Intro
Brand name: Zoloft
Class: SSRI
MOA:
1. Selective Serotonin Reuptake Inhibitor
2. Weakly inhibits dopamine transporter (DAT) = mild “activating” effect
Indications
FDA Indications: MDD, OCD (6y/o+), PTSD, PMDD, Panic disorder, Social anxiety disorder
Off-label uses: GAD, Separation Anxiety Disorder
Dosing
Forms: Tablet: 25 (scored), 50 (scored), 100 Capsule: 150, 200 Oral Solution: 20mg/mL
Starting:
[]Depression/OCD: 50mg qDay, wait several weeks, then can increase once a week by 50mg, max of 200mg qDay
[]Panic Disorder/PTSD/Social Anxiety Disorder: 25mg qDay, increase to 50mg after 1 week, wait several weeks, then can increase once a week by 25-50mg, max of 200
Maintenance: 50-200mg qDay
Max: 200mg qDay
Pharmacokinetics
Half-life: 22-36 hr
Metabolite (Norsertraline) half-life: 62-104 hr
Inhibits: CYP2D6, CYP3A4, CYP2C19
Substrate of: CYP2D6
Side Effects
Serious: Serotonin Syndrome, SIADH, increased risk of SI in children, Risk of birth defects
Notable: Sexual dysfunction (delayed ejaculation, ED, anorgasmia), SSRI most likely to cause diarrhea, Sedation, Bruising
Gems
-Sertraline is a weak DAT inhibitor -> increased DA -> possible “activating” effect
-The DAT inhibition may also make it a good option for cognitive and affective flattening
-Best evidence for tx of depression of patients with recent myocardial infarction
-SSRIs rarely cause hyperprolactinemia, however if wishing to be cautious, sertraline is thought to to be the SSRI least likely to increase prolactin (likely due to effects at DAT)
-In anxious patients with insomnia, initiating sertraline may initially worsen sleep disturbance due to activating properties
-Often considered to be DOC in pregnant and breastfeeding women
-SSRI most likely to cause diarrhea
-May cause false positive drug screen for Benzodiazepines
-Buspirone can be added to address Zoloft-induced sexual dysfunction
Special Populations
Renal Impairment: No dose adjustment necessary
Hepatic Impairment: Lower dose by half
Pregnancy: Often considered to be DOC for MDD in pregnancy
Breastfeeding: Often considered to be DOC for MDD in breastfeeding women.
References
Prescriber’s Guide: Stahl’s Essential Psychopharmacology