Sertraline (Zoloft, Lustral, Serlain, Apo-Sentral, Asenta, Gladen, Stimulotin, Corcorz)

Sertraline is an SSRI antidepressant. It was released by Pfizer Pharmaceuticals in 1991. In 2003, Zoloft (brand of sertraline) was approved to treat extreme obsessive compulsive disorder in children. Pfizer's patent expired in 2006, and generic forms are now available.

The Bottom Line: What You Really Need to Know

Uses of sertraline

The FDA has approved sertraline for the treatment of depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder and social anxiety disorder (SAD). Sertraline is also used for a number of other problems, such as:

Sertraline has been approved to treat severe OCD in children between the ages of 6 and 17.

Dosage and instructions

The usual dose of sertraline is 50 mg/day. Therapy is usually started at 50 mg/day and the dose is increased at weekly intervals if necessary. The maximum dose is 200 mg/day.

Children and older people often need smaller doses of medication and may start with 25 mg/day.

People with liver disease may need a smaller dose of sertraline.

How sertraline works

We don't know exactly what causes depression and other mental health problems, but one theory that is pretty well-accepted is that there is chemical imbalance in the brain and nervous tissue. Several chemicals called neurotransmitters help nerve cells communicate, and serotonin is one of those chemicals.

Nerve impulses cause the cell to release serotonin. The serotonin travels across the gap between cells and attaches to the other cell. Some serotonin is reabsorbed by the first cell.

Sertraline is a serotonin selective reuptake inhibitor; it keeps serotonin from being reabsorbed and allows it to accumulate, restoring chemical balance. Once you start taking sertraline, it takes several days for enough serotonin to accumulate to restore balance.

Sertraline is broken down (metabolized) by your liver. After it is broken down, most of it is excreted in feces and the rest is excreted in urine.

Side effects of sertraline

Most people experience some transient side effects with SSRI medications when they first start taking them. The most common side effects experienced with sertraline are sleepiness, nervousness, insomnia, dizziness, nausea, dry mouth, tremor and sexual side effects.

Sexual side effects are common with SSRI medications. People who take sertraline may experience decreased sexual desire, ejaculatory failure or inability to experience orgasm. These side effects may go away after a few weeks or months; if they do not, your doctor may decrease your dose or change you to a different medication.

Many other side effects can be associated with sertraline. Some of them are:

Serious side effects may occur, including activation of mania, serotonin syndrome and suicidality. These are discussed at more length in the section on Warnings and Precautions.

Drug Interactions

Monamine oxidase inhibitors (MAOI) can have a serious and potentially fatal interaction with SSRIs. If you have been taking a MAOI, you should not take sertraline for at least two weeks.

You may need a smaller dose of sertraline if you are taking cimetadine.

There is a risk of serotonin syndrome occurring if you take sertraline and sumatriptan or other similar migraine headache medications.

The elixir (liquid form) of sertraline contains alcohol and cannot be taken with Antabuse.

If you take sertraline and pimozide (Orap) or thoridazine (Mellaril), there is a chance you could have a serious or fatal heart dysrhythmia.

Other medications that can interact with sertraline are:

Withdrawal from sertraline

Sertraline and other SSRIs cause withdrawal symptoms and should not be stopped abruptly. The dosage should be tapered gradually over several weeks. Withdrawal symptoms include: mood changes, irritability, agitation, dizziness and lightheadedness, tingling and "electric shock" sensations, anxiety, confusion, headaches, insomnia and vivid dreams. Sometimes the symptoms can be severe and extremely uncomfortable.

Warnings, precautions and contraindications

Suicidality: There may be an increased risk of suicide when taking sertraline, especially in the first few weeks of treatment. Close monitoring is recommended during those first few weeks, including at least weekly appointments with a physician or therapist. Friends and family should be instructed to check the patient daily and should ask about thoughts of self-harm. The patient should be watched for:

MAOIs and sertraline: Serious interactions can occur when MAOI and SSRI medications are taken concurrently. This interaction is similar to serotonin syndrome or neuroleptic malignant syndrome and it can be fatal. At least two weeks should elapse between taking MAOIs and sertraline.

Activation of mania: Sertraline can activate mania in patients who have bipolar depression. The mania can be very severe and may be accompanied by agitation, paranoia and delusional thinking. Rapid cycling between mania and depression can occur, too.

Serotonin syndrome: Serotonin syndrome is a toxicity syndrome and is most likely to occur when someone is taking sertraline and they take another medication that affects serotonin. There is a very long list of medications that can affect serotonin and it includes prescription, over the counter and herbal medications and some illegal drugs.

Serotonin syndrome can be fatal. Mild toxicity symptoms may be headache, shivering, sweating, dilated eyes, rapid heart rate and twitching. If toxicity is more severe the symptoms get worse and can include extreme fever, rapid heart beat and high blood pressure, delirium, seizures, muscle spasms and rigidity, coma and death.

The symptoms can occur suddenly and progress rapidly, and usually occur within a few hours of taking the medication.

Pregnancy and lactation: If sertroline is taken during the 3rd trimester of pregnancy, the baby may suffer withdrawal after birth. The infant may also have PPHN (persistent pulmonary hypertension of the neonate), a serious lung problem that requires prolonged hospitalization and breathing support.

There is some evidence that SSRIs can cause congenital heart defects if the mother takes them during the first trimester of pregnancy. It is not clear whether sertraline causes birth defects or not.

Sertraline is found in breast milk, but in very small amounts. We don't know if or how this affects the baby.

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