Based on PubMed | Can sertraline cause constipation, and what can I do to prevent or treat it?

Short answer

Yes, sertraline (an SSRI) can cause constipation for some people, although many experience diarrhea or loose stools instead; constipation is listed among its possible side effects. ^[1] Constipation from antidepressants can often be managed with practical steps such as more fluids, fiber, exercise, and, if needed, gentle laxatives or stool softeners after discussing with a clinician. ^{[2] [3]}

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How sertraline may lead to constipation

• Class effect: SSRIs, including sertraline, commonly cause gastrointestinal side effects, and constipation is one of the reactions that can occur. ^[4] Constipation is explicitly noted among sertraline’s potential adverse effects for which you should alert your healthcare provider if it is severe or persistent. ^[1]
• Individual variation: While SSRIs overall tend to cause nausea or diarrhea more frequently, some users experience the opposite constipation depending on personal sensitivity and gut motility patterns. ^{[4] [5]}

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When to be concerned

• Duration and severity: If constipation does not resolve or becomes severe (for example, fewer than three bowel movements per week with straining or hard stools), contact your clinician for tailored advice. ^[1]
• Red flags: Seek medical attention if constipation is accompanied by severe abdominal pain, vomiting, blood in stool, unintended weight loss, or if you cannot pass gas or stool. These are not typical medication side effects and need evaluation.

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Prevention strategies

• Hydration: Aim for enough water daily so urine is pale-yellow; adequate fluids soften stool and aid movement. ^{[2] [3]}
• Dietary fiber: Gradually increase fiber through fruits, vegetables, beans, and whole grains to around 25–35 grams/day, as tolerated. Fiber adds bulk and helps the colon move stool along. ^{[2] [3]}
• Regular activity: Gentle, regular exercise (like walking) can stimulate intestinal motility. ^{[2] [3]}
• Routine and posture: Establish a regular bathroom schedule (often after meals) and consider a footstool to mimic a squatting posture, which can ease evacuation.

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First-line treatments you can discuss with your clinician

• Fiber supplements: Products like psyllium, methylcellulose, or calcium polycarbophil can be effective and are often well tolerated; start low and increase to avoid gas and bloating. ^{[2] [3]}
• Stool softeners: Docusate can help moisten stool if it is hard and painful to pass. ^{[2] [3]}
• Osmotic laxatives: Polyethylene glycol (PEG) draws water into the bowel and has good evidence for effectiveness and safety in chronic constipation; it is often preferred for sustained relief. ^{[6] [7]}
• Stimulant laxatives (as needed): Short courses of bisacodyl or senna can help if other measures fail, though they are usually reserved for intermittent use. ^{[6] [7]}

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Medication adjustments

• Dose timing or reduction: If constipation remains troublesome despite lifestyle measures, your clinician may consider adjusting the sertraline dose after weighing benefits and risks. ^[5]
• Switching agents: Some individuals tolerate one SSRI better than another; your clinician may discuss whether a different medication might suit you if side effects persist. ^[5]

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Special situations

• Older adults: Constipation is common with aging; hydration, fiber, mobility, and PEG have supportive evidence and are generally safe when individualized. ^{[8] [6]}
• Other medicines: If you also take constipating drugs (e.g., iron, anticholinergics, opioids), combined effects may be stronger; your clinician can help adjust the regimen.

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Practical step-by-step plan

1. Start with basics: Increase water intake, add dietary fiber, and walk daily. ^{[2] [3]}
2. Add a fiber supplement if food changes aren’t enough after a week or two. ^{[2] [3]}
3. Use PEG if constipation persists, as it has strong evidence and is typically well tolerated. ^{[6] [7]}
4. Consider short-term stimulants only if needed and after discussing with your clinician. ^{[6] [7]}
5. Review your sertraline plan with your clinician if symptoms remain significant; dose adjustments or switching may be considered. ^[5]

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Key takeaways

• Constipation can occur with sertraline, and you should notify your clinician if it is severe or ongoing. ^[1]
• Most cases respond to hydration, fiber, exercise, and targeted over-the-counter options like PEG. ^{[2] [6]}
• Personalized care matters: If simple measures don’t help, a medication review can identify better-tolerated alternatives or dosing strategies. ^[5]