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.

• Drug class: Antidepressant – SSRI
• ATC code: N06AB06

• 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.

• 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

• 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

• 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)

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

• 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

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

• 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

• Brand names: Zoloft®, Serlain®, Altruline®
• Generic name: Sertraline hydrochloride

• Selective Serotonin Reuptake Inhibitors
• Antidepressants overview
• Tinnitus management