems like someone isn’t genuinely interested in being your friend. Several telltale indicators include being reserved during your interactions, consistently failing to initiate contact, and constantly giving excuses in order to avoid plans.

To help you identify real friends from mere acquaintances, we’ll share tips on what to look out for. This article also covers how you can deal with this situation.

Why Recognizing True Friendships Matters

Because humans are largely social creatures, it’s natural to crave companionship and the company of others. While making and keeping friends is a vital part of your social and everyday life, after a certain age it can get a little difficult to find like-minded people who are willing to share their joys, fears, happiness, and worries with you.

If you’ve met someone new or have an existing companion who you consider a friend, there are times when you may be unsure if they look at you the same way.

“If you’re the one constantly reaching out and trying to maintain the friendship, while the other person seems passive or uninterested, it may be a sign that the other person doesn’t want to be your friend and doesn’t value your relationship,” says Avigail Lev, PsyD, the Founder and Director of the Bay Area CBT Center.

Because your time is limited, focus on devoting your energy toward genuine friendships with people who genuinely value you. If you feel like someone doesn’t really want to be your friend, it may be time to let the relationship go.

Signs Someone Doesn’t Want to Be Your Friend

Sometimes it’s easy to tell when someone doesn’t truly want to be friends, but the signs can also be more subtle. Relationships change over time, and you may find that people who used to be more invested in the relationship start to become more distant.

In either case, here are a few signs that someone doesn’t want to be friends:

You Always Reach Out First

While there’s no denying that our daily lives can get very busy, it may be a warning sign when you find that you constantly have to make the first move with a supposed friend, whether it is with phone calls, texts, or emails.

“You might also notice that they are often unavailable or unresponsive. They don’t get back to your texts or messages, or they take a really long time to reply. It can feel like you’re the one always reaching out, and they don’t make an effort to keep in touch,” says Lev.

Think about who is initiating the conversation. When you add things up and find that nine out of 10 (or all 10) times contact is established, the effort was made by you, the other person may not consider you a friend.

Lack of Genuine Enthusiasm

In another strike, a person could send signs that they are uninterested in a personal relationship with you consider the responses they give during your interactions.

Where this happens, you may find that they give one-word responses to questions, or lack any real enthusiasm when they hear from you. This is usually compounded by the fact that you most likely made the move to touch base first.

Being Reserved or Rude During Interactions

You can tell that a person has very little interest in being more than an acquaintance by examining how they speak to you.

While a friend might use relaxed language, share a few jokes, or otherwise interact in a light-hearted manner, a person that doesn’t consider you their friend may sound more official or formal, giving clipped responses when you meet up with them in person or otherwise engaging them in conversation.

In other cases, they might direct barbed or even rude comments toward you. “They might make indirect statements that are mean, rude, or put you down in some way. Their jokes or remarks can have a negative tone, making you feel undermined or not valued in the friendship,” Lev suggests.

They Avoid Meeting Up or Tend to Cancel Plans

An unfortunately hurtful way to identify someone uninterested in friendship is how little you see them. After taking the pains to invite them for drinks, a gallery opening, to check out your apartment, or another occasion, there always tends to be an excuse explaining why they cannot attend on the specified day.

In even worse cases, they may agree to meet up with you only to cancel on the day of through any number of means of postponement. These constant excuses and cancellations take a toll not only on the friendship but on your well-being as well.

“It can leave you feeling like you’re not a priority in their life,” Lev suggests.

You Put in More Effort Than They Do

Calling to check-in, arranging meetings, sending gifts, popping by to make sure their house plant is watered, and similar behaviors are easy ways to show that you care for a person.

If you find that you are routinely putting in more effort in the friendship, or performing very imbalanced acts of love for your supposed companion, this could mean that they view your interactions as something other, and usually less than a friendship.

They Do Not Engage With You on Social Media

While this may not always indicate that a person doesn’t want you as a friend, taking note of your social media engagements with them could paint a clearer picture of the true state of your relationship.

If they do not acknowledge your stories or posts, or perhaps even make an effort to ignore comments you make on their social media, this could mean that they do not want to be seen with you within that space.

Social media shunning may seem trivial, but it can be a valid way to determine how a person really feels about you.

