Sertraline

How it works

What does sertraline do?

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

Research suggests that depression or low mood is more likely to occur when the brain doesn’t have enough serotonin.

Serotonin (also called '5HT') is a naturally-occurring chemical messenger (or 'neurotransmitter') that has an important role in areas of the brain that control mood and thinking.

Selective serotonin reuptake inhibitors (SSRIs) - like sertraline - are thought to work by increasing levels of serotonin in the brain. They do this by blocking the recycling of released serotonin back into the nerve endings.

Sertraline is often prescribed alongside a talking therapy.

How long does sertraline take to start working?

Antidepressants like sertraline can start to work on depression within the first two weeks of treatment, and the improvement continues over the following few weeks.

It may take four weeks or longer for you to get the full effect.

For anxiety, antidepressants like sertraline can take slightly longer to work. For some people, anxiety briefly increases at the start of treatment, but the anxiety does decrease with continued treatment.

Your doctor will start with a low dose, which they increase slowly to a dose that is effective for you. This may take several days or weeks.

How long will I need to take sertraline?

You will need to take sertraline for several months after you feel better, otherwise your symptoms can come back.

Your doctor will advise you how long to take sertraline for, as it depends on why you are taking it. For depression it might be six months, for OCD it might be 12 months and for other anxiety related conditions such as PTSD and Panic Disorder it might be up to 18 months.

If you stop taking the sertraline too soon, there is more chance that your symptoms will come back.

If you have bipolar disorder, it is likely that the doctor will advise for the sertraline to be stopped sooner. This is because, in bipolar disorder, there is a risk of your mood becoming too high if an antidepressant is used for too long.

See your doctor if you want to stop sertraline.

Your doctor needs to know if...

You need to talk to your doctor or pharmacist before starting treatment with sertraline if you have (or have had) any of the following:

• seizures (fits)
• bipolar disorder
• schizophrenia
• thoughts of harming yourself or taking your own life
• serotonin syndrome (your doctor might have this on your records)
• low sodium level in your blood
• liver disease
• diabetes
• bleeding disorders
• if you are having electroconvulsive therapy (ECT)
• eye problems, such as glaucoma (increased pressure in the eye)

Taking sertraline

You should only take sertraline as agreed with your doctor

You will get the best effects from your medicine if you take it every day at the dose prescribed by your doctor.

Make sure that you know your dose. If it is not written on the label, check with your pharmacist or doctor.

You will usually take it once a day. When you start treatment, it is recommended that you take it in the morning and not at night, in case it affects your sleep.

To help you to take you tablet regularly you should choose a time that you will remember. This could be a mealtime or when you brush your teeth.

You will start with a low dose, which will be increased slowly to a dose that is effective for you. This may take several days or weeks.

You can take it with or without food.

Swallow the tablet whole with a glass of water - it tastes bitter if you chew it.

Do not drink grapefruit juice while you are taking sertraline - the juice increases the amount of sertraline absorbed from your gut.

What if I miss a dose?

If you remember later during the day, take it as soon as possible.

If you forget to take it by bedtime, just start again on the next day.

Do not take a double dose.

What will happen if I forget to take my sertraline?

If you forget to take your tablets for a few days, you may start getting your old symptoms back, or get withdrawal symptoms (feeling dizzy or shaky, sleep problems [including difficulty sleeping and intense dreams], feeling irritable or anxious, feeling or being sick, and headaches). If this happens you should talk to your doctor about it.

It is important to take sertraline every day, otherwise it will not work.

Stopping the use of sertraline

Stopping this medicine quickly, or reducing the dose too much at once, may cause uncomfortable withdrawal symptoms.

Once you start taking an SSRI, the brain adjusts to having a new level of serotonin around. If you stop taking the SSRI all at once, the balance starts to change again. You could get some symptoms from the change.

Sertraline is not addictive, but you may get uncomfortable withdrawal symptoms if you stop sertraline suddenly, as your body begins to miss it. It is better to agree stopping with a doctor who will reduce you gradually over about four weeks.

Some of the withdrawal symptoms include:

• dizziness or headaches
• tingling feelings like pins and needles or numbness - some people describe electric shock-like feelings down their head and back
• sleep disturbances (vivid dreams, nightmares, not being able to sleep)
• feeling anxious or agitated
• feeling sick or being sick
• shaking

These symptoms should stop after two to three weeks for most people, but a very few people can get them for two to three months or more.

Most people get mild symptoms, but for a very few people they can be very intense.

Go and speak to your doctor if you have decided to stop taking your medication.

The information on this page was reviewed by the College of Mental Health Pharmacy in March 2020.

Safety headlines

If you have taken more sertraline than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different.

While taking sertraline, some people may think about hurting themselves or taking their own lives. You must go straight to hospital with your tablets if you have any of these thoughts.

