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Sertraline is an active substance of the popular Zoloft preparation. Sertraline is one of the most commonly prescribed CNS medications due to its action on mental illnesses of various aetiologies.

Sertraline - action

Sertralinebelongs to thegroup of drugs with the abbreviation SSRI . These are serotonin reuptake inhibitors, and their action results in an increase in the amount of serotonin in the brain.

Sertraline is selective for serotonin reuptake receptors, with little effect on other receptors in the brain. It has little effect on norepinephrine and dopamine reuptake, while long-term administration of sertraline (which may be necessary in the treatment of obsessive-compulsive disorder) causesa reduction in the number and sensitivity of noradrenergic receptors in the brain . However, this is the effect that most antidepressants used in the treatment of obsessive-compulsive disorder induce.

What sets sertraline apart from other antidepressants (in particular tricyclic antidepressants) is its lack of affinity for muscarinic, other serotonin, dopaminergic, adrenergic, histamine, GABA or benzodiazepine receptors. As a result, sertralinehas fewer side effectsthan drugs that act on multiple receptors in the brain.

In clinical trialssertraline did not show any addictive potential . Patients do not experience sedation or hyperactivity after taking sertraline. Thanks to that, it does not significantly affect the ability to drive a car or psychomotor performance. However, during the first weeks of treatment, patients should be careful when performing these activities.

Sertraline - indications

Sertraline is used to treat:

  • episodes of major depression, also in relapse prevention,
  • panic disorder, most often in combination with other drugs that have a faster action time in the event of a panic attack (anxiolytics),
  • obsessive-compulsive disorders in both adults and children from 6 years of age,
  • social anxiety disorder,
  • of post-traumatic stress disorder (PTSD).

Sertraline -contraindications

Sertraline cannot be used if the patient ishypersensitive to the active substance .

Sertraline cannot be used together with:

  1. Monoamine oxidase inhibitors (MAO):irreversible MAO (e.g. selegiline), reversible selective MAO (maclobemide), reversible non-selective MAO (e.g. linezolid). The prohibition of the use of sertraline with the above-mentioned is due to the risk of serotonin syndrome in the patient. It is a serious condition where the person has too much serotonin in their body. Manifested by muscle tremors,psychomotor agitation and hyperthermia .
  2. Pimozide.Sertralineincreases blood levels of pimozide by about 35% . This may increase the likelihood of side effects from pimozide.

Sertraline - warnings and interactions

There is a risk of serotonin syndrome with the use of SSRIs. The risk is increased when the patient is concomitantly taking other antidepressants (serotonergic antidepressants, amphetamines, triptans) or drugs that impair the metabolism of serotonin itself (MAO inhibitors).Risks associated with the use of antipsychotics, dopamine antagonists or opioids with sertraline .

Sertraline may cause QT prolongation. Caution should be exercised in the presence of hypokalaemia, hypomagnesaemia, or heart disease, as these factors further predispose to QT prolongation.

People under 25 years of age should be treated with caution during the first weeks of treatment as this age group has a higher risk of suicide attempt early in therapy.People who have previously been diagnosed with suicidal tendencies should not take SSRIs.Additionally, bouts of aggression, manifestations of rebellion and anger have been documented in children treated for obsessive-compulsive disorder with sertraline. The physician should instruct the caregivers of patients and the patient himself about the possibility of such behaviors and suggest immediate contact with the physician if such behavior is observed.

The use of sertraline for the treatment of non-obsessive-compulsive disorders (e.g. depression in children and adolescents) is also not recommended, as there are no data on the effects of this drug on the child's future development (not only mental but also physical). ). The decision to start treatment with this drug should be made by a psychiatrist.

It has been observed in clinical trials thatsertraline may cause disturbances in some patientssexual . Usually they are temporary and the problem disappears with the course of therapy, but sometimes the symptoms last longer (even after stopping the drug).

Sertraline may cause abnormal blood clotting as manifested by bruising or purpura in the subject. If the patient is taking anticoagulants at the same time, he should inform the psychiatrist of this fact, because the inclusion of sertraline in the therapy may involve the risk of haemorrhage, e.g. from the gastrointestinal tract or gynecological. Non-steroidal anti-inflammatory drugs and acetylsalicylic acid are among the drugs that change the normal clotting time and have an anti-aggregating effect on platelets. These medications should be taken with caution while taking sertraline. Patients with a history of bleeding disorders resulting from disease or genetic conditions should be under constant medical care during treatment with this compound.

Hyponatraemia (too low sodium levels in the body) is common in patients taking SSRIs (including sertraline). It isa very serious condition and causes approximately 40 percent ofelectrolyte disturbances in SOR patients. The risk of hyponatraemia is greater in the elderly and in those treated with diuretines. The symptoms of hyponatraemia include, but are not limited to, headache, difficulty concentrating, memory loss, confusion and weakness.

Do not suddenly stop taking sertraline. It is best to gradually reduce the dose of the drug under medical supervision until it is completely discontinued. This will reduce the risk of withdrawal symptoms.

You should not drink grapefruit juice while taking sertraline . This drink may increase the plasma concentration of sertraline, which increases the risk of side effects.

People with a history of angle-closure glaucoma or a family history of glaucoma should be treated with caution with sertraline as treatment may lead to an increase in intraocular pressure and worsening of glaucoma symptoms.

You should not drink alcohol during treatment.

Pregnant women should not use the drug unless the clinical condition justifies it, and the benefits of treatment outweigh any possible risks. The same is true for women who are breastfeeding. If treatment is necessary, it is safest to discontinue breastfeeding.

Sertraline - dosage

Treatment depends on the underlying disorder. The doctor considers:

  • disease severity,
  • the patient's reaction to the drug,
  • age,
  • somatic diseasescoexisting.

Usually the therapy starts with 25 mg . After one week, the dose is increased. The minimum interval between dose changes is one week. The maximum dose of sertraline is 200 mg.

The effect of the drug can be observed after a week of use, while the full therapeutic effect requires longer treatment.

Sertraline is taken once a day, in the morning or evening. Preferably at the same time of the day. The drug can be administered with or without food.

Sertraline - side effects

The most common side effects include:

  • decrease or increase in appetite,
  • insomnia,
  • arousal,
  • libido reduction,
  • nervousness,
  • depersonalization,
  • nightmares,
  • dizziness,
  • sleepiness,
  • headaches,
  • trembling,
  • visual disturbance,
  • tinnitus,
  • hot flashes,
  • yawning,
  • nausea,
  • diarrhea,
  • indigestion,
  • constipation,
  • excessive sweating,
  • erectile dysfunction.

Sources:

  • Summary of Product Characteristics for Zoloft, accessed June 28, 2021.

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