They Only Talk About Their Interests

There are special cases where a person may tick many of the minor boxes that make up a friend: responding to calls, agreeing to meetings, checking in from time to time, but depending on the topics that your interactions cover, you may be able to tell whether or not they truly view you as a true friend.

When you find it hard to contribute anything to the conversation because your acquaintance goes on and on about their accomplishments, how they spent their week, what projects they are finding difficult, etc, this could be telling that they merely view you as a soundboard, and care less for what may be happening in your life.

A friend would want to listen to how you have been coping, any exciting projects you have been working on, they might even tease you about your love life, but you will always feel like it is an interaction and not a therapy session, where you have to play the role of silent listener.

How to Handle a One-Sided Friendship

There are many reasons why friendship is such a valued part of our society. A real friend is there for you in the good times, and will provide a helping hand through less-than-rosy periods. This is why care has to be taken when selecting people to be part of your inner circle.

When a person doesn’t count you as a friend, it means you may be in what is essentially a one-sided friendship. you may tell through their words and actions and the effect their indifferent attitude may have on your well-being. Just as you cannot expect to be friends with everyone, not everyone is going to be friends with you.

If someone is sending signals that they don’t want to be friends, it is important to heed those signs. However, it is just as important to avoid feeling bad about yourself.

Not all people are compatible, and it’s possible that the other person has things going on in their life that might be standing in the way of your friendship. Instead, focus on directing your energy toward other people who are more receptive to your gestures of friendship.

While accepting that you may not be a person’s cup of tea can be painful, it can also serve as an opportunity to appreciate the loved ones ready to stick with you through thick and thin. Keeping your chin up and moving past the disappointment may be hard, but it will leave you better off in the long run.

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This fast, free quiz can help give you insight into whether or not you possess traits that could make you more or less likable.

While no one enjoys being rejected, some people are more sensitive to social rejection than others. Individuals who are high in rejection sensitivity are so fearful and aversive of rejection that it impacts their daily lives.

These people expect to be rejected all the time. And as they anxiously look for signs that someone doesn’t want to be with them, they often behave in ways that push other people away. This behavior creates a painful cycle that can be difficult to break.

Signs of Rejection Sensitivity

Individuals with high rejection sensitivity constantly look for signs that they’re about to be rejected. They tend to respond dramatically to any hint that someone doesn’t want to be with them.

Because of their fears and expectations, people with rejection sensitivity tend to misinterpret, distort, and overreact to what other people say and do. They may even respond with hurt and anger. Here are the factors that influence these overreactions.

Facial Expressions

People with rejection sensitivity ofter misinterpret or overreact to various facial expressions. For instance, one study found that individuals higher in rejection sensitivity showed changes in brain activity when they saw a face that looked like it may reject them.

Using functional magnetic resonance imaging (fMRI), the researchers found that individuals higher in rejection sensitivity showed different brain activity when viewing faces that showed disapproval.

Subjects of the study did not show the same results when looking at individuals who showed anger or disgust. This observation was in line with individuals who do not experience rejection sensitivity.

Heightened Physiologic Activity

When people with rejection sensitivity fear they may be rejected, they experience heightened physiologic activity—more than individuals without sensitivity to rejection. They also remain alert for more cues that they’re about to be rejected. And, they may even exhibit fight-or-flight behavior.

Misinterpreted Behavior

Hypersensitivity to rejection will often cause individuals to distort and misinterpret the actions of others. For example, when friends don’t respond to a text message right away, a rejection-sensitive individual might think, “They no longer want to be friends with me.” Whereas someone without rejection sensitivity might be more likely to assume the friend is just too busy to reply.

Attention Bias

Additionally, individuals who rank high in rejection sensitivity often pay more attention to rejection or signs that they were rejected. This is known as attention bias.

For example, if someone high in rejection sensitivity asked 10 people on a date and nine accepted and one declined, they would focus the most on that one rejection. They might even refer to their dating attempts as a “total disaster” and start to believe no one likes them.

Conversely, someone who ranks low in rejection sensitivity might view the same circumstances as a great success. That person may focus on the nine positive interactions and pay little attention to the one rejection.

