Sertraline
A widely used once-a-day antidepressant for depression and anxiety-related conditions. One of the best-studied options in pregnancy and breastfeeding. Slow to start, so patience is part of the prescription.
At a glance
- For
- Depression, OCD, panic disorder, social anxiety, PTSD, premenstrual dysphoric disorder (PMDD)
- Works
- About half of people with depression improve a lot, compared with about a third on a dummy treatment. One of the better all-rounders for benefit and tolerability
- Cost
- Under the $25 PBS co-payment, about $21–22 for generics (brand premium extra); $7.70 concession. PBS-listed for depression; other uses may be a private script
- Kicks in
- First benefit in 2–4 weeks; full effect by 6–8 weeks (OCD can take 12 weeks)
- Taken for
- Usually at least 6–12 months after feeling well
- Watch for
- Nausea, diarrhoea, poor sleep or drowsiness, sweating, sexual side effects
Take it with food. Sertraline’s reputation for upsetting the bowels is earned, but it usually settles within a couple of weeks.
Brand names
- Zoloft, Setrona, Eleva, Sertra, plus generic brands sold as sertraline
How it works
A selective serotonin reuptake inhibitor (SSRI): it stops nerve cells soaking serotonin back up, so more is available to carry signals.
Used for
- Major depression (TGA-approved)
- Obsessive-compulsive disorder, including in children from age 6 (TGA-approved)
- Panic disorder, social anxiety disorder and premenstrual dysphoric disorder (TGA-approved)
- Post-traumatic stress disorder
Side effects
Full side-effect list (from the product information)
How often, from the official product information. Bold = serious.
Very common more than 1 in 10
- Nausea, diarrhoea, dry mouth
- Poor sleep or drowsiness
- Dizziness, headache, tiredness
- Delayed or absent ejaculation
Common 1 in 10 to 1 in 100
- Anxiety, agitation, vivid dreams, feeling detached
- Sexual problems (desire, erection)
- Tremor, tingling, poor concentration, teeth grinding
- Indigestion, constipation, vomiting, tummy pain
- Sweating, hot flushes, yawning, palpitations
- Appetite change, weight gain
- Rash, aches, irregular periods
Uncommon 1 in 100 to 1 in 1,000
- Hallucinations, mood lifting too high
- Seizures, fainting, fast heartbeat
- Nosebleeds, bruising
- Hair loss, hives
- Trouble passing urine
Rare 1 in 1,000 to 1 in 10,000
- Low sodium
- Serotonin syndrome
- Suicidal thoughts
- Long QT, dangerous heart rhythms
- Bowel bleeding, pancreatitis, liver problems
- Severe skin reactions, angioedema
- Prolonged erection
Frequency not known reported, rate unclear
- Bleeding after birth
- Bone fractures
Get help urgently if
- Fever, sweating, shaking, muscle jerks, confusion or a racing heart (possible serotonin syndrome)
- Thoughts of suicide or self-harm: Lifeline 13 11 14, or 000
- Fainting, a racing irregular heartbeat, or bleeding from the bowel
Good to know
- Serotonin syndrome is more likely with tramadol, triptans, St John’s wort or other antidepressants. Never use with an MAOI. Bleeding is more likely with anti-inflammatories, aspirin or blood thinners.
- Stopping: taper over several weeks to avoid dizziness, “brain zaps”, irritability and poor sleep. Low sodium is more likely in older people.
- Pregnancy and breastfeeding: one of the most studied antidepressants, often continued. Don’t stop suddenly: plan it with your doctor. Newborns may have mild, short-lived settling symptoms.
- Under 25s: suicidal thoughts can increase early on or after a dose change. Thoughts of self-harm: see your doctor now or call Lifeline 13 11 14.
Common questions
How long does sertraline take to work?
Benefit usually starts after 2 to 4 weeks, with full effect by 6 to 8 weeks (longer for OCD). Side effects like nausea and loose bowels often come first and usually fade.
Is sertraline safe in pregnancy and breastfeeding?
It’s one of the most studied antidepressants in pregnancy and passes into breast milk only in small amounts, so it’s often a preferred choice. Plan any changes with your doctor rather than stopping suddenly.
Does sertraline cause weight gain?
Weight gain is listed as common (between 1 in 10 and 1 in 100 people) and is usually modest. Nausea, diarrhoea and sleep changes are more common.
How do you stop sertraline?
Reduce it slowly with your doctor, usually over several weeks, to avoid dizziness, “brain zaps” and poor sleep.
Information only. Not a recommendation or endorsement of any product. Whether a medicine suits you depends on your health and other medicines, so talk to your doctor or pharmacist. In an emergency, call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
More information
- Cipriani et al. 2018: Comparing 21 antidepressants (The Lancet)
- PBS: Sertraline 50 mg
- Lifeline: 13 11 14
- NPS MedicineWise: Medicine Finder
maladywise.com/medicines/sertraline/