The ‘frightening’ side effect of coming off sertraline you don’t often hear about

Even when its done gradually, under medical supervision, it can cause confusion, irritability, nausea, and in some cases, vivid dreams.

The ‘brain zaps’ (brief, electric shock-like sensations in the head) and ‘dizziness’ didn’t cause them concern.

But the persistence of ‘weird and vivid dreams’ were apparently becoming extremely distressing.

Describing the dreams as ‘upsetting’ and emotionally lingering, the user revealed that these nightly-occurrences were having a lasting impact.

So, why is this happening?

Why are vivid dreams a symptom of coming off of sertraline?

Psychologist Dr Nikita Amin tells Metro that the key factor in why this occurs is because of one particular chemical: serotonin.

She explains: ‘Sertraline is a SSRI which works by increasing serotonin.’
This chemical plays a crucial role in regulating sleep, Dr Amin continues, including REM sleep, the stage most closely associated with dreams.

It might sound counterintuitive, but while serotonin is involved in sleep regulation, increased serotonin activity can suppress REM sleep.

As a result, dreams may become less vivid or harder to remember while taking the medication.

Then, when people begin to reduce or stop taking sertraline, this effect can reverse.

As serotonin activity decreases, the brain may temporarily experience more REM sleep — a phenomenon referred to as ‘REM rebound.’
Dr Amin explains that this can lead to more intense or vivid dreams as sleep patterns readjust.

The psychologist adds: ‘Sertraline works on neurotransmitters like serotonin, norepinephrine, and dopamine.

Suddenly reducing these levels forces your brain to try and rebalance itself.’

How long do vivid dreams last after coming off of sertraline?

According to Dr Amin, the amount of time it takes for vivid dreams to wear off as a withdrawal symptoms ‘differs from person to person.’
However, she notes that typically they peak between four and 14 days after stopping the medication.

‘They can last for a few weeks.

During this time, the brain is trying to adjust to the new levels of sertraline in the body,’ she adds.

‘Within three to six weeks symptoms tend to subside.’

Are vivid dreams always frightening?

Words such as ‘absurd’, ‘horrible’, ‘random’, and ‘shocking’ have all been used online by people who’ve experienced this symptom, with some even describing their vivid dreams as ‘night terrors’.

However, while this may be true for some individuals, Dr Amin emphasises that not all withdrawal dreams are frightening.

‘Vivid dreams will only become nightmares when they evoke a negative emotion such as fear, anxiety, distress.

But they can range from delightful to unsettling.’

Have you ever experienced vivid dreams before?

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She adds: ‘The dreams are very useful for me to arrange my ideas and many times they answer the questions I have in my mind.’

How many people experience withdrawal symptoms?

In 2024, NHS data revealed that Sertraline had been prescribed more than 24 million times in England.

Previously, research had indicated that over half of patients who stopped taking mental health medication would experience withdrawal symptoms.

However, this year new analysis of randomised controlled trials published in The Lancet Psychiatry, found that only 15% of patients will experience one or more discontinuation symptoms that are directly caused by stopping the drugs, while around 2-3% will suffer severe symptoms.

Because of this mental health professionals urge patients to gradually taper your dose to minimise any potential negative fall-out.

A tapering schedule will be dependent on your current dose, how long you’ve been taking Sertraline, and your individual response.

Doctors also encourage individuals to track your symptoms daily.

POLL

What do you think is the most common withdrawal symptom?

• Nausea
  Nausea

• Headaches

• Insomnia

• Anxiety

• Dizziness

• Vivid dreams