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Selective Serotonin Reuptake Inhibitor (SSRI)

Sertraline | Zoloft

Clinical Overview

Sertraline is a selective serotonin reuptake inhibitor (SSRI) indicated for depression, panic disorder, PTSD, social anxiety disorder, and OCD. It is one of the most widely prescribed antidepressants due to its broad efficacy across multiple psychiatric conditions, favorable side effect profile, and extensive safety data including use in pediatric populations.

Primary Clinical Applications

Sertraline is indicated for major depressive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, obsessive-compulsive disorder, and premenstrual dysphoric disorder. It is often considered first-line treatment for depression and anxiety disorders due to its well-established efficacy and tolerability profile.

Mechanism and Clinical Benefits

Sertraline selectively inhibits serotonin reuptake with high specificity and minimal effects on other neurotransmitter systems. It has the highest selectivity for serotonin among SSRIs and demonstrates linear pharmacokinetics. The medication has mild dopamine reuptake inhibition at higher doses, which may contribute to its efficacy.

Clinical Considerations

Sertraline has a relatively favorable side effect profile with moderate half-life (26 hours) that reduces discontinuation symptoms while allowing for once-daily dosing. It has fewer drug interactions than some other SSRIs and is generally well-tolerated across different age groups. The liquid formulation contains alcohol and requires special considerations.

Prescribing Information

Dosing & Administration

Major Depressive Disorder – Adults:

  • Initial: 50 mg once daily
  • Range: 50-200 mg once daily
  • Maximum: 200 mg once daily

Panic Disorder, PTSD, Social Anxiety:

  • Initial: 25 mg once daily
  • Target: 50 mg once daily after 1 week
  • Range: 50-200 mg once daily

Obsessive-Compulsive Disorder:

  • Adults: 50 mg once daily initially, range 50-200 mg daily
  • Children (6-12 years): 25 mg once daily initially
  • Adolescents (13-17 years): 50 mg once daily initially

Premenstrual Dysphoric Disorder:

  • Continuous: 50 mg daily throughout cycle
  • Luteal phase: 50 mg daily during luteal phase only

Administration:

  • Take once daily, morning or evening
  • With or without food
  • Oral concentrate: Mix with specified liquids only

Indications

  • Major depressive disorder (adults and pediatric patients ≥6 years)
  • Obsessive-compulsive disorder (adults and pediatric patients ≥6 years)
  • Panic disorder (adults)
  • Post-traumatic stress disorder (adults)
  • Social anxiety disorder (adults)
  • Premenstrual dysphoric disorder (adults)

Contraindications

  • Hypersensitivity to sertraline
  • Use with MAOIs (within 14 days)
  • Use with pimozide
  • Use with linezolid or IV methylene blue
  • Oral concentrate with disulfiram (contains alcohol)

Warnings & Precautions

  • Boxed Warning: Increased risk of suicidal thoughts and behavior in patients under 25 years
  • Serotonin syndrome: Risk with concurrent serotonergic drugs
  • Activation of mania: Monitor in patients with bipolar disorder
  • Discontinuation syndrome: Taper gradually when stopping
  • Abnormal bleeding: Increased risk with anticoagulants
  • Hyponatremia: Particularly in elderly patients
  • Angle-closure glaucoma: Pupillary dilation may trigger attack

Drug Interactions

  • MAOIs: Contraindicated – minimum 14-day washout
  • Pimozide: Contraindicated – QT prolongation risk
  • Serotonergic drugs: Increased risk of serotonin syndrome
  • Anticoagulants: Increased bleeding risk
  • CYP2D6 substrates: Sertraline weakly inhibits CYP2D6

Adverse Reactions

Common (≥5%):

  • Nausea, diarrhea, insomnia, somnolence, dizziness
  • Tremor, fatigue, decreased appetite, sweating
  • Sexual dysfunction, dry mouth

Pediatric-specific:

  • Agitation, hyperkinesia, flu syndrome

Special Populations

  • Hepatic Impairment: Use lower doses or less frequent dosing
  • Renal Impairment: No dose adjustment typically needed
  • Elderly: No specific dose adjustment, monitor for hyponatremia
  • Pregnancy: Category C – use only if benefits outweigh risks
  • Pediatric: Approved for OCD in children ≥6 years
Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. Always consult with qualified healthcare professionals before making any treatment decisions. Individual patient circumstances may vary significantly.