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Sertraline is a selective serotonin reuptake inhibitor (SSRI) indicated for the treatment of major depressive episodes, panic disorder with or without agoraphobia, obsessive-compulsive disorder (OCD), social anxiety disorder, and post-traumatic stress disorder (PTSD) in adults. It works by selectively inhibiting the reuptake of serotonin (5-hydroxytryptamine, 5-HT) at the presynaptic serotonin transporter in the central nervous system, thereby increasing serotonergic neurotransmission. Sertraline has minimal affinity for adrenergic, histaminergic, muscarinic, and dopaminergic receptors, which accounts for its relatively favourable tolerability profile compared to tricyclic antidepressants. It has a slow onset of therapeutic action, with improvements in mood, anxiety, and obsessional thinking developing over several weeks of continuous treatment.
Usual adult dose: For major depression and OCD: the recommended starting dose is 50 mg once daily. The dose may be increased in increments of 50 mg at intervals of at least one week, up to a maximum of 200 mg daily. For panic disorder, PTSD, and social anxiety disorder: treatment should be initiated at 25 mg once daily for the first week to minimise the risk of an initial anxiogenic effect, then increased to 50 mg once daily. The usual therapeutic maintenance dose across all indications is 50 mg to 100 mg once daily. Doses above 100 mg should be reserved for patients who have not responded to lower doses and should be prescribed under specialist supervision only. Sertraline should be taken as a single daily dose, either in the morning or evening, with or without food. In elderly patients, the starting dose of 25 mg is recommended, and the dose should be titrated with caution. No dose adjustment is required in mild to moderate renal impairment; caution is advised in severe renal impairment. In hepatic impairment, a lower dose or less frequent dosing should be considered due to reduced clearance. Abrupt discontinuation should be avoided; the dose should be tapered over several weeks to minimise withdrawal symptoms.
Dosage form: Film-coated tablets: 25 mg (white, capsule-shaped, biconvex, scored on one side), 50 mg (white, capsule-shaped, biconvex, scored on one side), and 100 mg (white, capsule-shaped, biconvex, scored on one side). All strengths are scored, allowing the tablets to be divided into equal halves. A 20 mg/mL oral concentrate solution is also available for patients who have difficulty swallowing tablets.
Onset of action: Sertraline has a gradual onset of therapeutic effect, consistent with the pharmacological mechanism of action involving adaptive changes in receptor sensitivity and neuroplasticity. Initial improvements in appetite, sleep, and energy may be observed within the first 1 to 2 weeks. Clinically significant improvements in depressed mood, anxiety, and anhedonia generally become apparent after 2 to 4 weeks of treatment at a therapeutic dose. The full antidepressant and anxiolytic response may require 8 to 12 weeks. In OCD, the therapeutic response may take longer, with maximal benefit often achieved after 12 weeks or more. Peak plasma concentrations of sertraline are reached 4.5 to 8.4 hours after oral administration.
Duration of action: Sertraline has a mean elimination half-life of approximately 26 hours, supporting once-daily dosing. The active metabolite, N-desmethylsertraline, has a longer half-life of 62 to 104 hours and contributes minimally to overall pharmacological activity. Steady-state plasma concentrations of the parent drug are achieved after approximately one week of daily dosing. On discontinuation, plasma levels decline gradually, and the prolonged presence of the metabolite provides a degree of self-tapering that may attenuate the severity of withdrawal symptoms compared to SSRIs with shorter half-lives, such as paroxetine.
Alcohol recommendation: Alcohol consumption should be avoided during treatment with sertraline. Although sertraline does not potentiate the cognitive and psychomotor effects of alcohol to the same degree as older sedating antidepressants, alcohol is a central nervous system depressant and can worsen depression, anxiety, and insomnia. Alcohol intake may interfere with the therapeutic benefit of sertraline and increase the risk of sedation, dizziness, and impaired judgement. In patients with a history of alcohol misuse, sertraline should be prescribed with caution, and the risks of combining sertraline and alcohol should be explicitly discussed. Patients are advised to abstain from alcohol during the initial phases of treatment and to limit intake thereafter.
