Sertraline
Selective Serotonin Reuptake Inhibitor (SSRI) for depression, anxiety disorders and OCD
📊 Quick Facts About Sertraline
💡 Key Takeaways About Sertraline
- Effective for multiple conditions: Sertraline is approved for depression, OCD, PTSD, panic disorder, and social anxiety disorder in adults
- Takes time to work: Full therapeutic effects typically develop after 4–6 weeks of consistent use; do not stop early
- Never stop abruptly: Gradual dose reduction over several weeks is essential to avoid withdrawal symptoms
- Watch for interactions: Must not be combined with MAO inhibitors or pimozide; many other drug interactions require monitoring
- Monitor young adults: Increased risk of suicidal thoughts in patients under 25 during the first weeks of treatment
What Is Sertraline and What Is It Used For?
Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant used to treat depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and social anxiety disorder. It works by increasing the amount of serotonin available in the brain, helping to restore chemical balance and improve mood, anxiety, and emotional well-being.
Sertraline belongs to a group of medications known as SSRIs (selective serotonin reuptake inhibitors). These medications work by selectively blocking the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. By preventing serotonin from being reabsorbed back into nerve cells, sertraline increases the availability of serotonin in the synaptic cleft, the space between nerve cells where chemical signals are transmitted. This enhanced serotonergic activity helps regulate mood, anxiety, and emotional responses.
Sertraline is one of the most widely prescribed antidepressants globally and is included on the WHO Model List of Essential Medicines, reflecting its established efficacy, safety, and importance in healthcare. It is marketed under various brand names worldwide, including Zoloft and Lustral, as well as numerous generic formulations such as Sertraline Medical Valley, Sertralin Zentiva, Sertralin ratiopharm, Sertralin Teva Pharma, Sertralin Amarox, Oralin, Sertralin Hexal, and Sertralin Bluefish.
Approved Indications
Sertraline is approved by regulatory authorities including the EMA and FDA for the treatment of the following conditions in adults:
- Major depressive disorder (MDD): Treatment and prevention of recurrent depression
- Social anxiety disorder (social phobia): Characterized by intense anxiety in social situations
- Post-traumatic stress disorder (PTSD): A condition that can develop after experiencing traumatic events
- Panic disorder: With or without agoraphobia
- Obsessive-compulsive disorder (OCD): In adults, and in children and adolescents aged 6–17 years
Depression is a clinical illness characterized by persistent low mood, loss of interest in activities, sleep disturbances, fatigue, difficulty concentrating, and feelings of worthlessness or hopelessness. OCD and panic disorder are anxiety-related conditions where patients experience intrusive thoughts (obsessions) and repetitive behaviors (compulsions) or sudden episodes of intense fear with physical symptoms. PTSD can occur following traumatic experiences and involves symptoms such as flashbacks, nightmares, hypervigilance, and emotional numbing. Social anxiety disorder involves intense fear and avoidance of social situations due to worries about embarrassment or negative evaluation by others.
Your doctor has assessed that sertraline is appropriate for your specific condition. Sertraline may also be used for conditions not listed here. Always follow your doctor's instructions and consult them if you have questions about why you have been prescribed this medication.
What Should You Know Before Taking Sertraline?
Before taking sertraline, you must inform your doctor about all medical conditions, other medications, and whether you are pregnant or breastfeeding. Sertraline must never be combined with MAO inhibitors or pimozide. Special caution is needed for patients with epilepsy, bipolar disorder, liver disease, diabetes, bleeding disorders, or a history of suicidal thoughts.
Contraindications
You must not take sertraline in the following situations:
- Allergy to sertraline or any of the other ingredients in the tablets
- If you are taking or have recently taken MAO inhibitors (monoamine oxidase inhibitors) such as selegiline, moclobemide, or the antibiotic linezolid, or methylene blue. You must wait at least 2 weeks after stopping an MAO inhibitor before starting sertraline, and at least 1 week after stopping sertraline before starting an MAO inhibitor
- If you are taking pimozide (a medication used for psychotic disorders)
Combining sertraline with MAO inhibitors can cause serotonin syndrome, a potentially life-threatening condition. Symptoms include confusion, agitation, rapid heartbeat, high blood pressure, dilated pupils, muscle twitching, and high fever. If you experience these symptoms, seek emergency medical attention immediately.
