Sertraline

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 from 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.

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 your 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

In some cases, these symptoms can continue even after stopping the medication. There is some evidence that sertraline can cause reduced genital sensation. This can last for a few months or longer, even after you stop your medication. Talk to your doctor if this is something you’re worried about.

Another rare side effect includes 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.

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.