Most common side effects: Nausea is the most frequently reported adverse effect at the start of treatment, occurring in approximately 20% to 25% of patients. This is generally mild to moderate, dose-related, and usually diminishes after the first 1 to 2 weeks. Diarrhoea, dry mouth, dyspepsia, and anorexia are also common gastrointestinal effects. Sexual dysfunction is a well-recognised and often under-reported side effect of SSRIs and includes delayed ejaculation, anorgasmia, erectile dysfunction, and reduced libido. These effects are frequently dose-dependent and may persist in some patients after discontinuation. Insomnia, somnolence, agitation, and tremor are common central nervous system effects, particularly during the early phase of treatment. Headache, fatigue, and increased sweating are also frequently reported. Hyponatraemia, usually attributed to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), is more common in elderly patients and should be considered in the setting of unexplained confusion, drowsiness, or seizure. A paradoxical increase in anxiety or agitation, particularly at the initiation of treatment or during dose escalation, may occur and requires close monitoring, especially in younger adults and adolescents. An increased risk of suicidal ideation and behaviour has been observed in young adults aged 18 to 24 years during the initial weeks of therapy, and all patients should be carefully monitored for clinical worsening and suicidality. Sertraline is associated with a dose-dependent QTc prolongation, which is generally modest but may be clinically relevant in patients with pre-existing cardiac conduction abnormalities or those receiving concomitant medications that prolong the QT interval.
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At our pharmacy, you can buy Sertraline without a prescription, with discreet and anonymous packaging delivered within 5-14 days across the UK.
Sertraline is an antidepressant of the SSRI class, selective serotonin reuptake inhibitor. It is used for major depression, panic disorder, obsessive-compulsive disorder, social anxiety disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder. It is one of the most prescribed antidepressants in the UK. For many patients, it is the first SSRI they try, and for a good number of them, it works. It is not a happy pill. It does not erase sadness in a few hours. It shifts the baseline over weeks, making the lows less low and the daily demands of life more manageable.
The starting dose for depression and most anxiety disorders is 50 mg once daily. This can be increased in 50 mg increments at weekly intervals based on response and tolerability. The maximum dose is 200 mg daily. For panic disorder and PTSD, starting at 25 mg for the first week reduces the initial anxiety surge that some patients experience, after which the dose is increased to 50 mg. For OCD, doses at the higher end of the range, 100 mg to 200 mg, are often needed. The tablets come as 25 mg, 50 mg, and 100 mg. The 50 mg tablet is the workhorse. The 25 mg is for titration. The 100 mg is for maintenance once the effective dose is established.
Sertraline blocks the serotonin transporter, SERT, on presynaptic neurons. That transporter is responsible for pulling serotonin back into the neuron after it has been released into the synaptic cleft. Block it, and serotonin stays in the synapse longer, binding to postsynaptic receptors and prolonging neurotransmission. That is the simple account. The reality is more layered. The immediate increase in synaptic serotonin triggers presynaptic 5-HT1A autoreceptors, which initially reduce serotonin firing. Over 2 to 4 weeks, these autoreceptors desensitise. Serotonergic transmission increases, and the therapeutic effect emerges. The delay between starting the drug and feeling better is built into the neurobiology. It cannot be bypassed by taking more.
Sertraline has a modest effect on dopamine reuptake, more so than most other SSRIs. This dopamine activity is weak but real and may contribute to its relatively favourable profile for energy and motivation compared to more sedating SSRIs like paroxetine. It also has some activity at sigma receptors, though the clinical significance is unclear. Oral bioavailability is about 80% to 100%, and food increases absorption modestly. Peak plasma levels are reached at 4 to 8 hours. The half-life is about 26 hours, which allows once-daily dosing. Steady state takes about a week. The drug is metabolised extensively in the liver by CYP2C19, CYP2B6, CYP2C9, CYP3A4, and CYP2D6 to desmethylsertraline, an active metabolite with about 10% of the potency. Excretion is roughly equal between urine and faeces.
Take it once daily, in the morning or evening. The timing depends on how it affects you. For some people, sertraline is activating, and taking it at night leads to insomnia. For others, it causes fatigue, and evening dosing makes sense. Start in the morning for the first week. If you feel wired, stay with morning dosing. If you feel sedated, switch to the evening. There is no pharmacological reason to prefer one over the other.
