What should a 14-year-old patient on Zoloft (sertraline) do if they forget to take it for a few days?

Management of Missed Sertraline Doses in a 14-Year-Old

If a 14-year-old patient misses several days of Zoloft (sertraline), they should take one dose as soon as they remember, then resume their regular daily schedule—do not attempt to "catch up" by taking multiple doses. 1

Immediate Action Steps

• Take the next scheduled dose immediately when the patient remembers they have missed doses 1
• Do not double up or take multiple doses to compensate for missed days, as this increases the risk of side effects without therapeutic benefit 1
• Resume the regular daily schedule going forward, taking sertraline at the same time each day 1

Understanding Discontinuation Symptoms

Missing several days of sertraline can trigger discontinuation symptoms, which are particularly relevant given sertraline's relatively shorter half-life compared to some other SSRIs. The patient and family should be aware of potential symptoms:

• Common discontinuation symptoms include anxiety, irritability, mood changes, restlessness, sleep disturbances, headache, sweating, nausea, dizziness, and electric shock-like sensations 1
• Onset timing: These symptoms typically emerge within 1-2 days after missing doses, given sertraline's approximately 26-hour half-life 2, 3
• Sertraline-specific risk: Research demonstrates that sertraline interruption causes more discontinuation symptoms than fluoxetine (which has a longer half-life) but fewer than paroxetine 2

Distinguishing Discontinuation from Relapse

It is critical to differentiate between discontinuation symptoms and return of underlying depression/anxiety:

• Discontinuation symptoms appear rapidly (within 1-3 days), include physical symptoms like dizziness and "brain zaps," and improve quickly once medication is resumed 4, 2
• Relapse symptoms develop more gradually (over weeks), primarily involve psychological symptoms matching the original condition, and require longer treatment to resolve 4

Monitoring and Follow-Up

• Contact the prescribing physician within 24-48 hours to report the missed doses and any emerging symptoms 1
• Monitor closely for both discontinuation symptoms and potential return of depression/anxiety symptoms over the next 1-2 weeks 4
• Assess adherence barriers: Identify why doses were missed (forgetfulness, side effects, lack of perceived benefit, access issues) to prevent future interruptions 5, 4

Preventing Future Missed Doses

Implement adherence strategies appropriate for adolescents:

• Use daily reminders such as phone alarms or medication reminder apps, as over 90% of adolescents have mobile phones 5
• Link medication-taking to daily routines (e.g., brushing teeth, meals) to create consistent habits 5
• Involve family support when appropriate, while respecting the adolescent's autonomy and confidentiality 5
• Address side effects proactively: If side effects contributed to non-adherence, discuss management strategies with the prescriber rather than stopping medication 1, 4
• Educate about treatment duration: Adolescents need to understand that antidepressants require consistent use even after symptoms improve, as premature discontinuation increases relapse risk 4, 6

Critical Safety Considerations

• Never abruptly stop sertraline without medical supervision, as this increases the risk of discontinuation syndrome 1, 4
• When discontinuation is planned, sertraline should be tapered gradually over days to weeks under physician guidance, not stopped suddenly 1, 4
• Watch for worsening mood: While resuming medication, monitor for increased depression, suicidal thoughts, or behavioral changes, particularly in the first few weeks, as this is a vulnerable period for adolescents on antidepressants 1

Common Pitfalls to Avoid

• Do not assume symptoms are "just" discontinuation: Any concerning psychiatric symptoms warrant immediate clinical evaluation, as distinguishing discontinuation from relapse can be challenging 4
• Do not restart at a lower dose unless specifically instructed by the prescriber—resume at the previously effective dose 1
• Do not delay restarting: The longer the interruption, the greater the risk of both discontinuation symptoms and relapse 2