Sertraline

Brand Names: Zoloft

Drug Class: Selective Serotonin Reuptake Inhibitor (SSRI)

Overview

Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. It works by increasing serotonin levels in the brain to improve mood, reduce anxiety, and decrease obsessive thoughts and compulsive behaviors.

Mechanism of Action

Sertraline is a potent and selective inhibitor of neuronal serotonin reuptake, increasing serotonin availability in synaptic clefts. It has minimal effects on norepinephrine and dopamine reuptake and no significant affinity for adrenergic, cholinergic, GABA, dopaminergic, histaminergic, serotonergic, or benzodiazepine receptors.

Indications

  • Major depressive disorder (MDD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder (PD)
  • Posttraumatic stress disorder (PTSD)
  • Social anxiety disorder (SAD)
  • Premenstrual dysphoric disorder (PMDD)

Common Doses

  • 25 mg
  • 50 mg
  • 100 mg

Dosage

Initial adult dose typically 50 mg once daily, may be increased gradually based on response and tolerability up to maximum 200 mg daily. For PMDD, dosing may be limited to luteal phase. Titrate slowly to minimize side effects.

Contraindications

  • Concomitant use with MAOIs or within 14 days of MAOI discontinuation
  • Concomitant use with pimozide
  • Known hypersensitivity to sertraline or any component

Side Effects

  • Nausea, diarrhea, dry mouth, insomnia, somnolence
  • Sexual dysfunction (decreased libido, delayed ejaculation, anorgasmia)
  • Increased sweating, dizziness, fatigue
  • Weight changes
  • Serotonin syndrome (agitation, hallucinations, tachycardia)
  • Withdrawal symptoms (dizziness, paresthesias, anxiety)

Interactions

  • MAOIs (risk of serotonin syndrome)
  • Pimozide (QTc prolongation)
  • Other serotonergic drugs (triptans, tramadol, lithium)
  • Warfarin and other anticoagulants (increased bleeding risk)
  • CYP2C19 inhibitors/inducers may affect sertraline levels

Counseling Points

  • Take once daily with or without food
  • May take 4-6 weeks for full therapeutic effect
  • Do not stop abruptly due to withdrawal risk
  • Report any worsening depression, suicidal thoughts, or unusual behavior
  • Avoid alcohol
  • Use caution with activities requiring alertness until effects known
  • Notify provider if pregnant or planning pregnancy