Sertraline

Introduced 1991

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Major depressive disorder (MDD)Obsessive-compulsive disorder (OCD)Panic disorderPost-traumatic stress disorder (PTSD)Social anxiety disorderPremenstrual dysphoric disorder (PMDD)

Mechanism

Selectively inhibits the reuptake of serotonin into presynaptic neurons, increasing serotonin availability in the synaptic cleft and enhancing serotonergic neurotransmission.

Dosing

Adult Dosing

oral: Start at 25–50 mg once daily; may increase by 25–50 mg/day at weekly intervals up to a maximum of 200 mg/day.

Dosage Forms

Tablets: 25 mg, 50 mg, 100 mg
Oral concentrate: 20 mg/mL

Onset Duration

Antidepressant and anxiolytic effects typically emerge within 2–4 weeks; full therapeutic effect may take 6–8 weeks.

Adverse Effects

Common Side Effects

• nausea

• diarrhea

• insomnia

• sexual dysfunction

• dry mouth

• dizziness

• fatigue

⚠️ Serious Side Effects

serotonin syndrome
suicidal ideation (especially in young adults)
hyponatremia/SIADH
QT prolongation (rare)

Warnings

Critical Safety Information

→Risk of suicidal thoughts and behaviors in children, adolescents, and young adults during initial treatment
→May cause serotonin syndrome if combined with other serotonergic agents
→Avoid abrupt discontinuation to prevent withdrawal symptoms
→May cause hyponatremia, particularly in elderly or diuretic-treated patients

Interactions

With: MAO inhibitors

Risk: Serotonin syndrome

Action: Contraindicated; observe washout period

With: Other serotonergic drugs

Risk: Serotonin syndrome

Action: Monitor closely or avoid combination

With: Pimozide

Risk: QT prolongation and arrhythmia

Action: Contraindicated

With: Warfarin and NSAIDs

Risk: Increased bleeding risk

Action: Monitor INR and bleeding signs

Monitoring

Clinical response and adverse effects
Signs of serotonin syndrome
Weight and growth in pediatric patients
Serum sodium in at-risk populations

Special Populations

👶Pregnancy

Generally considered lower risk among SSRIs; monitor neonates for withdrawal or persistent pulmonary hypertension if used late in pregnancy.

🤱Breastfeeding

Excreted in breast milk; generally considered compatible with breastfeeding but monitor infant for irritability or feeding issues.

👴Older Adults (65+)

Higher risk of hyponatremia and SIADH; start at lower doses and monitor closely.

Tapering

Gradually reduce dose over several weeks to minimize withdrawal symptoms such as dizziness, insomnia, and irritability.

Clinical Notes

Preferred SSRI for patients with cardiovascular disease due to favorable safety profile
Often well-tolerated in long-term use with appropriate monitoring
Take consistently at the same time each day; morning dosing may reduce risk of insomnia

References

Zoloft Prescribing Information NHS - Sertraline PubChem - Sertraline

This medication information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication. Never take medication without a prescription from a licensed healthcare provider.

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This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

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Sertraline

Introduced 1991

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Indications

Primary Indications

Major depressive disorder (MDD)Obsessive-compulsive disorder (OCD)Panic disorderPost-traumatic stress disorder (PTSD)Social anxiety disorderPremenstrual dysphoric disorder (PMDD)

Mechanism

Selectively inhibits the reuptake of serotonin into presynaptic neurons, increasing serotonin availability in the synaptic cleft and enhancing serotonergic neurotransmission.

Dosing

Adult Dosing

oral: Start at 25–50 mg once daily; may increase by 25–50 mg/day at weekly intervals up to a maximum of 200 mg/day.

Dosage Forms

Tablets: 25 mg, 50 mg, 100 mg
Oral concentrate: 20 mg/mL

Onset Duration

Antidepressant and anxiolytic effects typically emerge within 2–4 weeks; full therapeutic effect may take 6–8 weeks.

Adverse Effects

Common Side Effects

• nausea

• diarrhea

• insomnia

• sexual dysfunction

• dry mouth

• dizziness

• fatigue

⚠️ Serious Side Effects

serotonin syndrome
suicidal ideation (especially in young adults)
hyponatremia/SIADH
QT prolongation (rare)

Warnings

Critical Safety Information

→Risk of suicidal thoughts and behaviors in children, adolescents, and young adults during initial treatment
→May cause serotonin syndrome if combined with other serotonergic agents
→Avoid abrupt discontinuation to prevent withdrawal symptoms
→May cause hyponatremia, particularly in elderly or diuretic-treated patients

Interactions

With: MAO inhibitors

Risk: Serotonin syndrome

Action: Contraindicated; observe washout period

With: Other serotonergic drugs

Risk: Serotonin syndrome

Action: Monitor closely or avoid combination

With: Pimozide

Risk: QT prolongation and arrhythmia

Action: Contraindicated

With: Warfarin and NSAIDs

Risk: Increased bleeding risk

Action: Monitor INR and bleeding signs

Monitoring

Clinical response and adverse effects
Signs of serotonin syndrome
Weight and growth in pediatric patients
Serum sodium in at-risk populations

Special Populations

👶Pregnancy

Generally considered lower risk among SSRIs; monitor neonates for withdrawal or persistent pulmonary hypertension if used late in pregnancy.

🤱Breastfeeding

Excreted in breast milk; generally considered compatible with breastfeeding but monitor infant for irritability or feeding issues.

👴Older Adults (65+)

Higher risk of hyponatremia and SIADH; start at lower doses and monitor closely.

Tapering

Gradually reduce dose over several weeks to minimize withdrawal symptoms such as dizziness, insomnia, and irritability.

Clinical Notes

Preferred SSRI for patients with cardiovascular disease due to favorable safety profile
Often well-tolerated in long-term use with appropriate monitoring
Take consistently at the same time each day; morning dosing may reduce risk of insomnia

References

Zoloft Prescribing Information NHS - Sertraline PubChem - Sertraline

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

Locate Psychiatrists