Sertraline

• Depression
• Anxiety
• Eating disorders such as bulimia nervosa and binge eating disorder
• Panic Disorder (with or without agoraphobia)
• Generalised Anxiety Disorder
• Obsessive Compulsive Disorder
• Body Dysmorphic Disorder
• Post Traumatic Stress Disorder
• Social anxiety
• Phobias

What should I do if I forget to take a dose of sertraline?

What to do if you 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 might happen?

• 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.

You must go to A&E if you take too much 

What to do if you take too much:

• If you have taken more sertraline than it said on the label, you must get help quickly - 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’. This is when you can get a high fever, agitation, confusion, trembling, or weird movements of your muscles. This is rare, but you should watch out for it.

How long will it take sertraline 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.
• Some side effects of sertraline tend to happen at the start of treatment, but go away after a few days, such as feeling or being sick (nausea or vomiting).
• To get the best effect, you need to take your sertraline every day and give it a chance to work for you.
• Your doctor will start with a low dose that increases slowly to a dose that is effective for you. This may take several days or weeks.
• You will need to take sertraline for several months after you feel better - otherwise your symptoms can come back.
• Keep taking sertraline as you get better, which can take a few months, and then keep taking it. Your doctor will advise you how long as it depends on what you are taking the sertraline for. For depression it might be 6 months, for OCD it might be 12 months and for other conditions such as generalised anxiety disorder it might be up to 18 months.
• If your illness has come back, then you might be advised to keep taking sertraline for longer than this.
• This will help keep you well. If you stop taking the sertraline too soon, there is more chance that your mental health symptoms will come back.
• Discuss with your doctor how long you should take sertraline for.
• 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, to make sure it is not too soon to stop it.
• Also, the sertraline dose will need to be reduced gradually to reduce the chance of side effects when it is stopped (unless you are already on the lowest dose).

People who have had depression more than once may take this for over 6 months. This is to stop themselves having it again.

If you have any thoughts of suicide, or of other ways of hurting yourself, go straight to a hospital with your medicine.

This may be a side-effect, and you need urgent help.

• When taking sertraline or another antidepressant, some people think about hurting themselves or committing suicide. This is more common at the start of treatment than later on.
• This can happen to anyone, but is more likely to happen if you are less than 25 years old.
• You must to straight to hospital if you have thoughts of hurting yourself or committing suicide. Take your medicines with you and tell the doctor that you are taking sertraline.

Sertraline has possible side effects, and some of these are rare but serious

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

• thoughts of harming yourself or taking your own life.
• any combination of the following symptoms - high fever, agitation, confusion, trembling, sweating, diarrhoea (loose poo), fast heartbeat or weird movements of your muscles – which could be ‘Serotonin Syndrome’
• a severe skin rash that causes blistering, including your mouth and tongue. These may be signs of a condition known as Stevens Johnson Syndrome, or Toxic Epidermal Necrolysis (TEN). Your doctor will stop your treatment in these cases.
• allergic reaction or allergy, which may include symptoms such as an itchy skin rash, breathing problems, wheezing, swollen eyelids, face or lips
• if your skin or the whites of your eyes go yellow, which may mean liver damage (jaundice)
• if you feel restless and are not able to sit or stand still after you start to take sertraline
• if you have a fit (seizure)
• if you feel overexcited or very happy, as this may be a manic episode
• repeated movements of your face and tongue that you cannot control
• for men, a painful erection that lasts for a long time (priapism)

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

Not everyone will experience side effects with sertraline. Some of the more common side effects are listed at the bottom of this page. If you are experiencing a problem that might be a side effect, but that is not listed here, please take a look at the patient information leaflet that was in the medicine packet or speak to your pharmacist or doctor. If you think you have a side effect that has not got better within a few days go back to your doctor.

Some side-effects of sertraline may - strangely - seem like other mental health symptoms. Some side-effects here are also the opposites of each other. The balance of chemicals in the brain is very fragile, and hard to control. If they do not get better after a few days on the tablets, go back to the doctor.

