Sertraline

July 16, 2018

About sertraline

Sertraline is a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor).

It is often used to treat depression, and also sometimes panic attacks, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Sertraline helps many people recover from depression, and it has fewer unwanted effects than older antidepressants.

Sertraline comes as tablets which are available only on prescription.

Key facts

It usually takes 4 to 6 weeks for sertraline to work.
Side effects such as feeling sick, headaches and trouble sleeping are common. They are usually mild and go away after a couple of weeks.
Sertraline can cause withdrawal symptoms. Don't stop taking it without talking to your doctor.
Sertraline is also called by the brand name Lustral.

Who can and can't take sertraline

Sertraline can be taken by adults for depression or obsessive compulsive disorder.

Sertraline can be taken by children aged 6 to 17 but only for obsessive compulsive disorder.

Check with your doctor before starting to take sertraline if you:

have had an allergic reaction to sertraline or any other medicines in the past
have a heart problem as sertraline can speed up or change your heartbeat
have ever taken any other medicines for depression - some rarely used antidepressants can interfere with sertraline to cause very high blood pressure even when they have been stopped for a few weeks
are trying to become pregnant, are already pregnant or you are breastfeeding
have an eye problem called glaucoma because sertraline can increase the pressure in your eye

If you have diabetes, sertraline can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with sertraline and adjust your diabetes treatment if necessary.

How and when to take it

Take sertraline once a day. You can take sertraline with or without food.

You can choose to take sertraline at any time, as long as you stick to the same time every day. If you have trouble sleeping, it's best to take it in the morning.

How much will I take?

The usual dose of sertraline is 50mg a day in adults. However, it might be started at a lower dose then increased gradually to a maximum dose of 200mg a day. If you have liver problems your doctor might give you a lower dose, or advise you to take sertraline less often.

The usual dose of sertraline in children aged 6 to 12 is 25mg a day, but this may be increased to 50mg a day after a week.

The usual dose of sertraline in children aged 13 to 17 is 50mg a day. Children of any age might have their dose increased up to 200mg a day, if needed.

What if I forget to take it?

If you occasionally forget to take a dose, don't worry. Take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Ask your doctor for advice straight away. An overdose can lead to potentially serious symptoms such as:

vomiting
tremor
feeling sleepy
dizziness
fast heart rate
seizures

Side effects

Like all medicines, sertraline can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of sertraline will gradually improve as your body gets used to it. Some people who take sertraline for panic attacks find their anxiety gets worse during the first few weeks of treatment. This usually wears off after a few weeks but speak to your doctor if it bothers you - a lower dose may help reduce your symptoms.

Common side effects

These side effects happen in more than 1 in 100 people. If you get these side effects, keep taking the medicine, but tell your doctor if these side effects bother you or don't go away:

feeling sick
headache
being unable to sleep
feeling sleepy
diarrhoea
dry mouth
dizziness
feeling tired or weak
in men, problems ejaculating

Serious side effects

It happens rarely (in less than 1 in 100 people), but some people may have serious side effects when taking sertraline.

Tell a doctor straight away if you get:

headache, trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance - these can be signs of low sodium levels
thoughts about harming yourself or ending your life
chest pain or pressure, or shortness of breath
severe dizziness or passing out
fits, feelings of euphoria, excessive enthusiasm or excitement, or a feeling of restlessness that means you can't sit or stand still
yellow skin or eyes - this can be a sign of liver problems
putting on or losing weight without trying to
changes in your periods such as heavy bleeding, spotting, or bleeding between periods
painful erections that last longer than 4 hours - this may happen even when you are not having sex

Or, if you get any signs of abnormal bleeding including:

vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo - these can be signs of bleeding from the gut
bleeding from the gums or bruises that appear without a reason or that get bigger
any bleeding that is very bad or that you cannot stop

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction to sertraline.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

These are not all the side effects of sertraline. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

How to cope with side effects

What to do about:

feeling sick - try taking sertraline with or after food. It may also help if you avoid rich or spicy food.
headaches - make sure you rest and drink plenty of fluids. Don’t drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking sertraline. Talk to your doctor if they last longer than a week or are severe.
being unable to sleep - take sertraline first thing in the morning
feeling sleepy - cut down the amount of alcohol you drink
diarrhoea - drink plenty of water in small, frequent sips. It may also help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
a dry mouth - chew sugar-free gum or sugar-free sweets
dizziness - if sertraline makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better

You can reduce the chance of having a side effect that bothers you if you take sertraline in the evening. That way you're asleep when the level of medicine in your body is highest.

