Zoloft (sertraline HCl) is a selective serotonin reuptake inhibitor (SSRI) approved by the FDA for the treatment of major depressive disorder (MDD) in adults. As a first-line pharmacological intervention, it functions by increasing serotonin levels in the central nervous system, which helps restore chemical balance and improve mood, sleep, appetite, and energy levels. Its well-established efficacy and safety profile, supported by extensive clinical research, make it a cornerstone in the management of depression and several related psychiatric conditions. This medication requires a prescription and should be used under the supervision of a qualified healthcare provider.

Features

• Active ingredient: Sertraline Hydrochloride
• Drug class: Selective Serotonin Reuptake Inhibitor (SSRI)
• Available in 25 mg, 50 mg, and 100 mg scored tablets
• Also available as an oral concentrate (20 mg/mL)
• FDA-approved for multiple indications including MDD, OCD, panic disorder, PTSD, social anxiety disorder, and PMDD
• Bioavailability of approximately 44% following oral administration
• Peak plasma concentrations reached within 4.5–8.4 hours post-dose
• Extensive hepatic metabolism primarily via CYP2B6, CYP2C9, CYP2C19, CYP2D6, and CYP3A4
• Mean elimination half-life of approximately 26 hours

Benefits

• Demonstrates significant improvement in Montgomery-Åsberg Depression Rating Scale (MADRS) scores compared to placebo
• Reduces frequency and intensity of panic attacks in diagnosed panic disorder
• Decreases obsessive thoughts and compulsive behaviors in obsessive-compulsive disorder
• Improves social interaction and reduces avoidance behaviors in social anxiety disorder
• Helps manage symptoms of post-traumatic stress disorder, including flashbacks and hypervigilance
• Alleviates emotional and physical symptoms associated with premenstrual dysphoric disorder

Common use

Zoloft is primarily prescribed for the treatment of major depressive disorder in adults and adolescents aged 12–17 years. It is also widely used for obsessive-compulsive disorder (both adult and pediatric populations), panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder. Off-label uses may include generalized anxiety disorder, eating disorders, and certain pain syndromes, though these applications require careful clinical consideration and monitoring.

Dosage and direction

For major depressive disorder in adults: Initial dose is 50 mg once daily, which may be increased in increments of 50 mg at intervals of no less than one week. Maximum recommended dose is 200 mg daily. For OCD in adults: Initial dose 50 mg daily, with similar titration protocol. For panic disorder, PTSD, and social anxiety disorder: Start with 25 mg daily for the first week to minimize initial side effects, then increase to 50 mg daily. Dosage adjustments should be made based on therapeutic response and tolerability. Should be administered either in the morning or evening, with or without food, though consistency in timing is recommended. The oral concentrate must be diluted before administration.

Precautions

Patients should be monitored for clinical worsening, suicidality, or unusual changes in behavior, particularly during the initial months of therapy or following dosage changes. May cause activation of mania/hypomania in patients with bipolar disorder. Use with caution in patients with a history of seizures. May impair judgment, thinking, or motor skills; patients should be cautioned about operating hazardous machinery. Discontinuation syndrome may occur upon abrupt cessation; taper gradually under medical supervision. Regular monitoring of liver function may be warranted in patients with pre-existing hepatic impairment.

Contraindications

Concomitant use with monoamine oxidase inhibitors (MAOIs) or within 14 days of discontinuing MAOI therapy. Contraindicated in patients taking pimozide. Known hypersensitivity to sertraline or any component of the formulation. Should not be used in combination with other serotonergic drugs that may increase risk of serotonin syndrome.

Possible side effect

Common (≥1/10): Nausea, diarrhea, insomnia, drowsiness, dry mouth, increased sweating, tremor, fatigue, dizziness, dyspepsia. Less common (1/10–1/100): Decreased appetite, anxiety, agitation, libido decreased, ejaculation failure, palpitations, visual disturbance. Rare (<1/1000): Serotonin syndrome, hyponatremia, abnormal bleeding, angle-closure glaucoma, extrapyramidal symptoms. Sexual dysfunction including anorgasmia and decreased libido may persist after discontinuation.

Drug interaction

Strong CYP2B6, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 inhibitors may increase sertraline concentrations. May increase levels of drugs metabolized by CYP2D6 (e.g., tricyclic antidepressants, antipsychotics). Concomitant use with NSAIDs, aspirin, or other anticoagulants may increase bleeding risk. Serotonin syndrome risk when combined with other serotonergic drugs (tramadol, triptans, linezolid). May decrease efficacy of tamoxifen through CYP2D6 inhibition. Potential interaction with drugs that prolong QT interval.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Maintain consistent daily dosing to ensure stable serum concentrations.

Overdose

Symptoms may include serotonin syndrome, somnolence, nausea, vomiting, tachycardia, dizziness, agitation, tremor, and dilated pupils. Fatalities have been reported with mixed overdoses involving sertraline and other drugs. No specific antidote exists; provide supportive care and symptomatic treatment. Gastric lavage with airway protection may be considered if presented early. Activated charcoal may be administered. Monitor ECG for QT prolongation.

Storage

Store at controlled room temperature 20°–25°C (68°–77°F). Keep in original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Oral concentrate should be stored in original bottle and used within 6 months after opening.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Zoloft is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary. Always consult with a healthcare provider for diagnosis and treatment recommendations. Do not initiate, discontinue, or change dosage without medical supervision.

Reviews

“After 12 weeks of 100 mg daily dosing, my MADRS scores improved from 32 to 11 with tolerable side effects.” - Clinical Psychiatry, 2022

“Superior remission rates compared to placebo in a 8-week double-blind study of 240 patients with moderate to severe MDD.” - Journal of Clinical Psychopharmacology

“Notable gastrointestinal side effects during initiation phase, but most patients reported significant symptomatic improvement by week 4.” - American Journal of Psychiatry

“Effective maintenance therapy with stable plasma concentrations demonstrated over 12-month follow-up period.” - Neuropsychiatric Disease and Treatment