Sertraline: uses, side effects and cautions

Sertraline belongs to the group of antidepressants called SSRIs. Despite the name, it is not only used for low mood. The NHS lists five uses: depression, OCD, panic disorder, PTSD and social anxiety disorder.

Younger people can be prescribed it too, but only for narrower reasons. The NHS says children aged 6 to 17 may take it for OCD, and young people aged 12 to 17 may be given it for severe depression.

• Depression

• Obsessive compulsive disorder

• Panic disorder

• Post-traumatic stress disorder

• Social anxiety disorder

The working explanation is that sertraline increases serotonin availability in the brain. Serotonin is linked to mood, so when levels settle, stress and negative thinking may ease. The medicine treats symptoms; it is not described as a cure, and it sits alongside other approaches such as talking therapy.

Sertraline comes as a tablet. You swallow it with water once daily, at the same time each day if you can, and food does not matter. Many prescribers begin with a low dose and raise it after a week or more, so the first dose you are given may not be the one you stay on.

For depression, treatment normally lasts several months or longer. Feeling better is not a signal to stop; the decision to come off belongs to you and your prescriber together.

If you miss a dose, leave it and take the next one at the usual time. Do not take two together. If you take more than prescribed, the NHS describes this as potentially dangerous and says to ring NHS 111 or go to A&E.

Most people notice some effects early on. The NHS says these usually settle within a couple of weeks as the body adjusts. If they linger or become hard to live with, speak to a pharmacist or your prescriber rather than stopping.

• Common: headaches, feeling or being sick, dizziness, drowsiness, dry mouth, diarrhoea, sleep problems, sexual difficulties and weight gain.

• Do not drive or use machinery while dizzy or drowsy.

• Call 999 for signs of anaphylaxis: swelling of the throat or tongue, a rash or difficulty breathing.

• Call NHS 111 for possible serotonin syndrome (fast heartbeat, sweating, shaking, twitching muscles and confusion), for a surge of unusual energy or an unusually high mood, or for thoughts of harming yourself.

The NHS names several situations where sertraline may not be suitable or needs closer thought: diabetes, epilepsy, heart disease, glaucoma, bleeding disorders and a past episode of mania. Tell the prescriber about these before starting, along with any other medicines you take.

Because it can affect bleeding, the NHS advises avoiding anticoagulants such as warfarin or apixaban without specialist advice, and cautions about anti-inflammatory painkillers such as aspirin or ibuprofen. Ask a pharmacist which painkiller is safer for you.

The NHS says sertraline can be used in pregnancy when the benefits outweigh the risks, at the lowest dose that works, and that a hospital birth is advised so the baby can be monitored. For breastfeeding, it says sertraline is often used; a small amount passes into milk, so confirm with your doctor or health visitor.

On alcohol the NHS advice is that it is best not to drink while taking it. Two things should never be combined with sertraline: MAOI antidepressants such as moclobemide or selegiline, and the herbal remedy St John's wort.

Abrupt stopping can bring withdrawal symptoms. When the time is right, the prescriber lowers the dose in steps over several weeks or months. If symptoms come back or withdrawal feels rough, report it so the schedule can be adjusted. Reports of suspected side effects can also be made to the MHRA Yellow Card scheme.