Sertraline (Zoloft)

Sertraline (Zoloft): Overview
​Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and other mental health conditions. It is FDA-approved for use in adults and children (in specific conditions).

Mechanism of Action
​Sertraline primarily works by inhibiting the reuptake of serotonin (5-HT) in the brain, thereby increasing its availability in the synaptic cleft. Enhanced serotonin signaling is thought to improve mood, reduce anxiety, and regulate emotions.

• Secondary Effects: Sertraline has mild effects on dopamine and norepinephrine transporters, which may contribute to its therapeutic effects, especially in conditions like depression.

Clinical Benefits

1. Major Depressive Disorder (MDD):
   
   • Effective in reducing depressive symptoms such as low mood, anhedonia, fatigue, and feelings of worthlessness.
2. Generalized Anxiety Disorder (GAD):
   
   • Reduces excessive worry, restlessness, and physical symptoms of anxiety.
3. Obsessive-Compulsive Disorder (OCD):
   
   • Alleviates intrusive thoughts and compulsive behaviors.
4. Panic Disorder:
   
   • Decreases the frequency and intensity of panic attacks.
5. Post-Traumatic Stress Disorder (PTSD):
   
   • Helps reduce hyperarousal, flashbacks, and avoidance symptoms.
6. Premenstrual Dysphoric Disorder (PMDD):
   
   • Alleviates severe mood swings, irritability, and other emotional symptoms associated with the menstrual cycle.

Dosage

1. Starting Dose:
   
   • Depression and Anxiety Disorders: 25–50 mg daily.
   • OCD and Panic Disorder: Start at 25 mg daily, increasing to 50 mg after 1 week.
2. Titration:
   
   • Dosage can be increased in 25–50 mg increments every week, based on efficacy and tolerability.
3. Maximum Dose:
   
   • Adults: 200 mg daily.
   • Children (OCD): Maximum dose depends on age and clinical response, usually up to 200 mg/day.
4. Administration:
   
   • Taken once daily, with or without food.
   • Morning dosing is recommended to reduce insomnia; evening dosing may be considered for patients experiencing drowsiness.

Prevalence of Side Effects

1. Common Side Effects (≥10%):
   
   • Nausea: Most frequently reported.
   • Diarrhea.
   • Insomnia or drowsiness.
   • Dry mouth.
   • Increased sweating.
   • Sexual dysfunction: Includes decreased libido, delayed ejaculation, and difficulty achieving orgasm.
   • Weight changes: Mild weight loss or gain.
2. Less Common Side Effects (1–10%):
   
   • Dizziness.
   • Tremor.
   • Headache.
   • Fatigue.
   • Anxiety or agitation (early in treatment).
3. Rare but Serious Side Effects (<1%):
   
   • Serotonin Syndrome: Characterized by confusion, hyperreflexia, myoclonus, fever, and autonomic instability. Requires immediate medical attention.
   • Hyponatremia: Particularly in elderly patients or those on diuretics.
   • QT Prolongation: Rare cases of cardiac arrhythmias.
   • Increased Risk of Suicidality: Particularly in adolescents and young adults during initial treatment.
4. Discontinuation Syndrome:
   
   • Symptoms include dizziness, irritability, nausea, and "electric shock" sensations if abruptly stopped. Gradual tapering is recommended.

Efficacy

• Sertraline has demonstrated robust efficacy in treating depression and anxiety-related disorders in numerous clinical trials.
• It is considered a first-line treatment for many psychiatric conditions due to its favorable safety and efficacy profile.