SSRI·Psychiatry - Antidepressants

SERTRALine

Major Depressive Disorder (MDD), OCD, Panic Disorder, PTSD, Social Anxiety

PBSSSRIZoloft, Eleva50 mg tabletS4+1

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At a glance

Max Dose

200 mg/day

Half-life

26 h

Caution: GI Upset

COMMON

Post-MI Safe

YES

Cautions

Avoid / Cautions

Concurrent use of MAOIs (causes fatal Serotonin Syndrome). Pregnancy Category C. Considered one of the safest SSRIs for breastfeeding/pregnancy.

Where it stands

Rapid Summary

Overview

Selective Serotonin Reuptake Inhibitor (SSRI). Highly effective, broadly tolerated. Unique among SSRIs for having the best cardiovascular safety profile.

Clinical Focus

Often causes intense nausea and diarrhea in the first 1-2 weeks. Must counsel patients to push through it.

Bottom Line

Sertraline is the first-line SSRI for depression, anxiety, PTSD, and OCD with the best cardiovascular safety profile, but causes GI side effects initially and carries serotonin syndrome risk with other serotonergic drugs.

Formulation & Access

Brand Names

Zoloft, Eleva

Oral Routes

Tablets (50 mg, 100 mg).

Prescribing & PBS

Unrestricted General Benefit (S4).

Indications & Use

Primary

PBSTGA

Major Depressive Disorder (MDD), OCD, Panic Disorder, PTSD, Social Anxiety.

Clinical Place

First-line SSRI for almost all indications. Absolute first choice for patients with ischemic heart disease or recent MI (SADHART trial).

Quick reference

Class & Role

SSRI — Selective Serotonin Reuptake Inhibitor (SSRI).

Route / Formulation

Tablets (50 mg, 100 mg). (Zoloft, Eleva)

Usual Dose & Max

Start PO 50 mg OD (morning). Titrate by 50 mg increments every 2-4 weeks to target response. Max 200 mg/day.

Key Indication Doses

Depression / Anxiety / PTSD: Start PO 50 mg OD (morning). Titrate by 50 mg increments every 2-4 weeks to target response. Max 200 mg/day. Panic Disorder / Frail Elderly: Start PO 25 mg OD to minimize early activating anxiety/nausea.

Best Uses

Key Risks

Gastrointestinal: Nausea, diarrhea, dyspepsia (Serotonin receptors in the gut are heavily stimulated). Neurological: Insomnia, tremor, activation/anxiety in the first 2 weeks. CRITICAL — Serotonin Syndrome. Endocrine/GU: Sexual dysfunction (anorgasmia, decreased libido). Metabolic: Hyponatremia (SIADH), especially in the elderly.

Key Interactions

MAOIs, Tramadol, Tapentadol, St John's Wort. Massive risk of Serotonin Syndrome (hyperthermia, clonus, rigidity, death). NSAIDs and Aspirin. SSRIs deplete platelet serotonin, doubling the risk of upper GI bleeds. Cover with PPI if combined.

Monitoring

Check U&E (sodium) 2-4 weeks after initiation in elderly patients due to SIADH risk. Monitor for increased suicidal ideation in the first 2-4 weeks (energy returns before mood improves in adolescents/young adults).

Clinical Pearl

Patients often quit Sertraline on Day 3 because it makes them feel 'wired, sick, and anxious'. Warn them that the brain takes 2 weeks to downregulate serotonin receptors, and the anxiety WILL pass. Prescribe short-term diazepam if necessary.

Access

Zoloft, Eleva50 mg tablet

Brand: Zoloft, Eleva
Formulation: Tablets (50 mg, 100 mg).

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