Sertraline
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Experience
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Problems
- Major depressive disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
- Premenstrual dysphoric disorder
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.
Effects
- Improved mood no reports yet no reports yetOnset typically 2–4 weeks.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Anxiolysis no reports yet no reports yetOnset typically 2–4 weeks.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Reduced obsessive thoughts no reports yet no reports yetDelayed onset; full benefit often takes 4+ weeks.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Nausea no reports yet no reports yetOften improves over the first 1–2 weeks.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Diarrhea no reports yet no reports yetDid you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Sexual dysfunction no reports yet no reports yetDecreased libido, delayed orgasm, anorgasmia. Can persist long-term in some patients (PSSD).Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Insomnia no reports yet no reports yetDid you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Somnolence / sedation no reports yet no reports yetDid you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Sweating / diaphoresis no reports yet no reports yetDid you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Serotonin syndrome no reports yet no reports yetEspecially with other serotonergic agents (triptans, tramadol, MAOIs, linezolid).Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- QT prolongation no reports yet no reports yetDose-dependent; check ECG in cardiac risk.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Hyponatremia / SIADH no reports yet no reports yetEspecially in elderly patients.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Bleeding risk no reports yet no reports yetParticularly with concurrent NSAIDs or anticoagulants.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- Suicidality no reports yet no reports yetBlack box warning in patients under 25; close monitoring in first 4 weeks.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
- 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.Discontinuation syndrome no reports yet no reports yet"Brain zaps," dizziness, irritability, flu-like symptoms with abrupt cessation. Taper to avoid.Did you experience this?How often have you seen this?How was it? (-100 worst, +100 best)How was it? (-100 worst, +100 best)
Pharmacokinetics
Pharmacodynamics
Interactions
MAOIs (serotonin syndrome, contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.
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Patient experience
- checking this mechanism here
Pregnancy and lactation
Monitoring
Patient counseling
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See also
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.
Problems
- 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
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.
Problems
- 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