Interpersonal Sensitivity

Individuals with high interpersonal sensitivity are preoccupied with all types of rejection—both perceived rejections and actual rejections. They’re also vigilant in observing and monitoring the moods and behaviors of others and are overly sensitive to interpersonal problems.

They also crave close relationships. Yet, their fear of rejection can leave them feeling lonely and isolated. However, it’s important to note that while someone might experience rejection sensitivity in social scenarios, they may not experience it in other circumstances.

For example, an individual who is terrified of social rejection may not mind getting turned down for an online job. When a situation doesn’t have social repercussions, they may be able to handle those rejections differently.

Causes of Rejection Sensitivity

Rejection sensitivity isn’t caused by one single factor. Instead, there may be many factors at play. Some possible causes include childhood experiences like critical parents and bullying, along with biological factors and genetics. Here is a closer look at the factors that may lead to rejection sensitivity.

Childhood Experiences

Early experiences of rejection, neglect, and abuse may contribute to rejection sensitivity. For example, being exposed to physical or emotional rejection by a parent may increase the likelihood that someone will develop rejection sensitivity. However, the rejection doesn’t always need to be direct to have an impact.

Rejection-sensitive children also are more likely to behave aggressively. According to a study published in Child Development, children who were highly sensitive to rejection were more likely to angrily expect rejection. They showed heightened distress following an ambiguous social interaction with a peer.

Likewise, children who feel bullied or ostracized also may grow up to fear rejection more than others. Any type of prior exposure to painful rejection can cause someone to go to great lengths to avoid experiencing that pain again.

Biological Vulnerability

It’s also thought that some people may have a biological vulnerability to rejection sensitivity. There may be a genetic predisposition or certain personality traits that increase the likelihood that someone will be sensitive to rejection. Some researchers have even linked rejection sensitivity with low self-esteem, neuroticism, social anxiety, and an insecure attachment style.

Impact of Rejection Sensitivity

Individuals who experience high levels of rejection sensitivity experience higher degrees of psychological distress when they’re rejected, including emotional pain, anger, and sadness. In an attempt to deal with that discomfort, they’re also at a higher risk of engaging in aggressiveness, social isolation, and self-injury.

Additionally, there are two primary factors at play in people with rejection sensitivity: the constant need to be liked and the challenges they face in forming meaningful connections with other people. Here is a closer look at those two factors.

Constant Need to be Liked

People who are rejection-sensitive may feel the need to be liked by everyone. And, if they are rejected, they may work extra hard to try to win that person’s favor again. This reaction to rejection can lead to people-pleasing behavior as well as extensive ingratiating behaviors.

In fact, a study published in the Journal of Personality and Social Psychology found that men who are high in rejection sensitivity are likely to respond by trying to become more likable.

They also discovered that these men were willing to pay more money to be part of a group that rejected them. If a woman evaluated them negatively on a mock dating site, they spent more money on her during the date in an attempt to get her to like them. 

Female participants exhibited similar behavior only when they were rejected by a potential romantic match with whom they had already shared personal information.

Difficulty Making Connections

A rejection-sensitive person’s fear of being rejected causes them to struggle to form new connections and to undermine their existing relationships. For example, someone who is high in rejection sensitivity may constantly accuse a partner of cheating—which may contribute to the other person ending the relationship.

Furthermore, a rejection-sensitive individual may become angry and hostile whenever a friend doesn’t respond to their invitations in a timely fashion. Ultimately, that may cause the friend to retreat even more, which increases the sense of rejection.

Meanwhile, others with rejection sensitivity may avoid all situations and relationships where they might be rejected. Consequently, they may feel extremely isolated and lonely—which essentially leads to their biggest fears coming true.

Romantic Relationship Problems

People who struggle with rejection sensitivity often interpret rejection as proof that they are unacceptable in some way. To them, rejection is a judgment of their worth and value as a person. And, in relationships, this belief system can be disastrous.

When someone is expecting rejection, it’s hard to feel safe in relationships. Even if they aren’t being rejected at the moment, they’re always watching for it, expecting it to happen at any time.

Consequently, minor missteps are seen as a total lack of caring or as cruel judgments on their worth as a person. In the end, the rejection-sensitive person may grow distressed and angry as soon as they perceive a potential rejection. Here’s a closer look at how rejection sensitivity can impact relationships.

