Sertraline side effects, benefit, dosage and use for depression by Ray Sahelian, M.D.
April 15 2016


Sertraline is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over), panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks), posttraumatic stress disorder (disturbing psychological symptoms that develop after a frightening experience), and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Sertraline is also used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Sertraline is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). Sertraline works by increasing the amounts of serotonin, a natural substance in the brain that helps maintain mental balance in the treatment of patients with BED and also in binge eaters with a less severe eating psychopathology. If you have an interest in natural ways to lift mood, see depression.


Sertraline side effects

Possible side effects from sertraline antidepressant include: Nausea, diarrhea / loose stools, dyspepsia, male sexual dysfunction (primarily ejaculatory delay), female Sexual problems, insomnia, somnolence, tremor, increased sweating, dry mouth, and dizziness. A possible higher rate of suicide from sertraline has been reported but this claim is controversial. It has been suggested that SSRIs may cause depression to worsen and even lead to suicide in a small number of patients. These potential sertraline side effects are difficult to evaluate in depressed patients because depression can progress with or without treatment, and suicide is itself a consequence of depression.


Sexual dysfunction
Gen Hosp Psychiatry. 2015. Antidepressant-induced sexual dysfunction during treatment with fluoxetine, sertraline and trazodone; a randomized controlled trial. Compared with fluoxetine, and sertraline, trazodone was associated with the fewest sexual dysfunction. Fluoxetine was also associated with more sexual dysfunction than sertraline. Further research to better identify the differences among antidepressant drugs is recommended.


Chemosphere. 2014 Feb 14. Acute toxicity of 8 antidepressants: What are their modes of action? Currently, the hazard posed by pharmaceutical residues is a major concern of ecotoxicology. Most of the antidepressants belong to a family named the Cationic Amphipathic Drugs known to have specific interactions with cell membranes. The present study assessed the impact of eight antidepressants belonging to selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors by the combination of multi-approaches (in vivo, in vitro, in silico) and gives some insights on the mode of action for these molecules. Antidepressants were from the most to the least toxic compound for Daphnia magna: Sertraline (EC50=1.15mgL-1)>Clomipramine (2.74mgL-1)>Amitriptyline (4.82mgL-1)>Fluoxetine (5.91mgL-1)>Paroxetine (6.24mgL-1)>Mianserine (7.81mgL-1)>Citalopram (30.14mgL-1) and Venlafaxine (141.28mgL-1).


How sertraline works
The antidepressant effect is presumed to be linked to its ability to inhibit the neuronal reuptake of serotonin. Sertraline has only very weak effects on norepinephrine and dopamine neuronal reuptake. At clinical doses, sertraline blocks the uptake of serotonin into human platelets. In receptor binding studies, sertraline has no significant affinity for adrenergic (alpha(1), alpha(2) and beta), cholinergic, GABA, dopaminergic, histaminergic, serotonergic (5-HT1A, 5-HT1B, 5-HT2) or benzodiazepine binding sites.


Does Sertraline Increase Suicide Rates?

Studies have shown that children and teenagers who take antidepressants such as sertraline may be more likely to think about harming or killing themselves or to plan or try to do so than children who do not take antidepressants.


Sertraline for Depression after Stroke

In non-depressed patients who have recently suffered a stroke, prophylactic treatment with sertraline does not prevent the onset of depression in the following 6 months. Depression after stroke is common, affecting approximately 1 in every 3 survivors.


Generic sertraline
Indian drug maker Lupin Ltd. has received approval from the U.S. Food and Drug Administration for generic sertraline hydrochloride tablets in multiple strengths. Sertraline, the generic equivalent of Pfizer Inc.'s Zoloft, is used to treat disorders including depression and anxiety. Annual sales of Zoloft tablets in the United States were estimated at about $3.1 billion. Marketing exclusivity for Zoloft expired in February 2007 allowing generic sertraline to be sold.


Comparison to other antidepressants
Int Clin Psychopharmacol. January 2014. A comparative review of escitalopram, paroxetine, and sertraline: are they all alike? It is known that newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), provide advantages in tolerability over antidepressants such as the tricyclics. However, even within the SSRI class, differences in efficacy or tolerability exist between the individual drugs. Among the three most widely prescribed SSRIs are paroxetine, sertraline, and escitalopram. Escitalopram is commonly referred to as an SSRI, but also has well-documented allosteric properties, and thus can be further classed as an allosteric serotonin reuptake inhibitor. All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants. There are no direct data to regard either paroxetine or sertraline as a superior antidepressant. Escitalopram is superior compared with paroxetine, which has a less favorable tolerability profile. Paroxetine is associated with cholinergic muscarinic antagonism and potent inhibition of CYP2D6, and sertraline has moderate drug interaction issues in comparison with escitalopram. Overall, as an allosteric serotonin reuptake inhibitor that is somewhat different from classical SSRIs, escitalopram is the first choice judged by combined efficacy and tolerability, and nonclinical data have offered possible mechanisms through which escitalopram could be more efficacious, based on its interaction with orthosteric and allosteric binding sites at the serotonin transporter.


J Affect Disord. 2016. Vortioxetine for major depressive disorder: An indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed. Vortioxetine is approved for the treatment of major depressive disorder and differs from other antidepressants in terms of its pharmacodynamic profile. Given the limited number of head-to-head studies comparing vortioxetine with other antidepressants, indirect comparisons using effect sizes observed in other trials can be helpful to discern potential differences in clinical outcomes.METHODS:Data sources were the clinical trial reports for the pivotal short-term double-blind trials for vortioxetine and from publicly available sources for the pivotal short-term double-blind trials for two commonly used generic serotonin specific reuptake inhibitor antidepressants (sertraline, escitalopram), two commonly used generic serotonin-norepinephrine reuptake inhibitor antidepressants (venlafaxine, duloxetine), and two recently introduced branded antidepressants (vilazodone, levomilnacipran). Vortioxetine demonstrates similar efficacy to that observed for duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, however overall tolerability as measured by discontinuation because of an adverse event differs. Vortioxetine is 5.1 times more likely to be associated with response than discontinuation because of an adverse event when compared to placebo.


Q. Is 5-HTP a substitute for sertraline for the purpose of depression treatment?
   A. Some people find 5-HTP helpful to balance mood, but each person is different. Some may find 5-HTP to be as helpful as sertraline while others may prefer sertraline to 5-HTP.


I am currently taking sertraline once a day and have been taking it for 8 days. My primary purpose for this is for testing anxiety. I found out that I will be a couple pills short before my test day and I am wondering if I could take 50 mg of 5-htp on the days that I will not have the sertraline medication.
    It is not possible for us to predict how well any single individual will respond to 5-HTP as a substitute for this antidepressant. Some people may find the dietary supplement helpful, whereas others may not.