Sertraline
First-line SSRI for GAD, MDD, PTSD, panic disorder, OCD, social anxiety. | Compound
Aliases (2)
▸ Overview TL;DR
First-line SSRI for GAD, MDD, PTSD, panic disorder, OCD, social anxiety. Generally well-tolerated. Wrong tool for healthy biohacker — reduces emotional range, libido, and ejaculatory function. Not relevant to Dylan unless clinical indication develops.
▸ Mechanism of action
Sertraline blocks the serotonin transporter (SERT) on presynaptic neurons, preventing 5-HT reuptake from the synapse. This raises synaptic serotonin acutely, but clinical effects emerge over 2-6 weeks via downstream receptor adaptations (5-HT1A autoreceptor desensitization, BDNF upregulation, neuroplasticity changes). Sertraline is unique among SSRIs in having mild dopamine reuptake inhibition at clinical doses, which may explain its slightly more activating profile vs paroxetine/fluvoxamine.
▸ Pharmacokinetics No data
▸ What to expect Generic
- 1Week 1Tolerability and dose-response.
- 2Week 2-4Early effect window.
- 3Week 4-8Peak benefit assessment.
- 4Week 8+Cycle decision point.
▸ Side effects + safety
- Common (>10% users): Nausea, diarrhea, sexual dysfunction, insomnia or somnolence, sweating.
- Less common (1-10%): Weight gain, emotional blunting, bruxism, restless legs, vivid dreams.
- Rare-serious (<1%): Serotonin syndrome (with MAOIs, tramadol, MDMA), hyponatremia (especially elderly), QT prolongation at high doses, suicidal ideation in <25 yo (FDA black box).
- Specific watch periods: First 4 weeks for activation/suicidal ideation in young adults; first 2-3 weeks for GI; sexual side effects often persist throughout treatment.
▸References5 sources
PMID 29477251
2018Cipriani 2018 Lancet network MA of 21 antidepressants.
PMID 16390886
STAR*D trial outcomes.
PMID 18316756
SSRI sexual dysfunction prevalence.
PMID 30445564
Emotional blunting on SSRIs.
PMID 32033582
Pharmacogenomics of SSRI response.