Young people were more likely than adults to get some side-effects in tests

Young people aged under 25 were more likely than adults in clinical trials to get the following side-effects from SSRI medicines:

• Thoughts of harming yourself or taking your own life.
• Being hostile or aggressive

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

Tell your doctor or pharmacist before you take sertraline if you have any of these conditions

You need to talk to your doctor or pharmacist if you have, or have had, any of the following conditions:

• fits (seizures)
• manic depressive illness (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 electro-convulsive therapy (ECT)
• eye problems, such as certain kinds of glaucoma (increased pressure in the eye)

Sertraline does not mix well with some other medicines and drugs

Do not take sertraline if you take:

• monoamine oxidase inhibitors (MAOIs), like moclobemide (to treat depression) and selegiline (to treat Parkinson’s disease), the antibiotic linezolid and methylene blue (to treat high levels of methaemoglobin in the blood)
• If you have taken MAOIs in the last 14 days, you must wait until 14 clear days have passed before you can take sertraline
• pimozide to treat mental health problems like psychosis

If you have any further questions about this you can talk to your doctor or pharmacist.

Tell your doctor if you are taking any of these medicines that may cause problems when taken with sertraline:

• Herbal medicines containing St. John’s Wort (Hypericum perforatum). The effects of St. John’s Wort may last for 1-2 weeks.
• tryptophan.
• medicines to treat severe pain (like tramadol).
• medicines used in anaesthesia or to treat chronic pain (like fentanyl).
• medicines to treat migraines (like sumatriptan).
• blood thinning medicine (warfarin)
• medicines to treat pain or arthritis (Non steroidal anti-inflammatory drug (NSAID), such as ibuprofen and aspirin
• Sedatives (like diazepam)
• diuretics (also called ‘water’ tablets)
• medicines to treat epilepsy (like phenytoin, phenobarbital, carbamazepine).
• medicines to treat diabetes (like tolbutamide).
• medicines to treat stomach acid problems, ulcers and heartburn (like cimetidine, omeprazole, lanzoprazole, pantoprazole, rabeprazole).
• medicines to treat mania and depression (like lithium).
• other medicines to treat depression (like amitriptyline, nortriptyline, nefazodone, fluoxetine, fluvoxamine).
• medicines to treat schizophrenia and other mental health problems (such as risperidone, olanzapine and aripiprazole).
• medicines used to treat high blood pressure, chest pain or regulate the rate and rhythm of the heart (like verapamil, diltiazem, flecainide, propafenone).
• antibiotics used to treat infections (like rifampicin, clarithromycin, telithromycin, erythromycin).
• medicines used to treat fungal infections (like ketoconazole, itraconazole, posaconazole, voriconazole, fluconazole).
• medicines used to treat HIV/AIDS and Hepatitis C (protease inhibitors like ritonavir, telaprevir).
• medicines used to prevent nausea and vomiting after an operation or chemotherapy (aprepitant).

Always talk to the doctor if you are taking other medicines.

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

Sertraline does not mix well with 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 or 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 if this happens. Tell the doctor that you are taking sertraline.
• Sertraline does not seem to be affected by cannabis so there seem to be no extra problems if smoking cannabis with sertraline, although you might feel a little more drowsy.
• There are many other street drugs but we don’t know what effect taking them with sertraline will have.

• Tell the doctor everything that you have taken.

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

You can stop taking it safely with your doctor’s help

Once you start taking a 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 however, 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 4 weeks.

Some of the withdrawal symptoms include:

• dizziness or headaches
• tingling feelings like pins and needles or numbness
• 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 2-3 weeks for most people, but a very few people can get them for 2-3 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.

When you agree with your doctor to stop the medicine, you will carry on with a lower dose for about 2-4 weeks. This will lower your risk of getting any withdrawal symptoms.