Pregnancy and breastfeeding

It's important for you and your baby that you stay well during your pregnancy. If you become pregnant while taking sertraline speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Sertraline has been linked to a very small increased risk of problems for your unborn baby. However if your depression is not treated during pregnancy this can also increase the chance of problems.

You may take sertraline during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

For more information about how sertraline can affect you and your baby during pregnancy, read the leaflet about the best use of medicines in pregnancy (BUMPS).

Sertraline and breastfeeding

If your doctor or health visitor says your baby is healthy, sertraline is one of the preferred antidepressants to take when breastfeeding. It has been used by many breastfeeding mothers without any problems.

Sertraline passes into breast milk in tiny amounts and has been linked with side effects in a very few breastfed babies. However, it‘s important to continue taking sertraline to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby isn’t feeding as well as usual or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

Cautions with other medicines

Some medicines and sertraline can interfere with each other and increase the chances of you having side effects.

any medicines that affect your heartbeat - as sertraline can speed up or change your heartbeat
any other medicines for depression - some antidepressants can interfere with sertraline to cause very high blood pressure even when they have been stopped

Mixing sertraline with herbal remedies and supplements

Don't take St John's wort, the herbal remedy for depression, while you are being treated with sertraline as this will increase your risk of side effects.

Tell your doctor or pharmacist if you are taking any other medicines, including herbal remedies, vitamins or supplements.

Common questions

How does sertraline work?

Sertraline is one of a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medicines are thought to work by increasing the levels of a mood-enhancing chemical called serotonin in the brain.

How will it make me feel?

Antidepressants like sertraline help to jump start your mood so you feel better. You may notice that you sleep better and get on with people more easily because you’re less anxious. You will hopefully take in your stride little things that used to worry you.

Sertraline won’t change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

Don't expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

When will I feel better?

You may see an improvement in your symptoms after a week or two, although it usually takes between 4 to 6 weeks before you feel the full benefits. That's because it takes around a week for sertraline levels to build up in your body, and then a few weeks longer for your body to adapt and get used to it.

Do not stop taking sertraline after a week or two just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.

What will happen if I come off it?

If you stop taking sertraline suddenly you may get unpleasant withdrawal symptoms. These include:

dizziness
feeling sick
numbness or tingling in the hands or feet
feeling anxious
headaches
shaking

Withdrawal symptoms are usually harmless and only last a few days but it's possible to prevent them by reducing the dose gradually when you stop taking this medicine.

Don't stop taking sertraline unless your doctor tells you to.

How long will I take it for?

Once you're feeling better it's likely that you will continue to take sertraline for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed. Stopping before that time can make depression come back.

Is it safe to take it for a long time?

Sertraline is safe to take for a long time. There don't seem to be any lasting harmful effects from taking it for many months and years.

However, taking sertraline for more than a year has been linked to a small increased risk of getting diabetes. But you will be regularly checked for this.

Is sertraline better than other antidepressants?

Sertraline isn't any better or worse than other antidepressants. Sometimes people respond better to one antidepressant than another. If you aren't feeling any better after 6 weeks, talk to your doctor.

Will I gain or lose weight?

Sertraline can make you feel more or less hungry than usual, so you may lose or gain weight when you start taking it.

If you start to have problems with your weight while taking sertraline, talk to your doctor or pharmacist.

Will it affect my contraception?

For women, sertraline will not affect contraceptive pills or the morning after pill.

Will it affect my sex life?

The positive effects of sertraline may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible negative effects may include:

men getting painful erections, problems with getting an erection and problems with ejaculating
women having some vaginal bleeding and not reaching orgasm the same way as before
a lower sex drive

Sexual side effects should pass after the first couple of weeks. If they don't, and this a problem for you, go back to your doctor to see if there's another antidepressant for you to try.

Can I drive or ride a bike?

Some people can't concentrate properly while they're taking sertraline. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

Can I drink alcohol with it?

You can drink alcohol while taking sertraline but it may make you feel sleepy. It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Is there any food or drink I need to avoid?

Don't drink grapefruit juice while you're taking this medicine. Grapefruit juice can increase the amount of sertraline in your body and increase the risk of side effects.

Will recreational drugs affect it?

Sertraline does not seem to be affected by cannabis, although you might feel a little more sleepy.

Methadone can increase the risk of side effects in people taking sertraline.

Sertraline may reduce the effects of ecstasy and so might make people try higher doses and therefore get more side effects.

There are no reports of extra problems with sertraline and cocaine, although this doesn't mean it's safe.