Sertraline: Difference between revisions
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| intro = '''Sertraline''' is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety disorders, OCD, PTSD, and panic disorder. | | intro = '''Sertraline''' is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety disorders, OCD, PTSD, and panic disorder. In the US, it is one of the [https://www.definitivehc.com/resources/healthcare-insights/top-antidepressants-by-prescription-volume most frequently utilized SSRIs at this time]. | ||
| pharmacokinetics = Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week. | | pharmacokinetics = Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week. | ||
| pharmacodynamics = Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs. | | pharmacodynamics = Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs. | ||
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| references = | | references = | ||
}}<h2 id="Pharmacokinetics">Pharmacokinetics</h2> | }}<h2 id="Pharmacokinetics">Pharmacokinetics</h2> | ||
Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.<h2 id="Pharmacodynamics">Pharmacodynamics</h2> | |||
Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.<h2 id="Indications">Indications</h2> | |||
*Major depressive disorder | |||
*Generalized anxiety disorder | |||
*Obsessive-compulsive disorder | |||
*Post-traumatic stress disorder | |||
*Panic disorder | |||
*Premenstrual dysphoric disorder<h2 id="Dosing">Dosing and titration</h2> | |||
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.<h2 id="Effects">Effects</h2><span></span> | |||
''Therapeutic:'' improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks). | |||
<span></span> | |||
''Common adverse:'' nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.<h2 id="Adverse">Adverse effects</h2> | |||
Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.<h2 id="Contraindications">Contraindications</h2> | |||
MAOIs (within 14 days), pimozide, severe hepatic impairment. Caution: bipolar disorder (mood switching risk), seizure disorders.<h2 id="Interactions">Interactions</h2> | |||
MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.<h2 id="Pregnancy">Pregnancy and lactation</h2> | |||
Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.<h2 id="Monitoring">Monitoring</h2> | |||
Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.<h2 id="Counseling">Patient counseling</h2> | |||
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.<h2 id="SeeAlso">See also</h2><span></span> | |||
[[Fluoxetine]], [[Paroxetine]], [[Citalopram]], [[Escitalopram]] | |||
[[Category:Medicines]] | |||
<h2 id="Pharmacokinetics">Pharmacokinetics</h2> | |||
Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.<h2 id="Pharmacodynamics">Pharmacodynamics</h2> | Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.<h2 id="Pharmacodynamics">Pharmacodynamics</h2> | ||
Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.<h2 id="Indications">Indications</h2> | Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.<h2 id="Indications">Indications</h2> | ||
Revision as of 21:32, 11 May 2026
Experience
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Problems
- Major depressive disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
- Premenstrual dysphoric disorder
Titration strategies
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.
Effects
Therapeutic: improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks). Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.
Pharmacokinetics
Pharmacodynamics
Interactions
Pregnancy and lactation
Monitoring
Patient counseling
Relevant anecdote
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Relevant Literature
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See also
Pharmacokinetics
Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.
Pharmacodynamics
Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.
Indications
- Major depressive disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
- Premenstrual dysphoric disorder
Dosing and titration
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.
Effects
Therapeutic: improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks).
Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.
Adverse effects
Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.
Contraindications
MAOIs (within 14 days), pimozide, severe hepatic impairment. Caution: bipolar disorder (mood switching risk), seizure disorders.
Interactions
MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.
Pregnancy and lactation
Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.
Monitoring
Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.
Patient counseling
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.
See also
Fluoxetine, Paroxetine, Citalopram, Escitalopram
Pharmacokinetics
Well-absorbed orally, ~44% bioavailability. Metabolized hepatically via CYP3A4/CYP2C19/CYP2D6 to N-desmethylsertraline (less active). Half-life ~26h; steady state in ~1 week.
Pharmacodynamics
Highly selective inhibitor of the serotonin reuptake transporter (SERT). Mild dopamine reuptake inhibition at higher doses. Minimal affinity for muscarinic, histaminic, or adrenergic receptors — hence cleaner adverse effect profile than TCAs.
Indications
- Major depressive disorder
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
- Panic disorder
- Premenstrual dysphoric disorder
Dosing and titration
Start 25–50 mg PO daily. Titrate by 25–50 mg every 1–2 weeks based on response. Typical effective dose 50–200 mg/day; max 200 mg/day.
Effects
Therapeutic: improved mood, reduced anxiety, fewer obsessive thoughts (delayed 2–4 weeks).
Common adverse: nausea, diarrhea, sexual dysfunction, insomnia, somnolence, sweating.
Adverse effects
Serotonin syndrome (especially with other serotonergic agents), QT prolongation at high doses, hyponatremia (SIADH, esp. elderly), bleeding risk, suicidality warning in young adults, discontinuation syndrome.
Contraindications
MAOIs (within 14 days), pimozide, severe hepatic impairment. Caution: bipolar disorder (mood switching risk), seizure disorders.
Interactions
MAOIs (serotonin syndrome — contraindicated), triptans, tramadol, linezolid, lithium, NSAIDs/anticoagulants (bleeding), CYP2D6 substrates.
Pregnancy and lactation
Category C. SSRIs in third trimester associated with persistent pulmonary hypertension of the newborn (PPHN) and neonatal adaptation syndrome. Risk-benefit decision; sertraline often preferred in pregnancy among SSRIs.
Monitoring
Mood/suicidality (especially first 4 weeks), sodium (elderly), QT in cardiac risk, response and side effects.
Patient counseling
Take with or without food. Effect emerges over 2–4 weeks. Don't stop abruptly — taper to avoid withdrawal. Report serotonin-syndrome symptoms.
See also