Phil Day By Superintendent Pharmacist Published:

Depression and anxiety are common mental health conditions. Most of us will have experienced them at some point, and although these feelings can improve on their own, sometimes medication is prescribed to help. Here I’m going to take a look at sertraline, one of the most common prescribed treatments that Pharmacy2U dispenses for depression and anxiety. We’re going to explore the uses, precautions, and special considerations of sertraline here.

What is sertraline, and how does it work

Sertraline is a type of antidepressant which belongs to a group of medicines known as Selective Serotonin Re-uptake Inhibitors (SSRIs). It helps to relieve anxiety and depression for many people and tends to have fewer unwanted side effects than some other types of antidepressant. It is also used in the management of post traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).

What conditions does sertraline treat?

Depression is an illness with many symptoms including feeling sad, being unable to sleep properly, and struggling to enjoy life as you used to. OCD and panic disorders are illnesses which are linked to anxiety, with symptoms that include being constantly troubled by persistent ideas (obsessions) that make you carry out repetitive rituals (known as compulsions).

PTSD is a condition which occurs following emotionally traumatic experiences. Some of its symptoms are similar to those of depression and anxiety. Social anxiety disorder (social phobia) is characterised by feelings of intense anxiety or distress in social situations; for example, speaking in front of groups of people, talking to new people, eating or drinking in front of others, or worrying that you might behave in an embarrassing manner.

How should sertraline be taken? 

You should always take sertraline as agreed with your doctor. Check with them, or your pharmacist, if you’re unsure about any of the information you’ve been given.

When treating depression and OCD in adults:

  • The typical effective dose is 50mg per day. The daily dose may be increased in increments of 50mg, at weekly intervals, over a period of several weeks. The recommended maximum daily dose is 200mg.

When treating panic disorder, social anxiety disorder, and PTSD in adults:

  • Treatment should be started at 25mg a day, and increased to 50mg after one week. The daily dose may then be increased each week in increments over a few weeks. The recommended maximum daily dose is 200mg.

When treating children or adolescents:

  • Children aged 6 – 12: the recommended starting dose is 25mg, taken daily. After a week the dose may be increased to 50mg a day. The maximum dose is 200mg daily.
  • Adolescents aged 13 – 17: the recommended starting dose is 50mg. The maximum dose is 200mg daily.

When should I take sertraline during the day?

Sertraline tablets can be taken with or without food, and are usually taken once a day. It doesn’t matter what time of day this is, but try and make the time of day consistent so it’s easier for you to remember. If you’re struggling to sleep, then it’s a good idea to take sertraline in the morning.

How long does it take for sertraline to work?

It usually takes around 4 to 6 weeks for you to feel that sertraline is working. It’s important to know this, because you might experience some mild side effects within that time, without feeling any benefits – but the benefits will take just a little longer to become apparent, and any side effects often subside.

What are the potential side effects of sertraline?

As with all medicines, you may experience side effects when taking sertraline, but not everybody gets them. It’s important to note that side effects usually lessen or disappear with time. Nausea is the most common side effect people experience when taking sertraline.

If you experience any of the following side effects, you should contact your doctor or pharmacist immediately, who may recommend that you stop taking sertraline straight away:

  • A severe skin rash that causes blistering, including the mouth and tongue.
  • An allergic reaction, with symptoms such as an itchy skin rash, breathing problems, wheezing, swollen eyelids, face or lips.
  • Agitation, confusion, diarrhoea, high temperature, high blood pressure, excessive sweating, and/or a rapid heartbeat. These could be symptoms of ‘serotonin syndrome’, where the levels of serotonin in the body are too high. In some cases this syndrome is caused by taking certain other medicines at the same time as sertraline.
  • Yellow skin and eyes, which may indicate liver problems.
  • Depressive symptoms with ideas of harming yourself, or suicidal thoughts.
  • Feelings of restlessness, and being unable to sit or stand still after you start to take sertraline.
  • Manic episodes (part of having a bipolar condition).

If you experience any side effects, talk to your doctor or pharmacist. This includes any possible side effects that are not listed in the leaflet you’ll receive with your medicine. You can also report side effects directly to the manufacturer and the Government’s medicine safety body, the MHRA, via the Yellow Card Scheme. Reporting side effects helps to provide more information on the safety of this medicine so guidelines and leaflets can be changed in the future if necessary.

What other medicines does sertraline clash with?