Effects on Adolescents

Rejection sensitivity may start as early as the teenage years. Adolescent girls who rank high in rejection sensitivity may behave in ways that put them at a higher risk for victimization, according to a study published in Children Maltreatment.

Even when the girls knew there may be negative consequences for their actions, they still modified their behavior in an effort to preserve the relationship. They also were more likely to engage in relationships that involved physical aggression and nonphysical hostility during conflicts—and they tolerated unhealthy behaviors in an attempt to stay together.

Effects on Adults

Adults with rejection sensitivity who are in romantic relationships will likely experience ongoing relationship problems. They often misinterpret events and reactions because they’re hyper-vigilant about being rejected.

These behaviors may lead to irrational jealousy because the individual is terrified of being abandoned or rejected. They also might interpret other behaviors, such as a partner being preoccupied with work, as proof that the other person is no longer in love with them.

For men with rejection sensitivity, being in a committed relationship may be more helpful to them than it is to women. One study found that men are lonelier and more rejection sensitive when they’re not in a romantic relationship.

But women who rank high in rejection sensitivity aren’t likely to experience relief from being in a relationship. They may continue to feel just as lonely and fearful of rejection when in a relationship as compared to when they are alone.

Link to Mental Health Problems

Rejection is a direct threat to an individual’s sense of belonging and can have serious consequences for mental health. Even if someone isn’t actually being rejected all the time, if they perceive that they are an outcast or if they believe that they are being rejected, their mental health is still likely to decline.

However, rejection sensitivity isn’t a mental health diagnosis on its own, but it is associated with several different mental illnesses. For instance, rejection sensitivity is a risk factor for developing depression and can worsen existing symptoms.

For instance, college-aged women with high rejection sensitivity demonstrated increased depressive symptoms after a partner-initiated breakup compared to individuals who were low in rejection sensitivity.

Other studies have found that individuals who are high in rejection sensitivity are also at a higher risk of:

Extreme sensitivity to rejection is also part of the defining criteria for avoidant personality disorder and social phobia. Furthermore, researchers discovered a link between rejection sensitivity and suicidal thoughts in psychiatric patients.

The researchers found that individuals with suicidal ideation were more likely to feel like they didn’t belong, and they often felt as though they were a burden to others—things that people with rejection sensitivity often experience.

Coping Strategies

If you suspect that you’re sensitive to rejection, recognizing the symptoms—and the problems rejection sensitivity causes—can be the first step in creating change. Getting help could not only reduce your vulnerability to mental illness, but with appropriate help and intervention, also could improve your relationships.

In fact, research suggests that self-regulation, which involves monitoring and controlling one’s emotional and behavioral responses, may be the key to coping with rejection sensitivity. For instance, when you perceive a potential sign of rejection, it may help to stop and reflect on the situation rather than responding immediately.

One way to do this is to look for alternative explanations for the behavior instead of assuming the worst. If you’re unable to make these changes on your own, you may need to enlist the help of a counselor.

Start by talking to your physician, who can assist you with determining the appropriate next steps. Many times, cognitive behavioral therapy can help you deal with the thoughts, feelings, and behaviors that fuel the fear of rejection. And if you’re already in a relationship, couples therapy could help both of you work to establish a healthier, more secure relationship.

Acceptance and commitment therapy (ACT) is a type of psychotherapy that emphasizes acceptance to deal with negative thoughts, feelings, symptoms, or circumstances. ACT therapy encourages increased commitment to healthy, constructive activities that uphold your values or goals. 

“Acceptance and Commitment Therapy (ACT) is a third-wave cognitive-behavioral therapy approach that focuses on helping people accept difficult thoughts, feelings, sensations, and internal experiences while guiding them to commit to values-based actions,” explains Avigail Lev, PsyD, a licensed clinical psychologist who specializes in acceptance-based treatments.

ACT therapists operate under a theory that suggests that increasing acceptance can lead to increased psychological flexibility. This approach carries a host of benefits, and it may help people stop habitually avoiding specific thoughts or emotional experiences, which can lead to further problems.

