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Sertraline

1. About sertraline

Sertraline is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

It's often used to treat depression, and also sometimes panic attacks, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).

Sertraline helps many people recover from depression, and has fewer unwanted side effects than older antidepressants.

Sertraline comes as tablets, which are available only on prescription.

2. Key facts

  • It usually takes 4 to 6 weeks for sertraline to work.
  • Side effects such as feeling sick, headaches and trouble sleeping are common. They're usually mild and go away after a couple of weeks.
  • If you and your doctor decide to take you off sertraline, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
  • Sertraline is also called by the brand name Lustral.

3. Who can and can't take sertraline

Sertraline can be taken by adults for depression or obsessive compulsive disorder.

Sertraline can be taken by children aged 6 to 17, but only for obsessive compulsive disorder.

Check with your doctor before starting to take sertraline if you:

  • have had an allergic reaction to sertraline or any other medicines in the past
  • have a heart problem - sertraline can speed up or change your heartbeat
  • have ever taken any other medicines for depression - some rarely used antidepressants can interfere with sertraline to cause very high blood pressure, even when they have been stopped for a few weeks
  • are trying to become pregnant, already pregnant or breastfeeding
  • have an eye problem called glaucoma - sertraline can increase the pressure in your eye
  • have epilepsy or are having electroconvulsive treatment - sertraline may increase your risk of having a seizure

If you have diabetes, sertraline can make it more difficult to keep your blood sugar stable.

Monitor your blood sugar more often for the first few weeks of treatment with sertraline and adjust your diabetes treatment if necessary.

4. How and when to take it

Take sertraline once a day. You can take sertraline with or without food.

You can choose to take sertraline at any time, as long as you stick to the same time every day.

If you have trouble sleeping, it's best to take it in the morning.

How much will I take?

The usual dose of sertraline is 50mg a day in adults. But it might be started at a lower dose, then increased gradually to a maximum dose of 200mg a day.

If you have liver problems, your doctor might give you a lower dose or advise you to take sertraline less often.

The usual dose of sertraline in children aged 6 to 12 is 25mg a day, but this may be increased to 50mg a day after a week.

The usual dose of sertraline in children aged 13 to 17 is 50mg a day. Children aged 6 to 17 might have their dose increased up to 200mg a day, if needed.

What if I forget to take it?

If you occasionally forget to take a dose, don't worry. Take your next dose the next day at the usual time. Never take 2 doses at the same time to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

The amount of sertraline that can lead to an overdose varies from person to person.

Urgent advice: Call your doctor straight away if:

You have taken too much sertraline by accident and experience symptoms such as:

  • being sick (vomiting)
  • tremor
  • feeling sleepy
  • dizziness
  • fast heart rate
  • seizures

If you need to go to A&E, do not drive yourself - get someone else to drive you or call for an ambulance.

Take the sertraline packet, or the leaflet inside it, plus any remaining medicine with you.

5. Side effects

Like all medicines, sertraline can cause side effects in some people, but many people have no side effects or only minor ones.

Some of the common side effects of sertraline will gradually improve as your body gets used to it.

Some people who take sertraline for panic attacks find their anxiety gets worse during the first few weeks of treatment.

This usually wears off after a few weeks, but speak to your doctor if it bothers you - a lower dose may help reduce your symptoms.

Common side effects

These common side effects happen in more than 1 in 100 people.

If you get these side effects, keep taking the medicine, but tell your doctor if they bother you or don't go away:

  • feeling sick
  • headaches
  • being unable to sleep
  • feeling sleepy
  • diarrhoea
  • dry mouth
  • dizziness
  • feeling tired or weak

Serious side effects

It happens rarely (in less than 1 in 100 people), but some people may have serious side effects when taking sertraline.

Go to A&E immediately if you get:

  • chest pain or pressure, or shortness of breath
  • severe dizziness or passing out
  • painful erections that last longer than 4 hours - this may happen even when you're not having sex
  • any bleeding that's very bad or you can't stop, such as cuts or nosebleeds that don't stop within 10 minutes

Call a doctor straight away if you get:

  • headaches, trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance - these can be signs of low sodium levels
  • thoughts about harming yourself or ending your life
  • fits, feelings of euphoria, excessive enthusiasm or excitement, or a feeling of restlessness that means you can't sit or stand still
  • yellow skin or the whites of your eyes turn yellow - this can be a sign of liver problems
  • vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo - these can be signs of bleeding from the gut
  • bleeding from the gums or bruises that appear without a reason or that get bigger

Book an appointment with your doctor if you experience:

  • changes in your periods, such as heavy bleeding, spotting or bleeding between periods
  • weight gain or weight loss without trying

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to sertraline.

Urgent advice: Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction.

A serious allergic reaction is an emergency.

These aren't all the side effects of sertraline.

For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect to the UK safety scheme.

6. How to cope with side effects

What to do about:

  • feeling sick - try taking sertraline with or after food. It may also help if you avoid rich or spicy food.
  • headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking sertraline. Talk to your doctor if they last longer than a week or are severe.
  • being unable to sleep - take sertraline first thing in the morning
  • feeling sleepy - take sertraline in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this doesn't help, talk to your doctor.
  • diarrhoea - drink plenty of water or other fluids to avoid dehydration. Signs of dehydration include peeing less than usual and having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
  • dry mouth - chew sugar-free gum or sugar-free sweets
  • dizziness - if sertraline makes you feel dizzy, stop what you're doing and sit or lie down until you feel better
  • feeling tired or weak- if sertraline makes you feel tired or weak, stop what you're doing and sit or lie down until you feel better. Do not drive or use tools or machinery if you're feeling tired. Do not drink alcohol as it'll make you feel worse. If these symptoms don't go away after a week or two, ask your pharmacist or doctor for advice.

