What are the disadvantages of Sertraline?

From the Guidelines

Sertraline has several disadvantages, including a higher rate of diarrhea, sexual dysfunction, and an increased risk of nonfatal suicide attempts.

Disadvantages of Sertraline

• Gastrointestinal side effects: Sertraline has been associated with a higher rate of diarrhea compared to other SSRIs, such as bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, or venlafaxine 1.
• Sexual dysfunction: Sertraline has been shown to have a higher rate of sexual adverse events compared to bupropion, but a lower rate compared to paroxetine 1.
• Increased risk of nonfatal suicide attempts: SSRIs, including sertraline, have been associated with an increased risk of nonfatal suicide attempts compared to placebo, with an odds ratio of 1.57 (CI, 0.99 to 2.55) 1.
• Discontinuation syndrome: Sertraline, like other SSRIs, can cause a discontinuation syndrome characterized by dizziness, fatigue, lethargy, and other symptoms when the medication is stopped abruptly or the dose is reduced too quickly 1.

Important Considerations

When prescribing sertraline, it is essential to monitor patients closely for adverse events, particularly during the first 1-2 weeks of treatment, and to discuss the potential risks and benefits with patients before initiating therapy 1. Additionally, regular assessment of treatment response and adverse effects is crucial to ensure the safe and effective use of sertraline 1.

From the FDA Drug Label

Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking sertraline Clinical Worsening and Suicide Risk Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Psychiatric Disorders-Frequent: yawning, other male sexual dysfunction, other female sexual dysfunction; Infrequent: depression, amnesia, paroniria, teeth-grinding, emotional lability, apathy, abnormal dreams, euphoria, paranoid reaction, hallucination, aggressive reaction, aggravated depression, delusions; Rare: withdrawal syndrome, suicide ideation, libido increased, somnambulism, illusion The safety profile observed with sertraline treatment in patients with major depressive disorder, OCD, panic disorder, PTSD, PMDD and social anxiety disorder is similar (including Torsade de Pointes arrhythmias) (including reversible cerebral vasoconstriction syndrome and Call-Fleming syndrome) hypothyroidism, agranulocytosis, aplastic anemia and pancytopenia, leukopenia, thrombocytopenia, lupus-like syndrome, serum sickness, diabetes mellitus, hyperglycemia, galactorrhea, hyperprolactinemia, extrapyramidal symptoms, oculogyric crisis, serotonin syndrome, psychosis, pulmonary hypertension, severe skin reactions, which potentially can be fatal, such as Stevens-Johnson syndrome, vasculitis, photosensitivity and other severe cutaneous disorders, rare reports of pancreatitis, and liver events-clinical features (which in the majority of cases appeared to be reversible with discontinuation of sertraline) occurring in one or more patients include: elevated enzymes, increased bilirubin, hepatomegaly, hepatitis, jaundice, abdominal pain, vomiting, liver failure and death.

The disadvantages of Sertraline include:

• Clinical Worsening and Suicide Risk: emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, and suicidal ideation
• Psychiatric Disorders: yawning, sexual dysfunction, depression, amnesia, teeth-grinding, emotional lability, apathy, abnormal dreams, euphoria, paranoid reaction, hallucination, aggressive reaction, and delusions
• Serious Adverse Events: hypothyroidism, agranulocytosis, aplastic anemia, pancytopenia, leukopenia, thrombocytopenia, lupus-like syndrome, serum sickness, diabetes mellitus, hyperglycemia, galactorrhea, hyperprolactinemia, extrapyramidal symptoms, oculogyric crisis, serotonin syndrome, psychosis, pulmonary hypertension, and severe skin reactions
• Liver Events: elevated enzymes, increased bilirubin, hepatomegaly, hepatitis, jaundice, abdominal pain, vomiting, liver failure, and death 2, 2, 2

From the Research

Disadvantages of Sertraline

• Typical side effects of sertraline include gastrointestinal and central nervous system effects, as well as treatment-emergent sexual dysfunction 3
• Withdrawal reactions may be associated with abrupt discontinuation of the agent 3
• Sertraline has been associated with gastrointestinal disturbances (nausea, diarrhoea/loose stools) and male sexual dysfunction (primarily ejaculatory disturbance), although each of these effects is usually mild and transient, decreasing in frequency with continued treatment 4
• Sertraline is highly protein bound and may alter blood levels of other highly protein bound agents 3
• Steady-state plasma concentrations of sertraline vary widely, up to 15-fold, in patients receiving usual antidepressant dosages, which may lead to inconsistent therapeutic effects 5