ACT Therapy Techniques

Unlike cognitive behavioral therapy (CBT), the goal of ACT is not to reduce the frequency or severity of unpleasant internal experiences like upsetting cognitive distortions, emotions, or urges. Rather, the goal is to reduce your struggle to control or eliminate these experiences while increasing your involvement in meaningful life activities (i.e., those that are consistent with your personal values).

“ACT (Acceptance and Commitment Therapy) utilizes six processes to help people create psychological flexibility, meaning the freedom to choose our actions regardless of our internal experiences, ” Lev explains. She describes the six processes of ACT therapy as:

Identifying Values

These are the areas of your life that are important enough to you to motivate action. It is about recognizing what you want to be about and stand for.

Commitment to Action

This process involves changing your behavior based on principles covered in therapy. These specific actions can either move us closer or further toward our values.

Self as Context or Self as Observer

This involves learning to see your thoughts about yourself as separate from your actions. By doing so, people can make space for their thoughts and feelings without becoming entangled with them, Lev says.

One metaphor asks the client to think of themselves as the sky and their thoughts and feelings as weather patterns. While the weather can shift from clear to stormy, the sky remains the same despite the fleeting nature of the weather.

“This metaphor conveys that thoughts and feelings are transient, and we don’t equal our thoughts or feelings, nor are we defined by them,” Lev explains.

Cognitive Defusion Skills

Cognitive defusion is separating yourself from your inner experiences. This allows you to see thoughts simply as thoughts, stripped of the importance that your mind adds to them.

Acceptance

This means allowing your inner thoughts and feelings to occur without trying to change or ignore them. Acceptance is an active process.

Specific skills that are used in ACT therapy to help clients learn acceptance include:

• Self-compassion meditations
• Emotion exposure
• Physicalizing emotions or thoughts
• Loving-kindness phrases
• Experiential exercises and metaphors

Instead of trying to change your thoughts, Lev says, the goal is to create a non-judgemental relationship with them.

Present Moment Contact

ACT therapy encourages you to stay mindful of your surroundings and learn to shift your attention away from internal thoughts and feelings. This involves a conscious and deliberate effort to focus on the world around you in the moment.

Staying engaged with the present can help you build greater awareness and prevent past experiences, memories, and conditioning from negatively affecting your interactions in the here and now.

What to Expect in ACT Therapy

The first sessions of ACT therapy focus on clarify values with a client, Lev explains. Subsequent sessions then focus on helping people connect to those values and apply them in their lives.

Lev explains that a typical ACT therapy session involves:

• Reviewing the previous week and identifying and rewarding behaviors that were consistent with the individual’s values
• Examining behaviors that were not in alignment and work to understand the barriers that led to such actions
• Using the six ACT processes to work through barriers so the individual can move toward their values in the future

During ACT, your therapist will help you apply these concepts to your life. They may teach you how to practice acceptance and cognitive defusion or help you develop a different sense of yourself distinct from your thoughts and feelings.

Sessions can also include mindfulness exercises to foster non-judgmental, healthy awareness of thoughts, feelings, sensations, and memories you have otherwise avoided.

Your therapist may assign homework to practice between sessions, such as mindfulness, cognitive, or values clarification exercises. The homework is agreed upon between you and your therapist and can be modified to make it as personal and useful as possible.

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What ACT Can Help With

ACT may be effective in treating:

Benefits of ACT Therapy

One core benefit of ACT is the impact it has on psychological flexibility. Psychological flexibility is the ability to embrace your thoughts and feelings when they are useful and to set them aside when they are not. This allows you to respond thoughtfully to your inner experience and avoid short-term, impulsive actions, focusing instead on living a meaningful life.

ACT therapy also helps people cultivate greater self-awareness and self-compassion. “One of the primary benefits of ACT is that it helps individuals build a different relationship with their internal experiences. This means learning to relate to oneself and one’s inner narrator with kindness and gentleness,” Lev says.

How Effective Is ACT Therapy?

ACT is sometimes referred to as a “third wave” or “new wave” psychotherapy. The term “third wave” treatment refers to a broad spectrum of psychotherapies that also includes:

“Third-wave behavioral therapy approaches differ from traditional CBT methods because they emphasize acceptance and mindfulness-based strategies rather than cognitive restructuring which involves challenging and changing difficult thoughts and feelings,” Lev explains. “This means they focus more on helping people accept difficult emotions, developing a loving relationship with their emotions, and creating distance from troubling thoughts.”

