Sertraline (Zoloft)
SSRI antidepressant
- Major Depression2
- OCD (6+)2
- Panic2
- Social Anxiety2
- PTSD2
- Binge Eating2
- Bulimia3
- Best SSRI for heart disease and pregnancy
- Top SSRI for children (after fluoxetine, escitalopram)
Features
Dosing
Depression (50-100 mg/d), PTSD (50-200 mg/d), Anxiety disorders (100-200 mg/d), OCD (200-400 mg/d), binge eating (100-200 mg/d).
CHILD OCD: <6 years: Safety and efficacy not established; 6-12 years: 25 mg po qd initially; 12-17 years: 50 mg po qd initially; May increase by 50 mg qd at 1-week intervals to no more than 200 mg qd; give qhs if somnolence experienced.
INTERACTIONS: At doses ≥ 150 mg/d it has drug interactions, raising levels of meds metabolized through CYP 2D6, 3A4, C19, 2B6. Raise by 3-5x if using with carbamazepine
Management
Safest SSRI in heart disease and possibly in pregnancy/breast-feeding. Although approved in PTSD, fluoxetine is more effective.
TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, withdrawal syndrome.
RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly).
EMR Text
Depression
Sertraline use based on FDA approval in major depressive disorder.
SSRI side effects reviewed with patient.
Anxiety Disorder
Sertraline use based on FDA approval in anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder).
SSRI side effects reviewed with patient.
PTSD
Sertraline use based on FDA approval in Posttraumatic Stress Disorder.
SSRI side effects reviewed with patient.
OCD
Sertraline use based on FDA approval in OCD.
SSRI side effects reviewed with patient.
Binge Eating & Bulimia
Sertraline use based on controlled trials in binge eating and bulimia.
SSRI side effects reviewed with patient.
Premenstrual Syndrome
Sertraline use based on FDA approval in Premenstrual Syndrome.
SSRI side effects reviewed with patient.