Warnings and Precautions
Talk to your doctor before taking sertraline if you have or have previously had any of the following conditions:
- Epilepsy or seizures: Contact your doctor immediately if you experience a seizure while taking sertraline
- Bipolar disorder or schizophrenia: If you experience a manic episode, contact your doctor immediately
- Suicidal thoughts or self-harm: See the detailed section on suicidal thoughts below
- Serotonin syndrome: This rare but serious condition can occur when sertraline is taken with certain other medications
- Low blood sodium (hyponatremia): This can occur during treatment, especially in elderly patients or those taking diuretics
- Liver disease: A lower dose may be necessary
- Diabetes: Blood sugar levels may be affected, and diabetes medication may need adjustment
- Bleeding disorders: Sertraline may increase the risk of bleeding, particularly when taken with blood thinners or NSAIDs
- Glaucoma: Certain types of glaucoma (increased eye pressure) require caution
- Heart conditions: Including prolonged QT interval on ECG, low potassium or magnesium levels, or slow heart rate
- Electroconvulsive therapy (ECT): Inform your doctor if you are receiving ECT
Restlessness (Akathisia)
Use of sertraline has been associated with akathisia, a distressing inner restlessness and a compelling need to move, often characterized by an inability to sit or stand still. This occurs most commonly during the first few weeks of treatment. If you develop such symptoms, increasing the dose may be harmful, and you should speak with your doctor.
Withdrawal Reactions
Withdrawal effects when stopping treatment are common, particularly if treatment is stopped abruptly. The risk of withdrawal symptoms depends on the duration of treatment, the dosage, and how quickly the dose is reduced. Symptoms typically appear within the first few days after stopping and usually resolve on their own within 2 weeks. In some patients, symptoms may last longer (2–3 months or more). When discontinuing sertraline, it is recommended to gradually reduce the dose over several weeks or months. Always discuss with your doctor the best way to stop treatment.
Suicidal Thoughts and Worsening of Depression or Anxiety
If you are depressed or suffer from anxiety, you may sometimes have thoughts of self-harm or suicide. These thoughts may increase when first starting antidepressant treatment, as it takes time for these medications to take effect, usually about 2 weeks and sometimes longer.
These thoughts are more likely if you:
- Have previously had thoughts of self-harm or suicide
- Are a young adult under 25 years of age. Clinical studies have shown that young adults with psychiatric conditions treated with antidepressants have an increased risk of suicidal thoughts
If you have thoughts of self-harm or suicide at any time, contact your doctor immediately or go to the nearest emergency department. It may be helpful to tell a relative or close friend that you are depressed or anxious, and to ask them to read this information. Ask them to tell you if they think your condition is getting worse or if they are worried about changes in your behavior.
Sexual Dysfunction
Medications such as sertraline (SSRIs/SNRIs) can cause symptoms of sexual dysfunction, including decreased libido, delayed ejaculation, erectile difficulties, and anorgasmia. In some cases, these symptoms have persisted after discontinuation of treatment. If you experience sexual side effects, discuss them with your doctor.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor before taking sertraline. The safety of sertraline during pregnancy has not been fully established. It should only be used during pregnancy if your doctor considers the benefit to you to outweigh the potential risks to the baby.
Use of SSRI medications during the last three months of pregnancy may increase the risk of persistent pulmonary hypertension of the newborn (PPHN), which causes the baby to breathe faster and appear bluish. Symptoms usually begin within 24 hours of birth. Newborns may also experience other symptoms including breathing difficulties, feeding problems, irritability, tremor, muscle stiffness or limpness, and seizures. If your newborn has any of these symptoms, contact your doctor or midwife immediately.
There is evidence that sertraline passes into breast milk. Sertraline should only be given to breastfeeding women if the benefit outweighs the potential risks to the infant. Some animal studies have shown that medications like sertraline can reduce sperm quality, although no effect on human fertility has been demonstrated.
Children and Adolescents
Sertraline should generally not be used in children and adolescents under 18 years of age, except for patients with OCD. The risk of side effects such as suicidal behavior, self-harm thoughts, and hostility (aggression, defiance, anger) is greater in patients under 18. A long-term study of more than 900 children aged 6–16 years followed over a 3-year period showed that children treated with sertraline generally develop normally, apart from a small weight gain in those treated with higher doses.
Driving and Operating Machinery
Psychotropic medications like sertraline may affect your ability to drive or operate machinery. You should not drive or operate machinery until you know how this medication affects your alertness and coordination. Discuss with your doctor if you are unsure.
How Does Sertraline Interact with Other Drugs?
Sertraline has significant interactions with several medications. It must never be combined with MAO inhibitors or pimozide due to the risk of life-threatening reactions. Many other medications, including blood thinners, lithium, tramadol, St. John's Wort, and certain migraine medications, require careful monitoring when taken with sertraline. Always inform your doctor of all medications you are taking.