Historically, third-wave treatments were seen as appropriate for people not benefiting from pre-existing treatments like classical CBT. However, it is now believed that a third-wave therapy option may make sense as a first-line treatment for some individuals.

Recent theories suggest that attempting to resist or change thoughts and feelings can make them stronger. So, instead of challenging them as one would in traditional CBT, ACT takes a different approach.

Research shows ACT to be effective at treating a wide range of conditions, including some that span several diagnoses. ACT also appears to improve quality of life and may help people deal with physical conditions and chronic pain.

Things to Consider

While ACT is an effective treatment for a variety of conditions, research shows that it may be about as helpful as other available forms of therapy, such as CBT. These findings suggest that someone who benefits from ACT may have also benefited from another treatment.

ACT has also faced criticism for its similarity to other forms of therapy. Some proponents of CBT claim that ACT, like other third-wave therapies, doesn’t represent a significantly different approach.

How to Get Started

Several types of mental health professionals may offer ACT, including psychiatrists, psychologists, social workers, or mental health counselors. If you are interested in learning more about this approach, you might ask about your treatment provider’s training background with it or seek out an experienced ACT practitioner.

You may also try referral sources such as the Association for Contextual Behavioral Science (ACBS) or the Association for Behavioral and Cognitive Therapies (ABCT). The ACBS also provides free resources about ACT in the form of videos, audio clips, and mindfulness exercises.

ACT sessions tend to be hands-on, often including psychological exercises or mindfulness training, as well as homework after the session is done. Completing these exercises is an important part of ACT, as this is the way you can learn new skills and improve your psychological flexibility. 

Your therapist will also want to discuss your values and goals during therapy. This is another crucial part of treatment, as these values will inform your actions moving forward.

Zoloft (sertraline) belongs to a class of medications called selective serotonin reuptake inhibitors, or SSRIs. These medications work by increasing the level of available serotonin in the brain. Low levels of serotonin in the brain are linked to a depressed mood as well as other psychiatric symptoms.

Besides major depressive disorder, Zoloft is also approved by the Food and Drug Administration (FDA) to treat the following psychiatric conditions:

Zoloft Timeline

Learning how Zoloft works and what to watch out for when taking it can help you better cope with your illness and stick to your treatment plan. For example, it’s important not to expect immediate results when taking Zoloft.

Depression

Sertraline may improve physical symptoms of depression (such as difficulty sleeping, low energy levels, and lack of appetite) in one to two weeks. However, it may take up to eight weeks before you notice improvement in emotional symptoms (like depressed mood, apathy, and social withdrawal).

Anxiety

A 12-week trial in 2015 found that daily doses of sertraline—between 50mg and 150mg—noticeably reduced mental and somatic symptoms of generalized anxiety disorder in participants by week four. (Mental symptoms of anxiety include nervousness, worry, and irritability, whereas somatic symptoms include chest pain, stomach ache, and nausea.)

Obsessive Compulsive Disorder

Sertraline may reduce OCD symptoms in four to six weeks. A daily dose of sertraline between 50mg and 200mg is linked with the reduction of anxiety, fear, physical symptoms, and avoidance behaviors in people with OCD. However, a doctor may increase the dosage if no improvements occur after four weeks (and there are no major side effects),

How Does Zoloft Make You Feel?

During your first few days on Zoloft, you may feel fatigued or drowsy. A doctor may recommend that you take it in the evening to avoid feeling tired during the day.

In other cases, Zoloft can actually have a stimulatory effect and increase energy. It may also cause sleep disturbances, such as insomnia. In this instance, a doctor may recommend that you take Zoloft early in the day and avoid other stimulants, such as caffeine, so that your sleep isn’t negatively impacted.

How to Know If Zoloft Is Working

SSRIs like sertraline work by boosting serotonin levels, which can help you regulate your emotions and feel less inhibited by any disruptive symptoms of your mental health condition. You may know that Zoloft is working if you:

• Experience emotional stability
• Feel an increase in happiness and well-being
• Feel calmer
• Feel more focused

Zoloft Side Effects

In addition to changes in energy levels, you may experience additional side effects during the first few weeks of taking Zoloft.

