Sertraline

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SSRI, Antidepressant, Anxiolytic

Sertraline

Zoloft, Lustral

Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety disorders, OCD, PTSD, and panic disorder. Among SSRIs it has a relatively favorable side-effect profile and is often a first-line choice.

Experience

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Problems

Major depressive disorder
Generalized anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
Panic disorder
Premenstrual dysphoric disorder

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Titration strategies

Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.

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Effects

Therapeutic: improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks). Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.

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Pharmacokinetics

Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.

Pharmacodynamics

Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.

Interactions

MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.

Pregnancy and lactation

Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.

Monitoring

Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.

Patient counseling

Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.

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