Trade Names: Zoloft, Sertraline Aurovitas, Sertraline Krka, Asentra, Asertin, Setaloft, Zotral, Sertagen, Miravil, Stimuloton
Sertraline: an antidepressant that works slowly but effectively
Sertraline is another representative of the SSRI group. While this medication does not take full effect as quickly as many would like, it has unique characteristics that make it indispensable in psychiatric practice.
The main action of sertraline is related to increasing the level of serotonin in the brain. When this neurotransmitter stays longer in the synaptic cleft and performs its function, the person starts to feel better: anxiety decreases, mood improves, and panic attacks disappear. But sertraline doesn’t stop there. Unlike other antidepressants in its group, it also partially blocks dopamine reuptake. Yes, this happens a hundred times weaker than with serotonin, but it still gives it a slight advantage over other SSRIs. Thanks to this, sertraline is better at dealing with depressions characterized by apathy and a lack of motivation.
However, it is worth knowing that sertraline also blocks Sigma-1 receptors in the intestines. This means one thing — gastrointestinal side effects are not only common but can be quite pronounced. If you start taking sertraline, diarrhea, nausea, and heartburn may become frequent companions. But don’t be alarmed, this doesn’t happen to everyone. If you are lucky and don’t experience side effects from the intestines, consider it a success.
A slow start and the illusion of quick improvement
When you start taking sertraline, you shouldn’t expect quick results. Yes, there are antidepressants that show the first signs of action within a month, but sertraline is not one of them. Here, you need to be patient because its antidepressant effect does not reveal itself until after at least three months. However, this does not mean that you won’t feel any changes during the first three months.
At the very beginning, you may experience a slight reduction in anxiety. Some patients even say that within a few weeks, they feel a surge of energy, vitality, and an improved mood. But it’s important to understand that this is only a temporary effect. Sertraline gives a small “boost,” but this does not mean that the depression is gone. After a few weeks, the stimulating effect may fade, and the patient may feel disappointed, thinking that the drug has stopped working. In reality, it hasn’t even begun to show its main action.
When does sertraline help?
It is often prescribed for depressions, especially if they are somatized or accompanied by anxiety. Atypical depressions, where a person has increased appetite, excessive sleepiness, and sensitivity to criticism, also respond well to treatment with sertraline. This drug is actively used for panic attacks, social phobia, and generalized anxiety disorder. If a patient suffers from obsessive thoughts or is fixated on repetitive actions (as with OCD), sertraline can be a lifesaver.
It is also used to treat bulimia, as it can reduce compulsive overeating. But it’s important to understand that this is part of a comprehensive treatment, and sertraline alone will not be enough.
Side effects
The most unpleasant side effects of sertraline are related to the gastrointestinal tract. Nausea, heartburn, loss of appetite, and diarrhea can all appear in the first days of use. This is entirely understandable since 95% of serotonin receptors are located in the intestines. When serotonin levels rise, the digestive system is the first to respond. However, as we have already mentioned, sertraline has another “unique feature” – Sigma-1 receptor blockade. This further intensifies gastrointestinal side effects. So if you experience diarrhea, it is a typical reaction to sertraline and usually resolves over time.
Another important side effect is decreased libido and delayed ejaculation. Sertraline indeed dulls sexual sensations: tactile stimuli, smells — all of these are perceived less intensely. But fantasies may remain at the same level. As a result, a man may have a mechanical erection but will not feel pleasure from it.
Among other side effects, excessive sweating should be noted. Patients complain of waking up at night in wet bedding, and this discomfort can last for up to two months. If this causes significant inconvenience, the doctor may prescribe additional medications to reduce sweating.
Sometimes tremors occur — slight hand tremors or tension throughout the body. This usually happens at high doses (100 mg and above) and lasts for 2-3 hours. Tachycardia is also not uncommon, especially an hour after taking the drug. If it causes discomfort, beta-blockers may be prescribed.
Dosage and administration regimen
Sertraline is usually started with a minimal dose — 25-50 mg per day. If side effects are pronounced, the starting dose is 12.5 mg. The dose is gradually increased every 3-4 days to allow the body to adapt. The therapeutic dose is 50-100 mg per day, but if there is no effect, it can be increased to 200 mg.
However, it is important to note that each dose increase may temporarily intensify side effects. For example, if you increase the dose from 50 mg to 100 mg, exacerbations may occur within a month. This is normal — you just need to wait for the body to adjust. If the side effects become unbearable, the dose can be reduced and then gradually increased again.
Withdrawal syndrome
As with all SSRIs, abrupt discontinuation of sertraline can cause dizziness, headaches, chills, sore throat, and general malaise. The symptoms resemble flu-like conditions and may be accompanied by emotional instability. To avoid this, the dose should be gradually tapered. If symptoms still appear, alternating days with a reduced dose and the original dose can help.
Comparison with other SSRIs
Compared to escitalopram and paroxetine, sertraline occupies an intermediate position. It is better tolerated than paroxetine but less so than escitalopram. In terms of antidepressant effect, it may be weaker than fluoxetine or paroxetine, but it causes fewer problems with increased prolactin levels due to its effect on the dopamine system.
Sertraline affects cytochrome P450 enzymes less than many other antidepressants, making it compatible with various drugs — both psychotropic and somatic.
Conclusion
Sertraline is not an instant solution, but with patience and the right approach, it can significantly improve the patient’s condition. The key is not to give up treatment due to temporary side effects and to understand that this drug requires time to fully reveal its effects.
If you want to discuss appropriate treatment or simply understand your symptoms, book a consultation at the Plexus center, located in Warsaw — we have a psychiatrist who speaks Russian and Polish, who will find a solution tailored to your needs.