Sertraline Uses and Applications
Sertraline is primarily used to treat major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). 1
Primary Indications
Sertraline is FDA-approved for the following conditions:
- Major Depressive Disorder (MDD)
- Obsessive Compulsive Disorder (OCD)
- Panic Disorder
- Posttraumatic Stress Disorder (PTSD)
- Social Anxiety Disorder
- Premenstrual Dysphoric Disorder (PMDD)
Mechanism of Action
Sertraline is a selective serotonin reuptake inhibitor (SSRI) that works by:
- Inhibiting presynaptic reuptake of serotonin from the synaptic cleft 2
- Slowly absorbing following oral administration
- Undergoing extensive first-pass metabolism to form N-desmethyl-sertraline (a weakly active metabolite)
- Having an elimination half-life of 22-36 hours, allowing for once-daily dosing 2
Dosing Guidelines
The American College of Psychiatry recommends the following dosing protocol for sertraline 3:
| Step | Intervention | Dose | Duration |
|---|---|---|---|
| 1 | Initial dose | 25-50mg daily | 1 week |
| 2 | Increase dose | 50-100mg daily | 1 week |
| 3 | Target dose | 50-200mg daily | 4-6 weeks |
- Sertraline can be taken with or without food
- For older adults, start at lower doses (25mg daily) and titrate slowly
- For patients with cardiovascular disease, start at 25mg daily and increase by 25mg every 2 weeks
Special Populations
Older Adults
- Should be started on lower doses of sertraline due to increased risk of adverse effects 3
- Initial dose of 25mg daily recommended
Patients with Cardiovascular Disease
- Start at 25mg daily and titrate slowly (increase by 25mg every 2 weeks) 3
- Monitor for cardiovascular side effects
Children and Adolescents
- Efficacy demonstrated for OCD in ages 6-17
- Not sufficiently supported for MDD in pediatric patients
- Dosing: 25mg/day (ages 6-12) or 50mg/day (ages 13-18), titrated weekly to maximum 200mg/day 1
- Monitor for weight loss, which occurs more commonly than in adults
Important Safety Considerations
Suicide Risk
- May increase suicidal thoughts or actions in children, teenagers, or young adults within the first few months of treatment 1
- Close monitoring required during initial treatment period
- Evaluate response after 2 weeks to adjust dosage and monitor side effects 3
Serotonin Syndrome
- Life-threatening condition that can include agitation, hallucinations, coma, coordination problems, racing heartbeat, and other symptoms 1
- Avoid combining with other serotonergic agents
Pregnancy Considerations
- Use during pregnancy only if potential benefit justifies risk to fetus
- Neonates exposed to sertraline late in third trimester may develop complications requiring hospitalization 1
- Increased risk for persistent pulmonary hypertension of the newborn (PPHN)
Discontinuation
- Do not stop sertraline abruptly
- Gradual tapering recommended to avoid withdrawal symptoms including anxiety, irritability, headache, dizziness, and "electric shock-like sensations" 1
Drug Interactions
Sertraline has minimal inhibitory effects on major cytochrome P450 enzymes 2, but avoid use with:
- Pimozide (Orap®) due to risk of serious heart problems
- MAOIs (wait at least 2 weeks between stopping an MAOI and starting sertraline)
- Disulfiram (if taking liquid form of sertraline)
Efficacy Data
- Sertraline is as effective as other antidepressants across a wide range of indications 4
- In panic disorder, sertraline (50-175 mg/day) has proven effective in both short and long-term studies 5
- For OCD, sertraline shows significant therapeutic efficacy in daily dosages of 50-200 mg 6
- May offer tolerability benefits compared to other antidepressants in patients with psychiatric and/or medical comorbidities 4
Monitoring Recommendations
- Complete evaluation at 4-6 weeks to assess full response
- Use standardized measures like PHQ-9 to track depression symptoms
- Monitor for adverse effects, particularly in the first weeks of treatment
- For long-term treatment, continue for at least 9-12 months after symptom remission to prevent relapse 3