sertraline

Adjunctive therapy

Brands: ZOLOFT

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is sertraline?
Sertraline (Zoloft) is a first-line SSRI for depression, PTSD, OCD, and anxiety disorders, favored in patients with serious mental illness because of modest interaction liability and metabolic neutrality.
What is ZOLOFT?
ZOLOFT is a brand name for sertraline.
What is ZOLOFT (sertraline) used for?
Label indications include: MDD; OCD; panic disorder; PTSD; social anxiety disorder.
What drug class is ZOLOFT (sertraline)?
Selective serotonin reuptake inhibitor (SSRI).
What strengths does ZOLOFT (sertraline) come in?
Tablets (sertraline hydrochloride / sertraline HCl) 25 mg, 50 mg, 100 mg; oral concentrate 20 mg/mL (requires dilution prior to ingestion).
What is the maximum dose of ZOLOFT (sertraline) for major depressive disorder (clinical depression)?
Start 50 mg once daily for major depressive disorder (clinical depression) or anxiety; titrate by 25–50 mg increments every ≥1 week to 100–200 mg/day (max 200 mg/day).
What is sertraline hydrochloride (HCl)?
Tablets (sertraline hydrochloride / sertraline HCl) 25 mg, 50 mg, 100 mg; oral concentrate 20 mg/mL (requires dilution prior to ingestion).

Snapshot

Class: Adjunctive therapy
Common US brands: ZOLOFT
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

MDD; OCD; panic disorder; PTSD; social anxiety disorder.

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Clinical Highlights

Sertraline (Zoloft) is a first-line SSRI for depression, PTSD, OCD, and anxiety disorders, favored in patients with serious mental illness because of modest interaction liability and metabolic neutrality. Often paired with antipsychotics to target comorbid anxiety or depressive symptoms without exacerbating weight or prolactin issues.

Low CYP inhibition and once-daily dosing support use alongside antipsychotics; monitor GI tolerability and sodium in older adults.
The compare view can help contrast activation, discontinuation, and metabolic profiles, and the Sertraline evidence feed can support adjustment planning.
Symptom improvement is usually gradual: early side effects (GI upset, sleep changes, jitteriness) may occur in the first days, while mood and anxiety benefits often take several weeks.
Sertraline is often preferred in polypharmacy because interactions are modest, but medication reconciliation still matters when TCAs, antipsychotics, or anticoagulants are part of a regimen.
Major depressive disorder (FDA 1991)
Obsessive-compulsive disorder (FDA 1996)
Panic disorder (FDA 1996)

Dosing & Formulations

Tablets (sertraline hydrochloride / sertraline HCl) 25 mg, 50 mg, 100 mg; oral concentrate 20 mg/mL (requires dilution prior to ingestion). Start 50 mg once daily for major depressive disorder (clinical depression) or anxiety; titrate by 25–50 mg increments every ≥1 week to 100–200 mg/day (max 200 mg/day).

For PTSD, OCD, or panic disorder, consider 25 mg daily for 1 week before increasing to reduce activation.
Use lower starting doses or extended titration in hepatic impairment; avoid abrupt discontinuation when possible.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in children, adolescents, and young adults; monitor during initiation and titration. Gastrointestinal upset: Nausea or diarrhea common early; taking with food can improve tolerability.

Sleep disturbance: Insomnia or somnolence—adjust dosing time based on patient response.
Sexual dysfunction: Discuss expectations and management strategies up front.
Tremor/activation: Usually transient; consider slower titration if problematic.
Headache: Generally self-limited; reassure patients during first weeks.
Hyponatremia can occur in older adults and diuretic users; check sodium when symptoms (confusion, falls) emerge.
Discontinuation symptoms are possible with abrupt stopping (dizziness, irritability); tapering tends to be better tolerated than sudden discontinuation.

Drug Interactions

Moderate CYP2D6/CYP2C19 inhibition—monitor narrow therapeutic index substrates (e.g., TCAs, metoprolol). Contraindicated with MAOIs, linezolid, methylene blue; enforce appropriate washout periods.

Additive bleeding risk with NSAIDs, antiplatelets, anticoagulants; counsel on easy bruising.

Practice Notes

Oral concentrate must be diluted in water, ginger ale, lemonade, or orange juice immediately before administration. Encourage adherence through first 4–6 weeks before assessing nonresponse.

Screen for bipolar spectrum symptoms—sertraline can precipitate mania/hypomania; coordinate mood stabilizer plans with the bipolar disorder hub if activation emerges.

References

ZOLOFT (sertraline) prescribing information — DailyMed (2025)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)Guidelinedepressionclinical
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)