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medications. Some medications can affect how sertraline works, and sertraline can affect how other medications work. Taking sertraline with certain medications can cause serious side effects.
Major Interactions (Do Not Combine)
| Medication | Type | Risk |
|---|---|---|
| MAO inhibitors (selegiline, moclobemide, linezolid, methylene blue) | Antidepressants / Antibiotics | Serotonin syndrome – potentially life-threatening. Mandatory washout period required. |
| Pimozide | Antipsychotic | Increased pimozide levels, risk of serious cardiac arrhythmias (QT prolongation). |
Moderate Interactions (Use with Caution)
| Medication | Type | Effect |
|---|---|---|
| Warfarin | Blood thinner | Increased bleeding risk. INR monitoring required. |
| Lithium | Mood stabilizer | Increased risk of serotonin syndrome. Monitor lithium levels. |
| Tramadol, Fentanyl | Opioid analgesics | Risk of serotonin syndrome and seizures. |
| Sumatriptan and other triptans | Migraine medication | Increased risk of serotonin syndrome. |
| St. John's Wort (Hypericum perforatum) | Herbal supplement | Increased serotonergic activity. Effects may last 1–2 weeks after stopping. |
| NSAIDs (ibuprofen, aspirin) | Pain / Anti-inflammatory | Increased risk of gastrointestinal and other bleeding. |
| Diazepam | Benzodiazepine | Sertraline may increase diazepam levels. |
| Phenytoin, Carbamazepine | Antiepileptics | Altered drug levels. Monitoring required. |
| Cimetidine, Omeprazole | Acid reducers (PPIs/H2 blockers) | May increase sertraline levels. |
| Amphetamines | ADHD medication | Risk of serotonin syndrome. |
| Other antidepressants (fluoxetine, amitriptylin, nortriptylin) | Antidepressants | Increased serotonergic activity and risk of serotonin syndrome. |
Food and Alcohol Interactions
Sertraline tablets may be taken with or without food. However, the following should be noted:
- Alcohol: Should be avoided during treatment with sertraline. Alcohol affects the central nervous system and can worsen side effects such as drowsiness and dizziness, and may counteract the therapeutic effects of the medication
- Grapefruit juice: Should not be consumed while taking sertraline, as it can increase sertraline levels in the body by inhibiting the enzyme CYP3A4
What Is the Correct Dosage of Sertraline?
The usual effective dose of sertraline for depression and OCD in adults is 50 mg once daily, which can be increased up to a maximum of 200 mg daily. For panic disorder, PTSD, and social anxiety, treatment starts at 25 mg daily and is increased to 50 mg after one week. Sertraline should be taken once daily, either in the morning or evening, with or without food.
Adults
| Condition | Starting Dose | Usual Dose | Maximum Dose |
|---|---|---|---|
| Depression | 50 mg/day | 50–100 mg/day | 200 mg/day |
| OCD | 50 mg/day | 50–200 mg/day | 200 mg/day |
| Panic Disorder | 25 mg/day | 50–200 mg/day | 200 mg/day |
| PTSD | 25 mg/day | 50–200 mg/day | 200 mg/day |
| Social Anxiety Disorder | 25 mg/day | 50–200 mg/day | 200 mg/day |
Doses may be increased in increments of 50 mg at intervals of at least one week. Your doctor will determine the appropriate dose and duration of treatment based on your condition and response. Treatment for depression should usually continue for at least 6 months after improvement is noticed. It may take several weeks before your symptoms begin to improve.
Children and Adolescents (OCD Only)
Sertraline is only approved for children and adolescents aged 6–17 years for the treatment of OCD:
- Children aged 6–12 years: Starting dose of 25 mg daily, which may be increased to 50 mg daily after one week. Maximum dose: 200 mg daily
- Adolescents aged 13–17 years: Starting dose of 50 mg daily. Maximum dose: 200 mg daily
Elderly and Patients with Liver or Kidney Problems
Elderly patients may be more susceptible to certain side effects, particularly low blood sodium levels (hyponatremia). If you have liver problems, your doctor may prescribe a lower dose. Patients with kidney problems should also inform their doctor, who will adjust the dosage accordingly.
How to Take Sertraline
Take sertraline exactly as your doctor has instructed. The tablets may be taken with or without food, once daily, either in the morning or in the evening. Swallow the tablets whole with water. Your doctor will advise you on how long to continue treatment.
Missed Dose
If you forget to take a dose, do not take a double dose to make up for the missed one. Simply skip the missed dose and take the next dose at the regular time.