Take it with or without food. Food reduces the likelihood of nausea, which affects about 20% of patients in the first week. A small meal or a cracker is enough. If nausea persists, taking it with a proper breakfast helps. The nausea almost always passes within a week or two as the gut serotonin receptors adapt. Do not stop sertraline abruptly. Discontinuation symptoms, dizziness, electric shock sensations, irritability, flu-like symptoms, can appear within days of stopping. The dose should be tapered over weeks to months depending on the duration of treatment and the dose. A patient on 200 mg for years needs a slow, stepwise reduction. A patient on 50 mg for 3 months can taper faster.
If you forget a dose, take it as soon as you remember. If it is nearly time for the next dose, skip the missed one. Do not double up. Missing a single day of sertraline is unlikely to cause discontinuation symptoms because of the long half-life. Missing several days in a row can. Keep a routine. Pair it with something you do every morning, brushing your teeth, making tea, so it becomes automatic.
Gastrointestinal disturbance dominates the early weeks. Nausea, diarrhoea, and loose stools affect a significant minority. This is serotonin acting on 5-HT3 and 5-HT4 receptors in the gut. It is not an allergy. It settles as the gut adapts. Taking the tablet with food and avoiding spicy or fatty meals in the first fortnight reduces the misery. Headache, dry mouth, and increased sweating occur in a smaller percentage. The sweating, particularly night sweats, can persist beyond the initial weeks and is one of the more stubborn side effects.
Sexual dysfunction is the side effect that matters most to many patients and is the least likely to be volunteered unless asked directly. Delayed ejaculation, reduced libido, and erectile difficulty affect about 30% to 50% of men on SSRIs. In women, reduced desire and delayed orgasm are similarly prevalent. For some, this improves after the first few months. For others, it persists for the duration of treatment. It is dose-dependent. Reducing the dose from 100 mg to 50 mg can restore function without losing the therapeutic effect. Adding bupropion or switching to a drug with a lower sexual side effect burden, agomelatine or vortioxetine, are options. Do not stop sertraline because of sexual side effects without discussing alternatives. There are alternatives.
Weight gain is less pronounced with sertraline than with paroxetine or mirtazapine, but it happens. A gain of 2 to 5 kg over a year of treatment is typical. The mechanism is partly increased appetite, partly metabolic. If weight starts to climb, dietary attention and exercise early in treatment are easier than trying to lose weight after it has accumulated. Insomnia or somnolence, depending on the patient, usually declare themselves in the first week and guide the timing of the dose. Agitation and an increase in anxiety can occur in the first days to weeks. This is why starting at 25 mg for anxiety disorders is common. The anxiety surge is transient. It is not a sign the drug is wrong. It is a sign the serotonergic system is being perturbed before it adapts.
Pregnancy is a risk-benefit analysis. Sertraline crosses the placenta. The data on congenital malformations are largely reassuring. A small increase in cardiac septal defects has been reported, but the absolute risk is low. The more pressing concern is neonatal adaptation syndrome in the third trimester. Irritability, feeding difficulties, respiratory distress, and jitteriness occur in about 10% to 30% of exposed neonates. It is usually mild and self-limiting, lasting a few days to a week. Untreated depression in pregnancy carries its own risks, poor antenatal care, low birth weight, postnatal depression, and impaired mother-infant bonding. The decision to continue sertraline or taper off is made by the patient and the perinatal psychiatrist together. Sertraline is one of the SSRIs with the most pregnancy data and is often the preferred agent if an SSRI is needed.
Breastfeeding is compatible with sertraline. Levels in breast milk are low. The amount an infant ingests is a small fraction of the maternal dose. Adverse effects in nursing infants are rare. The benefits of treating maternal depression during the postnatal period are substantial. Sertraline and paroxetine are the SSRIs with the lowest milk levels and the most lactation data.
Children and adolescents with depression can be treated with sertraline, but the evidence for efficacy is weaker than in adults. The risk of increased suicidal ideation in the first weeks of treatment is well-documented across all SSRIs in this age group. This is not a reason to avoid treating depression in a young person. It is a reason to monitor closely, particularly in the first month, and to ensure the prescribing is done by a child and adolescent psychiatrist.
Older adults metabolise sertraline more slowly. Starting at 25 mg and titrating slowly is sensible. Hyponatraemia is more common in the elderly on SSRIs, particularly in those also taking diuretics. Sodium should be checked before starting and a few weeks into treatment. A confused older patient on sertraline with a sodium of 125 mmol/L is a classic clinical scenario. Stopping the SSRI and fluid restriction usually corrects it.
