Medications Directory

Approved indications: Sertraline is FDA-approved for major depressive disorder in adults; obsessive-compulsive disorder in adults and children 6–17 years; and for panic disorder, posttraumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder in adults.

Off-label uses (evidence varies):

• Generalized anxiety disorder and other anxiety conditions.
• Premature ejaculation and certain eating disorders (such as bulimia nervosa) in selected patients.
• Depression or anxiety associated with some medical or neurologic illnesses when other options are unsuitable.

Efficacy expectations: Many patients notice early improvement in sleep, energy, or anxiety within 1–2 weeks, but full benefit for mood and other symptoms usually develops over 4–6 weeks or longer; in clinical trials, sertraline reduces symptom scores to a similar degree as other SSRIs, though individual response and tolerability vary.

Comparison to similar drugs: Sertraline’s overall antidepressant and anti-anxiety effectiveness is comparable to other SSRIs, with relatively favorable data for anxiety disorders and a side-effect profile that for many patients is manageable with dose adjustment and time.

Adult depression, PTSD, panic disorder, and social anxiety disorder: Typical starting dose is 25–50 mg by mouth once daily, increased in steps of 25–50 mg at intervals of about 1 week to a usual maintenance range of 50–200 mg once daily.

Adult premenstrual dysphoric disorder (PMDD): Dosing may be continuous (commonly 50–150 mg once daily) or limited to the luteal phase of the menstrual cycle, adjusted based on symptom control and tolerability.

Pediatric obsessive-compulsive disorder: For children 6–12 years, treatment often starts at 25 mg once daily and increases gradually up to a maximum of 200 mg/day if needed; adolescents 13–17 years often start at 50 mg once daily with similar maximum doses, under specialist supervision.

How to take: Take sertraline once daily at about the same time each day, with or without food (taking with food can reduce stomach upset); tablets are swallowed whole with water, and the oral solution should be measured carefully and diluted in the recommended beverage immediately before taking.

Special dosing instructions: Dose changes should generally not occur more often than once per week; people with liver impairment usually require lower or less frequent doses, and use is generally avoided in severe hepatic impairment.

Missed dose: If a dose is missed, take it as soon as remembered the same day; if it is close to the time of the next dose, skip the missed dose and resume the regular schedule—do not take two doses at once.

Overdose: In suspected overdose, including taking much more than prescribed or combining with other substances, call poison control or seek emergency medical care immediately, even if symptoms are mild or absent.

Common side effects: Nausea, diarrhea, dry mouth, sweating, tremor, headache, feeling tired or restless, and sexual side effects (reduced libido, delayed orgasm) are common, usually mild to moderate, and often lessen after the first few days to weeks of treatment.

Serious or rare adverse effects needing urgent care:

• New or worsening suicidal thoughts or behavior, especially in children, adolescents, and young adults.
• Signs of serotonin syndrome (e.g., agitation, confusion, fever, sweating, stiff or twitching muscles, rapid heart rate).
• Severe allergic reaction, seizures, very low sodium (confusion, severe weakness, seizures), unusual bruising or bleeding, or manic symptoms (very elevated mood, racing thoughts, risky behavior).

Warnings and precautions: Avoid use with MAO inhibitors, linezolid, IV methylene blue, or pimozide; use carefully in people with bipolar disorder (risk of mania), seizure disorders, bleeding risks, low sodium or risk factors for hyponatremia (especially older adults and those on diuretics), liver disease, or significant heart disease.

Pregnancy and breastfeeding: Sertraline is widely used when treating depression or anxiety during pregnancy is important; data suggest generally favorable reproductive safety but a small risk of neonatal adaptation symptoms and possible persistent pulmonary hypertension of the newborn, so decisions are individualized; during breastfeeding, infant exposure through milk is low and sertraline is often a preferred SSRI.

Comparative safety: Overall safety is similar to other SSRIs, with relatively low risk of weight gain and limited effects on heart rhythm at standard doses, but the same class risks of serotonin syndrome, bleeding, and withdrawal symptoms if stopped abruptly.

Side-effect reporting and safety updates: Patients and clinicians can report suspected side effects to the FDA MedWatch program and review current safety communications and prescribing information on FDA and manufacturer websites.

Major drug interactions:

• Contraindicated with MAO inhibitors (e.g., phenelzine, selegiline), linezolid, IV methylene blue, and pimozide because of risks of serotonin syndrome or serious heart rhythm problems.
• Use caution with other serotonergic agents (other SSRIs/SNRIs, triptans, tramadol, fentanyl, lithium, St. John’s wort, tryptophan) due to serotonin syndrome risk.
• Sertraline can inhibit CYP2D6 and affect levels of some tricyclic antidepressants, antipsychotics, beta-blockers, and antiarrhythmics, sometimes requiring dose adjustments and monitoring.
• Combining with NSAIDs, aspirin, or anticoagulants (e.g., warfarin, DOACs) increases bleeding risk.

OTC medicines and supplements: Many cough/cold, migraine, and weight-loss products, as well as herbal remedies like St. John’s wort, can interact with sertraline; check labels and ask a clinician or pharmacist before using them regularly.

Food, alcohol, and lifestyle: Sertraline has no major food restrictions and can be taken with or without meals; alcohol can increase dizziness, drowsiness, and may worsen mood, so most clinicians advise avoiding or strictly limiting alcohol.

Conditions requiring extra caution: Use carefully in people with bipolar disorder, seizure disorders, bleeding disorders or low platelets, low sodium or risk factors for hyponatremia, liver disease, significant cardiac disease, or narrow-angle glaucoma.

Monitoring needs: Routine blood tests are not usually required, but clinicians typically monitor mood, anxiety, and suicidal thoughts (especially early in treatment and in younger patients); they may periodically check sodium levels in older adults or those on diuretics, and consider liver tests or weight and growth checks in children when clinically indicated.

Q: How long does it take for sertraline to start working?
A: Some people notice better sleep, energy, or less anxiety within 1–2 weeks, but full improvement in mood and other symptoms usually takes 4–6 weeks or longer.

Q: Can I drink alcohol while taking sertraline?
A: Alcohol can increase side effects like drowsiness and may worsen depression or anxiety, so many clinicians recommend avoiding or strictly limiting alcohol while on sertraline.

Q: Will sertraline make me gain weight?
A: Sertraline may cause small weight changes in some people, but it tends to have a lower risk of significant weight gain than some other antidepressants; healthy eating and activity can help minimize changes.

Q: Is sertraline safe during pregnancy or breastfeeding?
A: Sertraline is commonly used when treatment is needed in pregnancy or breastfeeding, with generally reassuring safety data, but the decision to use it should be made with a clinician after weighing the benefits and potential risks.

Q: What happens if I stop sertraline suddenly?
A: Stopping abruptly can cause withdrawal-like symptoms such as dizziness, irritability, flu-like feelings, or “electric shock” sensations, so doses are usually tapered slowly under medical supervision.