Sertraline (Zoloft / J Zoloft)

What is sertraline?

Sertraline is known as Zoloft in the United States and many other countries, Lustral in the UK, and J Zoloft in Japan (ジェイゾロフト on Japanese packaging); it's all the same medicine. It belongs to the SSRI group of antidepressants. It works on serotonin, a chemical messenger in the brain linked to mood and anxiety, and it's one of the most widely prescribed antidepressants in the world.

How is it different from other antidepressants?

In large published comparisons of antidepressants, sertraline stands out as one of the best balanced between effectiveness and tolerability; a well-known comparison even suggested it as a sensible first choice. In practice:

• A true all-rounder: works on low mood, panic, and anxiety, with decades of worldwide experience behind it
• Approved in Japan for panic disorder and PTSD as well as depression, which few antidepressants here are
• Flexible dosing: treatment starts low and is stepped up gradually, so it can be tuned to you
• Some of the most reassuring pregnancy and breastfeeding data of any antidepressant

What is it used for in Japan?

• Depression
• Panic disorder
• Post-traumatic stress disorder (PTSD)

How does it help?

By gradually increasing serotonin in the brain, it eases low mood, panic, and anxiety over time. The full effect often takes a few weeks. If you don't feel better right away, that's normal; keep taking it as prescribed.

What should I tell my doctor before starting?

Sertraline suits most people, but a few situations rule it out entirely; your doctor will choose something else if any of these apply:

• A past allergic reaction to sertraline
• Taking, or recently stopping, an MAO inhibitor (a medicine for depression or Parkinson's); these can't overlap
• The medicine pimozide; the combination isn't allowed

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

• Other antidepressants, tramadol (a painkiller), migraine triptans, or lithium
• Blood thinners, or regular painkillers like ibuprofen
• A heart rhythm problem (including long QT), or medicines that affect heart rhythm
• Liver problems
• A history of seizures
• Being older, or taking water tablets (diuretics)
• St John's Wort supplements
• Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it, and what if I miss a dose?

Sertraline is taken once a day, morning or evening, with or without food; pick a time you can keep. Doctors start at a low dose and step it up gradually over weeks, which keeps the early side effects gentle.

• If you miss a dose: take it when you remember, unless the next dose is close; in that case just skip. Never take a double dose to catch up
• The first week or two is when nausea and restlessness are most likely; taking it with food helps, and this usually fades as your body adjusts
• Rarely, the early weeks bring the opposite of calm: unusual agitation, irritability, or feeling wired. If that happens, contact your doctor promptly rather than waiting it out

What side effects should I expect?

Most are mild and settle within the first week or two as your body adjusts, and many can be eased with a counter-medicine (for nausea, for example). Not everyone gets them; the rough figures below just give a sense of how common each one is.

• Nausea (around 20%): taking it with food helps, and it usually fades within a couple of weeks
• Drowsiness (around 15%), or trouble sleeping (less common)
• Diarrhea or loose stools
• Headache
• Dizziness
• Dry mouth
• Feeling a bit more anxious or restless at first; this usually passes as the medicine starts working
• Sexual side effects

If anything is bothering you, tell your doctor; there's often a way to adjust. And if you ever feel worse instead of better, tell us straight away; it's easily managed, and that's what we're here for.

Will I become dependent? How do I stop safely?

No; sertraline isn't addictive, but it does need a planned, gradual stop. There's no craving and no urge to take more the way some sleep or anti-anxiety medications cause. Your body does get used to it, though, and stopping suddenly can cause withdrawal-like symptoms: dizziness, nausea, tingling, brief electric-shock-like sensations, irritability, or vivid dreams, usually starting a few days after stopping and settling over days to a couple of weeks. So never stop suddenly on your own.

Tapering makes this a non-issue for most people: the dose comes down in small steps, staying a week or two at each step, with a gentler pace near the end. If symptoms do appear along the way, stepping back up briefly and slowing down solves it. Many people continue for some months after they feel better, and coming off is planned together.

Can I drive while taking it?

Yes, with care, especially at the start. Sertraline can cause drowsiness or dizziness, so see how it affects you before driving, particularly when starting or changing the dose. The Japanese label asks for caution here, not a ban.

What about pregnancy and breastfeeding?

Often, treatment can continue through both; sertraline is in fact one of the antidepressants doctors most often choose when pregnancy or breastfeeding is in the picture. Very little of it passes into breast milk, giving it some of the most reassuring breastfeeding data of any antidepressant. The decision is still made individually with your doctor, weighing the real risks of untreated depression. Never stop on your own on learning you're pregnant. Our guides to medication in pregnancy and medication while breastfeeding cover the details.