Bipolar disorder must be excluded before starting sertraline. An SSRI without a mood stabiliser can precipitate a manic episode. The screening question is simple: have you ever had a period of days where you felt unusually high, energetic, or irritable, needed less sleep, and did things you later regretted? If the answer is yes, the diagnosis may not be unipolar depression, and the prescribing decision changes.
Sertraline can cause drowsiness, dizziness, and blurred vision, particularly in the first weeks. If you are affected, do not drive. Once you are stable on a dose and these effects have passed, driving is generally fine. The drug does not impair alertness in the way that older tricyclic antidepressants do. If you feel slowed or your concentration is off, err on the side of caution.
Alcohol and sertraline do not have a direct pharmacological interaction of the disulfiram type. Alcohol is not prohibited. The problem is that alcohol is a depressant. Drinking while treating depression undermines the treatment. A single drink on a social occasion is unlikely to do harm. Regular or heavy drinking impairs the brain's ability to recover. It worsens sleep, which worsens depression, which makes the sertraline look like it is not working. If you are taking sertraline, keep alcohol light and intermittent. If alcohol is a coping mechanism, talk to your doctor.
Monoamine oxidase inhibitors, phenelzine, tranylcypromine, isocarboxazid, and the reversible MAOI moclobemide, are contraindicated with sertraline. The combination causes serotonin syndrome, hyperthermia, rigidity, autonomic instability, and can be fatal. A washout period of at least 14 days is required when switching from an irreversible MAOI to sertraline, and at least 7 days when switching from sertraline to an MAOI.
Other serotonergic drugs increase the risk of serotonin syndrome when combined with sertraline. Tramadol, fentanyl, pethidine, triptans, sumatriptan, zolmitriptan, and other antidepressants, SNRIs, TCAs, mirtazapine, all add to the serotonin load. Serotonin syndrome exists on a spectrum. Mild cases present as tremor, sweating, and agitation. Severe cases involve clonus, hyperthermia, and organ failure. The risk of severe serotonin syndrome with sertraline monotherapy is very low. The risk climbs when multiple serotonergic drugs are combined. St. John's wort, an over-the-counter herbal antidepressant, is serotonergic. Do not combine it with sertraline.
NSAIDs, aspirin, and anticoagulants increase the risk of gastrointestinal bleeding when taken with SSRIs. Sertraline impairs platelet aggregation by blocking serotonin uptake into platelets. Serotonin is needed for platelet plug formation. The result is a modest increase in bleeding risk. For a healthy young person on sertraline alone, the absolute risk is tiny. For an older patient on sertraline, warfarin, and ibuprofen, the risk of a significant upper GI bleed is real. A proton pump inhibitor like omeprazole should be considered if an NSAID is necessary. Paracetamol is the safer analgesic.
CYP2C19 inhibitors, omeprazole, esomeprazole, fluconazole, can increase sertraline levels modestly. The interaction is not usually clinically significant, but if a patient on a stable sertraline dose develops new side effects after starting omeprazole, the sertraline dose may need to be reduced. CYP2C19 is the main enzyme metabolising sertraline, but multiple CYP pathways provide backup, which limits the impact of inhibiting a single enzyme.
Within SSRIs, citalopram and escitalopram are the closest alternatives. They are cleaner drugs pharmacologically, with fewer off-target effects, but they carry a higher risk of QTc prolongation at high doses. Fluoxetine has a much longer half-life, which reduces discontinuation symptoms but makes switching drugs a slower process. Paroxetine is more sedating and has the highest risk of sexual dysfunction and discontinuation symptoms. It is rarely the right first choice.
SNRIs, venlafaxine, duloxetine, add noradrenaline reuptake inhibition to serotonin reuptake inhibition. They can be more effective for some patients, particularly those with neuropathic pain or significant fatigue. Venlafaxine has a reputation for difficult discontinuation. Duloxetine has a shorter half-life and can also be challenging to stop. Mirtazapine is a noradrenergic and specific serotonergic antidepressant with a different side effect profile. It causes weight gain and sedation, which can be useful in an underweight, insomniac patient. Agomelatine targets melatonin receptors and has no sexual side effects, but it requires liver function monitoring. Vortioxetine is a newer agent with multimodal serotonin activity and a better cognitive profile. Bupropion is a noradrenaline and dopamine reuptake inhibitor with no serotonergic activity. It has no sexual side effects and is used as an add-on or alternative when SSRIs cause sexual dysfunction.