Some medicines you’re already taking may interfere with the way sertraline works, or vice versa, so you should tell your doctor or pharmacist if you’re taking any other medication before starting it – including over-the-counter medicines.

Taking sertraline with the following medicines may cause serious side effects, and the combination should be avoided:

  • Medicines called monoamine oxidase inhibitors (MAOIs), such as moclobemide (to treat depression) and selegiline (to treat Parkinson’s disease). Do not take sertraline together with these medicines.
  • Pimozide, a medicine to treat mental disorders such as psychosis.

Tell your doctor if you’re taking any of the following medicines:

  • Medicines containing amphetamines, which are often used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity.
  • Herbal medicines containing St. John’s Wort (Hypericum perforatum), which is available without a prescription, usually as a remedy for mild anxiety or depression. The effects of St. John’s Wort may last for 1 to 2 weeks after you stop taking it, so leave plenty of time before starting sertraline.
  • Products which contain an amino acid called tryptophan.
  • Medicines to treat severe pain (such as tramadol).
  • Medicines used to treat chronic pain (such as fentanyl).
  • Medicines that treat migraines (such as sumatriptan).
  • Medicines that thin the blood (such as warfarin).
  • Medicines for treating pain or arthritis, and non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.
  • Sedatives (such as diazepam).
  • Diuretics (water tablets).
  • Medicines to treat epilepsy (such as phenytoin, phenobarbital, and carbamazepine).
  • Medicines to treat diabetes (such as tolbutamide).
  • Medicines to treat excessive stomach acid, ulcers or heartburn (such as cimetidine, omeprazole, lansoprazole, pantoprazole, or rabeprazole).
  • Medicines to treat mania and depression (such as lithium).
  • Other medicines to treat depression (such as nortriptyline, amitriptyline, nefazodone, fluvoxamine or fluoxetine).
  • Medicines to treat schizophrenia and other mental disorders (such as perphenazine, levomepromazine and or olanzapine).
  • Medicines used to treat high blood pressure, chest pain, or to regulate the rate and rhythm of the heart (such as verapamil, diltiazem, flecainide, or propafenone).
  • Medicines used to treat bacterial infections (such as rifampicin, clarithromycin, telithromycin, or erythromycin).
  • Medicines used to treat fungal infections (such as ketoconazole, itraconazole, posaconazole, voriconazole, or fluconazole).
  • Medicines used to treat HIV/AIDS and Hepatitis C (protease inhibitors such as ritonavir, or telaprevir).

Can I take sertraline with alcohol?

You can drink alcohol in moderation while taking sertraline, but it’s best to avoid it if you can, especially at the start of your treatment, because it can make you sleepy.

Grapefruit juice should definitely be avoided – it blocks the body’s ability to break down sertraline, meaning you would be more likely to have side effects.

Taking sertraline during pregnancy or while breastfeeding

If you’re pregnant, breastfeeding, or planning to have a baby, then speak to your doctor or pharmacist before taking sertraline. It will only be prescribed if the benefit to you is considered by the doctor to be greater than the risk of side effects. If you’re taking sertraline and become pregnant, then you should tell your doctor as soon as you can.

Sertraline can pass into breast milk. Sertraline should only be taken by breastfeeding women if your doctor considers the benefit exceeds any possible risk of side effects.

When sertraline might not be suitable for you

Tell your doctor before you take sertraline:

  • If you have epilepsy or a history of seizures.
  • If you have suffered from manic depressive illness (bipolar disorder) or schizophrenia.
  • If you have or have previously had thoughts of harming yourself, or suicidal thoughts.
  • If your blood has low levels of sodium. Tell your doctor if you are taking medicines for high blood pressure (hypertension), as above, since some of these medicines may also alter the sodium level in your blood. The elderly are also more likely to have low levels of sodium in the blood.
  • If you have liver disease – your doctor may decide that you should have a lower dose of sertraline.
  • If you have diabetes – your blood glucose levels may be altered due to sertraline, and your diabetes medicines may need to be adjusted.
  • If you have suffered from bleeding disorders or have been taking medicines which thin the blood (such as aspirin or warfarin).
  • If you are having electro-convulsive therapy (ECT).
  • If you have eye problems, such as glaucoma (increased pressure in the eye).
  • If you have been told that you have an abnormality of your heart tracing after an electrocardiogram (ECG).
  • If you have heart disease, low blood potassium levels or low magnesium levels, a family history of heart rhythm problems, or a low heart rate.

Further sources of information

For more information, talk to your pharmacist or doctor. You may also find the following links helpful.