Sertraline

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. It is one of the most frequently utilized SSRIs at this time.

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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See also

Fluoxetine, Paroxetine, Citalopram, Escitalopram

Summary

Classes

SSRI, Antidepressant, Anxiolytic

Common uses

• Depressive disorders★★★★★★★★★★★★★★★—×
• Anxiety disorders broadly★★★★★★★★★★★★★★★—×
• Panic disorder★★★★★★★★★★★★★★★—×
• Social anxiety disorder★★★★★★★★★★★★★★★—×
• Generalized Anxiety Disorder★★★★★★★★★★★★★★★—×

+ 4 more uses →

Pharmacy

Pharmacology

Routes

Oral

Onset

2–4 weeks for full effect

Half-life

26 hours (parent); norsertraline 62–104 hours

Bioavailability

~44%

Pregnancy

Category C

Legal status

Rx-only

Purported mechanism

SSRI; weak DRI

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.

Indications

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

  Dosing and titration

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.

Effects

Therapeutic: improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks).

Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.

Adverse effects

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.

Contraindications

MAOIs (within 14 days), pimozide, severe hepatic impairment. Caution: bipolar disorder (mood switching risk), seizure disorders.

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.

See also

Fluoxetine, Paroxetine, Citalopram, Escitalopram