Sertraline

Sertraline is a selective serotonin reuptake inhibitor (SSRI). In the United States it is FDA-approved to treat major depression, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and premenstrual dysphoric disorder (PMDD). Doctors also prescribe it off-label for generalized anxiety and, relevant at midlife, for perimenopausal mood changes and hot flashes when hormone therapy isn't wanted or suitable. It works by raising levels of serotonin, a brain chemical involved in mood, sleep, and anxiety.

Sertraline is usually taken once a day, by mouth, at the same time each day — with or without food, though taking it with food can ease early nausea. It is typically started at a low dose and increased gradually if needed, so the full benefit often takes four to six weeks to appear even though side effects can show up sooner. Your prescriber sets and adjusts your dose; do not change it on your own. If you miss a dose, take it when you remember unless it's nearly time for the next one — never double up. Because stopping abruptly can cause withdrawal-like symptoms, any change should be tapered with your prescriber. This is general information, not a dosing instruction.

It can take several weeks to feel the full effect, and it's common to notice side effects before benefits. Keep a simple note of mood, sleep, and any symptoms to share at follow-up. Don't stop suddenly — work with your prescriber to adjust or discontinue.

The most common side effects are usually mild and often ease over the first few weeks: nausea or other stomach upset (diarrhea, indigestion), headache, insomnia or drowsiness, dry mouth, dizziness, and sweating. Two that can persist and are worth raising with your clinician are sexual side effects (lower libido, delayed orgasm) and changes in appetite or weight. Report anything that concerns you — an alternative or dose change is often possible.

Suicidal thoughts in younger people. Like other antidepressants, sertraline carries a boxed warning: it can increase the risk of suicidal thoughts or behaviour in children, teenagers, and young adults under 25, especially in the first weeks of treatment or after a dose change. Anyone starting it should be watched closely for worsening mood or unusual changes and seek help promptly if these occur.

Serotonin syndrome. Rarely, sertraline can cause a dangerous build-up of serotonin — more likely when combined with other serotonergic medicines (including some migraine drugs, other antidepressants, tramadol, or St John's wort). Warning signs include agitation, a fast heartbeat, high temperature, muscle stiffness or twitching, and confusion. This is a medical emergency.

Do not stop suddenly. Stopping sertraline abruptly can cause discontinuation symptoms such as dizziness, flu-like feelings, irritability, and "brain-zap" sensations. Any change should be made gradually and with your prescriber.

This is general information, not personal medical advice. Always follow your prescriber's guidance and tell them about every medicine and supplement you take.