Sertraline is a selective serotonin reuptake inhibitor (SSRI) used for depression and several anxiety-related disorders. It blocks the serotonin transporter (SERT), increasing synaptic serotonin in key brain circuits involved in mood, arousal, and threat processing. Unlike older antidepressants, sertraline has minimal anticholinergic or antihistaminic activity, so it is generally less sedating and better tolerated. The terminal half-life is ~26 hours (once-daily dosing), and a weakly active metabolite (desmethylsertraline) has a longer half-life but limited clinical impact.
Across large trials and meta-analyses, sertraline improves core mood symptoms (low mood, anhedonia), vegetative symptoms (sleep/appetite), cognitive symptoms (concentration, indecision), and anxiety symptoms. It is effective for Major Depressive Disorder (MDD), Generalised Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Obsessive–Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD). Symptom relief usually begins in 2–4 weeks, with full response over 6–8+ weeks. Continuing treatment for 6–12 months after remission reduces relapse; people with recurrent or chronic illness may need longer maintenance.
Sertraline is not habit-forming, but stopping suddenly can cause discontinuation symptoms (dizziness, “electric zaps,” insomnia, irritability). Tapering is recommended. As with all antidepressants, monitor for suicidality during initiation and dose changes—especially under age 25—while balancing that untreated depression/anxiety themselves increase suicide risk. Pairing medication with psychotherapy (CBT, ERP for OCD, trauma-focused therapies for PTSD), sleep hygiene, activity, and social support improves outcomes.
Set expectations: early side effects are common but often settle; therapeutic benefit builds over weeks. Encourage sleep routines, exercise, and regular follow-up.
Most adverse effects appear in the first fortnight and reduce with time or dose adjustment. If troublesome, discuss strategies rather than stopping abruptly.
Many effects can be managed: slower titration, dose timing change, taking with food, or considering alternatives for persistent sexual side effects.
Advise moderation of alcohol, consistent sleep/exercise routines, and prompt reporting of mood worsening or emergent suicidality.
Sertraline is a substrate of multiple CYP enzymes and a moderate CYP2D6 inhibitor. Interactions mainly involve serotonergic toxicity, bleeding risk, or altered concentrations of co-medications.
Review OTC products (e.g., dextromethorphan) and herbals; document everything on a single medication list.
Missed dose: take when remembered the same day; if close to the next dose, skip and continue the usual schedule. Do not double up.
Accidental double dose: commonly causes mild nausea, tremor, or restlessness—seek advice if symptoms are concerning or if other serotonergic agents are used.
Large overdose: may cause somnolence, tachycardia, nausea/vomiting, tremor, agitation, seizures, QT prolongation, or serotonin syndrome. Seek emergency care. Hospital care is supportive: airway/ventilation, ECG monitoring, IV fluids, benzodiazepines for agitation/seizures, active cooling and cyproheptadine for serotonin syndrome when indicated; consider activated charcoal if early after ingestion.
Any intentional overdose requires urgent psychosocial assessment after medical stabilisation.
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