Sertraline

Sertraline is a selective serotonin reuptake inhibitor (SSRI) that blocks the reuptake of serotonin at the presynaptic membrane, increasing the availability of serotonin in the synaptic cleft. This enhancement of serotonergic neurotransmission is the basis for its antidepressant and anxiolytic effects. Sertraline has minimal effects on norepinephrine and dopamine reuptake and minimal affinity for adrenergic, cholinergic, GABA, or histaminergic receptors, which contributes to its relatively favorable tolerability profile compared to older antidepressants.¹

Sertraline was the most commonly prescribed psychotropic medication in the United States as of 2016 and remains among the most prescribed. Its elimination half-life of approximately 26 hours enables once-daily dosing.

• Major depressive disorder (MDD) — adults
• Obsessive-compulsive disorder (OCD) — adults and children 6–17 years
• Panic disorder — adults
• Post-traumatic stress disorder (PTSD) — adults
• Social anxiety disorder — adults
• Premenstrual dysphoric disorder (PMDD) — adults¹

For most indications: starting dose 25–50 mg once daily. Increase by 25–50 mg per day at intervals of at least 1 week. Target dose typically 50–200 mg per day. Maximum: 200 mg per day.¹

Oral tablets or oral concentrate solution.

Store at controlled room temperature. Oral concentrate must be diluted before use and should not be mixed with certain liquids (see label for specifics).¹

Boxed warning: Antidepressants increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults (under 25) in short-term trials. Monitor closely, especially during the first few months of treatment and after dose changes.¹

Critical interactions and considerations:

• Serotonin syndrome — CRITICAL: Sertraline combined with MAOIs (including linezolid and intravenous methylene blue), other SSRIs, SNRIs, triptans (including rizatriptan), buspirone, tramadol, tryptophan, St. John's Wort, tricyclic antidepressants, or fentanyl can produce potentially life-threatening serotonin syndrome. Symptoms include agitation, hallucinations, rapid heart rate, high blood pressure, dilated pupils, muscle twitching, and high body temperature. Seek emergency care if these symptoms occur.
• Methylene blue — CRITICAL: Intravenous methylene blue is an MAO inhibitor. The FDA has issued safety communications warning against combining methylene blue with serotonergic drugs including SSRIs. This combination can cause fatal serotonin syndrome. Users of sertraline should not use methylene blue supplements without discussing with their physician.
• MAOIs: Do not start sertraline within 14 days of stopping an MAOI; do not start an MAOI within 14 days of stopping sertraline.
• Bleeding risk: SSRIs impair platelet aggregation and increase bleeding risk, particularly when combined with NSAIDs, aspirin, or anticoagulants (warfarin, clopidogrel).
• QT prolongation: Sertraline can prolong the QT interval — avoid combining with other QT-prolonging medications.
• Hyponatremia: SSRIs can cause low sodium, particularly in older adults — monitor for symptoms of confusion, weakness, and headache.
• Discontinuation syndrome: Do not stop sertraline abruptly — gradual tapering is recommended to avoid discontinuation symptoms (dizziness, nausea, flu-like symptoms, sensory disturbances).
• Sexual dysfunction: Decreased libido, delayed ejaculation, and anorgasmia are common and often dose-dependent.