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Overview

Sertraline is a selective serotonin reuptake inhibitor (SSRI) widely used to treat mood and anxiety disorders. As a member of the SSRI class, it works primarily by increasing serotonin availability in the brain and is prescribed in many countries for adults and children in a range of conditions. For a general description of the SSRI class see drug class overview. Sertraline was introduced by its original manufacturer in 1991 and later became available as a generic product.

How it works and characteristics

Sertraline blocks the serotonin transporter on presynaptic neurons, which reduces reuptake of serotonin and raises extracellular serotonin levels. Clinically this can lead to gradual improvement in mood, anxiety and obsessive thoughts over several weeks. Its pharmacological profile differs from older antidepressants in being more selective for serotonin and generally having lower risk of certain toxicities in overdose.

Medical uses and examples

Common licensed uses include treatment of major depressive disorder in adult outpatients and a range of anxiety-related diagnoses. It is routinely used for obsessive–compulsive disorder, panic disorder and social anxiety disorder, with use in some pediatric cases where evidence supports safety and benefit. Clinicians often select sertraline when an SSRI is indicated because of its established track record; in fact, in 2011 it ranked among the most dispensed antidepressants with millions of prescriptions reported (prescription data).

Side effects, risks and interactions

Side effects commonly reported include gastrointestinal upset (nausea or diarrhea), sleep changes (insomnia or drowsiness), headache and sexual dysfunction. Less common but serious concerns include serotonin syndrome when combined with other serotonergic agents, increased bleeding risk with anticoagulants or NSAIDs, and withdrawal symptoms if stopped abruptly. Because of potential interactions, sertraline should not be taken with monoamine oxidase inhibitors without an appropriate washout period.

Dosage, monitoring and practical considerations

Typical treatment begins at a low or moderate dose and is adjusted according to response and tolerability; full antidepressant benefits may take several weeks. Patients starting sertraline are usually monitored for worsening mood, emerging suicidal thoughts (especially in young people), and for side effects. Decisions about use in pregnancy, breastfeeding or in combination with other medicines are individualized and rely on weighing benefits versus risks.

History and notable facts

Developed and marketed at the end of the 20th century, sertraline became one of the most widely prescribed antidepressants. It is often compared with other SSRIs for tolerability and effectiveness and remains a first-line option in many clinical guidelines. For clinical guidelines and prescribing information consult a trusted medical resource or your clinician via clinical guidance.