Overdose
If you take too much sertraline, contact your doctor immediately or go to the nearest emergency department. Always bring the medication packaging with you. Symptoms of overdose may include drowsiness, nausea and vomiting, rapid heartbeat, tremor, agitation, dizziness, and in rare cases, loss of consciousness.
What Are the Side Effects of Sertraline?
Like all medicines, sertraline can cause side effects, although not everyone experiences them. The most common side effect is nausea. Most side effects are dose-dependent and tend to improve or resolve with continued treatment. Serious side effects such as serotonin syndrome, severe skin reactions, and suicidal thoughts require immediate medical attention.
Severe skin rash with blisters (Stevens-Johnson syndrome), allergic reaction with swelling of face/lips/tongue, symptoms of serotonin syndrome (confusion, rapid heartbeat, high blood pressure, fever, muscle twitching), yellowing of skin or eyes (liver damage), or thoughts of self-harm or suicide.
Very Common
Affects more than 1 in 10 people
- Nausea
- Headache
- Insomnia
- Diarrhea
- Dizziness
- Drowsiness (somnolence)
- Dry mouth
- Delayed ejaculation
- Fatigue
Common
Affects 1 in 10 to 1 in 100 people
- Decreased or increased appetite
- Anxiety, depression, agitation, nervousness
- Decreased libido, nightmares, teeth grinding
- Tremor, muscle tension, tingling/numbness
- Visual disturbances, tinnitus (ringing in ears)
- Palpitations, hot flashes, yawning
- Abdominal pain, constipation, vomiting, flatulence
- Excessive sweating, rash
- Back pain, joint pain, muscle pain
- Erectile dysfunction, irregular menstruation
- Weight gain, chest pain, weakness, fever
Uncommon
Affects 1 in 100 to 1 in 1,000 people
- Suicidal thoughts, psychotic disorder, hallucinations
- Aggression, euphoria, paranoia, apathy
- Memory loss, involuntary muscle contractions, fainting
- Migraine, seizures, abnormal coordination
- Enlarged pupils, ear pain
- Rapid heartbeat, high blood pressure
- Bleeding problems, nosebleeds, blood in urine
- Shortness of breath, difficulty swallowing
- Hives, hair loss, itching, facial swelling
- Frequent urination, urinary incontinence
- Sexual dysfunction in women, vaginal bleeding
- Leg swelling, chills, difficulty walking, thirst
Rare
Affects 1 in 1,000 to 1 in 10,000 people
- Decreased platelet or white blood cell count
- Severe allergic reaction (anaphylaxis)
- High cholesterol, diabetes, low blood sugar
- Coma, abnormal movements, sudden severe headache
- Glaucoma, double vision, unequal pupil size
- Heart attack, abnormal heart rhythm, slow heartbeat
- Pancreatitis, liver dysfunction, jaundice
- Skin reaction to sunlight, muscle breakdown (rhabdomyolysis)
- Prolonged erection (priapism), breast enlargement
- Interstitial lung disease
Side Effects in Children and Adolescents
In clinical studies with children and adolescents, side effects were generally similar to those seen in adults. The most common side effects in children and adolescents were headache, insomnia, diarrhea, and nausea.
Withdrawal Symptoms
If you suddenly stop taking sertraline, you may experience withdrawal symptoms including dizziness, numbness, sleep disturbances, agitation or anxiety, headache, nausea, vomiting, and tremor. These symptoms can be minimized by gradually reducing the dose under your doctor's supervision.
An increased risk of bone fractures has been observed in patients taking SSRIs, including sertraline. If you have risk factors for osteoporosis, discuss this with your doctor.
How Should You Store Sertraline?
Store sertraline at room temperature in the original packaging, out of the reach and sight of children. Do not use the medication after the expiry date printed on the packaging. Do not dispose of medications via wastewater or household waste.
Keep sertraline out of the reach and sight of children. Do not use the medication after the expiry date stated on the carton and blister pack after “EXP.” The expiry date refers to the last day of that month. No special storage conditions are required for sertraline film-coated tablets. Store in the original packaging to protect from moisture.
Do not throw away medications in wastewater or household waste. Ask your pharmacist how to dispose of medications that are no longer needed. These measures help protect the environment.
What Does Sertraline Contain?
Each sertraline tablet contains sertraline hydrochloride as the active ingredient, equivalent to 25 mg, 50 mg, or 100 mg of sertraline. Inactive ingredients include hydroxypropyl cellulose, microcrystalline cellulose, sodium starch glycolate, calcium hydrogen phosphate dihydrate, and magnesium stearate in the tablet core, with a film coating of titanium dioxide (E171), hypromellose, macrogol 400, and polysorbate 80.
