SSRIs · Psychiatry
Sertraline
Zoloft®(brand names vary by market)
A first-line SSRI with a clean interaction profile and a mountain of indications.
Also: oral liquid
Mechanism
Selective serotonin reuptake inhibitor: blocks SERT, raising synaptic serotonin; clinical effect builds over weeks as receptors adapt.
Open the interactive pathwayIndications
- Major depressive disorder
- Generalized anxiety and panic disorder
- OCD
- PTSD
Formulations
Dosing concepts
Expectation setting
Two to four weeks before mood moves, sometimes longer; early side effects fade first. Stopping in week two is the classic adherence failure.
Discontinuation
Taper rather than stop; discontinuation symptoms (dizziness, 'electric' sensations) are unpleasant though not dangerous.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~44%
- Half-life
- ~26 h
- Elimination
- hepatic: Least CYP-entangled of the older SSRIs at usual doses
Adverse effects
- Nausea, diarrhea (early)common
- Sexual dysfunctioncommonThe adverse effect patients quietly stop over; ask.
- Insomnia or somnolencecommon
- Hyponatremia (SIADH), especially in older adultsserious
- Bleeding risk (platelet serotonin)seriousAdditive with NSAIDs and anticoagulants.
- Serotonin syndrome with serotonergic partnersserious
Contraindications & precautions
Contraindications
- MAO inhibitor within 14 days
- Concurrent pimozide
Precautions
- Young adults early in therapy (activation, suicidality monitoring)
- Bleeding-prone patients on NSAIDs or anticoagulants
- Older adults (sodium)
Interactions
- SSRIs / SNRIs + MAO inhibitors (including linezolid)avoidSerotonin syndrome: agitation, clonus, hyperthermia: potentially fatal.
- SSRIs + NSAIDs / anticoagulantsmonitorUpper GI bleeding risk roughly doubles versus either alone.
- SSRIs / SNRIs + TramadolcautionSerotonin syndrome (usually milder spectrum) and seizures, especially at higher doses or in the elderly.
Monitoring
Mood, anxiety, and safety (structured scales help)
Effectiveness · 2-4 weeks after start, then regularly
Sodium in older adults if symptomatic
SIADH is an SSRI class effect
Activation, agitation, suicidal thoughts early
The first weeks carry the known risk window
Counselling points
- It takes a few weeks to feel the benefit; the side effects usually come first and then fade.
- Do not stop suddenly; we will taper when the time comes.
- Avoid regular ibuprofen/naproxen without checking, because of bleeding risk.
- Seek help immediately if mood worsens sharply or new thoughts of self-harm appear.
Clinical pearls
- Tramadol is a hidden serotonergic: combined with an SSRI it is a common real-world serotonin-syndrome pairing.
References & review
- Sertraline product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.