SSRI (Selective Serotonin Reuptake Inhibitor)
Selective serotonin reuptake inhibitor (SERT) with mild dopaminergic activity via dopamine transporter (DAT) inhibition, enhancing serotonergic and dopaminergic neurotransmission.
Major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (SoAD), premenstrual dysphoric disorder (PMDD)
Generalized anxiety disorder (GAD), binge eating disorder, bulimia nervosa, agitation and aggression in traumatic brain injury (TBI), post-stroke affective lability, post-stroke depression, depression in Parkinson’s disease (PD), depression in dementia
Oral tablets and liquid solution (25 mg, 50 mg, 100 mg)
25–50 mg p.o. daily, titrating as clinically indicated
50–200 mg/day
Half-life ~26 hours; metabolized primarily by CYP3A4, CYP2B6, CYP2C19; steady state in ~7 days
Nausea, diarrhea, tremor, dizziness, insomnia, dry mouth, fatigue, sexual dysfunction
Serotonin syndrome, hyponatremia, bleeding risk, withdrawal symptoms on abrupt discontinuation
Monitor for serotonin syndrome symptoms, suicidality, hyponatremia (especially in elderly), and withdrawal symptoms during discontinuation
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Sertraline may be used in post-stroke depression with relatively low anticholinergic burden. It is preferred in patients with seizure disorders due to fewer CYP450 interactions compared to other SSRIs, reducing the risk of interactions with antiepileptic drugs. Use cautiously in hepatic dysfunction, and consider slower titration in elderly patients or those with multiple comorbidities.