Sertraline and Psychiatry

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Sertraline or Zoloft is kind of a favorite medication of mine (and most psychiatrists). It's not necessarily that I think it works better than other options, the wide range of dosing means I can use it for different things and different people. Doses I'll use are: 12.5 mg, 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg, 175 mg, 200 mg and sometimes up to 300 mg (although this is above FDA approved dosing). There being so many dosing options makes this a convenient medication to prescribe. If someone is doing well with the medication, but having side effects, then I decrease the dose. If someone is not doing well enough with the medication, but not having any side effects, then I can increase the dose. If someone is not doing well on the medication and having lots of side effects, I will probably just change medications.

I often see PCPs start people on sertraline 50 mg, honestly, I very rarely start this high because I work with mostly women and minorities. This dosing was initially made for white males and is not necessarily generalizable to the population. Sertraline can cause a lot of diarrhea and soft stools. Most people need some time to get used to the medication before they can tolerate 50 mg.

A prescription bottle lies on its side, spilling green and teal capsules onto a textured wooden surface, highlighting the importance of medication management.

One of the most common reasons for side effects with antidepressants is starting them too high and increasing them too fast. It’s really a disservice to patients when we do this because say they were started on sertraline 50 and had a terrible experience 10 years ago. They don’t remember the dose they were started on, but they remember they pooped their pants in their car on their way home from work. Now a person who may benefit from this medication at a lower dose (or the same dose titrated to slower) will probably never want to give it another shot. Remember these drugs were tested primarily in white males, for women and people of color, it’s probably better to “start low and go slow.”

Other benefits of sertraline: considered safe for pregnancy and breastfeeding, no QT prolongation, it doesn’t have too many drastic interactions. So it’s a nice choice for medically frail or elderly people who need to be on multiple medications (for diabetes, HTN, etc).

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