SSRI Antidepressant Pregnancy: Not recommended in pregnancy unless the clinical condition of the woman is such that the benefit is expected to outweigh the potential risk. Neonates should be observed if use continues into later pregnancy (withdrawal/serotonergic symptoms; possible increased risk of persistent pulmonary hypertension of the newborn). Use in nursing mothers is not recommended unless the benefit outweighs the risk.

Sertraline (Elderly)

Brand names: Lustral, Zoloft

Used in: Depression & Anxiety

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used for depression and anxiety disorders; it is a commonly preferred SSRI in older or medically complex patients.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Depression and OCD: start at 50 mg/day. Panic disorder, PTSD and social anxiety disorder: initiate at 25 mg/day, increased after one week to 50 mg once daily.

Route: Oral (with or without food)

Frequency: Once daily, either in the morning or evening

Max: 200 mg/day

Titration (all indications): patients not responding to 50 mg may benefit from dose increases in steps of 50 mg at intervals of at least one week, up to a maximum of 200 mg/day; dose changes should not be made more frequently than once per week given the 24-hour elimination half-life. Onset of effect may be seen within 7 days but longer periods are usually needed, especially in OCD. Maintenance: keep at the lowest effective level; depression should be treated for at least 6 months free of symptoms. ELDERLY: the SPC states only that 'elderly should be dosed carefully, as elderly may be more at risk for hyponatraemia (see section 4.4)' - no separate numeric elderly dose is given. Hepatic impairment: use with caution, a lower or less frequent dose should be used; must not be used in severe hepatic impairment (no clinical data). Discontinuation: avoid abrupt stopping - reduce gradually over at least one to two weeks. Paediatric (OCD only, per SPC): dosing is stated by age band and is not reproduced here - verify against a children's formulary and the full SPC; efficacy is not shown in paediatric major depressive disorder and no data are available under 6 years of age.

Dose adjustments

Renal

No dosage adjustment is necessary in patients with renal impairment (SPC 4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Initial Treatment Dosage for Adults Major Depressive Disorder –Sertraline hydrochloride treatment should be administered at a dose of 50 mg once daily. While a relationship between dose and effect has not been established for major depressive disorder, OCD, panic disorder, PTSD or social anxiety disorder, patients were dosed in a range of 50-200 mg/day in the clinical trials demonstrating the effectiveness of Sertraline hydrochloride for the treatment of this indication. Consequently, a dose of 50 mg, administered once daily, is recommended as the initial therapeutic dose. Patients not responding to a 50 mg dose may benefit from dose increases up to a maximum of …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2019-11-01. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or any of the excipients
Concomitant treatment with irreversible monoamine oxidase inhibitors (MAOIs) - risk of serotonin syndrome; do not initiate for at least 14 days after stopping an irreversible MAOI, and stop sertraline at least 7 days before starting one
Concomitant intake of pimozide

Side effects

Nausea (the most common undesirable effect)
Insomnia
Dizziness
Headache
Somnolence
Sexual dysfunction (ejaculation failure in men - 14% vs 0% placebo in social anxiety disorder)

Interactions

Irreversible MAOIs (including methylene blue) - contraindicated; risk of serotonin syndrome (SPC 4.3/4.4)
Pimozide - contraindicated (SPC 4.3)
Other serotonergic drugs (other serotonergic antidepressants, amphetamines, triptans, tryptophan, fenfluramine, 5-HT agonists, St John's wort) - use with caution and avoid where possible; risk of serotonin syndrome (SPC 4.4)
Antipsychotics and other dopamine antagonists, and opioids - increased risk of serotonin syndrome / neuroleptic malignant syndrome (SPC 4.4)
Medicines that prolong the QTc interval - caution; cases of QTc prolongation and torsade de pointes reported (SPC 4.4)

Clinical monograph

How it works

Sertraline selectively inhibits the reuptake of serotonin (5-HT) at the presynaptic neuron, increasing synaptic serotonin over several weeks.

Prescribing in practice

Start low and review early; therapeutic benefit typically takes 2–4 weeks, and initiation can transiently worsen anxiety.
In older patients watch for hyponatraemia (SIADH) and an increased bleeding risk, especially with NSAIDs or antithrombotics; consider gastroprotection.
Taper when stopping to limit discontinuation symptoms; be alert to serotonin syndrome when combined with other serotonergic drugs.

Monitoring

Review mood, anxiety and suicidal ideation early after starting and at dose changes; check sodium if features of hyponatraemia develop in older patients.

Counselling the patient

It can take a few weeks to work, and anxiety may briefly increase at first.
Do not stop suddenly — withdrawal effects can occur.
Report worsening mood or thoughts of self-harm, and unusual bleeding.

Evidence & guidelines

SSRIs are first-line drug treatment for moderate-to-severe depression and many anxiety disorders (NICE NG222/related guidance), with safety advantages in older patients.

Reference: NICE NG222; PROSPECT trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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