Sertraline [Neurosurgery Wiki]

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====== Sertraline ======

Sertraline is a **selective serotonin reuptake inhibitor (SSRI)** used primarily in the treatment of depression, anxiety disorders, and related psychiatric conditions. It is also used off-label in some somatic conditions like tinnitus or premature ejaculation.

===== Classification =====
  * **Drug class:** Antidepressant – SSRI
  * **ATC code:** N06AB06

===== Mechanism of Action =====
  * Selectively inhibits the **presynaptic reuptake of serotonin (5-HT)** in the central nervous system.
  * Increases extracellular serotonin levels → enhances serotonergic neurotransmission.
  * Minimal effect on norepinephrine and dopamine reuptake.

===== Indications =====
  * **Major depressive disorder (MDD)**
  * **Obsessive-compulsive disorder (OCD)** – including pediatric patients
  * **Panic disorder**
  * **Social anxiety disorder**
  * **Post-traumatic stress disorder (PTSD)**
  * **Premenstrual dysphoric disorder (PMDD)**
  * **Off-label:** tinnitus-related anxiety or distress

===== Dosage (Adults) =====
  * Starting dose: **50 mg/day**
  * Titration: Increase by 50 mg every few weeks if tolerated
  * Maximum: **200 mg/day**
  * Takes **2–4 weeks** to observe therapeutic effect

===== Adverse Effects =====
  * **Common:** Nausea, insomnia, headache, diarrhea, sexual dysfunction, dry mouth
  * **Less common:** Anxiety, tremor, sweating, weight changes
  * **Serious:** Suicidality in young adults, serotonin syndrome, hyponatremia (SIADH), QT prolongation (rare)

===== Contraindications =====
  * Concomitant use with **MAO inhibitors** (risk of serotonin syndrome)
  * Known hypersensitivity to sertraline
  * Use with **pimozide** (QT risk)

===== Warnings and Precautions =====
  * Monitor for **suicidal ideation** (especially in adolescents and young adults)
  * Taper gradually when discontinuing to avoid **withdrawal symptoms** (e.g., dizziness, irritability, paresthesias)
  * Caution in **hepatic impairment** – dose adjustment may be needed

===== Drug Interactions =====
  * **Serotonergic drugs:** Risk of serotonin syndrome
  * **NSAIDs, anticoagulants:** Increased bleeding risk
  * **CYP2D6 inhibitors/inducers:** May affect metabolism

===== Clinical Notes =====
  * Better tolerated than older antidepressants (e.g., TCAs, MAOIs)
  * Often preferred in patients with **comorbid anxiety**
  * Does **not cause sedation or weight gain** as frequently as some other SSRIs

===== Synonyms and Brand Names =====
  * **Brand names:** Zoloft®, Serlain®, Altruline®
  * **Generic name:** Sertraline hydrochloride

===== Related Topics =====
  * [[SSRI|Selective Serotonin Reuptake Inhibitors]]
  * [[antidepressants|Antidepressants overview]]
  * [[tinnitus|Tinnitus management]]