Sertraline can also cause rare but serious side effects: allergic reactions (difficulty breathing, swelling of your face or throat, itching skin lumps), a seizure (fit), serotonin syndrome (see 'Side Effects' tab for description), and liver problems (which may present as yellowing of skin and eyes). Go to a hospital with your medicine if you get any of these symptoms.

Do not take sertraline if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Stopping sertraline suddenly can cause unpleasant withdrawal effects. Go to your doctor if you want to stop, or if you are having these effects.

Sertraline is not addictive, but stopping it suddenly can cause problems such as: feeling dizzy or shaky, sleep problems (including difficulty sleeping and intense dreams), feeling irritable or anxious, feeling or being sick, and headaches.

Go to your doctor if you want to stop, or if you are having these effects.

You might feel sleepy or restless, and may not be able to see as clearly, in the first few days after taking sertraline. Do not drive a car, ride a bike or operate machines until you see how this affects you.

If you are pregnant, or thinking of becoming pregnant, please read the pregnancy section (see 'Side Effects' tab) because sertraline may affect the developing baby.

When to go to the hospital

If you have taken more sertraline than the dosage recommended by the doctor who prescribed it to you, you must get medical help immediately – even if you do not feel any different. Go to A&E. Take your medicine with you to show to the doctors. Tell them how much you have taken. Get a friend to go with you, if you can, just in case you feel ill on the way.

You might get some of the following signs:

• drowsiness
• feeling or being sick
• fast heartbeat
• shaking
• agitation
• dizziness
• in very rare cases, going unconscious

You are also at risk of getting serotonin syndrome. Symptoms include a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it.

If you have any thoughts of taking your own life or of other ways of hurting yourself, go straight to a hospital with your medicine. This may be a side effect of taking sertraline, and you need urgent help. This can happen to anyone but is more likely to happen if you are under 25 years old.

Go to a doctor or hospital straight away if you get any of the following symptoms:

• any combination of the following symptoms: high fever, agitation, confusion, trembling, sweating, diarrhoea (loose poo), fast heartbeat or weird movements of your muscles – this could be serotonin syndrome
• allergic reaction or allergy, which may include symptoms such as an itchy skin rash, breathing problems, wheezing, swollen eyelids, face or lips
• jaundice (yellowing of your skin or the whites of your eyes) which may mean liver damage
• if you feel restless and are not able to sit or stand still after you start to take sertraline
• if you have a seizure (fit)
• if you feel overexcited or very happy, as this may be a manic episode
• a painful erection that lasts for a long time (priapism)

Side effects

Some side effects that appear should go away or get better after a few days. If they do not, you should go back to your doctor.

Don't stop taking sertraline until you talk to your doctor or you may get withdrawal symptoms as well.

Very common side effects of sertraline, affecting more than one in ten people, include:

• dizziness or headache
  
• sleepiness, feeling very tired, or difficulty getting to sleep
  
• diarrhoea (loose poo)
  
• feeling sick
• dry mouth
• problems with ejaculating (coming)

Common side effects, affecting up to one in ten people, include:

• sore throat, teeth grinding, or a funny taste in your mouth
  
• changes in your appetite (feeling hungrier or less hungry)
  
• having nightmares
  
• feeling anxious, agitated, depressed, nervous, or just strange
  
• less interest in sex, or problems having sex - like difficulty getting an erection
  
• numbness and tingling, tense muscles, having muscle pain, or shaking
• problems with focusing and concentration
  
• effects on your eyesight
  
• ringing in your ears
  
• palpitations, chest pain, hot flushes and sweating
  
• yawning a lot
  
• being sick or having stomach and gut pain
  
• having constipation, an upset stomach, lots of wind
  
• getting a rash

In clinical trials, young people aged under 25 were more likely than adults to get the following side effects from SSRI medicines:

• thoughts of self-harm and/or taking their own lives
• being hostile or aggressive

The most common side effects reported in children and adolescents are headache, insomnia, diarrhoea and nausea (feeling sick).

Body

A side effect of sertraline may be weight loss or weight gain.

Gaining some weight is more likely, but it is very difficult to know how it will affect each person who takes it.

Talk to your doctor about this if it worries you.

Do not take sertraline at the same time as weight-loss products.

Sleep

You can feel drowsy in the first few days of taking sertraline. This should get better after the first week or two. If it makes you feel drowsy, try taking it just before you go to bed.

You could also, strangely, get insomnia (difficulty getting to sleep), and disturbing dreams or nightmares. If this happens, try taking the tablet first thing in the morning.

If you feel like a zombie, and you’ve been taking it for more than a month, you can go back to the doctor and see what else you could do.

Sex and fertility

Sex

Sertraline can have side effects that might affect your sex life. These might include:

• a lower sex drive
• problems getting an erection (getting hard) and ejaculating (coming)
• a painful erection that lasts for a long time (priapism). If this happens to you, see a doctor for help straight away
• bleeding from the vagina and difficulty reaching orgasm (coming) the same way as before
• some growth of the breasts and milk flow, regardless of gender (this is very rare)

These effects should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to the doctor and see what else you could try.

