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SSRI (Selective Serotonin Reuptake Inhibitor) Pregnancy: Use only if benefit outweighs risk. Neonatal adaptation syndrome if used near term. Persistent pulmonary hypertension of newborn (very rare).

Sertraline

Brand names: Lustral, Zoloft

Adult dose

Dose: 50 mg once daily; increase to 100–200 mg if needed
Route: Oral
Frequency: Once daily (morning or evening)
Max: 200 mg/day
Depression/PTSD: start 50 mg OD, increase by 50 mg every 4–7 days to target (100–200 mg). OCD: start 50 mg, titrate up to 200 mg/day. Panic disorder: start 25 mg for 1 week then 50 mg. PMDD: 50 mg daily or during luteal phase only. Allow 4–6 weeks for full antidepressant effect.

Paediatric dose

Route: Oral
Frequency: Once daily
Max: 200 mg/day
OCD (6–17 years): 25 mg once daily (6–12 years); 50 mg once daily (13–17 years). Increase after 1 week to 50 mg/day (6–12) or 100 mg/day (13–17), max 200 mg/day. Not licensed for depression in under 18s in UK.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Reduce dose in hepatic impairment; use with caution.

Clinical pearls

  • First-line SSRI for most conditions — best evidence for PTSD and OCD
  • Sexual side effects may persist — address proactively (dose reduction, drug holiday strategy, switching)
  • Monitor for suicidal ideation in adolescents/young adults in first 1–4 weeks
  • SIADH more common in elderly — check serum sodium
  • Discontinuation syndrome (headache, dizziness, 'brain zaps') — taper before stopping

Contraindications

  • MAO inhibitors (within 14 days — risk of serotonin syndrome)
  • Pimozide (QT prolongation)
  • Hypersensitivity to sertraline

Side effects

  • Nausea and GI upset (most common, usually transient)
  • Insomnia or somnolence
  • Sexual dysfunction (reduced libido, delayed ejaculation, anorgasmia)
  • Headache
  • Increased anxiety or agitation (initial — start low)
  • Suicidal ideation in young people (monitor closely)
  • Hyponatraemia (SIADH — especially elderly)
  • QT prolongation (rare)

Interactions

  • MAOIs — serotonin syndrome (fatal — 14-day washout required)
  • Triptans — serotonin syndrome risk
  • Tramadol — serotonin syndrome risk
  • Anticoagulants (warfarin) — increased bleeding risk
  • NSAIDs — increased GI bleeding risk
  • Pimozide — contraindicated (QT prolongation)

Monitoring

  • Mood and suicidality (especially early)
  • Serum sodium (elderly)
  • Body weight
  • Sexual function

Reference: BNFc; BNF; NICE CG90 Depression; NICE NG116 PTSD; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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