Should sertraline (Zoloft) be continued during hospitalization?

From the Guidelines

You should continue taking sertraline while in the hospital unless your healthcare providers specifically instruct you to stop. When you're admitted to a hospital, it's essential to inform the medical staff about all medications you're currently taking, including sertraline, so they can incorporate it into your treatment plan. Abruptly stopping sertraline can lead to withdrawal symptoms such as dizziness, irritability, headaches, nausea, and even a return of depression or anxiety symptoms 1. The hospital staff will typically continue your regular medication schedule, though they may need to adjust the timing to fit with hospital routines.

According to the American College of Physicians, clinicians should continue treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder, and for patients who have had 2 or more episodes of depression, an even longer duration of therapy may be beneficial 1. This guideline suggests that sertraline should be continued during hospitalization, as stopping it abruptly may lead to a relapse of depressive symptoms.

It's also important to note that the principle of continuing preexisting medications during hospitalization is supported by other guidelines, such as the 2022 AHA/ACC/HFSA guideline for the management of heart failure, which recommends continuing preexisting guideline-directed medical therapy (GDMT) during hospitalization unless contraindicated 1. Although this guideline is specific to heart failure, the principle of minimizing disruptions to established medication regimens can be applied more broadly.

If there are concerns about interactions with other treatments you're receiving in the hospital, your doctors will evaluate this and make appropriate changes. Always follow the guidance of the healthcare team caring for you during your hospital stay, as they have the most complete understanding of your current medical situation. Key considerations include:

• Informing hospital staff about your current medications
• Avoiding abrupt cessation of sertraline
• Potential adjustments to medication timing
• Monitoring for interactions with other treatments
• Following healthcare team guidance for your specific situation.

From the FDA Drug Label

In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered Patients should be periodically reassessed to determine the need for maintenance treatment

The decision to continue sertraline while in hospital should be made on a case-by-case basis, considering the individual patient's needs and circumstances.

• If the patient is being treated for a condition that requires maintenance treatment, such as Major Depressive Disorder, Posttraumatic Stress Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, or Panic Disorder, it is likely that sertraline should be continued.
• However, if the patient requires urgent treatment with other medications, such as linezolid or intravenous methylene blue, sertraline may need to be stopped promptly due to the risk of serotonin syndrome 2 2.
• In general, patients should be periodically reassessed to determine the need for maintenance treatment.

From the Research

Considerations for Continuing Sertraline in a Hospital Setting

• The decision to continue sertraline while in hospital should be based on the individual's medical history, current condition, and the potential benefits and risks of the medication 3, 4.
• Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is commonly used to treat depression, anxiety disorders, and other mental health conditions 3, 5.
• The medication has a relatively long elimination half-life, ranging from 22-36 hours, which allows for once-daily administration 3.
• Studies have shown that sertraline is generally well-tolerated and effective in treating various mental health conditions, including major depressive disorder, obsessive-compulsive disorder, and anxiety disorders 6, 4.

Potential Benefits of Continuing Sertraline

• Continuing sertraline in a hospital setting may help to maintain therapeutic levels of the medication and prevent withdrawal symptoms 3.
• Sertraline has been shown to be effective in reducing symptoms of depression and anxiety, which may be beneficial for patients who are experiencing these conditions while in hospital 4, 7.
• The medication may also help to improve sleep quality, appetite, and overall mental health, which can be beneficial for patients who are recovering from illness or injury 5, 4.

Potential Risks and Considerations

• As with any medication, there are potential risks and side effects associated with sertraline, including nausea, diarrhea, and sexual dysfunction 3, 5.
• Patients who are taking sertraline should be monitored closely for signs of adverse reactions, such as changes in mood, behavior, or physical condition 4.
• The decision to continue sertraline in a hospital setting should be made in consultation with a healthcare provider, taking into account the individual's medical history, current condition, and potential benefits and risks of the medication 6, 7.