If any of these side effects persist or are causing significant problems, talk to a doctor. Sometimes, simple remedies can ease Zoloft’s side effects, like taking it at a different time of day or changing the dose. Your doctor may also recommend switching to a different SSRI or a different class of medication altogether.

Serious Side Effects

In addition to the common side effects mentioned above, there are some serious effects to be aware of if you are taking Zoloft. If you experience any of the following, contact your doctor right away.

Suicidal Thoughts and Behavior

A “black-box warning” refers to a serious notice made by the FDA about a medication. The black-box warning for Zoloft indicates it may cause or increase thoughts of suicide in children and young adults. Monitor your loved one or yourself if you’re in this age group for any signs of such thoughts, and seek help immediately if they occur.

Serotonin Syndrome 

Taking Zoloft may put you at risk for a rare, possibly life-threatening condition called serotonin syndrome. This risk is higher if you are also taking other serotonin-related medications like triptans (a common migraine medication), tricyclic antidepressants, or the pain medication Ultram (tramadol). However, the syndrome can occur when taking Zoloft alone, as well.

Signs and symptoms of this condition include: 

• Agitation
• Confusion
• Fluctuating blood pressure
• Gastrointestinal problems like diarrhea
• High heart rate
• Rigid muscles and/or coordination problems
• Tremors

To be proactive in avoiding this rare syndrome, be sure to tell your doctor all the medications you are taking, including any over-the-counter drugs or supplements. 

Before You Start Taking Zoloft

It’s important that a doctor is aware of your relevant medical history prior to prescribing Zoloft. This includes any pre-existing conditions you may have, medications you’re taking, or if you’re pregnant or breastfeeding.

Zoloft, like any medication, presents certain risks and precautionary measures should be taken when possible.

Risk of Bleeding

There is an increased chance of bleeding when taking Zoloft, along with medications that block platelets or medications that thin your blood. Examples include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and Coumadin (warfarin).

Notify your doctor right away if any bleeding events, like nosebleeds or increased bruising. Seek medical attention immediately if you notice more serious bleeding events, such as blood in your stool. 

Low Sodium Levels

Low sodium levels in the bloodstream (called hyponatremia) may occur with Zoloft and other SSRIs. In severe cases, hyponatremia can lead to seizures and other serious neurologic and medical issues. Signs and symptoms of hyponatremia include:

• Confusion
• Headache
• Memory difficulties
• Problems concentrating
• Unsteadiness and potentially falling
• Weakness

Hypomanic or Manic Episodes

Zoloft can trigger a hypomanic or manic episode in a person with bipolar disorder. Before taking Zoloft, tell your doctor if you have ever been diagnosed or suspected of having bipolar disorder or have a family history of it.

Allergic Reactions

While not common, if you take Zoloft and develop signs or symptoms of an allergic reaction like rash, hives, swelling, or problems breathing, contact your doctor right away.

Risk to Unborn Babies

You should inform your doctor if you become pregnant while taking Zoloft or are planning a pregnancy. Zoloft use in the third trimester may increase a baby’s chance of developing complications like a rare condition known as persistent pulmonary hypertension, which can cause breathing problems. In addition, third-trimester use of Zoloft may cause neonatal withdrawal symptoms.

However, some women may need to continue taking Zoloft during pregnancy because the benefit of treating their illness outweighs the potential risks. Overall, this decision requires a careful and thoughtful discussion with both an obstetrician and a mental health professional. 

Low levels of Zoloft may be present in breast milk, so lactating parents should consult with their doctors before nursing while taking this medication. Breastfeeding is typically encouraged unless there is a medical reason for the parent to avoid breastfeeding.

How to Take Zoloft

It’s important to follow the instructions that a doctor provides when taking Zoloft. The dosage that is prescribed will vary from person to person.

Zoloft is most often taken in tablet form once per day. A typical dosage for those with depression, obsessive-compulsive disorder, and premenstrual dysphoric disorder is 50mg per day. Those with panic disorder, PTSD, and anxiety disorders may start out at 25mg per day.