Active Ingredient
The active substance is sertraline hydrochloride. Each film-coated tablet contains sertraline hydrochloride equivalent to:
- 25 mg sertraline
- 50 mg sertraline
- 100 mg sertraline
Inactive Ingredients (Excipients)
Tablet core: Hydroxypropyl cellulose, microcrystalline cellulose, sodium starch glycolate Type A, calcium hydrogen phosphate dihydrate, magnesium stearate.
Film coating: Titanium dioxide (E171), hypromellose, macrogol 400, and polysorbate 80.
The tablets are white to off-white, film-coated, capsule-shaped, biconvex tablets. The 50 mg tablet has a score line and can be divided into two equal doses. The medication contains less than 1 mmol (23 mg) sodium per tablet, making it essentially sodium-free.
Frequently Asked Questions About Sertraline
Sertraline typically begins to show some effects within 1–2 weeks, but it usually takes 4–6 weeks of consistent daily use to experience the full therapeutic benefit. For some conditions like OCD, it may take 8–12 weeks. It is important to continue taking sertraline as prescribed even if you do not notice immediate improvement. Your doctor will monitor your progress and may adjust the dosage if needed.
No, alcohol should be avoided while taking sertraline. Both substances affect the central nervous system, and combining them can intensify side effects such as drowsiness, dizziness, and impaired coordination. Alcohol can also worsen symptoms of depression and anxiety, counteracting the therapeutic effects of sertraline. If you have questions about alcohol consumption during treatment, speak with your doctor.
If you forget to take a dose, do not take a double dose to make up for the missed one. Simply skip the missed dose and take your next dose at the usual time. Taking a double dose increases the risk of side effects without providing additional therapeutic benefit. If you frequently forget doses, consider setting a daily reminder or taking your medication at the same time each day.
The safety of sertraline during pregnancy has not been fully established. It should only be used when the potential benefit to the mother outweighs the possible risks to the baby. Use during the third trimester may increase the risk of persistent pulmonary hypertension of the newborn (PPHN) and neonatal withdrawal symptoms. Women who are pregnant, planning to become pregnant, or breastfeeding should discuss the risks and benefits with their healthcare provider. Treatment decisions should always be made in consultation with your doctor.
No, never stop sertraline abruptly. Sudden discontinuation can cause withdrawal symptoms including dizziness, numbness, tingling, sleep disturbances, vivid dreams, agitation, anxiety, headache, nausea, vomiting, and tremor. These symptoms are usually mild to moderate but can be severe in some patients. Your doctor will recommend gradually reducing the dose over a period of several weeks or months. Always discuss any changes to your medication with your doctor before making them.
Sertraline is one of several SSRIs, which also include fluoxetine, citalopram, escitalopram, and paroxetine. All SSRIs block serotonin reuptake, but they differ in their pharmacokinetic profiles, half-lives, side effects, and drug interaction potential. Sertraline has a relatively favorable side effect profile and fewer significant drug interactions compared to some other SSRIs. It is one of the most widely prescribed antidepressants worldwide and is listed on the WHO Model List of Essential Medicines. The choice of SSRI depends on individual patient factors, including medical history, other medications, and tolerability.
References and Sources
This article is based on the following peer-reviewed sources and international guidelines. All medical claims are supported by evidence level 1A (systematic reviews and randomized controlled trials).
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: WHO; 2023. Sertraline listed as essential antidepressant.
- European Medicines Agency (EMA). Sertraline – Summary of Product Characteristics (SmPC). EMA; 2024. Full prescribing information for the European Union.
- U.S. Food and Drug Administration (FDA). Zoloft (sertraline hydrochloride) – Prescribing Information. FDA; 2024. Complete United States prescribing information.
- National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. NICE; 2022. Updated 2024.
- Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018;391(10128):1357-1366.
- British National Formulary (BNF). Sertraline. NICE BNF; 2025. Drug monograph with dosing, interactions, and side effects.
- Soomro GM, Altman DG, Rajagopal S, Oakley-Browne M. Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev. 2008;(1):CD001765.
- Stein DJ, Ipser JC, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2006;(1):CD002795.
About the Medical Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, consisting of licensed specialist physicians with expertise in clinical pharmacology, psychiatry, and evidence-based medicine.
All content is reviewed by board-certified physicians following international guidelines (WHO, EMA, FDA, BNF, NICE) and the GRADE evidence framework.
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Last medical review: | Published: | Evidence level: 1A (Systematic reviews and RCTs) | Next scheduled review: