Sertraline | SSRI Antidepressant Mental Health Medication

Medication name

Sertraline ("SIR-tra-leen")
Brand name

Lustral ("LUSS-trawl")
Medication type

Selective serotonin reuptake inhibitor (SSRI)

Tablets: 25mg, 50mg,100mg, 150mg and 200mg strengths

Liquid: 100mg/5ml concentrate for oral solution (this needs to be diluted before taking). Use the syringe provided to remove the required amount of sertraline concentrate for oral solution and dilute with approximately 120 ml (one glass) of water, ginger ale, lemon/lime soda, lemonade or orange juice. Do not mix sertraline concentrate for oral solution with anything other than the liquids listed. The dose should be taken immediately after dilution. At times, a slight haze may appear in the solution after mixing – this is normal.

Other strengths of sertraline liquid may occasionally be prescribed. Always check the strength of the liquid you are dispensed to avoid taking too much or too little.

If you are 18 or over, the doctor can prescribe sertraline for you as a licensed medicine for the treatment of depression, obsessive compulsive disorder (OCD), panic disorder, social anxiety and post-traumatic stress disorder (PTSD). Sertraline is also sometimes prescribed for other conditions such as generalised anxiety disorder (GAD).

If you are aged six to 17, the doctor can prescribe sertraline for you as a licensed medicine for the treatment of obsessive-compulsive disorder (OCD).

If you are under 18, a specialist doctor may still consider this as a treatment option for other conditions such as anxiety or depression.

Read our guide to depression

About sertraline

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

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

Sertraline is thought to work by increasing levels of serotonin in the brain.

Depression, and other conditions like anxiety disorders, are not just caused by low serotonin levels, but a rise in serotonin levels can improve symptoms and help you to feel better.

Sertraline and everyday life

Sertraline can start to work on depression within the first one to 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.

How people respond to treatment can vary. Sometimes improvement is slow, and you may not feel any different to start with. This can be hard when your mood is low, and if you experience any side effects form your medication you may think you feel worse and not better. If you can, give your medication a chance to work and continue to take it for at least three to four weeks to see if it makes a difference.

Your parents, friends and doctor may notice an improvement in you before you feel it yourself, so it’s a good idea to talk to them.

If you think your medicine has not made any difference to how you feel after three to four weeks, you should go back to your doctor. They might recommend a change in dose or a different medication. However, it can take longer to work for some people than for others, so they may suggest you wait six to eight weeks before deciding.

For anxiety or obsessive-compulsive disorder, it can take longer for the benefits to be noticed. It could take up to three months before you feel the full benefit.

For some people, anxiety symptoms briefly increase at the start of treatment, but this should decrease over time as you continue to take your medicine. To avoid or minimise this, your doctor will usually start treatment with a low dose and increase this after one to two weeks.

Sertraline can cause people to lose weight when they first start taking it.

Some people find that they gain a little weight in the long term. This might be due in part to a return of their appetite.

It is not possible to predict how sertraline will affect each person before they start taking it. Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking sertraline.

A very common side effect of sertraline is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

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.

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.

Some people find that sertraline causes insomnia (difficulty getting to sleep), and disturbing dreams or nightmares. If this happens, try taking the sertraline first thing in the morning.

If you have been taking sertraline for more than a month and you continue to feel very tired, sleepy or struggle to function during the day, you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

It may be possible to drink some alcohol in moderation while taking sertraline but having the two together might make you very sleepy and unsteady on your feet.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

Methadone and heroin can make drowsiness worse with sertraline. The sertraline could increase the concentration of methadone in your body. In some situations, methadone may be prescribed by your doctor. Sertraline and methadone can be prescribed together but your doctor would monitor this very carefully.

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 amphetamines 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 urgently 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.

There are many other street drugs, but we don’t know what effect taking them with sertraline will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on our drugs and alcohol guide.

Sertraline does not mix well with some other medicines, including herbal remedies. It may affect how they work or could cause more side effects.

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.

Before you start taking sertraline, tell your doctor if you are taking any other medications including things you have bought from a pharmacy or other shop for common illnesses like colds and flu. This includes things that you put on your skin.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with sertraline. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

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

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available. Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

The sertraline liquid contains a small amount of alcohol, but not enough to affect your blood alcohol level.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

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 is recommended that you stop driving or riding a bike for the first few days or weeks until you know how it affects you.

Most people drive as normal while taking sertraline. It you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

If you become pregnant while you are on sertraline, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing sertraline and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking sertraline during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Remember that untreated depression or anxiety can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that carrying on with sertraline has more benefits than risks, you should tell your midwife that you are continuing to take this at your next appointment. If you are planning to get pregnant, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with sertraline.

Some research suggests that taking SSRI antidepressants during the last month of pregnancy can mean there is an increased risk of bleeding after you have given birth. Let your midwife and doctor know you are taking sertraline and they can monitor you after birth.

Post-natal

If sertraline is taken in the last five months of a pregnancy, studies have shown a small increased risk of persistent pulmonary hypertension of the new-born (PPHN). This happens very quickly after birth and can make the baby breathe faster and look a bit. If you are worried about this, talk to your doctor and midwife.

There are also some symptoms that can happen in newborn babies if sertraline in taken in the last three months of pregnancy. They are usually mild and go away quickly, but if you baby is restless, having feeding and breathing difficulties or is very sleepy, speak to your midwife.

Breastfeeding

Sertraline passes to the baby in breastmilk in small amounts.

If your baby was born early, then breastfeeding while you are taking sertraline may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking sertraline, seek urgent medical advice if your baby becomes restless, very sleepy, or develops feeding problems.

Sex

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

a lower sex drive
problems getting an erection and ejaculating
a painful erection that lasts for a long time (priapism). If this happens, go to the hospital for treatment
bleeding from the vagina and difficulty reaching orgasm

Another rare side effect include breast growth or milk flow from the breasts (regardless of gender). These may affect your confidence and therefore your desire to have sex. Talk to your doctor if you get these symptoms.

There is some evidence that suggests sertraline can cause reduced genital sensation, which can last for a few months or longer, after you stop your medication. Talk to your doctor if this is something you’re worried about.

Untreated depression or anxiety can have a negative effect on your sex life, so if sertraline helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is no evidence to show that sertraline affects human fertility. Talk to your doctor about your sertraline if you are trying to get pregnant or planning a family.

Sertraline is not a banned substance in sport. Most people play sports as normal while taking sertraline. However, it may affect your ability to play sports that require a lot of focus. Sertraline can also make you feel very restless in the first few weeks of taking it. It might be best to stop doing any sports for the first few days until you know how it affects you or the effects get better.

If you have any concerns, discuss this with your doctor.

Ideally it is best not to take sertraline for the first time just before your exams, as it may affect your concentration, eyesight and make you feel tired.

It’s not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking sertraline.

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 and ability to study.

Most people take exams as normal while taking sertraline, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking sertraline

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If you are prescribed sertraline for low mood or depression, it is recommended that you take it for at least six months after you feel well again. This means that most people take it for at least seven to nine months. Research has shown that stopping it sooner, or immediately after you start to feel better, increases the risk of your low mood returning.

If you have had low mood or depression more than once, or if there is a higher risk of you becoming unwell again, your doctor may advise you to continue sertraline for at least two years after you feel well again.

If you are prescribed sertraline for anxiety or obsessional-compulsive disorder (OCD), it is recommended that you take sertraline for at least one year after you feel well again. Research has shown that stopping it sooner, or immediately after you start to feel better, increases the risk of your symptoms returning.

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.

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

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 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. However, some people find this medicine makes them feel tired, so you may prefer to take it in the evening instead.

When you have worked out what time of day is best for you, it is recommended that you take your medication at roughly the same time every day. To help you to take your tablet regularly you should choose a time that you will remember. This could be a mealtime or when you brush your teeth.

You can take it with or without food, but taking it with or just after food may help to minimise side effects like feeling sick.

Swallow the tablet whole with a glass of water – it tastes bitter if you chew it. If you are prescribed the liquid, dilute it as directed before taking. The instructions for this will be on the information leaflet.

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

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 try and catch up by taking a double dose.

If you forget to take it for a few days, you may start getting discontinuation or withdrawal symptoms. These should improve quickly after you start taking sertraline again. If they do not, seek advice from your doctor or pharmacist.

If you regularly forget to take it every day, your medicine may not work as well and it could increase the risk of you becoming unwell again.

Do not stop taking sertraline suddenly.

If you have been taking sertraline regularly for more than one to two months, it is recommended that you stop gradually (ideally over at least four weeks).

Discuss stopping your medication with your doctor. If you have important events coming up or are going through a period of life which is very demanding, it might not be the best time to stop your medication. Planning and support are important to stopping your antidepressant medication successfully.

Antidepressants are not addictive, but if stopped suddenly they can cause discontinuation or withdrawal symptoms. These are caused by the receptors and levels of chemical transmitters in your brain readjusting after you reduce or stop your medication (and can also occur if you miss doses of medication).

Some of the symptoms you get may be like symptoms you had when you were unwell, so understandably, you might feel anxious or upset that your illness could be returning.

If you experience symptoms immediately or soon after stopping medication (days rather than weeks), this is usually a withdrawal symptom caused by your body adjusting to not having the medication anymore. If the symptoms start after a month or more after stopping your medicine, this might be a sign that you are becoming unwell again.

Withdrawal symptoms usually start within a few days of stopping (or sometimes reducing) your medication. A wide range of symptoms have been reported. You may experience a few or a range of these:

dizziness and/or feeling unsteady
headaches
numbness or tingling in hands or feet
sleep disturbances (vivid dreams, nightmares, not being able to sleep)
electric shock-like feelings in the head, spine, arms, legs or hands.
feeling anxious, agitated or irritable and/or restless
confused or disorientated and reduced concentration
poor appetite, feeling or being sick or having diarrhoea (loose poo)
sweating or shaking
feeling emotional, low mood and tearful
flu-like symptoms/muscle aches and pains
tinnitus (ringing in your ears)
problems with your eyes, or fluttering/pounding heartbeat (these are not as common as the other symptoms listed above)

It is not possible to predict if you will experience withdrawal symptoms, or how bad they will be if you do experience them, but studies report about half of people may get them. The risk appears to be higher if:

you have been taking your medication for six to eight weeks and you stop taking it suddenly
you are a child or young person
you experienced an increase in anxiety symptoms when you started medication
you have experienced withdrawal symptoms with another antidepressant before

If you do experience symptoms, they are usually mild and don’t last long (two to three weeks for most people), but for a few these could be severe enough to make you feel very unwell and last longer (two to three months or more). Arrange an appointment with your doctor to discuss your symptoms and seek advice if you are concerned or unable to tolerate them.

You can stop taking sertraline safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

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

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

Depression (and other mental illnesses) can sometimes cause you to have thoughts about hurting yourself or taking your own life. While uncommon, this could also be a side effect of your medicine. This can happen to anyone but is more likely to happen if you are under 25 years old.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Sertraline can cause rare but serious side effects, including allergic reactions.

Stop taking sertraline and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing
an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, or really bad itching of the skin with raised lumps)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
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)
you start having seizures or fits for the first time

A very rare side effect is a painful erection (priapism). Look on the NHS website for things you can do to help. If it lasts longer than three hours, go to A&E.

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

Contact your doctor immediately but don't stop taking sertraline, if you get any of the following symptoms:

you feel restless and are not able to sit or stand still after you start to take sertraline
fits that you have had in the past happen more often
your behaviour changes because you feel very happy or over-excited or experience severe irritability or agitation
any unusual bleeding, including blood in your poo
you experience tiredness, confusion and muscle-twitching (you may have a low blood-level of sodium)
yellowing of the skin or whites of the eyes (your liver may not be working properly)

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking sertraline. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

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 sertraline 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

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

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Uncommon but important side effects to be aware of include thoughts of harming yourself, thinking about taking your own life or trying to take your own life. This may be a symptom of your illness, including depression, but may be a side effect of medication. If you experience these thoughts, contact your doctor to seek immediate support to keep you safe

Your doctor will make sure you are monitored carefully for these side effects, and you should decide with your doctor what to do if you experience these feelings while taking sertraline. It’s a good idea to write these plans down and keep them somewhere safe.

If you are taking sertraline and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents, family member or friend about it too.

Another uncommon side effect is an increase in your risk of bleeding, including intestinal (stomach or gut) bleeding. Let your doctor know if you vomit blood or develop black or blood-stained poo.

There is no routine monitoring recommended before starting or while you are taking sertraline, although your doctor may recommend specific tests, like a blood test, to help them make decisions about your medication.