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

Fertility

There have not been any concerns about fertility problems with sertraline.

If you are trying to get pregnant, you should not take sertraline unless you have talked about it with your doctor.

Pregnancy, post-natal and breastfeeding

Pregnancy

When deciding whether to take sertraline during pregnancy it is important to weigh up how necessary sertraline is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are.

Remaining well is particularly important during pregnancy and while caring for a baby. For some women, treatment with sertraline in pregnancy may be the best option for both mother and baby.

If you do become pregnant while you are on sertraline, you should carry on taking the medicine and go back to your doctor as soon as possible, to see if you should stop or change your medicine.

If you and your doctor agree that you will carry on taking sertraline, you should tell your midwife that you are taking it before you give birth.

Post-natal

There are some other symptoms that can occur in newborn babies if sertraline is taken in the last three months of pregnancy, so do look out for these and get help if they happen:

• fits or shaking
• being too hot or cold
• feeding difficulties or being sick
• having stiff or floppy muscles, or overactive reflexes
• being jittery, irritable or having constant crying
• being very sleepy or finding it difficult to sleep

These are usually mild and go away in a few days without treatment.

If sertraline is taken in the last five months of a pregnancy, it can cause a serious condition called persistent pulmonary hypertension of the new-born (PPHN). This can make the baby breathe faster and look a bit blue in colour. PPHN affects around three in 1,000 babies born to mums who take SSRIs. This compares with a rate of two in 1,000 among babies born to mums who do not take SSRIs.

PPHN appears in the first 24 hours after birth. You will need help from the midwife and doctors, so it is better if they are looking out for symptoms.

Breastfeeding

Sertraline passes to the baby through breast milk in small amounts.

Breastfeeding may help offset any withdrawal symptoms.

Please talk to your midwife, doctor or pharmacist if you want to breastfeed while taking sertraline.

Talk to your doctor or midwife about your feeding options.

If your baby was premature or has health problems, then you will need to be extra careful about taking medicines while breastfeeding. It may be best not to breastfeed if this is the case, but you should discuss this with your doctor.

Driving and transport

Taking sertraline may make you feel sleepy, dizzy and restless, and could affect your eyesight when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you and your body gets used to it.

Do not worry - most people drive as normal while taking sertraline.

School and exams

Try not to take sertraline for the first time just before your exams.

Sertraline can make you feel very restless in the first few weeks that you take it and may affect you when you sit or stand still.

It can also disturb your sleep, and your eyesight.

You should talk to your doctor about any future exams if you are starting sertraline. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start sertraline to improve your motivation to study.

Do not worry - most people take exams as normal while taking sertraline.

Friends and family

You may want to let your family and friends know you are taking sertraline so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Sport

Sertraline is not a banned substance in sport.

Taking sertraline may affect your ability to do things like riding a bike, competitive sports or anything else that needs a lot of focus.

You may also find it difficult to sit or stand still at first.

It might be best to stop such sports for the first few days, until you know how it affects you.

Do not worry - most people play sports as normal while taking sertraline.

Alcohol and street drugs

Alcohol

You can continue to drink alcohol while taking sertraline, but having the two together might make you very sleepy and unsteady on your feet.

During the first few days, it might be best to stop drinking alcohol until you see how the medicine affects you, or the side effects pass.

If you want to drink alcohol, remember that you might be very sleepy and make sure you can get home safely.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and the sertraline will not get the best chance to act.

Street drugs

Methadone and heroin can make drowsiness worse with sertraline. The sertraline could increase the concentration of methadone in your body.

SSRIs may reduce the effects of ecstasy and so might make people try higher doses and therefore get more side effects.

Taking sertraline with cocaine, ecstasy or amfetamines could bring on serotonin syndrome. You could get a high temperature/fever, agitation, confusion, trembling or weird muscle movements. You need to go to hospital if this happens. Tell the doctor that you are taking sertraline.

Sertraline does not seem to be affected by cannabis, although it may make you a bit drowsier.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis. For more information, have a look at our drugs and alcohol page.

There are many other street drugs, but we don’t know what effect taking them with sertraline will have.

Prescription medicines

Sertraline does not mix well with some other medicines and drugs.

Do not take sertraline if you are on or have taken MAOIs (drugs like phenelzine, isocarboxazid, tranylcypromine or moclobemide) in the last 14 days; you must wait until 14 clear days have passed before you can take sertraline.

Tell your doctor if you are taking any other medicines.

Tell the pharmacist you are taking sertraline if you buy medicines over the counter (including things you put on your skin) for common illnesses.

References and further reading

For more helpful links and information, have a look at our references and further reading page.