7. Pregnancy and breastfeeding

It's important for you and your baby that you stay well during your pregnancy.

If you become pregnant while taking sertraline, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Sertraline has been linked to a very small increased risk of problems for your unborn baby.

But if your depression isn't treated during pregnancy, this can also increase the chance of problems.

You may take sertraline during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.

For more information about how sertraline can affect you and your baby during pregnancy, read the leaflet about the best use of medicines in pregnancy (BUMPS).

Sertraline and breastfeeding

If your doctor or health visitor says your baby is healthy, sertraline is one of the preferred antidepressants to take when breastfeeding. It has been used by many breastfeeding mothers without any problems.

Sertraline passes into breast milk in tiny amounts and has been linked with side effects in a very few breastfed babies.

But it's important to continue taking sertraline to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby isn't feeding as well as usual or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines and sertraline can interfere with each other and increase the chances of you having side effects.

  • any medicines that affect your heartbeat - sertraline can speed up or change your heartbeat
  • any other medicines for depression - some antidepressants can interfere with sertraline to cause very high blood pressure even when they have been stopped

Mixing sertraline with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're being treated with sertraline as this will increase your risk of side effects.

Important

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does sertraline work?

Sertraline is one of a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs.

These medicines are thought to work by increasing the levels of a mood-enhancing chemical called serotonin in the brain.

How will it make me feel?

Antidepressants like sertraline help to jump start your mood so you feel better.

You may notice that you sleep better and get on with people more easily because you're less anxious. You'll hopefully take in your stride little things that used to worry you.

Sertraline won't change your personality or make you feel euphorically happy. It'll simply help you feel like yourself again.

Don't expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

When will I feel better?

You may see an improvement in your symptoms after a week or two, although it usually takes between 4 to 6 weeks before you feel the full benefits.

That's because it takes around a week for sertraline levels to build up in your body, and then a few weeks longer for your body to adapt and get used to it.

Do not stop taking sertraline just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.

How do I come off sertraline?

If you have been feeling better for 6 months or more, your doctor may suggest coming off sertraline.

Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking sertraline for a long time.

This is to help prevent any extra side effects you might get as a reaction to coming off the medicine.

These include:

  • dizziness
  • feeling sick
  • numbness or tingling in the hands or feet
  • trouble sleeping
  • feeling agitated or anxious
  • headaches
  • shaking

Important

Do not stop taking sertraline suddenly, or without talking to your doctor first.

How long will I take it for?

Once you're feeling better it's likely that you'll continue to take sertraline for several more months.

Most doctors recommend that you take antidepressants for 6 months to a year after you no longer feel depressed.

Stopping before that time can make depression come back.

Is it safe to take it for a long time?

For most people, sertraline is safe to take for a long time.

A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases these can continue even after stopping the medicine. Speak to your doctor if you are worried.

Taking sertraline for more than a year has also been linked to a small increased risk of getting diabetes. You'll be regularly checked for this.

Otherwise there don’t seem to be any lasting harmful effects from taking sertraline for many months and years.

Is sertraline better than other antidepressants?

Sertraline isn't any better or worse than other antidepressants. Sometimes people respond better to one antidepressant than another.

If you aren't feeling any better after 6 weeks, talk to your doctor.

Will I gain or lose weight?

Sertraline can make you feel more or less hungry than usual, so you may lose or gain weight when you start taking it.

If you start to have problems with your weight while taking sertraline, talk to your doctor or pharmacist.

Will it affect my contraception?

Sertraline will not affect any type of contraception, including the contraceptive pill or emergency contraception.

Will it affect my fertility?

There's some evidence that sertraline can reduce the quality of sperm. This should reverse once you stop taking the medicine.

It's not known whether this reduces male fertility. Talk to your doctor if you're concerned.

There's no firm evidence to suggest that taking sertraline will reduce fertility in women.

But speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.

Will it affect my sex life?

The positive effects of sertraline may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible negative effects may include:

  • men getting painful erections and problems with getting an erection and ejaculating
  • women having some vaginal bleeding and not reaching orgasm the same way as before
  • a lower sex drive

Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.

If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.

Can I drive or ride a bike?

Some people can't concentrate properly while they're taking sertraline.

It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

Can I drink alcohol with it?

You can drink alcohol while taking sertraline, but it may make you feel sleepy.

It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Is there any food or drink I need to avoid?

Do not drink grapefruit juice while you're taking this medicine.

Grapefruit juice can increase the amount of sertraline in your body and increase the risk of side effects.

Are there other treatments that will help?

Antidepressants, including sertraline, are just one of several approaches to treating depression.

Other potential treatments include:

  • talking therapy (such as cognitive behavioural therapy)
  • exercise programmes
  • help to get a good night's sleep

Choosing a treatment that's most suitable for you depends on:

  • how long you have had depression
  • your symptoms
  • whether you have had any previous periods of depression
  • whether previous treatment has worked
  • how likely you are to stick with your treatment
  • the potential side effects
  • your preferences and priorities
Will recreational drugs affect it?

Cannabis with sertraline can give you a fast heartbeat. Cannabis can also make drowsiness worse with sertraline, especially in people who have just started taking it.

Methadone can increase the risk of side effects in people taking sertraline.

It can be potentially dangerous to take sertraline with:

  • stimulants like MDMA (ecstasy) or cocaine
  • hallucinogens like LSD
  • novel psychoactive substances (which used to be known as legal highs) like mephedrone

Important

Sertraline has not been properly tested with recreational drugs.

Talk to your doctor if you think you might use recreational drugs while taking sertraline.