Try to take your Zoloft at the same time every day. Setting a timer on your phone may be helpful so you don’t forget.

Overdose

Contact a poison control center and your doctor for guidance if you or a loved one overdoses on Zoloft. The most common signs and symptoms associated with Zoloft overdose include:

• Agitation
• Dizziness
• Fast heart rate
• Nausea
• Sleepiness
• Tremor
• Vomiting

Stopping Zoloft

Stopping Zoloft may result in symptoms of sertraline withdrawal, also known as SSRI discontinuation syndrome. This is one reason why it’s important to consult with your doctor before stopping this medication.

If you and your doctor decide it’s best for you to stop Zoloft, they can provide you with a tapering strategy to minimize any withdrawal symptoms like irritability, anxiety, or flu-like symptoms.

Zoloft (sertraline)) belongs to a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). While safe when taken as prescribed, it may lead to overdose when taken in high doses or combined with other medications that impact serotonin levels.

Someone who’s taken too much Zoloft could have one or many symptoms ranging from mild to severe, but they’re rarely life-threatening. Some are common in most cases, whereas other, less common effects can be more consequential.

Zoloft is one of the most commonly prescribed SSRI antidepressants. It’s typically prescribed for anxiety disorders such as obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and post-traumatic stress disorder (PTSD). It’s also used to treat major depressive ​disorder and premenstrual dysphoric disorder (PMDD).

Symptoms of Zoloft Overdose

Zoloft increases the available amount of serotonin, the “feel happy” neurotransmitter responsible for mood and other aspects of health. Too much serotonin, however, can cause symptoms ranging from unpleasant to serious.

Serotonin Syndrome

Among the most serious risks of Zoloft overdose is serotonin syndrome, in which levels of serotonin reach a level that can cause symptoms such as:

Serotonin syndrome is most likely to happen in interaction with another drug.

Getting Help for Zoloft Overdose

If you or someone you know has accidentally taken a higher dose of Zoloft than prescribed, it’s a good idea to get help right away, before the drug has a chance to cause unpleasant or dangerous symptoms.

If a trip to an emergency room isn’t possible, call the national toll-free Poison Control hotline at 1-800-222-1222 or visit PoisonHelp.org. The staff there is trained to assess your situation over the phone and give advice about what to do.

Information to Have Ready

When you go to the emergency room or call Poison Control, the more information you can provide, the more precise the treatment can be. Having the following information available will be helpful:

• Any other drugs or supplements taken along with Zoloft
• Current signs/symptoms
• How long since the drug was taken
• How much Zoloft was consumed (actual amount or your best guess)
• The person’s age, sex, and weight
• The regular dosage (what the doctor prescribed)
• Whether the person attempted suicide

Treatment for Zoloft Overdose

If the overdose was fairly recent, healthcare providers might pump the person’s stomach to remove any of the drug that the body has not absorbed yet. Another option is to use activated charcoal to absorb any remaining medication in the stomach.

There’s no antidote for a Zoloft overdose. Healthcare providers will monitor the person’s vital signs—heart rate, breathing, and blood pressure—and treat any problems that might arise.

Next Steps After a Zoloft Overdose

Following treatment for a Zoloft overdose, full recovery occurs once the drug has fully left the system. If the overdose was accidental, the doctor will advise the person on what to do next, which may involve switching to a different antidepressant or adjusting the dosage.

The next step is to make sure that an overdose does not happen again. To prevent accidental overdose:

• Avoid recreational substance use.
• Avoid taking Zoloft with other prescription antidepressants.
• If you miss a dose of your medication, take the dose as soon as you remember. If it’s almost time for your next dose, however, skip the missed dose and take your next dose at your regular time.
• Talk to your doctor about any other medications you’re taking.
• Never take two doses of Zoloft at the same time.

If the overdose was intentional, short-term treatment might involve hospitalization until the risk of suicide is no longer imminent. Health professionals might advise switching to another type of antidepressant if sertraline has not been effective in reducing depressive symptoms. 

Long-term treatments might involve further use of antidepressants, psychotherapy, and psychosocial support to address suicidal thoughts and symptoms of depression.