What are the adverse effects of sertraline (Selective Serotonin Reuptake Inhibitor - SSRI) in elderly individuals?

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Last updated: March 16, 2025 • View editorial policy

From the Guidelines

Sertraline can cause significant adverse effects in elderly individuals, including increased risk of upper gastrointestinal (UGI) bleeding, particularly when combined with NSAIDs, as well as other side effects such as dizziness, drowsiness, and hyponatremia. The risk of UGI bleeding increases with age, from 4.1 hospitalizations per 1000 adults aged 65 to 70 years to 12.3 hospitalizations per 1000 octogenarians 1. Additionally, the odds of UGI bleeding in adults aged 40 to 79 years who currently receive SSRIs is much higher when they also receive an NSAID (adjusted OR, 15.6 [CI, 6.6 to 36.6]) 2.

Some key points to consider when prescribing sertraline to elderly individuals include:

  • Starting at a lower dose (typically 25mg daily) and gradually increasing if needed, with careful monitoring for side effects
  • Monitoring for worsening depression or suicidal thoughts, particularly during the initial treatment period
  • Regular follow-ups with healthcare providers to assess effectiveness and manage any side effects
  • Being aware of potential drug interactions, as older adults often take multiple medications
  • Considering the risk of hyponatremia, particularly in those taking diuretics

It's also important to note that antidepressant use seems to be protective against suicidal behavior in adults older than 65 years (OR, 0.06 [CI, 0.01 to 0.58]) 3. However, the risk of suicidal behaviors is highest in the first month of treatment, and patients should be closely monitored during this period 4, 5.

Overall, when prescribing sertraline to elderly individuals, it's essential to carefully weigh the potential benefits and risks, and to closely monitor patients for any adverse effects. The benefits of sertraline in treating depression in elderly individuals must be balanced against the potential risks, and healthcare providers should carefully consider these factors when making treatment decisions.

From the FDA Drug Label

As with all medications, greater sensitivity of some older individuals cannot be ruled out No overall differences in the pattern of adverse reactions were observed in the geriatric clinical trial subjects relative to those reported in younger subjects In 354 geriatric subjects treated with sertraline in placebo-controlled trials, the overall profile of adverse events was generally similar to that shown in Tables 2 and 3. Urinary tract infection was the only adverse event not appearing in Tables 2 and 3 and reported at an incidence of at least 2% and at a rate greater than placebo in placebo-controlled trials SSRIs and SNRIs, including sertraline, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event

The adverse effects of sertraline in elderly individuals include:

  • Urinary tract infection
  • Hyponatremia, which may be more likely in elderly patients It is also noted that greater sensitivity of some older individuals to sertraline cannot be ruled out. 6

From the Research

Adverse Effects of Sertraline in Elderly Individuals

The adverse effects of sertraline in elderly individuals include:

  • Dry mouth
  • Headache
  • Diarrhoea
  • Nausea
  • Insomnia
  • Somnolence
  • Constipation
  • Dizziness
  • Sweating
  • Taste abnormalities 7, 8

    Risk of Hyponatremia

    Elderly patients taking sertraline are at risk of developing hyponatremia, a condition characterized by low sodium levels in the blood 9

  • This condition can be severe and may require discontinuation of sertraline and replacement with a non-serotonergic antidepressant
  • Regular monitoring of serum sodium levels is recommended in elderly patients taking sertraline or other SSRIs 10

Comparison with Other Antidepressants

Sertraline has a relatively low potential for drug interactions and a favorable side effect profile compared to other SSRIs and tricyclic antidepressants (TCAs) 7, 8, 11

  • However, the risk of hyponatremia and other adverse effects should be carefully considered when prescribing sertraline to elderly patients 9, 10

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.