Cognitive behavioural therapy has comparable efficacy to SSRIs for mild to moderate depression. For moderate to severe depression, the combination of medication and CBT outperforms either alone. The availability of NHS talking therapies varies by region. The waiting list is often measured in months. For someone who cannot wait that long, sertraline is a reasonable bridge. Exercise has evidence as an adjunct. A structured programme of aerobic exercise three times a week improves outcomes in depression. It is not a replacement for medication in severe illness, but it adds something that medication does not provide.
INN (International Nonproprietary Name): Sertraline hydrochloride
Available brand names in the UK: Lustral, and numerous generic sertraline products
ATC code: N06AB06
Forms and strengths: Tablets: 25 mg, 50 mg, 100 mg; Oral concentrate: 20 mg/mL (for patients who need liquid or cannot swallow tablets)
Manufacturers: Pfizer (Lustral), and diverse generic manufacturers including Teva, Sandoz, Mylan, Accord, Zentiva, Actavis
Registration status in the UK: Registered as a Prescription Only Medicine (POM). Sertraline is one of the most commonly prescribed antidepressants in the NHS.
Classification: Prescription Only Medicine (POM)
The 50 mg tablet is the starting dose for most adults. The 25 mg tablet is for titration, particularly in anxiety disorders, the elderly, and patients who are sensitive to serotonergic activation. The 100 mg tablet is for maintenance once the effective dose is known. A patient on 100 mg daily can take one tablet instead of two, which is simpler and reduces the cost difference, which is negligible in generic form but still relevant for adherence.
Generic sertraline and branded Lustral are bioequivalent. The switch from brand to generic is well-established and unproblematic. The tablets are small and easy to swallow. The oral concentrate is for patients who need a liquid form, children, the elderly with dysphagia, or those who need precise doses that are not multiples of 25 mg. It must be diluted in water, orange juice, or lemonade before taking. It is not taken undiluted. The concentrate contains alcohol, which is relevant for patients with a history of alcohol dependence.
How long does sertraline take to work?
Sleep, appetite, and energy may improve within the first week or two. Mood, interest in activities, and anxiety take longer, usually 2 to 4 weeks for initial improvement and 6 to 8 weeks for the full effect. Do not decide after 10 days that it has failed. The neurobiology of serotonin adaptation takes time. If there is no improvement at all by 4 to 6 weeks at a therapeutic dose, a dose increase or a switch to a different drug is considered.
Will I feel worse before I feel better?
Some patients do. Increased anxiety, agitation, and restlessness can occur in the first week. This is more common in panic disorder. Starting at 25 mg reduces this. The effect is transient, lasting days, not weeks. If it is severe or accompanied by suicidal thoughts, contact your doctor immediately. Do not sit with it in silence.
Can I stop sertraline suddenly?
No. Discontinuation symptoms affect about 20% to 30% of patients who stop abruptly. Dizziness, electric shock sensations, known as brain zaps, nausea, irritability, and flu-like symptoms. These are not a sign of addiction. They are a sign of serotonin receptor adaptation. Taper the dose over weeks to months. The longer you have been on it and the higher the dose, the slower the taper should be.
Will sertraline affect my sex life?
It can. Delayed ejaculation, reduced libido, and difficulty reaching orgasm are common. They do not affect everyone. They are dose-dependent. If they occur and are troubling, options include reducing the dose, switching to an antidepressant with fewer sexual side effects, adding bupropion, or taking a drug holiday if the condition and formulation allow. Do not stop treatment without discussing it. Sexual dysfunction from untreated depression is also real, and it can be hard to know which is the illness and which is the drug.
Can I take sertraline during pregnancy?
The decision is individual. Sertraline has the most pregnancy data of the SSRIs. The risk of congenital malformations is low. Neonatal adaptation syndrome affects a minority of exposed infants and is usually mild and self-limiting. Untreated depression in pregnancy carries its own risks. The decision to continue, taper, or stop should be made with the GP, the midwife, and ideally a perinatal psychiatrist. Do not stop sertraline abruptly if you discover you are pregnant. Arrange a discussion with your doctor first.
We ship Sertraline to all parts of the United Kingdom. Delivery times depend on your location:
All shipments are packed discreetly with no branding or indication of contents on the outside. At our pharmacy, you can purchase Sertraline without a prescription, with delivery across the UK.
